Strength Training on Ozempic, Wegovy or Zepbound: How to Start

Yes, you can do strength training on semaglutide (Ozempic, Wegovy) or tirzepatide (Zepbound, Mounjaro), and medical societies recommend it. The US labels don’t give an exercise plan and don’t rule exercise out^[1,2,3,4]. A 2025 advisory from four US obesity, nutrition and lifestyle-medicine societies suggests two things: strength training at least three times a week, and at least 150 minutes of moderate aerobic activity a week^[7]. For beginners, the usual reference is two or three full-body sessions a week, with small increases in load^[10]. It’s sensible not to train after many hours without eating or drinking, and to stop if you feel dizzy.

This page covers how to train; why muscle matters and how much protein you need are in protein and muscle on GLP-1 medications. It’s general information: your doctor or an exercise professional can adapt a plan to you.

Why strength training matters during treatment

When you lose weight on these drugs, you also lose some lean mass, and strength training is, together with protein, what has the most support for limiting it^[7]. The advisory (that’s how I’ll refer to the 2025 document) adds that aerobic exercise alone has a smaller effect on preserving lean mass, and asks for programs tailored to each person’s fitness level^[7].

Direct evidence with semaglutide or tirzepatide is still thin: the advisory leans on retrospective studies and on a randomized trial, S-LiTE, that used an older GLP-1, liraglutide^[7,17]. See the S-LiTE trial summary.

What the US labels say that matters for training

I checked the US Prescribing Information on DailyMed for Wegovy and Zepbound, approved for weight reduction, and for Ozempic and Mounjaro, approved for type 2 diabetes. None of them says how to exercise: no plans, limits or timing relative to the injection^[1,2,3,4]. Physical activity shows up in two places. One is the indication: Wegovy and Zepbound are approved in combination with a reduced-calorie diet and increased physical activity^[1,2]. The other is the trials, where participants got instruction on a reduced-calorie diet (about 500 kcal a day below needs) and physical activity counseling, with a recommended minimum of 150 minutes a week^[1,2].Dotted underline: a drug-label fact; hover over it to see the date it was checked.

The labels do list effects worth keeping in mind when you train:

Sources: Table 3 and sections 5.9 and 6.1 of the Wegovy label^[1]; Table 1 and section 6.1 of the Zepbound label^[2]. The figures come from the placebo-controlled weight trials, up to 68 weeks with Wegovy and up to 72 with Zepbound.

A few details from the same labels:

• Heart rate. With Wegovy, 26% of adults vs. 16% on placebo had a peak increase of 20 beats per minute or more at some visit. The label asks patients to tell their healthcare provider about palpitations or a racing heartbeat while at rest^[1]. The diabetes labels report an average increase of 2 to 3 beats per minute with Ozempic^[3] and 2 to 4 with Mounjaro, vs. 1 on placebo^[4].
• Low blood pressure. Both labels say it was more frequent in people also taking blood pressure medicines, and that some cases were linked to digestive side effects and fluid loss^[1,2].
• Timing. In Europe, the Wegovy label says dizziness and fatigue are seen mainly during the dose-escalation period, and its package leaflet places the dizziness mainly in the first 4 months of treatment^[5]. The US labels don’t give that detail.

Two more warnings:

• Dehydration. All four US labels describe postmarketing reports of acute kidney injury, some requiring dialysis, mostly in people whose nausea, vomiting or diarrhea led to dehydration^[1,2,3,4]. Their Medication Guides tell patients that it’s important to drink fluids to help reduce the chance of dehydration^[1,2,3,4].
• Low blood sugar (hypoglycemia). The risk goes up when the drug is combined with insulin or an insulin secretagogue such as a sulfonylurea, two types of diabetes treatment^[1,2,3,4]. In Zepbound’s trial in type 2 diabetes, 10.3% of people on Zepbound who also took a sulfonylurea had low blood sugar, vs. 2.1% of those who didn’t^[2]. The American Diabetes Association notes that in type 2 diabetes, exercise-related lows happen mainly with those same medicines^[13]. If that’s your situation, ask your doctor how to organize your training; the semaglutide guide covers this warning in more detail.

A beginner strength plan: 2 or 3 full-body days

The figures below come from the American College of Sports Medicine (ACSM) 2009 position stand on how to progress in resistance training^[10]. They’re general references for healthy adults with no training experience, not a prescription.

Source: ACSM (2009)^[10]. The US Physical Activity Guidelines say much the same: one set of 8 to 12 reps per exercise is effective, though 2 or 3 sets may be more effective, done to the point where another rep would be hard^[6].

You don’t need to measure the most you can lift once: the advisory doesn’t recommend it unless you’re highly trained^[7]. According to the ACSM, free weights and machines both work for building strength^[10].

Five basic movements

A full-body plan can be built on five movement patterns. These are common examples; a professional can adapt them to your level.

How to spread them across the week

• With 2 days (for example, Monday and Thursday): all five movements each session, 2 sets of 8 to 12 reps.
• With 3 days (for example, Monday, Wednesday and Friday): all five movements each session, 1 to 3 sets depending on how you feel that day.

If you’re starting from zero, one set per exercise already counts. The US guidelines ask inactive people to “start low and go slow,” raising how often and how long they’re active over time^[6], and the WHO stresses that some activity is better than none^[9].

How to train with a small appetite and low energy

When to train relative to meals

I haven’t found studies on the best time to train on a GLP-1 medication, and the advisory doesn’t address it. It does note that nausea often shows up in the morning or after long stretches without eating, and that vomiting is more likely after large meals; it suggests a small breakfast and then small meals every 3 to 4 hours, with enough fluids^[7]. So it’s reasonable not to train after many hours without eating, or right after a big meal.

Protein around your workout

The International Society of Sports Nutrition (ISSN) writes for healthy adults who exercise. Its priority is reaching your total protein for the day, in servings of 20 to 40 g every 3 to 4 hours^[12]. It adds that high-quality protein in the 2 hours after training stimulates muscle building, and that how much this matters also depends on what you ate before^[12].

With a small appetite, line up one of your small meals with the hours before or after training. Estimate your daily target with the protein calculator and find ideas in what to eat on GLP-1 medications.

Fluids

Adequately hydrated women take in about 2.7 liters (91 fl oz) of total water a day and men about 3.7 liters (125 fl oz), counting drinks and food, according to the US National Academies^[18]. Europe’s EFSA sets lower references (2.0 and 2.5 liters) for moderate temperatures and activity; heat and exercise raise needs^[19]. MedlinePlus advises drinking more when the weather is hot or you’re exercising^[20]. More in hydration on GLP-1 medications and the hydration calculator.

Low-energy days

Fatigue was more common on both drugs than on placebo (see the table above)^[1,2]. A low day can be a short session, with one set per exercise, or a walk. The US guidelines count any amount of moderate activity, however it’s split up^[6].

To see whether symptoms line up with certain days, log them in the symptom diary. If the fatigue doesn’t improve over weeks, mention it to your doctor.

Symptoms during exercise: what they can be and what to do

This is general guidance, not a diagnosis. The ACSM’s 2015 update on pre-exercise screening lists dizziness, fainting, palpitations, chest pain, shortness of breath with little effort and unusual fatigue among the signs of possible cardiovascular disease^[11]. If you notice them, get checked by a doctor before you keep training.

Walking and aerobic activity

The US guidelines recommend 150 to 300 minutes a week of moderate activity, such as brisk walking^[6]. Their 2018 edition dropped the requirement for bouts of at least 10 minutes, as the WHO did in 2020, and both ask adults to sit less and replace sitting time with activity of any intensity, even light^[6,9].

An example: 30 minutes five days a week adds up to 150, the same as three 10-minute walks on those five days. Neither the US guidelines nor the WHO sets a daily step count, so I don’t give one^[6,8]. If you use insulin, the ADA mentions doing strength exercises before aerobic ones in the same session as one strategy to prevent lows^[13].

What to avoid

• Hard sessions on an empty stomach if you have nausea. Dizziness is common on these drugs^[1,2]; do something gentle or wait until you’ve eaten.
• Increasing load or volume quickly. The ACSM recommends small increases and asks for special caution in older adults with high blood pressure, arthritis or cardiovascular disease^[10].
• Training right after vomiting or diarrhea. Both can lead to dehydration, the labels warn^[1,2].
• Using exercise to “make up for” what you eat. Intensive and excessive exercise is among the symptoms of anorexia and bulimia, according to MedlinePlus^[21]. If you notice you’re training out of guilt or fear of food, look for professional help.

If you’re over 65

• Balance and strength. Besides the multicomponent activity in the table above, the US guidelines ask older adults to set their level of effort relative to their fitness^[6]; the WHO’s 3 or more days a week aim to improve functional capacity and prevent falls^[8].
• A safe, tolerated level. The PROT-AGE group on protein and aging recommends endurance and resistance exercise at individualized levels that are safe and tolerated and, for people who exercise, at least 1.2 g of protein per kilogram of body weight a day (0.54 g per pound)^[14].
• Start gentler. The ACSM notes that its previous position stand suggested 10 to 15 reps for older or frail adults, and asks for cautious progression^[10].
• Get assessed first. The advisory recommends checking strength and function when treatment starts (for example, standing up from a chair or climbing stairs) and suggests an exercise physiologist or strength trainer^[7].
• Fluids. MedlinePlus notes that older adults are at higher risk of dehydration^[20].

If you have pain, a hernia or can’t train

A hernia, recent surgery or joint pain doesn’t leave you choosing between the plan above and nothing. The WHO’s 2020 guidelines say that adults with chronic conditions who can’t meet the recommendations should aim to be active according to their abilities. They add that a healthcare professional or physical activity specialist can advise on the type and amount of activity that suits your limitations, medications and treatment plan^[9]. The 2025 advisory on GLP-1 therapy suggests referral to physical therapy or an exercise physiologist where appropriate^[7].

• Hernia. According to MedlinePlus, the discomfort may be worse when standing, straining or lifting heavy objects^[23]. The NHS says to see a doctor if you think you have one, and to get urgent help if it hurts, your belly is bloated, or you feel sick or are vomiting^[24]. Get checked before you lift weights or do ab work.
• Joint pain, back pain or recovery from surgery. According to the NHS, physical therapy treats bone, joint and muscle problems and helps restore movement and strength after surgery, with strengthening exercises or exercise in warm water (hydrotherapy)^[25].
• Low-impact options. The National Institute on Aging (NIA) suggests low-impact activities such as swimming, walking and tai chi for arthritis, and water exercises or weightlifting if bending or moving is hard. If one area has pain, swelling or inflammation, it suggests focusing on another area or resting for a day or two^[26]. For people with low mobility, the WHO notes that activity done while seated counts too^[9].

While you can’t do strength training, protein still matters: the advisory calls it a priority for preserving muscle^[7] (numbers in protein and muscle on GLP-1 medications). Which exercises to do and when to start is a question for your doctor or physical therapist.

Frequently asked questions

Can I exercise on Ozempic, Wegovy or Zepbound?

In general, yes: Wegovy and Zepbound are approved alongside increased physical activity^[1,2]. If you have heart disease, joint problems, or diabetes treated with insulin or a sulfonylurea, check with your doctor first.

Can I work out on injection day?

The labels say nothing about exercise and injection day. They only say the weekly injection can be given at any time of day, with or without meals^[1,2,3,4]. If nausea or fatigue peak in the following days, you can ease off then and mention it at your appointment.

Will I lose muscle if I don’t train?

Some of the weight you lose is lean mass. The US labels say both drugs lower body weight with greater fat mass loss than lean mass loss^[1,2]. In a STEP 1 substudy of 140 people over 68 weeks on semaglutide, lean mass was 38% of the weight lost (5.3 of 13.6 kg, or 11.7 of 30 lb)^[7,16]. In a SURMOUNT-1 substudy of 160 people over 72 weeks on tirzepatide, it was about 25%, the same share as on placebo^[15]. Not all of it is muscle: the advisory estimates muscle at about half of lean mass^[7]. More data in the protein guide; measuring it at home is covered in bioimpedance scale or DEXA.

Is walking enough?

It helps you reach 150 minutes of aerobic activity a week, but it doesn’t replace strength training, which the US guidelines and the WHO ask for on at least 2 days a week^[6,8]. Aerobic activity alone also protects lean mass less, according to the advisory^[7].

What should I do if I get dizzy at the gym?

Stop, sit or lie down, and drink, as in the symptom table above. Dizziness is common with both drugs^[1,2]. If it happens again, if you faint, or if you use insulin or a sulfonylurea, talk to your doctor before you train again.

Do I need a doctor’s clearance to start?

According to the US guidelines, people without diagnosed chronic conditions and without symptoms most likely don’t need to consult a healthcare provider about physical activity^[6]. The ACSM recommends medical clearance if you have symptoms such as chest pain, dizziness or palpitations, or if you’re inactive and have cardiovascular, metabolic (such as diabetes) or kidney disease^[11]. Related reading: the GLP-1 weight plateau and stopping GLP-1 medications and weight regain.

Do I need 10,000 steps a day?

Not according to the WHO, which sets minutes of activity a week, not steps, and stresses that some activity is better than none^[8,9]; the US guidelines are covered in walking and aerobic activity. The best step data come from a meta-analysis of 15 cohorts with 47,471 adults. Compared with the quarter who walked least (about 3,500 steps a day), the others had a lower risk of death, and the benefit leveled off at about 6,000 to 8,000 steps a day in adults 60 and older and 8,000 to 10,000 in younger adults^[22]. The authors note there’s little evidence behind the 10,000 figure. These are observational links, not proof that steps cause the benefit, and they don’t replace strength training.