💊 + 🏃‍♀️ Why Exercise Still Matters in the "Ozempic Era'

An evidence-based message for health professionals and patients

By Natalie Costanzo, Accredited Exercise Physiologist

As anti-obesity medications like semaglutide and tirzepatide become more accessible and widely used in Australia, it’s tempting to think we’ve found the “magic bullet” for managing obesity. And while these medications have changed the landscape, we mustn’t lose sight of a powerful truth:

Exercise is not optional. It’s essential.

A 2025 systematic review and meta-analysis published in The European Journal of Translational Myology [Marmett et al., 2025] gives us fresh insight into exactly why structured exercise is a critical adjunct to pharmacotherapy for obesity — and what it offers that medication alone cannot.

🧪 What the Review Looked At

This review analysed randomised controlled trials comparing:

• Anti-obesity medication alone vs

• Anti-obesity medication + structured exercise training in non-diabetic adults with obesity.

Exercise protocols were typically supervised aerobic training, with some combining aerobic and resistance training — the gold standard we recommend as Exercise Physiologists.

🔑 Key Takeaways: Why Add Exercise?

Let’s break down what exercise adds when paired with pharmacotherapy:

1. More Weight Loss

• Combining GLP-1 drugs with exercise led to ~4 kg more weight loss than medication alone.

📣 Why this matters: Even modest additional weight loss can improve cardiometabolic risk factors.

2. Greater Fat Loss

• Exercise enhanced fat mass reduction beyond medication alone (up to 2.9 kg extra in some studies).

📣 Why this matters: It’s not just about the number on the scale — losing fat mass is key to improving insulin sensitivity, inflammation, and metabolic health.

3. Preservation of Lean Muscle Mass

• While many pharmacological weight loss interventions cause muscle loss, combining with resistance training preserved (and in some cases increased) fat-free mass.

📣 Why this matters: Muscle mass is your metabolic engine. Preserving it means preserving strength, function, resting metabolic rate, and long-term independence.

4. Improved Cardiorespiratory Fitness

• VO₂peak increased by ~2.5 mL/kg/min in groups that exercised — a meaningful boost in cardiovascular health and physical function.

📣 Why this matters: Medications don’t train the heart or lungs. Exercise does. Improving aerobic fitness reduces mortality risk — independently of weight loss.

5. Better Metabolic Health

• In GLP-1 + exercise groups, participants saw improvements in:

  • Insulin resistance (HOMA-IR)

  • HDL (good cholesterol)

  • LDL (bad cholesterol)

📣 Why this matters: These changes reduce the risk of type 2 diabetes and cardiovascular disease — and reflect improvements in how the body is functioning under the hood.

🤔 But Isn't the Evidence Novel?

Yes — and that’s worth acknowledging. The review noted:

• Only 4 trials met inclusion criteria (200+ participants)

• Some had small sample sizes or moderate risk of bias

• Certainty of evidence was “low to very low” according to GRADE criteria

However: The physiological rationale and consistency across outcomes still support one clear message…

🗣️ As an Exercise Physiologist, Here’s What I Tell My Patients and Colleagues:

“Medication may help you lose weight — but exercise will help you keep it off, feel strong, move well, and live longer.”

And to my fellow health professionals:

If your patients are on anti-obesity medication, don’t stop there. Refer them to an Accredited Exercise Physiologist. Together, we can:

• Preserve muscle mass

• Prevent deconditioning

• Improve functional capacity

• Sustain long-term weight maintenance

• Support mental health and confidence

💬 Final Thoughts

This review doesn’t dismiss the role of medication — it clarifies the role of exercise. Obesity is a complex, chronic condition. And like any chronic condition, multimodal care works best.

Let’s continue to champion collaboration between GPs, nutritionists, exercise professionals and — most importantly — the patients at the centre of it all.

Because no pill can do what we know exercise and good nutrition does 💪🏼🥑

Need support for your weight loss and health journey?

Book a free 10 minute discovery call with Nat here

With 10 years experience, Nat is a highly qualified exercise physiologist, Pilates instructor & personal trainer, with a special interest in supporting women and AFABs to navigate preconception, pregnancy, postpartum, perimenopause and healthy ageing. As an exercise physiologist, she is uniquely qualified in supporting all those wishing to adopt or return to exercise when challenged by confidence, injury or disability.

View Nat's profile here.