The combination could save billions in healthcare costs, leading fitness organizations to call for deeper integration of structured exercise in GLP-1 treatment.

Pairing GLP-1 therapy with regular structured exercise would improve long-term health outcomes, reduce downstream costs, and generate positive economic returns across multiple countries, according to new multinational research by the Health & Fitness Association developed by FTI Consulting’s Center for Healthcare Economics and Policy. 

Released as a white paper entitled From Weight Loss to Lasting Value: Structured Exercise and the Economics of GLP-1 Therapy, the research compares impacts of GLP-1 therapy as a standalone obesity treatment with GLP-1 therapy combined with exercise in five countries. 

The research was developed in collaboration with the HFA Foundation and four fitness industry federations: AUSactive, Exercise New Zealand, Fitness Industry Council of Canada, and ukactive.

The white paper provides some of the strongest evidence to date that exercise significantly enhances the value of GLP-1 treatment for patients, healthcare systems, employers, and society as a whole.

Across all five countries studied, the analysis found that a combined approach supports improved long-term health outcomes, reduced healthcare costs, and produced positive economic returns.

Combining regular exercise with GLP-1 therapy is estimated to generate:

• United States: US$120 billion in economic and societal value over 10 years and a 496% return on investment, rising to 1,572% and US$393 billion over 30 years.
• Australia: A$182 million in economic and societal value over 10 years and a 59% return on investment, rising to 457% and A$1.4 billion over 30 years.
• Canada: C$3.5 billion in economic and societal  value over 10 years and a 105% return on investment, rising to 526% and C$17.9 billion over 30 years.
• New Zealand: NZ$51 million in economic and societal  value over 10 years and a 27% return on investment, rising to 306% and NZ$592 million over 30 years.
• United Kingdom: £2.7 billion in economic and societal  value over 10 years and a 164% return on investment, rising to 717% and £13 billion over 30 years.

The findings demonstrate that as GLP-1 use expands, exercise should play an essential role in helping patients and health systems maximize the long-term value from new generations of weight-loss drugs.

The fitness industry has an unprecedented opportunity to be part of the solution as GLP-1 usage continues to grow. 

“GLP-1 medications are rapidly changing obesity treatment, but weight loss alone is not the full measure of success,” says Greta Wagner, interim president and CEO of the Health & Fitness Association and president of the HFA Foundation. “The health and fitness industry has long known that lasting wellness requires more than a number on a scale; it requires strength, function, and sustainable healthy life habits. This research confirms that exercise, especially strength training, helps patients sustain the benefits of GLP-1 treatment over time. It sends a clear message that exercise belongs at the center of GLP-1 care.”

Based on this data, HFA, HFA Foundation, AUSactive, Exercise New Zealand, Fitness Industry Council of Canada, and ukactive are calling on policymakers, payers, and healthcare systems to integrate structured exercise into GLP-1 treatment pathways. 

Specifically, the groups are asking that: 

1. Structured exercise, including strength training, be recognized as an essential part of obesity care;
2. GLP-1 care models include exercise support;
3. Referral pathways are established between healthcare providers and qualified exercise professionals;
4. Patient access to qualified exercise professionals and fitness facilities be supported; and
5. Outcomes beyond weight loss be measured, including long-term health and economic value.

This call to action builds on a recent joint position statement signed by the participating fitness industry groups, the World Obesity Federation (WOF), and the World Federation of the Sporting Goods Industry (WFSGI), which emphasized the urgency of ensuring physical activity and nutrition are central to systems supporting the global roll-out of obesity medications. 

Download the complimentary full report to see how structured exercise can help unlock the full promise of GLP-1 therapy.

This white paper is complimentary.

GLP-1 medications are reshaping obesity care and creating new opportunities to improve long-term health outcomes. But weight loss alone is not the full measure of success. As use of these medications grows, policymakers, payers, healthcare providers, and patients face an important question: what helps ensure that the benefits of GLP-1 therapy are sustained over time?

This first-of-its kind multi-country research examines the health and economic value of combining GLP-1 therapy with structured exercise. The findings make clear that structured exercise help protect and extend the investment being made in GLP-1 treatment by supporting more sustainable health outcomes, reducing costly downstream medical events, and generating substantial economic value.

Across all five studied markets, the research projects that combining structured exercise with GLP-1 therapy can generate substantial health, economic, and societal value compared with GLP-1 therapy alone:

• United States: US$120 billion in economic and societal value over 10 years and a 496% return on investment, rising to 1,572% and US$393 billion over 30 years.
• Australia: A$182 million in economic and societal value over 10 years and a 59% return on investment, rising to 457% and A$1.4 billion over 30 years.
• Canada: C$3.5 billion in economic and societal value over 10 years and a 105% return on investment, rising to 526% and C$17.9 billion over 30 years.
• New Zealand: NZ$51 million in economic and societal value over 10 years and a 27% return on investment, rising to 306% and NZ$592 million over 30 years.
• United Kingdom: £2.7 billion in economic and societal value over 10 years and a 164% return on investment, rising to 717% and £13 billion over 30 years.

If public and private payers are investing in GLP-1 therapy, they should also be asking what helps that investment produce more sustainable health and economic returns. Structured exercise is one of the clearest answers.

Methodology

The research was conducted by by FTI Consulting’s Center for Healthcare Economics and Policy in partnership with a multinational coalition of fitness sector organizations, including the Health & Fitness Association, the HFA Foundation, AUSactive, Exercise New Zealand, Fitness Industry Council of Canada, and ukactive. 

Drawing on the existing body of research on GLP-1 therapy, weight loss, physical activity, and related health outcomes, the analysis modeled the incremental health and economic impact of adding structured exercise to GLP-1 therapy across participating markets. The model compares combined treatment against GLP-1 therapy alone over 10-year and 30-year horizons.

With so much emphasis being placed on accumulating a minimum of 150 minutes of moderate to vigorous exercise a week, there’s little discussion about what you should be doing the other 9,930 minutes.  

Sure, the estimated 20-per-cent reduction in mortality risk among individuals who meet the recommended amount of physical activity is impressive enough on its own. But there’s even greater improvements in longevity when you do more than just rest on the laurels of meeting the bare minimum.

A recent study published in the journal of Applied Physiology, Nutrition and Metabolism took on the challenge of determining the impact of supplementing 150 minutes of intentional physical activity with more incidental movement during the day.  

“Important questions remain regarding the joint and comparative benefits of light physical activity and moderate to vigorous physical activity,” said the study’s authors, who hail from the School of Kinesiology and Health Studies at Queen’s University in Kingston, Ont. 

Light physical activity broadly covers most of the movement behaviours outside of deliberate exercise. Household chores and yard work, strolling to the store, bus stop or coffee shop, playing with the kids, walking the dog and low-intensity recreational activities like lawn games, fishing and leisurely paddling are examples of the type of activity that people engage in over the course of a day and/or weekend. 

Early studies on the benefits of light physical activity have been faced with difficulty distinguishing between light and moderate intensity activity — especially when using self-reported data. But the newest generation of wearables, which track any and all activity over the course of the day, have negated the bias related to personal recall and the self-determination of movement/exercise intensity. Using data from the National Health and Nutrition Examination Study, the researchers extrapolated a subset of 3,949 study subjects (an almost equal number of males and females) aged 40 and older who wore an accelerometer to record their daily activity. Their movement history was then cross-referenced with death records to establish mortality risk.

“The most notable finding was the substantial joint effect of light physical activity and moderate to vigorous physical activity on reducing mortality risk, which exceeded the maximal benefit of either intensity alone,” the researchers said. 

The combination of 335 minutes a day of light physical activity and 20 minutes a day of moderate/vigorous physical activity yielded an impressive six-fold reduction in mortality risk. But even about half that effort, 220 minutes of light physical activity a day and 10 minutes of moderate/vigorous activity, resulted in three-fold lessening in risk.

If that seems like a lot of minutes to be active, keep in mind that light physical activity is pretty much any movement you perform while not sitting. And in this particular cohort most of the higher-intensity activity was more moderate than vigorous and 45 per cent of the participants accumulated their exercise minutes in short bouts of less than 10 minutes.  

“These comparisons underscore how crucial physical activity is as a modifiable risk factor for longevity, emphasizing that its protective effect likely surpasses the impact of major health risks, particularly when light physical activity and moderate/vigorous physical activity are considered together,” the researchers said.

Still not convinced you can find the time to make a significant dent in your mortality risk?  A substantial number (58 per cent) of the study subjects accumulated the combined amount of light and moderate/vigorous physical activity needed to realize the three-fold improvement in longevity. Twenty-six per cent combined both intensities in a dose large enough to obtain a six-fold reduction in mortality risk. 

“This suggests that health-enhancing levels of physical activity are reasonable and attainable for most adults,” the researchers said. 

That’s an important message for both active and not-so-active Canadians. What you do all day matters as much as a single workout. That’s not to downplay the benefits gained by hitting the gym regularly, but if you spend the rest of the day sitting at a desk or staring at a screen, you’re not doing all you can to add years to your life. 

As for those of you who struggle sustaining a regular workout schedule, the impact of short bouts of exercise combined with getting out of your chair more often is not only doable, it’s impressive enough to make you rethink your current lifestyle. Simple choices like going to the park with the kids, biking to the library, getting up from your desk more often and leaving the car at home the next time you want to hang out at the coffee shop all contribute toward the goal of four to six hours a day of light physical activity. Combine that with 150 minutes a week of intentional exercise in the moderate to vigorous range, even in short bouts, and you’ll have more years to enjoy life to its fullest. 

Those extra years might be motivation enough to get you out of your chair, but knowing that you’re also more likely to be in good health and with energy enough to continue doing the things you love is added incentive to move more and sit less.