Effects of combined GLP-1 receptor agonist therapy and exercise on body composition in individuals with obesity: a systematic review

Abstract

Background. Obesity management necessitates a multidisciplinary approach. Combining tailored exercise therapy with pharmacotherapy utilizing GLP-1 receptor agonists is emerging as a prominent interventional strategy. Aim. This systematic review evaluates the efficacy of combining GLP-1 agonists with exercise therapy versus monotherapies. The focus was on maximum weight reduction and the prevention of adverse musculoskeletal effects following treatment cessation, specifically muscle mass loss and reduced bone mineral density (BMD). Materials and methods. Conducted according to PRISMA 2020 guidelines, the review included English-language randomized controlled trials (RCTs) published after 2016, retrieved from PubMed and PEDro databases. Results. Three publications based on a single cohort (n=215) were included. Combination therapy was the most effective modality, yielding the greatest weight reduction, most favorable cardiometabolic improvements, and highest subjective quality of life. Furthermore, during a 52-week post-treatment follow-up, it demonstrated the greatest efficacy in mitigating weight regain. Crucially, unlike isolated pharmacotherapy, combination therapy increased BMD in the evaluated regions. Conclusions. Combination therapy (GLP-1 agonists and exercise) is the most effective long-term obesity treatment. It highlights the necessity of tailored exercise programming—integrating resistance and aerobic training—to preserve musculoskeletal integrity and sustain beneficial metabolic adaptations.