- Drugs like Wegovy and Zepbound have helped individuals who are living with obesity or overweight with a specific underlying condition lose significant weight, often where diet and exercise alone have not.
- However, a new article — and clinical trials involving the new drugs — indicate that physical activity is still an essential part of someone’s overall health plan.
- About 150 minutes per week of moderate-intensity exercise, such as brisk walking, combined with two days of resistance training can offer benefits in addition to aiding with weight loss.
People who take GLP-1 drugs like Wegovy and Zepbound for weight loss can see significant progress.
The drugs are being hailed as “game-changing” for helping people who had previously tried first-line treatments like diet and exercise but were unable to lose and maintain weight.
“Those who are obese often need an additional tool in their kit to help move things along,” says Dr. Steven Batash, a board-certified gastroenterologist and leading physician at the Batash Endoscopic Weight Loss Center.
However, researchers pointed out something that often feels like a footnote when discussing the results of GLP-1 drugs: Lifestyle interventions, including 150 minutes of exercise weekly.
“You have to look at weight loss as a multidisciplinary approach to an overarching lifestyle change,” Batash says. “Taking medications like Wegovy…enhance the impact of diet and exercise. These weight loss drugs are designed to work best when combined with regular physical activity.”
Batash and other experts shared more on the importance of physical activity and offered tips for safely starting a routine.
Drs. John Jakicic, Ph.D. and Renee Rogers, Ph.D. of the University of Kansas Medical Center looked at physical activity in an age where medications can offer a tool for weight loss and management.
“The authors point out the efficacy of weight loss medications in reducing body weight and stress the importance of including activity and exercise for the improvement of many health factors beyond weight loss,” says Catherine Tuppo, PT, MS, CLT-LANA, a physical therapist and the program coordinator at the Stony Brook Bariatric and Metabolic Weight Loss Center.
Tuppo says these benefits include:
- Cardiorespiratory fitness
- Muscle strength
- Physical function
- Preventing loss of lean body mass that can occur with weight loss intervention, including GLP-1s
One healthcare provider says the last point is critical for maintaining day-to-day functioning and weight loss.
“Muscle mass is important for normal activity,” says Dr. Mir Ali, MD, a bariatric surgeon and medical director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in Fountain Valley, Calif. “Loss of muscle makes a person weaker and more tired. Furthermore, more muscle leads to a higher resting metabolic rate and facilitates weight loss, as well as weight maintenance.”
Because of the importance of muscle mass and strength, researchers suggest two days of resistance training weekly.
In addition to this resistance training, researchers also say that 150 minutes of moderate-intensity exercise weekly should suffice for people taking GLP-1s.
The recommendation is a departure from a
“This is what we have long recommended to people and is ideal for everyone, not just those taking medication for weight loss,” says Dr. Angela Fitch, FACP, FOMA, the president of the Obesity Medicine Association and chief medical officer of knownwell, a weight-inclusive healthcare company. “We also have to remember that body size doesn’t define health.”
For instance, Fitch says that people with BMIs of 33 may be running long distances and be in good health, while those with BMIs of 23 may live a more sedentary lifestyle.
“Moderate intensity” can feel vague.
In the simplest terms, “Moderate intensity [means] not too hard, not too easy,” Tuppo says, saying she agrees it’s a good place for people new to physical activity to start.
What does that feel like in practice, and what workouts qualify? Experts clarified.
Tuppo says there are a few ways people can determine whether or not they are exercising at a moderate intensity.
- Perceived exertion. This method for determining intensity is highly customizable and relies on feeling. “Perceived exertion considers variability among individuals in response to exercise. It is based on an individual’s tolerance to a given exercise routine,” Tuppo says. On a scale of 1 to 10, where 1 is easy, and 10 is very hard, Tuppo says moderate-intensity falls at a 5 or 6.
- Talk test. Fast breathing and an ability to talk (but not sing) is moderate intensity, Tuppo says. “If doing a vigorous-intensity activity, a person will only be able to say a few words without pausing for a breath,” she adds.
- Pulse monitoring. A person can monitor their pulse or
target heartrate using a monitor to determine intensity. However, Tuppo says this method isn’t a good fit for people taking medications for heart rate and suggests these individuals use perceived exertion instead.
Batash says that aerobic exercises to start with might include:
Resistance training examples include:
Starting a new workout routine can feel overwhelming. Experts shared advice to help people start or get back into a routine.
Speak with a doctor
Before starting any workout routine, experts share it’s essential to speak with your healthcare team.
“There are a few disclaimers before starting any physical activity regimen like pre-existing and known underlying health conditions to consider as well as taking a personalized fitness approach tailored to the patient’s needs,” Batash says.
While the new article recommends 150 minutes of physical activity with two days of resistance training, experts share you don’t have to build up to that during the first week.
“It is good to start an exercise program slowly, methodically, and consistently in order to achieve your desired goals gradually,” Ali says.
“Setting a step goal can be a good way to get started,” Fitch says. “Increase the amount of steps every week by 500 steps a day as an option. Ride a stationary bike for 10 min a day and increase from there.”
Build in rest days
Even if you’re loving your new workout routine, experts say taking a breather is a good idea.
“Rest days should be built into a workout routine,” Batash says. “Rest days allow for muscles to heal and grow. However, do something every day. If it is your rest day from weight training, go for a walk around the block or go up and down a few flights of stairs.”
Give yourself grace
Not every workout session will feel great, and you may hit fewer reps one day than you did two days prior. It’s OK.
“It is always better to do something rather than nothing,” Batash says.
Tuppo shared sample aerobic and resistance training routines for beginners to give a more concrete example.
Sample aerobic routine
- 5 to 10 minutes of warm-up, like gentle stretching plus slow walking, cycling, or swimming
- 30 minutes of your exercise of choice at moderate intensity, such as a brisk walk or jog, cycle, or swim
- Cool down for 5 to 10 minutes at a slower pace
- 10 minutes of stretching
Sample resistance training routine
- 5 to 10 minute warm-up of gentle stretching and slow aerobic activity
- 8 to 12 repetitions (one set) each for each strength exercise. Tuppo recommends working up to 2 to 3 sets per exercise with a minute or two of rest between sets. Recommended moves include sit-ups, squats, pushups, and lunges.
- 5 to 10 minutes of slow aerobic exercise to cool down
- 10 minutes of gentle stretching focused on muscle groups worked
Though medications like Wegovy are critical new tools in helping individuals lose and manage weight, current research and experts indicate they work best when combined with other lifestyle habits like exercise.
About 150 minutes weekly of moderate-intensity exercise, such as brisk walking, combined with two days of resistance training (squats, lunges, and lifting weights), offer benefits beyond weight loss, including rebuilding reduced muscle mass from weight loss. It can be challenging to start and maintain a routine.
Experts suggest speaking to a doctor before starting anything new. From there, start small. Even 10 minutes of riding a stationary bike daily is an excellent place to start.
Build in rest days, and give yourself grace—if you’re not running the pace you want to during a run, just keep putting one foot in front of the other. It’s not all or nothing.