There is no escaping the GLP-1 craze, and the integration of pharmacological interventions with physical activity, which has quickly become a popular way to manage obesity and type 2 diabetes. Understanding the interplay between these medications and exercise physiology is important when tailoring effective and safe programs for clients. 

This primer touches on the mechanisms of GLP-1 receptor agonists, their physiological implications for exercise, and practical strategies for program adaptations.

Introduction to GLP-1 Receptor Agonists

GLP-1 receptor agonists, such as liraglutide, semaglutide and exenatide, are a class of medications increasingly prescribed for the treatment of type 2 diabetes and obesity. By mimicking the action of the glucagon-like peptide-1 hormone, these drugs enhance insulin secretion, inhibit glucagon release, slow gastric emptying, and promote satiety. 

These effects not only aid in glycemic control but also support weight loss efforts, making them a critical component of treatment plans for many individuals.

The primary mechanism of GLP-1 receptor agonists involves the stimulation of insulin secretion in response to elevated blood glucose levels, which is particularly beneficial postprandially (after a meal). By inhibiting glucagon release, these medications prevent the liver from producing excessive glucose. 

Another aspect is their ability to delay gastric emptying, contributing to a feeling of fullness and reduced appetite, which supports weight loss. Understanding these mechanisms is important for health coaches to comprehend the potential impacts on performance and recovery.

Physiological Implications for Exercise

Exercise creates a variety of metabolic responses, including increased glucose uptake and changes in appetite. For clients on GLP-1 receptor agonists, these effects may be particularly relevant. 

The enhanced insulin sensitivity and altered glucose metabolism may affect energy levels and exercise capacity. Additionally, the delayed gastric emptying can impact nutritional strategies surrounding exercise, requiring adjustments to pre-exercise eating habits to avoid gastrointestinal discomfort.

Hypoglycemia risk is another consideration, especially in clients with diabetes. While GLP-1 receptor agonists have a lower risk of hypoglycemia compared to other diabetes medications, the combination with exercise, which naturally lowers blood glucose levels, may increase this risk. Wellness professionals need to be able to recognize signs of hypoglycemia and know how to respond.

The National Association of Sports Medicine (NASM), recently released an evidence-based review specifically for the fitness professional and wellness coach. In it, the authors discussed the STEP 1 study, which looked at the efficacy of semaglutide with a healthy lifestyle.

The study, according to NASM, provides insightful data for fitness professionals and wellness coaches on the impact of semaglutide when combined with lifestyle interventions. 

Conducted over 68 weeks with 1,961 participants, this research compared the effects of semaglutide and a healthy lifestyle against a placebo group. Participants engaged in regular counseling sessions to support adherence to a reduced-calorie diet and increased physical activity, using tools like diaries or apps for daily tracking.

The findings revealed significant differences in weight loss outcomes. Those in the semaglutide group lost an average of 14.9% of their baseline body weight, in stark contrast to just 2.4% weight loss in the placebo group. 

A follow-up a year later showed that people who discontinued semaglutide and stopped their healthy lifestyle practices regained two-thirds of their weight and also saw setbacks in cardiometabolic health indicators.

For health coaches, these results underscore the importance of integrating pharmaceutical interventions like semaglutide with sustained lifestyle modifications. The initial weight loss can be substantial, but without ongoing lifestyle support, the benefits may not be maintained long-term. The study highlights the need for a holistic approach that includes diet, exercise and behavioral counseling to achieve and sustain health improvements.

As always, it’s critical to also stay within scope of practice, conduct thorough assessments, and work closely with healthcare providers to understand any limitations or precautions. 

GLP-1 Exercise Programs

Of note, fitness chains like Life Time and Equinox have already rolled out lifestyle programs that include GLP-1 specific programming. In October 2023, Life Time, which runs approximately 170 “athletic resort” destinations, announced a pilot program to prescribe weight-loss injections for members. 

Xponential Fitness—a boutique fitness franchise that includes Club Pilates and Rumble—announced it was acquiring Lindora, which currently offers weight-loss medications, hormone replacement therapy and IV hydration.

According to a recent article, Equinox’s GLP-1 protocol is a “set of best practices” developed by a health advisory board, a collection of fitness professionals and doctors—that Equinox’s personal trainers can go to for help with clients, including the physical and metabolic changes that can happen. 

Michael Crandall, a personal trainer at one of Equinox’s private-training-only E Clubs in New York City, was quoted in the article as saying “just because you’re at a healthy weight, or on the path to a healthier weight, doesn’t mean fitness wouldn’t have a strong purpose in your life. As far as I can see, demand for memberships and training are just growing because of these drugs. I’m having to say ‘no’ [to potential clients] more than ever.”

For clients on GLP-1 receptor agonists, a combination of cardiovascular and resistance exercises can maximize health benefits. After an assessment, if indicated, encourage walking, cycling, or swimming at a low to moderate intensity. Resistance training may be essential for maintaining and building muscle mass, which can be particularly beneficial for metabolic health and glucose management.

Communication with the client’s healthcare provider is vital to ensure that the program aligns with their overall treatment plan.

GLP-1 Future Directions

As the use of GLP-1 receptor agonists continues to rise, health coaches have a duty to stay informed about the latest research and best practices. By understanding the mechanisms of action and physiological implications, coaches can tailor exercise programs that safely and effectively support clients’ health goals.

The future of exercise design in the “Ozempic world” looks promising. Ongoing research may provide deeper insights into optimizing exercise types, intensities and durations to complement the metabolic effects of these medications. 

Exploring the synergistic effects of exercise and GLP-1 receptor agonists on mental health, cardiovascular fitness, and overall quality of life will further enhance the holistic approach to managing obesity and diabetes, and wellness coaches play a key role in this new frontier.