Indoor cycling academy
Exercise: The secret ingredient in medicated weight loss

It would be impossible not to have seen the headlines and hype around the new generation of obesity drugs. Hailed by many scientists and doctors as a gamechanger in the fight against obesity and other chronic conditions, they have also spawned derogatory phrases such as ‘skinny jab’ and ‘Ozempic face’.
I have been conducting research into the psychosocial determinants of obesity-related behaviours and the lived experience of obesity for over 16 years. As a health coach and trainer, I have worked directly with clients living with obesity for even longer. I see the huge potential of these drugs in helping people live longer, healthier lives.
Yet as the evidence grows, it’s clear that physical activity has a huge role to play in maximising this potential.

But how exactly? How does exercise dovetail with medicated obesity treatment? What do instructors and clubs need to know to support individuals during and after use of weight-loss medication? Does indoor cycling’s calorie-burning role in weight management still apply when used alongside weight-loss drugs? Let’s start by digging into the science.
“Drugs kick-start the weight loss and bring down some of the barriers to physical activity. Motivation to exercise and levels of activity increase.”

Obesity: Causes, effects & treatment
Firstly, it is important to remind ourselves that the development of obesity is not solely about willpower or personal choice around calories in vs out, as is often suggested. Genetics, environment, socioeconomic circumstances and stress are among the many factors that can make achieving a healthy weight much more challenging for some people. This is exactly why additional support, including drug treatments, are needed.

Obesity is defined by excess body fat – adipose tissue – which poses health risks by impacting metabolic, cardiovascular and inflammatory processes.
- High levels of body fat – especially visceral fat surrounding internal organs – increase the likelihood of insulin resistance and type 2 diabetes and contribute to hypertension, high cholesterol and an increased risk of cardiovascular diseases such as heart attack and stroke.
- Adipose tissue is also biologically active, releasing pro-inflammatory cytokines that can lead to chronic inflammation, which in turn elevates the risk of several cancers and liver diseases.
- Moreover, excess weight can strain joints, leading to conditions such as osteoarthritis and exacerbating respiratory issues including obstructive sleep apnea.
All of this impacts overall health and quality of life. The good news: it is now undeniable that exercise has a positive effect on these metabolic, cardiovascular and inflammatory processes, enhancing insulin sensitivity, improving blood lipids (cholesterol), regulating blood pressure and reducing chronic inflammation.
“Most participants regain significant weight when they stop using the drugs. People may require ongoing drug treatment unless they can make lifestyle changes.”
This means that someone living with obesity can significantly improve their health through exercise, even if their body weight remains the same. However, achieving weight loss brings additional physical, psychological and social benefits and remains an important goal for many.
Yet people living with obesity often struggle to be sufficiently active to benefit their health or achieve their weight goals. Commonly reported barriers include low mood, pain, fatigue, limited mobility and low self-efficacy. Additionally, the stigma of living in a bigger body can make people with obesity feel very exposed and unwelcome in gyms and classes or when exercising in public spaces.

And so initial evidence around the new obesity drugs represents good news, indicating that motivation to exercise and levels of physical activity both increase among those taking these drugs. This is likely due to a combination of the exercise becoming physically easier, a desire to maximise weight loss and increased confidence from early weight change.
Some of the best interventions I have seen have involved a combination of physical activity and behavioural change support, integrated alongside the use of drugs which kick-start the weight loss and bring down some of the barriers to physical activity.
The new drugs: How do they work?
The new class of weight-loss drugs are known as GLP-1 agonists and include liraglutide (under the brand name Saxenda®), tirzepatide (Mounjaro®) and semaglutide (Wegovy® and Ozempic®). Usually taken by self-administered injection, these medications mimic the action of the natural hormone GLP-1 (glucagon-like peptide-1), which is produced in the gut and plays important roles in appetite regulation and glucose metabolism.
A topline understanding of the science is useful here. Poor blood sugar control and obesity are closely linked in a cycle where each can contribute to the other: high blood sugar caused by insulin resistance results in excess production of insulin, which in turn encourages the body to store fat, while obesity worsens insulin resistance.

GLP-1 drugs help control blood sugar and support both weight loss and overall metabolic health in several ways:
- They cause food to leave the stomach more slowly, allowing for more gradual absorption of sugars. This helps control blood sugar after meals; it is spikes and dips in glucose levels that can lead to insulin resistance, weight gain, obesity, metabolic syndrome, pre-diabetes and type 2 diabetes.
- They help keep blood sugar levels down by reducing glucagon, a hormone that raises blood sugar.
- They encourage the pancreas to release insulin after meals, which controls blood sugar levels. When insulin levels are normal, cells can also burn fat more effectively.
- They signal the brain to feel fuller sooner, which can reduce appetite and help people eat less. This may lead to weight loss.
- They have added benefits for heart health, including helping to lower blood pressure and improve cholesterol levels.
“When GLP-1 medication is taken alongside structured exercise programmes, greater weight loss is achieved. There is also lower weight regain after the treatment ends.”
Results from using GLP-1 drugs
Clinical trial results for GLP-1 agonists have been remarkable, showing they are highly effective in…
- Improving glycemic control: Average blood sugar can reduce by enough to move someone from the diabetic range to pre-diabetic, or even back to a non-diabetic range.
- Boosting weight loss: A loss of 5–15 per cent body mass is typical, with the most advanced drugs producing up to 20 per cent loss.
- Reducing cardiovascular events: Risk can be reduced by up to 25 per cent in those at the highest risk.
However, although trials have shown the drugs to be safe and effective, they are not without their side-effects – most commonly nausea, vomiting, diarrhoea, constipation and decreased appetite. While the latter can aid weight loss, it can also lead to overly low blood sugar, fatigue and nutrient deficiencies if diet is not carefully managed.

Crucially, follow-up data from these trials show that most participants (about two-thirds) regain a significant amount of weight and lose many of the improvements in metabolic health when they stop using the drugs.
This suggests that many people may require ongoing drug treatment, unless they are able to make the necessary lifestyle changes to sustain their lower weight and improved metabolic health without medication. This is where physical activity and a healthy, balanced diet come in.
“Measures of body composition after GLP-1 use show a 20–50% loss of lean mass. Exercise professionals have a huge opportunity to minimise any negative effects.”
Dovetailing diet and exercise
Whenever GLP-1 medications are prescribed, patients should – as part of their treatment – also be counselled by a healthcare professional on reducing calorie intake, eating a healthy balanced diet and completing 150 minutes of at least moderate-intensity physical activity every week.
Studies show that when GLP-1 medication is taken alongside structured exercise programmes, greater weight loss is achieved. There is also lower weight regain after the treatment ends.

Another hugely important finding: measures of body composition after treatment with GLP-1 agonists show a 20–50 per cent loss of lean body mass. While research is still ongoing to discover whether this level of muscle loss might have negative consequences for future health, this change in body composition is a potential cause for concern given the importance of muscle mass in maintaining bone density, preserving physical function, immune support and overall metabolic health.
Meanwhile, there is positive evidence of the benefits of exercise during other weight-loss interventions, including bariatric surgery and very low-calorie diets. These range from increased insulin sensitivity to the preservation of muscle mass – and even increased muscle strength and size.
As exercise professionals, we therefore have a huge opportunity to maximise the potential of GLP-1 drugs, harnessing the power of exercise to:
- Increase weight loss and metabolic health improvements
- Minimise any negative effects of the drugs on body composition
- Help create physical activity habits that will outlast the drug treatment
“The exercise prescription for GLP-1 patients is the same as for the general adult population. Indoor cycling is great for the 150 minutes’ moderate-intensity activity.”
Indoor cycling during or after GLP-1 treatment
The exercise prescription for GLP-1 patients is the same as for the general adult population: 150 minutes of at least moderate-intensity activities each week, plus at least two strength training sessions a week.
Indoor cycling is a great option for accumulating a lot of those 150 minutes, with its low-impact, simple movement pattern and option to individualise intensity through resistance.

The cycle studio might also be a slightly more comfortable environment for those who are conscious of their size – for example, where there is the option for low lighting, avoiding mirrors and choosing a spot where they feel less exposed.
As always, if an individual’s current activity level is low, they should start gradually – with shorter bouts of 10–15 minutes – and gradually progress to participating in full classes.
For those with good conditioning and experience – and no contraindications – incorporating vigorous-intensity sessions such as high-intensity interval training (HIIT) in an indoor cycling class can have additional benefits for both blood sugar control and weight loss.
Top tips for cycling instructors & studios
#1 – Create the right space
Co-location of exercise and health facilities is the optimal set-up. This enables exercise professionals to work directly with the clinical staff prescribing the medication, providing holistic care to patients on this journey. Unfortunately, this is still rare.
In the absence of this set-up, the most positive step any instructor or studio can take is to create a space where people of all sizes feel safe and welcome; those living with obesity can experience a huge amount of shame and often won’t reveal they are using GLP-1 drugs, even to close friends or family.

Note that not everyone who exercises wants to lose weight, including those with obesity, so weight-focused messaging is best avoided. Design programmes that emphasise holistic health and enjoyment rather than weight loss. Show people of all body types in marketing and signage. Create workout areas that feel private as well as larger, accessible changing rooms with seating. Avoid weight-biased language.
This type of environment will make your club and classes more appealing to someone seeking options to increase their physical activity alongside their medication. It may also encourage them to disclose their medication to instructors, so they can be given the best possible support. But it starts with an approach that’s inclusive of all.
It might then be appropriate to also offer specific programmes for those using GLP-1s or seeking weight loss, where individuals can receive tailored advice and be connected with others on the same journey, creating a supportive community.
#2 – Be aware of side-effects
Ordinarily, we would advise anyone experiencing nausea, vomiting, diarrhoea or stomach pain to skip the workout until they feel better. However, to achieve their exercise goals, some people on GLP-1 medication will need to navigate working out even with these symptoms.
Although the severity of side-effects will vary person to person, the majority of patients report at least some gastrointestinal issues. With some drugs, the dose gradually increases over time, with a corresponding spike in side-effects with each increase.
The key is to encourage clients to experiment with the types and timings of food, to minimise symptoms and create the best opportunities for exercise.
For example, patients often report that bland food creates less discomfort and that they need to schedule exercise to allow adequate time for the stomach to empty after eating.
Additionally, many patients will be in calorie deficit, so coaches should advise them to be mindful of signs of low blood sugar during exercise – for example, light headedness or sudden weakness – and promote taking breaks when needed.
It is really important to remind clients that this is a long-term process. Taking a few days off when symptoms are severe is not a sign of failure or lack of willpower. ‘Consistency’ doesn’t mean turning up regardless of how you feel. It means doing the best you can each day and staying in it for the long run.
#3 – Support strength training
Indoor cycling is great for cardiovascular fitness, but it can actually contribute to muscle loss if not combined with resistance exercise.
Body weight training (including yoga and pilates), resistance band exercises, weight machines and free weights all count, but it is lifting heavier weights – typically in the range of 6–12 reps a set – that stimulates greater muscle activation. This helps preserve muscle fibres that might otherwise be lost in a calorie deficit.
For this reason, fusion classes – where time is split between being on the bike and doing heavier resistance training – is likely to be more effective than using lighter hand weights while in the saddle. It allows participants to work at sufficient intensity to stimulate muscle growth. It is also simpler and safer for novice indoor cyclists to master, as they don’t have to combine movements.
Clients should also be reminded of the importance of sufficient protein in their diet, as this provides the building blocks of muscle.

#4 – Prepare for de-prescribing
Many patients report a noticeable return of hunger and an increase in food cravings when they stop GLP-1 treatment, which can make it challenging to maintain the weight loss achieved. Continuing with physical activity once they come off the drugs will reduce weight regain and continue to provide significant physical and mental health benefits.
It is therefore important not only to harness the initial boost in motivation to exercise – experienced during treatment – but also to provide behavioural change support in the weeks and months running up to the end of treatment. The aim is to provide individuals with the tools that can help limit the impact of the loss of the drugs’ effects.
From an activity perspective, planning ahead to create suitable programmes and setting up motivational structures – for example, a supportive network of friends, family and workout buddies – can help people maintain their activity levels and sustain the results they’ve achieved.
“Remind clients that this is a long-term process. Taking a few days off when symptoms are severe is not a sign of failure or lack of willpower.”
Clubs can also help people prepare by encouraging them to identify and minimise triggers that lead to over-eating – for example, specific settings, times or emotions – as well as practising portion control, removing tempting foods and structuring eating times to help manage hunger and cravings. Teaching mindful eating is another good technique: eating slowly, savouring food and paying attention to how full they feel.

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