Exercise on GLP-1 Medication: How to Protect Your Muscle and Joints

The short answer: Yes, exercise matters on GLP-1 medication such as Ozempic, Wegovy, Mounjaro, or Zepbound. Some of the weight you lose can be muscle, and strength training 2 to 3 times a week is the main way to help protect it. Build up slowly, protect your joints, and follow your prescriber's advice.

• Most of the weight lost on GLP-1 medication is fat, but some is lean mass (muscle and other non-fat tissue). One review puts lean mass at roughly 15% to 40% of weight lost, depending on the drug, dose, and person [1].
• Strength (resistance) training is the usual recommendation. A 2024 review calls it a proposal worth using, not a proven treatment for GLP-1 users [4].
• A good target is strength work 2 to 3 times a week, plus gradual walking toward 150 minutes a week [1][9].
• In one large trial of adults with obesity and knee osteoarthritis, semaglutide improved knee pain, though the trial could not explain why [7].
• Eat enough protein and drink enough fluid. If you are vomiting or cannot keep liquids down, skip exercise and call your prescriber [6][8].
• Loosn gives no dosing advice. Follow your prescriber on your medication.

For most people, yes, once your prescriber agrees. GLP-1 medicines help you eat less, but they do not build strength, fitness, or tougher joints. Exercise does that.

Here is what the evidence says. A 2025 mini review of GLP-1 medicines and exercise concluded that combining the two may give additive benefits, including better weight-loss maintenance after stopping the medicine [1]. A 2024 review in Diabetes Care goes further: its authors recommend tailored resistance training as an add-on to these drugs, aiming to preserve lean mass while reducing fat. They call this a proposal, not a tested intervention [4].

The word "may" matters. The 2025 review also notes that studies use different exercise plans, most follow people for 12 months or less, and there may be publication bias toward positive results [1]. So think of exercise as a sensible, low-risk step supported by good reasoning, not a guaranteed fix.

What this means: you do not need to wait to feel "ready." You do need to check with your prescriber first, start easy, and build up.

Yes, some. Most weight lost on these medicines is fat, but a share is lean mass. Here is what the main trials found.

• Semaglutide (Wegovy, Ozempic). In a body-composition substudy of the STEP 1 trial, 140 adults had DXA scans (a scan that splits body weight into fat and lean tissue). After 68 weeks on semaglutide 2.4 mg, body weight fell 15.0% (placebo: 3.6%). Fat mass fell 19.3% and lean body mass fell 9.7% [2].
• Tirzepatide (Zepbound, Mounjaro). A review reports that about 25% of weight lost in SURMOUNT-1 over 72 weeks was lean mass [1]. In the DXA substudy, 160 people had scans before and after treatment. Their fat-to-lean ratio improved, meaning they lost proportionally more fat than lean tissue. But the age groups were small (just 20 people aged 65 or older), and the findings were presented as a conference abstract [3].
• Across reviews. Lean mass makes up roughly 15% to 40% of the weight lost, depending on drug, dose, starting body composition and how long people take it [1].

Notice two things. First, a scan's "lean mass" includes muscle but also water and organs, so it is not the same as muscle alone. Second, some lean mass loss is expected with any weight loss. The Diabetes Care review estimates the loss on these drugs at about 10% of lean mass, or around 6 kg (13 lb), which the authors compare to a decade or more of aging [4].

Is the muscle loss harmful? That is still unresolved. The 2025 review says it is not yet clear whether it is adaptive or maladaptive, and the evidence on direct muscle effects of the drugs is limited and comes mainly from rodent and lab studies [1]. Our deeper look at the research is in do you lose muscle on GLP-1 drugs, and can exercise stop it?.

What this means: losing some muscle is common, not a sign that something has gone wrong. Strength training is how you tilt the balance in your favor.

Muscle helps you stand up from a chair, climb stairs, carry groceries and stay steady on your feet. Losing strength along with weight can make everyday tasks harder, and that matters more as you get older.

The Diabetes Care authors also suggest that preserving lean mass during treatment could help reduce weight and fat regain after the medicine stops. Again, this is their suggestion, not a proven result [4]. In a Danish randomized trial of 195 adults with obesity, the group combining exercise and liraglutide achieved a larger weight difference from placebo at 52 weeks (9.5 kg lower) than exercise alone (4.1 kg lower) or liraglutide alone (6.8 kg lower). Exercise was also linked to increased lean mass, and the combination reduced body-fat percentage most [5]. This trial used liraglutide, an older GLP-1 drug, so the findings may not carry over exactly to semaglutide or tirzepatide.

In general adult populations, supervised resistance training lasting more than 10 weeks has been reported to increase lean mass by about 3 kg (6.5 lb) and strength by about 25% in men and women [4]. That figure comes from studies outside GLP-1 treatment. Whether you get the same gain while eating much less is not well tested.

Resistance training also appears more effective than aerobic exercise alone for limiting lean mass loss during weight-loss diets, according to a European obesity group cited in the 2025 review [1]. Aerobic exercise still helps your heart and mood, so aim for both.

Weight loss can ease joint pain in some people, and the trial below shows it for knees. Some people also notice new aches as their body changes, so it helps to know what is normal and what is not.

The best evidence comes from STEP 9, a 68-week trial of just over 400 adults with obesity and moderate knee osteoarthritis, published in the New England Journal of Medicine in 2024. Their average age was 56 and 81.6% were women. On a 0 to 100 knee-pain scale (higher is worse), scores fell by 41.7 points with semaglutide 2.4 mg and by 27.5 points with placebo. Weight fell 13.7% versus 3.2%. Everyone received diet and activity counseling. The authors said the trial was not designed to explain why pain improved, though they suggested weight loss is likely a major contributor [7].

Knee pain also fell in the placebo group, which tells you that counseling and activity help too [7]. Exercise is a standard part of osteoarthritis care: the US Physical Activity Guidelines page notes that physical activity can decrease pain for people with osteoarthritis [9].

Practical joint tips while you lose weight:

• Choose exercises you can control, such as step-ups to a low step, bridges and sit-to-stands.
• Keep the first few weeks easy. Muscles and tendons adapt more slowly than the scale changes.
• Mild muscle soreness is normal. Sharp pain, a swollen joint or pain that is worse the next day is a signal to scale back.
• If a joint is hot, red and swollen, or you have a fever, see a provider the same day [10].

If new joint or back pain appears as the weight comes off, we cover it in joint and back pain during rapid weight loss: what is normal?.

Work toward the national guideline, and build in strength from the start.

• Aerobic activity. The US Physical Activity Guidelines advise adults to get at least 150 to 300 minutes of moderate-intensity aerobic activity a week, such as brisk walking [9]. If you are not active now, the 2025 review suggests starting at about 10 minutes a day and building gradually [1].
• Strength training. The same US guidelines advise muscle-strengthening activity on at least 2 days a week [9]. The 2025 review suggests sessions of 20 to 30 minutes, 2 to 3 times weekly, using bands, weights or bodyweight exercises [1].
• Balance and mobility. The review also recommends balance and mobility work, especially for older adults [1].

Go slowly at first. The plan below is a common clinical starting point, not a prescription, and it is not from a cited trial. Adjust it to how you feel, and talk to your prescriber or physical therapist if you have medical conditions.

Rest at least one day between strength sessions. Move up only when the current level feels comfortable for a full week.

Choose moves that train the big muscle groups (legs, hips, back and chest), because that is where most lean mass sits. Start with these four. Do 2 sets of 8 to 10 repetitions each, unless the plan above says 1 set.

1. Goblet squat. Hold a light weight (or a water jug) at your chest. Sit your hips back and down as if into a chair, keep your chest tall, then stand. Start by squatting to a chair if needed. See our goblet squat exercise.
2. Glute bridge. Lie on your back with your knees bent. Squeeze your buttocks and lift your hips until your body forms a straight line from shoulders to knees. Hold for 2 to 3 seconds, then lower slowly. See our glute bridge exercise.
3. Incline push-up. Place your hands on a counter or sturdy table, step your feet back and keep your body in a straight line. Bend your elbows to lower your chest toward the surface, then press back. The higher the surface, the easier. See our incline push-up exercise.
4. Step-up. Stand in front of a low, sturdy step (about 6 inches or 15 cm). Step up with one foot, press through your heel until you stand tall, then lower slowly. Do each leg. Hold a rail if you need to. See our step-up exercise.

Stop if you feel sharp pain, dizziness or faintness, nausea that gets worse, a joint locks or gives way, or a joint swells. Rest, drink water if you can, and contact your provider if it keeps happening.

Kai, Loosn's AI physio coach, can help you pace and progress these around your own aches and your treatment. It does not replace an assessment if your symptoms are severe, getting worse or unusual.

If you are looking for a structured plan, see our GLP-1 companion programme for how these moves fit into a week.

Exercise needs fuel, and GLP-1 medicines reduce appetite, so this deserves a plan.

In 2025, four US groups (the American College of Lifestyle Medicine, the American Society for Nutrition, the Obesity Medicine Association and The Obesity Society) published a joint advisory on nutrition during GLP-1 therapy. As reported, it advises getting sufficient protein to limit lean mass loss and notes that protein intake is at risk when stomach side effects cut how much you eat. It also recommends including resistance training, and it describes monitoring of nutrients such as iron, B vitamins, calcium and vitamin D when intake is low. As reported, it gave no numeric protein target, so ask your prescriber or a registered dietitian what is right for you [6].

On fluids, MedlinePlus says to tell your doctor if you have vomiting or cannot drink liquids by mouth, because this may cause dehydration [8]. Take that seriously on exercise days.

Use a simple rule: on rough days, scale down, do not push through.

• Mild nausea or low energy: a short, easy walk or a light version of one or two strength moves may be fine.
• Vomiting, diarrhea, or you cannot drink liquids: skip exercise and call your prescriber. MedlinePlus lists severe or persistent vomiting, diarrhea and inability to drink as reasons to tell your doctor [8].
• Dizziness or faintness: stop. MedlinePlus lists fainting or dizziness among the serious side effects that call for contacting a doctor or getting emergency care [8].
• After a dose increase: consider keeping workouts lighter. This is a practical suggestion, not from a cited source, so check with your prescriber.

Emergency: call 911 (or your local emergency number) or go to the emergency department if [8]:

• you faint
• you have ongoing pain that starts in the upper left or middle of your stomach and may spread to your back, with or without vomiting
• you have chest pain or trouble breathing during exercise

(Other common emergency numbers are 999 in the UK, 112 across the EU and 000 in Australia.)

Urgent: contact your prescriber or get seen today if [8][10]:

• you have severe or persistent vomiting or diarrhea, or you cannot keep liquids down
• you feel dizzy or lightheaded
• a joint is swollen, red and hot, or you have joint pain with a fever

Contact your prescriber soon if [8]:

• you are losing weight very rapidly
• you have unusual pain or new joint or back pain that does not settle
• you notice a big drop in your strength or energy
• you want to change your dose or stop the medication (do not do this on your own)

Loosn is not a substitute for assessment when symptoms are severe, getting worse or unusual.

Should I exercise while taking Ozempic or other GLP-1 medication? 

Usually yes, once your prescriber agrees. Some of the weight you lose on these drugs is lean mass, and a 2024 Diabetes Care review proposes tailored resistance training to help preserve it [4]. US guidelines advise muscle-strengthening activity on at least 2 days a week [9]. Start gently and follow your prescriber's advice.

Does exercise stop muscle loss on GLP-1 drugs? 

It may reduce it, but this is not fully proven. Supervised resistance training lasting more than 10 weeks increases lean mass in general adult populations [4], yet the Diabetes Care review presents its use alongside GLP-1 drugs as a proposal, not a tested treatment [4]. Strength work is still a sensible, low-risk step for most people.

How many times a week should I do strength training on a GLP-1? 

Two to three times a week is a common target. A 2025 review suggests resistance sessions of 20 to 30 minutes, 2 to 3 times weekly, with a gradual walking build-up [1]. US guidelines set the minimum at 2 days a week [9]. If you are new to exercise, start with two short sessions.

Is it safe to work out if I feel nauseous or dizzy on a GLP-1? 

Skip hard exercise on those days. MedlinePlus says to tell your doctor if nausea, vomiting or diarrhea is severe or does not go away, or if you cannot drink liquids, which may cause dehydration [8]. Fainting or dizziness needs medical attention [8]. A short, easy walk may suit mild days; check with your prescriber.

Can GLP-1 medication help knee pain? 

It may for some people with obesity and knee osteoarthritis. In the STEP 9 trial of just over 400 adults, knee pain scores improved more on semaglutide than placebo, alongside greater weight loss [7]. The trial was not designed to show why. Strength training and a pain plan still matter, so ask your provider.

Should I eat more protein on a GLP-1? 

Ask your prescriber or a dietitian. A 2025 joint advisory from US nutrition and obesity groups stresses getting sufficient protein to limit lean mass loss, especially when stomach side effects reduce how much you eat [6]. As reported, it gave no numeric target, so your own needs are best set by a professional.

Ready to start? The Loosn app gives you gentle strength exercises and a weekly plan from Kai, Loosn's AI physio coach, built to fit alongside your prescriber's care. Download the Loosn app.