By Rush PT
If you’re over 65 and using a GLP-1 medicine, strength and everyday function deserve a place in your treatment plan alongside weight and other health measures. Discuss how you’ll monitor them with your treating clinician, how you’ll stay adequately nourished, and what sort of exercise suits you. There isn’t one proven training formula for every older adult taking these medicines.
The useful question is: “How am I going to keep doing the things that matter to me?” Carrying the shopping, getting out of a chair, enjoying a decent walk and keeping up with family all count. The bathroom scales have a fairly limited job description.
Turning 65 isn’t a fitness assessment
Someone who’s been lifting for years and someone rebuilding confidence after illness may share a birthday and need very different starting points. Age alone doesn’t tell a coach how strong you are, what you can manage or whether you’re frail.
That distinction matters when reading GLP-1 research. A 2026 narrative review of muscle outcomes found that only four of its 21 included studies specifically examined older adults. Their methods varied, leaving too little evidence to establish how age changes vulnerability to muscle loss or its consequences. This was a review of existing studies, not a new trial.
So we shouldn’t assume everyone over 65 will lose function. Equally, results from a younger, healthier study group don’t give every older person an all-clear. Your starting strength, health conditions, appetite and daily activity belong in the conversation.
Lean mass, muscle and strength are different things
Headlines sometimes turn a reduction in “lean mass” into the same amount of “muscle lost”. That shortcut can be misleading. Lean soft tissue measured by a DXA scan includes water and non-muscle tissues; it isn’t a direct count of skeletal muscle. Tinsley and Heymsfield explain why these measurement terms matter.
Even a measure of muscle size doesn’t tell the whole story about strength or what you can do. A scan and an everyday task answer different questions. Both may be useful, but neither should be asked to do the other’s job.
A recent STEP UP secondary analysis illustrates the distinction. It examined MRI measurements and chair-rise performance in 55 adults with obesity. Chair-rise repetitions were maintained during treatment, while body-composition measures changed. But there were only six placebo participants, and the estimated difference in thigh muscle volume between groups was uncertain. This small analysis wasn’t designed to settle the question for people over 65.
There’s a good reason to include strength work
We have useful exercise evidence in older adults, even where it isn’t a direct test of GLP-1 treatment.
In a six-month randomised trial involving 160 older adults with obesity, a weight-management programme combining aerobic and resistance exercise improved a physical-performance test more than either exercise type alone. Resistance training, alone or combined with aerobic training, also limited lean-mass loss more than aerobic training alone. It didn’t eliminate it. This was a diet-and-exercise trial, so we can’t promise the same results during medication treatment.
The American College of Sports Medicine’s 2026 position stand also supports progressive resistance training for strength and physical performance. Its evidence concerns healthy adults broadly, rather than providing a specific programme for older GLP-1 users.
For coaching, the practical starting point is to choose manageable exercises, establish a repeatable routine and adjust the challenge as your ability changes. That might include a supported sit-to-stand, a row or a carry, depending on your assessment. Walking and other aerobic activity can have their own place too. The details should fit your health and experience; there’s no prize for borrowing someone else’s hardest workout.
Our guide to getting fitter after 60 explains how strength, stamina and balance contribute different things.
Appetite belongs in the training conversation
If eating has become difficult, that’s useful information for your care team. “I’m less hungry” and “I’m managing to eat enough for my needs” aren’t necessarily the same thing.
An expert consensus on nutrition and lifestyle support during GLP-1 treatment recommends individualised nutrition and exercise, attention to appetite and symptoms, and dietitian involvement where possible. Much of its guidance comes from indirect evidence and clinical experience. It’s practical guidance, not proof that a particular diet or workout guarantees muscle preservation.
Bring persistent difficulty eating, unusual weakness or worsening tolerance of normal activity to your treating clinician. Ask how nutrition and training should be adjusted together. Medication decisions stay with your prescriber.
Five useful questions for your next appointment
- What are we aiming to improve? Agree on goals that include the activities you want to keep doing.
- What should we measure now? Ask whether an assessment of strength, walking or chair-rise ability would give you a useful starting point.
- Am I eating enough for my needs? Discuss appetite, meals and whether a dietitian could help.
- What exercise is appropriate for me? Bring up injuries, balance concerns, health conditions and your current routine.
- When should we review things? Agree on follow-up and which changes in symptoms or daily function should prompt earlier contact.
Build a plan you can actually use
Choose one or two everyday goals to discuss with your coach: carrying your usual shopping more comfortably, for example, or finishing a familiar walk with less difficulty. Simple notes about activity and how it feels can make those conversations more useful. They don’t diagnose a medical problem.
For the broader evidence, read GLP-1 and exercise: why strength and fitness still matter. If you’d like help turning your care team’s advice into a manageable routine, get in touch with Rush PT about personal training in Sydney’s Eastern Suburbs or online fitness coaching. Start with where you are and what you want daily life to feel like.
