Exercise physiologists should be part of obesity care for patients on weight management drugs, said the Canadian Society for Exercise Physiology (CSEP).

CSEP joined 11 other sport, exercise science, and clinical exercise physiology organizations in developing and endorsing an international joint statement, “Exercise and Physical Activity in the Era of Obesity Pharmacotherapy,” which was published online on August 5.

The signatories included professional organizations in Australia, New Zealand, South Africa, Ireland, Norway, the UK, and other countries in Europe.

Although weight-loss medications are providing meaningful benefits to many patients, “current evidence suggests that 20%-40% of total weight lost during treatment may come from lean tissue, including skeletal muscle,” said CSEP Executive Director Kalie McKenna. “That makes preserving muscle, strength, and physical function an important part of care.”

Furthermore, “the benefits of exercise extend well beyond changes in body weight,” she told Medscape News Canada. “While weight loss may be one outcome of treatment for some individuals, health is not defined by body weight alone. Regular physical activity and exercise can support cardiovascular and metabolic health, mental and brain health, maintain bone and muscle health, improve strength and physical function, and contribute to overall quality of life.”

The statement’s timing “reflects an opportunity to build comprehensive, multidisciplinary care into treatment pathways now, while prescribing, funding, and referral models are still taking shape,” McKenna added. “A comprehensive approach should focus not only on weight but also on improving and preserving health, function, and well-being.”

Generic ‘Move More’ Advice Untenable

The new joint statement calls for “integrated, multidisciplinary models of care to ensure the safe, equitable, and effective use of GLP-1 and related weight management medications.”

Structured exercise delivered by clinical exercise physiologists “is an essential clinical component for preserving muscle, strength, and physical function during weight loss and sustaining outcomes after treatment,” according to the statement.

“Obesity is a complex, chronic, and relapsing condition, not a simple matter of willpower or ‘eating less and moving more,’” the statement highlighted. “Its causes are a multifactorial interplay of genetic, epigenetic, neurobiologic, environmental, psychologic, physiologic, behavioral, and sociocultural influences, and obesity management should reflect that complexity.”

Physical activity for patients on obesity pharmacotherapy “cannot be reduced to generic advice to ‘move more,’” the statement said. “It should be individually assessed, prescribed, and progressed by a clinical exercise physiologist who can account for each patient’s comorbidities, medications, and risk profile.”

In publishing the statement, the signatory organizations called on global governments and international institutions to embed integrated, multidisciplinary care within obesity pharmacotherapy pathways; address equity and access; counter weight stigma within healthcare systems and among healthcare professionals; align health and economic policy so that funding mechanisms support whole-of-care approaches rather than medication-only pathways; and invest in research, surveillance, and data sharing.

For their part, the collaborating organizations agreed to inform policy with evidence; collaborate internationally to build a shared evidence base and professional standards; advocate for equitable access to clinical exercise physiologists as foundational obesity care globally; advance recognition of exercise and physical activity as a clinical — not lifestyle — component of obesity pharmacotherapy; and hold their member organizations and professions to the highest standards of practice, education, and accountability.

Who Is Best Qualified to Deliver Exercise?

“People using GLP-1 medications also have cardiovascular disease, type 2 diabetes, metabolic syndrome, musculoskeletal conditions, reduced physical capacity, or polypharmacy,” McKenna said. “Exercise prescription therefore has important safety and pharmacologic considerations.”

Medications and medication-related physiologic changes can affect exercise tolerance and adaptation, and changes in fatigue, strength, mobility, and physical capacity may need to be monitored over time, she noted.

“CSEP clinical exercise physiologists are trained to bring those factors together and adjust exercise accordingly,” McKenna said. “Independent exercise can still be beneficial, but it does not provide the same level of clinical assessment, individualization, progression, and monitoring.”

Commenting on the statement for Medscape News Canada, Martin Sénéchal, PhD, professor and co-director of the Cardiometabolic Exercise and Lifestyle Laboratory at the University of New Brunswick in Fredericton, New Brunswick, said, “The conversation must extend beyond ‘whether’ exercise should be included and focus on ‘who’ is best qualified to deliver it.” Sénéchal was not involved in developing the statement.

“The real challenge is not determining whether certified exercise physiologists [CEPs] and other clinical exercise professionals should be part of the healthcare system. Their expertise in exercise assessment, prescription, behavior change, and management of chronic disease is well established,” he added. “Rather, the challenge lies in developing the policies, funding mechanisms, referral pathways, and healthcare models that enable these professionals to be fully integrated into interdisciplinary obesity care teams.”

“Clinicians and other healthcare professionals should not be expected to take on responsibility for the exercise component of obesity treatment, particularly when their clinical workloads are already substantial,” said Sénéchal. “Instead, they should advocate for the integration of certified exercise physiologists (CEPs) and other qualified exercise professionals into obesity care pathways.”

If formal integration into a particular healthcare system is not yet possible, “a practical short-term solution is to establish clear referral pathways to qualified CEPs in the community,” he suggested. “This approach allows patients to access specialized exercise assessment, prescription, and support while enabling physicians and other healthcare providers to focus on their areas of expertise.”

On the individual level, he added, “clinicians should educate patients undergoing GLP-1 therapy that the primary purpose of exercise is not to accelerate weight loss but rather to preserve muscle mass, maintain muscle strength, and protect physical function throughout the weight-loss process. In this context, exercise serves as a critical strategy to support healthy body composition and long-term functional health.”

McKenna reported no relevant financial relationships. Sénéchal declared being a CSEP clinical exercise physiologist and noted that his comments reflect his own views. 

Marilynn Larkin, MA, is an award-winning medical writer and editor based in New York City whose work has appeared in numerous publications, including Medscape Medical News and its sister publication MDedge, The Lancet (where she was a contributing editor), and Reuters Health.