GLP-1 receptor agonist (GLP-1)

GLP-1 RA is short for glucagon-like peptide 1 receptor agonist.^{1Ozemek et al., ACSM’s Guidelines for Exercise Testing and Prescription, 12th ed., p. 1029.} ACSM lists the class among medicines for type 2 diabetes, with weight loss ranging from intermediate to very high.^{2Ozemek et al., ACSM’s Guidelines for Exercise Testing and Prescription, 12th ed., p. 1027.} On its own the class carries no risk of hypoglycemia.^{2Ozemek et al., ACSM’s Guidelines for Exercise Testing and Prescription, 12th ed., p. 1027.} Gut side effects are possible and are typically temporary.^{2Ozemek et al., ACSM’s Guidelines for Exercise Testing and Prescription, 12th ed., p. 1027.}

A dual GIP and GLP-1 receptor agonist produces very high weight loss.^{2Ozemek et al., ACSM’s Guidelines for Exercise Testing and Prescription, 12th ed., p. 1027.} It is not recommended for people with a history of gastroparesis.^{2Ozemek et al., ACSM’s Guidelines for Exercise Testing and Prescription, 12th ed., p. 1027.}

In practice

ACSM states that structured moderate- to vigorous-intensity exercise is safe, effective and recommended for people taking weight-loss medicines such as GLP-1 receptor agonists.^{3Ozemek et al., ACSM’s Guidelines for Exercise Testing and Prescription, 12th ed., p. 694.} Adding exercise prevents the loss of lean mass seen when weight comes off with the drug alone.^{3Ozemek et al., ACSM’s Guidelines for Exercise Testing and Prescription, 12th ed., p. 694.} It also prevents the rise in resting heart rate that some of these drugs cause.^{3Ozemek et al., ACSM’s Guidelines for Exercise Testing and Prescription, 12th ed., p. 694.}

Compared with either the drug or exercise alone, the combination gives greater body fat loss and more lasting weight loss.^{3Ozemek et al., ACSM’s Guidelines for Exercise Testing and Prescription, 12th ed., p. 694.} It has also shown greater gains in insulin sensitivity, glycated hemoglobin and cardiorespiratory fitness.^{3Ozemek et al., ACSM’s Guidelines for Exercise Testing and Prescription, 12th ed., p. 694.}

• Pair the medicine with a structured exercise program to protect fat-free mass while weight is falling.^{3Ozemek et al., ACSM’s Guidelines for Exercise Testing and Prescription, 12th ed., p. 694.}
• For dosing of a specific drug, ACSM points to the manufacturer’s prescribing information.^{1Ozemek et al., ACSM’s Guidelines for Exercise Testing and Prescription, 12th ed., p. 1029.}