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Part of Strength training on GLP-1 medicines

What happens to weight and muscle after stopping a GLP-1 medicine

The withdrawal trials agree on one thing: when the medicine stops, weight comes back. People in the STEP 1 extension regained about two thirds of what they had lost over the following year off treatment, and in SURMOUNT-4 the group that switched to placebo put on 14.0% of body weight over the 52 weeks that followed. What none of those trials measured is muscle, so they cannot tell you what happens to your strength after you stop. The one study that followed people for a year after everything ended found that those who had trained alongside the medicine held onto more of their loss than those who had taken it alone. Whether, when or how to stop is a decision for the prescriber, and this page gives no advice on it.

What the withdrawal trials found

Three large trials stopped treatment on purpose and watched what followed.

The STEP 1 extension took 327 people who had finished 68 weeks of semaglutide or placebo and followed them for another year with no treatment and no lifestyle program. The semaglutide group had lost 17.3% of their body weight by week 68. By week 120 they had regained 11.6 percentage points of that, leaving them 5.6% below where they began, while the placebo group finished at 0.1% (Wilding 2022). Most of the improvements in cardiometabolic measures seen at week 68 had moved back toward the starting values by week 120.

STEP 4 asked the question earlier in treatment. After a 20 week run-in on semaglutide, 803 people were randomly assigned to continue it or switch to placebo, with a lifestyle program in both arms. From week 20 to week 68 the continuing group lost a further 7.9%, the placebo group gained 6.9%, and the difference between them was 14.8 percentage points (Rubino 2021).

SURMOUNT-4 ran the same design with tirzepatide. In it, 670 adults lost a mean 20.9% during 36 weeks of open label treatment, then continued the medicine or switched to placebo for 52 weeks. Over those 52 weeks, weight fell a further 5.5% in the group that continued and rose 14.0% in the group that stopped (Aronne 2024). The authors put it plainly: withdrawing the medicine led to substantial regain of the lost weight, while continuing it maintained and added to the reduction.

What those trials did not measure

None of them measured muscle. The STEP 1 extension recorded body weight, BMI and cardiometabolic markers, with no scans of body composition, and it did not record whether anyone took up a diet or exercise program once treatment ended (Wilding 2022). So the honest answer to the question people actually ask, which is what happens to muscle and strength after stopping, is that these trials cannot say.

Two things are known either side of that gap. During treatment, about a quarter of the weight lost in the SURMOUNT-1 scan substudy was lean tissue and three quarters was fat, in the placebo group as well as the treated group (Look 2025). Whether the regained weight arrives in the same proportions has not been settled in a trial. A 2025 review of GLP-1 treatment in older adults warns that repeated cycles of treatment and stopping may move body composition toward fat relative to lean mass, and calls the evidence on preserving muscle during and after treatment unclear (Prokopidis 2025).

The trial that followed the habit

One group in Copenhagen did go back and look. Their trial put 195 adults with obesity through an 8 week low calorie diet, which took off a mean 13.1 kg (29 lb), then randomized them to a year of supervised exercise, liraglutide, both together, or placebo. The combination lost the most weight, clearly more than exercise alone though not significantly more than liraglutide alone, and cut body fat percentage about twice as much as either treatment by itself (Lundgren 2021). The exercise program was two supervised group sessions a week of indoor cycling and circuit training, plus two sessions done alone (Jensen 2024, JAMA Network Open).

Then everything stopped, and 109 of them came back a year later. Those who had done exercise plus liraglutide were 5.1 kg (11 lb) lighter and 2.3 percentage points lower in body fat than those who had taken liraglutide alone. Regain during that year off treatment was 6.0 kg (13 lb) larger after stopping liraglutide than after stopping supervised exercise. More people were still down at least 10% on their starting body weight after combination treatment than after placebo (odds ratio 7.2) or liraglutide alone (4.2), and more after exercise than after placebo (3.7) (Jensen 2024, eClinicalMedicine).

The authors interpret it as evidence that adding supervised exercise to obesity medicine improves weight maintenance after treatment ends. Three limits are worth holding onto. It is a single trial, the medicine was liraglutide rather than semaglutide or tirzepatide, and the exercise was supervised in a way most people never get.

Why the strength habit is worth keeping

Treatment can change or end for all sorts of reasons, and that decision sits with the prescriber. Training is the part of the plan that does not need a prescription to continue, and in the Copenhagen study it was the part still showing an effect a year after everything else stopped (Jensen 2024, eClinicalMedicine).

There is also the matter of what you are training for. Body weight is a number; getting up off the floor, carrying a case upstairs and walking without watching your feet are abilities, and they are built by loading muscle regularly. If the weight does return in part, those abilities are what you would rather still have.

A habit built while treatment is going well survives better than one started in the month after it ends. The staged strength program on this site is strength training for older adults, and this topic sets out the weekly plan and the home version.

This page gives no advice about stopping

Whether to stop, when to stop, how to come off, whether to restart later and what any of that means for your dose are decisions for the prescriber. Pharmacists answer medicine questions between appointments. Nothing here is a reason to change what you take, or to change it without telling anyone.

If stopping is on your mind, book the conversation, write down what you want to ask, and take your training record with you. The prescriber will want to know how much you are exercising, and a physio can help you get that in place first.

When to see a physio

See a physio, or a physical therapist if you are in the USA, when you want the training set up properly before treatment changes, when strength work has stopped feeling manageable, or when an old knee, back or shoulder problem keeps interrupting it. Bring the exercise you are already doing, so the plan starts from real life rather than an ideal week.

Ask for a plan that names the exercises, the sets and the days, and that you could keep going during a busy month. Ask what to drop first if time runs short. What you drop first usually decides whether the habit survives the year after the medicine.

Related exercise programs

See a doctor promptly if

  • Emergency: if chest pain, pressure or tightness does not ease quickly when you rest, spreads to your arm, neck, jaw, stomach or back, or comes with sweating, feeling sick, feeling light-headed or being short of breath, call emergency services straight away, as this can be a heart attack. If it eases quickly and none of these happen, get medical advice the same day, and do not exercise again until you have been checked.
  • Emergency: any sign of a stroke, even if it goes away. That means a face that droops on one side, an arm you cannot lift or keep up, slurred or muddled speech, weakness or numbness on one side of your body or face, sudden blurred vision, double vision or loss of sight, trouble swallowing, sudden dizziness with unsteadiness or falling over, a sudden severe headache, or a sudden fall where your legs give way but you do not black out (a drop attack). Call emergency services straight away.
  • Emergency: sudden severe stomach pain together with pain spreading to your back, bloating that will not settle, a fast heartbeat, trouble breathing, or skin around your belly button, waist or upper outer thigh that looks blue or bruised (this can be harder to see on brown or black skin). Call emergency services or go to an emergency department, and do not drive yourself. If that sudden severe pain does not go away or keeps coming back, or comes with a high temperature or chills, without any of the signs above, get an urgent medical appointment or call your health service's urgent advice line the same day.
  • Same day: dizziness or feeling faint during or after exercise, without any of the emergency signs above. Stop the exercises and get medical advice the same day. If you faint, it does not settle within a few minutes of sitting still, or you cannot stand or walk steadily, call emergency services.
  • Same day: you blacked out or fainted, even for a moment. Get medical advice the same day. Call emergency services instead if the person cannot be woken within 1 minute, has not fully recovered or has trouble speaking or moving, has chest pain or a pounding, fluttering or irregular heartbeat, fainted while exercising or lying down, is shaking or jerking, or was badly hurt.
  • Same day: shakiness, sweating, tingling lips, hunger, a pounding heartbeat, blurred vision, feeling weak or confusion during or after a session, if you take insulin or other diabetes medicines. These can be signs of low blood sugar, and the risk of it is higher when insulin or a sulfonylurea is taken alongside one of these medicines. Treat it the way your diabetes team has told you, then contact them or your prescriber the same day. If someone cannot be woken, cannot swallow safely or has a seizure, call emergency services.
  • Same day: you cannot keep fluids down, you are being sick or have diarrhea that will not settle, you are peeing less than usual or your pee is dark yellow and strong smelling, you feel unusually tired, you feel dizzy when you stand up, or you are breathing quickly or your heart is racing. Contact your prescriber or get medical advice the same day, as these can be signs of dehydration. Call emergency services or go to an emergency department if your skin, lips or tongue look blue, gray, pale or blotchy (on brown or black skin this can be easier to see on the palms of the hands or soles of the feet), your skin feels cold, you are breathing fast or finding it hard to breathe, you are confused, or you are unusually sleepy or hard to wake.
  • Within a day or two: losing weight without trying, for example weight that keeps coming off after the medicine has stopped. See your doctor within a day or two and mention it. If you also have new back or neck pain, get medical advice the same day. If you are being treated for cancer now, contact your cancer team the same day.
  • Within a few days: stairs, carrying shopping or getting up off the floor have become noticeably harder than they were a month ago. Book an appointment with a physio or your GP within a few days.

Common questions

Will I put the weight back on if I stop?

The trials that tested this say most of it, for most people, over about a year. In the STEP 1 extension, 327 people were followed for 52 weeks after treatment ended with no program in place. The semaglutide group had lost 17.3% of their body weight by week 68, then regained 11.6 percentage points of it by week 120, finishing 5.6% below their starting weight (Wilding 2022). SURMOUNT-4 found the same pattern with tirzepatide (Aronne 2024).

How quickly does the weight come back?

Gradually, over months rather than weeks, in the trials that measured it. STEP 4 switched a third of its participants to placebo after 20 weeks of treatment: over the next 48 weeks the group that continued lost a further 7.9% while the placebo group gained 6.9%, a gap of 14.8 percentage points (Rubino 2021). In SURMOUNT-4, the placebo group gained 14.0% over the 52 weeks after withdrawal while the continuing group lost another 5.5% (Aronne 2024).

Do you lose muscle after stopping a GLP-1 medicine?

Nobody can answer that from the withdrawal trials, because they weighed people rather than scanning them. The STEP 1 extension reported body weight, BMI and cardiometabolic markers, and no body composition (Wilding 2022). What is known is the split during treatment: in the SURMOUNT-1 scan substudy about a quarter of the weight lost was lean tissue (Look 2025). Whether regained weight returns in the same proportions has not been settled, and a 2025 review warns that repeated rounds of treatment and stopping may shift body composition toward fat relative to lean mass in older adults (Prokopidis 2025).

Does exercise stop the weight coming back?

It helped in the one trial that followed people after treatment ended. A year after everything stopped, the group that had done supervised exercise plus liraglutide were 5.1 kg (11 lb) lighter and 2.3 percentage points lower in body fat than the group that had taken liraglutide alone, and regain over that year was 6.0 kg (13 lb) larger after stopping liraglutide than after stopping exercise (Jensen 2024, eClinicalMedicine). It is one trial, the exercise was supervised, and the medicine was liraglutide rather than the newer ones. The authors' own conclusion is that adding exercise to obesity medicine seems to improve weight maintenance after treatment ends.

Should I stop the medicine now that I am training regularly?

That is not a question this page or a physio can answer. It belongs to the prescriber, who knows your history, your other medicines and what the treatment is doing for you beyond your weight. Book the conversation, and keep training while you have it.

References

  1. Wilding JPH, Batterham RL, Davies M, et al. Weight regain and cardiometabolic effects after withdrawal of semaglutide: the STEP 1 trial extension. Diabetes, Obesity and Metabolism. 2022;24(8):1553-1564. doi:10.1111/dom.14725
  2. Rubino D, Abrahamsson N, Davies M, et al. Effect of continued weekly subcutaneous semaglutide vs placebo on weight loss maintenance in adults with overweight or obesity: the STEP 4 randomized clinical trial. JAMA. 2021;325(14):1414-1425. doi:10.1001/jama.2021.3224
  3. Aronne LJ, Sattar N, Horn DB, et al. Continued treatment with tirzepatide for maintenance of weight reduction in adults with obesity: the SURMOUNT-4 randomized clinical trial. JAMA. 2024;331(1):38-48. doi:10.1001/jama.2023.24945
  4. Jensen SBK, Blond MB, Sandsdal RM, et al. Healthy weight loss maintenance with exercise, GLP-1 receptor agonist, or both combined followed by one year without treatment: a post-treatment analysis of a randomised placebo-controlled trial. eClinicalMedicine. 2024;69:102475. doi:10.1016/j.eclinm.2024.102475
  5. Lundgren JR, Janus C, Jensen SBK, et al. Healthy weight loss maintenance with exercise, liraglutide, or both combined. New England Journal of Medicine. 2021;384(18):1719-1730. doi:10.1056/NEJMoa2028198
  6. Jensen SBK, et al. Bone health after exercise alone, GLP-1 receptor agonist treatment, or combination treatment: a secondary analysis of a randomized clinical trial. JAMA Network Open. 2024;7(6):e2416775. doi:10.1001/jamanetworkopen.2024.16775
  7. Look M, Dunn JP, Kushner RF, et al. Body composition changes during weight reduction with tirzepatide in the SURMOUNT-1 study of adults with obesity or overweight. Diabetes, Obesity and Metabolism. 2025;27(5):2720-2729. doi:10.1111/dom.16275
  8. Prokopidis K, Daly RM, Suetta C. Weighing the risk of GLP-1 treatment in older adults: should we be concerned about sarcopenic obesity? Journal of Nutrition, Health and Aging. 2025;29(10):100652. doi:10.1016/j.jnha.2025.100652
  9. NHS. Symptoms of a stroke. https://www.nhs.uk/conditions/stroke/symptoms/
  10. NHS. Acute pancreatitis. Page last reviewed 11 March 2026. https://www.nhs.uk/conditions/acute-pancreatitis/
  11. NHS. Low blood sugar (hypoglycaemia). Page last reviewed 3 August 2023. https://www.nhs.uk/conditions/low-blood-sugar-hypoglycaemia/
  12. NHS. Dehydration. Page last reviewed 1 May 2026. https://www.nhs.uk/conditions/dehydration/
  13. NHS. Fainting. Page last reviewed 17 August 2026. https://www.nhs.uk/symptoms/fainting/

Written and checked by the PocketPhysio editorial team. Last updated 2026-10-01.

This page is general education, not a diagnosis or a personal treatment plan. See a physiotherapist or doctor for advice about your own situation.