{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T16:07:04Z","timestamp":1791994024233,"version":"4.4.0"},"reference-count":119,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T00:00:00Z","timestamp":1785110400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and related incretin-based therapies are highly effective anti-obesity treatments, but weight loss may also include reductions in fat-free mass, raising concern for selected patients at risk of sarcopenia. This narrative review summarizes current evidence and practical, evidence-informed strategies to support muscle health during GLP-1 RA-based anti-obesity therapy. Particular emphasis is placed on identifying higher-risk patients, including older adults, frail individuals, patients with low baseline muscle mass or strength, sarcopenic obesity, chronic kidney disease, low physical activity, or rapid weight loss. Preventive strategies include baseline assessment of body composition and muscle function, individualized resistance and multicomponent exercise, adequate protein intake, attention to nutritional adequacy, and periodic monitoring of body composition, strength, and physical performance. Treatment pace and dose escalation may also be individualized in higher-risk patients when unfavorable changes in fat-free mass or function occur. Current evidence remains limited, and many recommendations are extrapolated from weight-loss, nutrition, exercise, and sarcopenia literature rather than GLP-1 RA-specific trials. Overall, a risk-stratified and multidisciplinary approach may help preserve muscle mass and function while maintaining the cardiometabolic benefits of GLP-1 RA-based therapy.<\/jats:p>","DOI":"10.3390\/jcm15155870","type":"journal-article","created":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T14:08:14Z","timestamp":1785161294000},"page":"5870","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Preventive Strategies to Reduce Sarcopenia Risk During GLP-1-Based Anti-Obesity Therapy"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7848-6600","authenticated-orcid":false,"given":"Andrej","family":"Belan\u010di\u0107","sequence":"first","affiliation":[{"name":"Department of Basic and Clinical Pharmacology and Toxicology, Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0379-5235","authenticated-orcid":false,"given":"Kristina","family":"Skro\u010de","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia"},{"name":"Hospital for Medical Rehabilitation of Heart and Lung Diseases and Rheumatism Thalassotherapia-Opatija, 51410 Opatija, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-1255-8653","authenticated-orcid":false,"given":"Elvira Meni Maria","family":"Gkrinia","sequence":"additional","affiliation":[{"name":"Independent Researcher, 11741 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mihaela","family":"Marinovi\u0107 Glavi\u0107","sequence":"additional","affiliation":[{"name":"Department of Social Medicine and Epidemiology, Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3777-4766","authenticated-orcid":false,"given":"Man Ki","family":"Kwok","sequence":"additional","affiliation":[{"name":"School of Nursing and Health Sciences, Hong Kong Metropolitan University, Hong Kong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e001206","DOI":"10.1136\/bmjnph-2025-001206","article-title":"GLP-1 receptor agonists induce loss of lean mass: So does caloric restriction","volume":"8","author":"Mocciaro","year":"2025","journal-title":"BMJ Nutr. Prev. Health"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"101681","DOI":"10.1016\/j.diabet.2025.101681","article-title":"GLP-1 receptor agonists, body composition, skeletal muscle and risk of sarcopaenia: From promising findings in animal models to debated concern in human studies","volume":"51","author":"Scheen","year":"2025","journal-title":"Diabetes Metab."},{"key":"ref_3","unstructured":"Maihemuti, A., Cui, C., Wang, Q., Amuti, R., Chau, W.W., Chai, S., Zhang, N., Wong, R.M.Y., Ko, H., and Kwok, T.C. (Aging Dis., 2025). Glucagon like peptide-1 receptor agonists for sarcopenia and muscle wasting disorders: A systematic review of efficacy and mechanisms, Aging Dis., online ahead of print."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1016\/j.arr.2018.07.005","article-title":"The age-related loss of skeletal muscle mass and function: Measurement and physiology of muscle fibre atrophy and muscle fibre loss in humans","volume":"47","author":"Wilkinson","year":"2018","journal-title":"Ageing Res. Rev."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1007\/s13668-025-00649-w","article-title":"Impact of glp-1 receptor agonist therapy in patients high risk for sarcopenia","volume":"14","author":"Memel","year":"2025","journal-title":"Curr. Nutr. Rep."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"156113","DOI":"10.1016\/j.metabol.2024.156113","article-title":"Effect of glucagon-like peptide-1 receptor agonists and co-agonists on body composition: Systematic review and network meta-analysis","volume":"164","author":"Karakasis","year":"2025","journal-title":"Metabolism"},{"key":"ref_7","unstructured":"ClinicalTrials.gov, and National Library of Medicine (US) (2025, September 04). GLP-1R Actions on Muscle and the Skeleton (GRAMS), Available online: https:\/\/clinicaltrials.gov\/study\/NCT07154719."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2179","DOI":"10.2337\/dbi25-0004","article-title":"Treating sarcopenic obesity in the era of incretin therapies: Perspectives and challenges","volume":"74","author":"Chen","year":"2025","journal-title":"Diabetes"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1708","DOI":"10.1002\/jcsm.13524","article-title":"Sarcopenia-related changes in serum GLP-1 level affect myogenic differentiation","volume":"15","author":"Huang","year":"2024","journal-title":"J. Cachexia Sarcopenia Muscle"},{"key":"ref_10","first-page":"458","article-title":"Muscle mass loss during GLP1 receptor agonist therapy prevented with GDF8 and activin A blockade","volume":"21","author":"Tysoe","year":"2025","journal-title":"Nat. Rev. Endocrinol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1003","DOI":"10.14336\/AD.2024.0407","article-title":"Aging-related sarcopenia: Metabolic characteristics and therapeutic strategies","volume":"16","author":"Chen","year":"2024","journal-title":"Aging Dis."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1007\/s00223-013-9758-y","article-title":"Quality of life in sarcopenia and frailty","volume":"93","author":"Rizzoli","year":"2013","journal-title":"Calcif. Tissue Int."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"4773","DOI":"10.1038\/s41467-021-24956-2","article-title":"Impact of aging and exercise on skeletal muscle mitochondrial capacity, energy metabolism, and physical function","volume":"12","author":"Grevendonk","year":"2021","journal-title":"Nat. Commun."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Argyropoulou, D., Geladas, N.D., Nomikos, T., and Paschalis, V. (2022). Exercise and nutrition strategies for combating sarcopenia and type 2 diabetes mellitus in older adults. J. Funct. Morphol. Kinesiol., 7.","DOI":"10.3390\/jfmk7020048"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1218","DOI":"10.1056\/NEJMoa1008234","article-title":"Weight loss, exercise, or both and physical function in obese older adults","volume":"364","author":"Villareal","year":"2011","journal-title":"N. Engl. J. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1136\/bjsports-2017-097608","article-title":"A systematic review, meta-analysis and meta-regression of the effect of protein supplementation on resistance training-induced gains in muscle mass and strength in healthy adults","volume":"52","author":"Morton","year":"2018","journal-title":"Br. J. Sports Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1016\/j.clnu.2012.06.010","article-title":"Sarcopenic obesity: A critical appraisal of the current evidence","volume":"31","author":"Prado","year":"2012","journal-title":"Clin. Nutr."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1038\/s41574-018-0062-9","article-title":"Sarcopenic obesity in older adults: Aetiology, epidemiology and treatment strategies","volume":"14","author":"Batsis","year":"2018","journal-title":"Nat. Rev. Endocrinol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1111\/obr.12143","article-title":"Weight loss composition is one-fourth fat-free mass: A critical review and critique of this widely cited rule","volume":"15","author":"Heymsfield","year":"2014","journal-title":"Obes. Rev."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"xvii","DOI":"10.1016\/j.mcna.2017.09.003","article-title":"Obesity medicine: A core competency for primary care providers","volume":"102","author":"Kahan","year":"2018","journal-title":"Med. Clin. N. Am."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"989","DOI":"10.1056\/NEJMoa2032183","article-title":"Once-weekly semaglutide in adults with overweight or obesity","volume":"384","author":"Wilding","year":"2021","journal-title":"N. Engl. J. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2636","DOI":"10.1016\/S0140-6736(19)31138-9","article-title":"Sarcopenia","volume":"393","author":"Sayer","year":"2019","journal-title":"Lancet"},{"key":"ref_23","first-page":"37","article-title":"Beta-hydroxy-beta-methylbutyrate and sarcopenia: From biological plausibility to clinical evidence","volume":"22","author":"Landi","year":"2019","journal-title":"Curr. Opin. Clin. Nutr. Metab. Care"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1093\/ajcn\/84.3.475","article-title":"The underappreciated role of muscle in health and disease","volume":"84","author":"Wolfe","year":"2006","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"S157","DOI":"10.2337\/dc09-S302","article-title":"Skeletal muscle insulin resistance is the primary defect in type 2 diabetes","volume":"32","author":"DeFronzo","year":"2009","journal-title":"Diabetes Care"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1093\/ageing\/afy169","article-title":"Sarcopenia: Revised european consensus on definition and diagnosis","volume":"48","author":"Bahat","year":"2019","journal-title":"Age Ageing"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1016\/j.bone.2019.05.021","article-title":"The clinical impact and biological mechanisms of skeletal muscle aging","volume":"127","author":"Aversa","year":"2019","journal-title":"Bone"},{"key":"ref_28","first-page":"186","article-title":"Changes in muscle mass and strength after menopause","volume":"9","author":"Maltais","year":"2009","journal-title":"J. Musculoskelet. Neuronal Interact."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1007\/s10522-013-9425-8","article-title":"Sex hormones and skeletal muscle weakness","volume":"14","author":"Sipila","year":"2013","journal-title":"Biogerontology"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1497","DOI":"10.2337\/dc09-2310","article-title":"Prevalence and determinant factors of sarcopenia in patients with type 2 diabetes: The Korean Sarcopenic Obesity Study (KSOS)","volume":"33","author":"Kim","year":"2010","journal-title":"Diabetes Care"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1813","DOI":"10.2337\/db05-1183","article-title":"Decreased muscle strength and quality in older adults with type 2 diabetes: The health, aging, and body composition study","volume":"55","author":"Park","year":"2006","journal-title":"Diabetes"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"101708","DOI":"10.1016\/j.diabet.2025.101708","article-title":"GLP-1-derived therapies and sarcopenia: Plea for a specific focus on at risk special populations","volume":"52","author":"Scheen","year":"2026","journal-title":"Diabetes Metab."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"107927","DOI":"10.1016\/j.phrs.2025.107927","article-title":"Glucagon-like peptide-1 receptor agonists and muscle mass effects","volume":"220","author":"Ceasovschih","year":"2025","journal-title":"Pharmacol. Res."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Achamrah, N., Colange, G., Delay, J., Rimbert, A., Folope, V., Petit, A., Grigioni, S., Dechelotte, P., and Coeffier, M. (2018). Comparison of body composition assessment by DXA and BIA according to the body mass index: A retrospective study on 3655 measures. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0200465"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"3548284","DOI":"10.1155\/2019\/3548284","article-title":"Assessment of body composition in health and disease using bioelectrical impedance analysis (BIA) and dual energy x-ray absorptiometry (DXA): A critical overview","volume":"2019","author":"Marra","year":"2019","journal-title":"Contrast Media Mol. Imaging"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"e642","DOI":"10.1093\/milmed\/usae439","article-title":"Comparison of four body composition methods: Circumference measurements, eight-point bioelectrical impedance analysis up to 500 and 1000 kHz to dual-energy x-ray absorptiometry to measure body fat percentage","volume":"190","author":"Combest","year":"2025","journal-title":"Mil. Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1111\/dom.15728","article-title":"Changes in lean body mass with glucagon-like peptide-1-based therapies and mitigation strategies","volume":"26","author":"Neeland","year":"2024","journal-title":"Diabetes Obes. Metab."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1007\/s11695-020-05082-2","article-title":"Measuring muscle mass and strength in obesity: A review of various methods","volume":"31","author":"Sizoo","year":"2021","journal-title":"Obes. Surg."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1151","DOI":"10.1001\/jamainternmed.2025.1794","article-title":"Integrating diet and physical activity when prescribing glp-1s-lifestyle factors remain crucial","volume":"185","author":"Mehrtash","year":"2025","journal-title":"JAMA Intern. Med."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Sember, V., Meh, K., Soric, M., Starc, G., Rocha, P., and Jurak, G. (2020). Validity and reliability of international physical activity questionnaires for adults across eu countries: Systematic review and meta analysis. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17197161"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"US Preventive Services Task Force, Krist, A.H., Davidson, K.W., Mangione, C.M., Barry, M.J., Cabana, M., Caughey, A.B., Donahue, K., Doubeni, C.A., and Epling, J.W. (2020). Behavioral counseling interventions to promote a healthy diet and physical activity for cardiovascular disease prevention in adults with cardiovascular risk factors: US Preventive Services Task Force recommendation statement. JAMA, 324, 2069\u20132075.","DOI":"10.1001\/jama.2020.21749"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1718","DOI":"10.2337\/dci23-0100","article-title":"Incretin-based weight loss pharmacotherapy: Can resistance exercise optimize changes in body composition?","volume":"47","author":"Locatelli","year":"2024","journal-title":"Diabetes Care"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1093\/gerona\/glad038","article-title":"Nutritional interventions: Dietary protein needs and influences on skeletal muscle of older adults","volume":"78","author":"Campbell","year":"2023","journal-title":"J. Gerontol. Ser. A Biol. Sci. Med. Sci."},{"key":"ref_44","first-page":"25","article-title":"Nutrients to mitigate osteosarcopenia: The role of protein, vitamin D and calcium","volume":"24","author":"Kirk","year":"2021","journal-title":"Curr. Opin. Clin. Nutr. Metab. Care"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"2191","DOI":"10.2337\/dbi25-0003","article-title":"High-quality weight loss in obesity: Importance of skeletal muscle","volume":"74","author":"Harper","year":"2025","journal-title":"Diabetes"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"S179","DOI":"10.1038\/sj.ejcn.1602194","article-title":"Role of social support in lifestyle-focused weight management interventions","volume":"59","author":"Verheijden","year":"2005","journal-title":"Eur. J. Clin. Nutr."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"e348","DOI":"10.1111\/j.1467-789X.2010.00767.x","article-title":"Voluntary weight loss: Systematic review of early phase body composition changes","volume":"12","author":"Heymsfield","year":"2011","journal-title":"Obes. Rev."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1038\/sj.ijo.0803483","article-title":"Changes in fat-free mass during significant weight loss: A systematic review","volume":"31","author":"Chaston","year":"2007","journal-title":"Int. J. Obes."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1038\/s41413-025-00483-4","article-title":"Weight loss induced bone loss: Mechanism of action and clinical implications","volume":"13","author":"Liu","year":"2025","journal-title":"Bone Res."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"e13841","DOI":"10.1111\/obr.13841","article-title":"Strategies for minimizing muscle loss during use of incretin-mimetic drugs for treatment of obesity","volume":"26","author":"Mechanick","year":"2025","journal-title":"Obes. Rev."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"169","DOI":"10.3233\/JND-200568","article-title":"Molecular mechanisms of skeletal muscle hypertrophy","volume":"8","author":"Schiaffino","year":"2021","journal-title":"J. Neuromuscul. Dis."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"511","DOI":"10.3945\/an.116.014506","article-title":"Preserving healthy muscle during weight loss","volume":"8","author":"Cava","year":"2017","journal-title":"Adv. Nutr."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4158\/EP161365.GL","article-title":"American Association of Clinical Endocrinologists and American College of Endocrinology comprehensive clinical practice guidelines for medical care of patients with obesity","volume":"22","author":"Garvey","year":"2016","journal-title":"Endocr. Pract."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1159\/000442721","article-title":"European guidelines for obesity management in adults","volume":"8","author":"Yumuk","year":"2015","journal-title":"Obes. Facts"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"E875","DOI":"10.1503\/cmaj.191707","article-title":"Obesity in adults: A clinical practice guideline","volume":"192","author":"Wharton","year":"2020","journal-title":"CMAJ"},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Sardeli, A.V., Komatsu, T.R., Mori, M.A., Gaspari, A.F., and Chacon-Mikahil, M.P.T. (2018). Resistance training prevents muscle loss induced by caloric restriction in obese elderly individuals: A systematic review and meta-analysis. Nutrients, 10.","DOI":"10.3390\/nu10040423"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"1148","DOI":"10.1007\/s12603-018-1139-9","article-title":"International Clinical Practice Guidelines for Sarcopenia (ICFSR): Screening, diagnosis and management","volume":"22","author":"Dent","year":"2018","journal-title":"J. Nutr. Health Aging"},{"key":"ref_58","doi-asserted-by":"crossref","unstructured":"Codella, R., Senesi, P., and Luzi, L. (2025). GLP-1 agonists and exercise: The future of lifestyle prioritization. Front. Clin. Diabetes Healthc., 6.","DOI":"10.3389\/fcdhc.2025.1720794"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"2341","DOI":"10.1007\/s40279-017-0747-6","article-title":"Effects of supervised vs. Unsupervised training programs on balance and muscle strength in older adults: A systematic review and meta-analysis","volume":"47","author":"Lacroix","year":"2017","journal-title":"Sports Med."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1249\/MSS.0b013e3181949333","article-title":"American College of Sports Medicine Position Stand. Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults","volume":"41","author":"Donnelly","year":"2009","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1451","DOI":"10.1136\/bjsports-2020-102955","article-title":"World Health Organization 2020 guidelines on physical activity and sedentary behaviour","volume":"54","author":"Bull","year":"2020","journal-title":"Br. J. Sports Med."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1186\/s12933-023-01765-z","article-title":"Combination of exercise and GLP-1 receptor agonist treatment reduces severity of metabolic syndrome, abdominal obesity, and inflammation: A randomized controlled trial","volume":"22","author":"Sandsdal","year":"2023","journal-title":"Cardiovasc. Diabetol."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1111\/dom.15829","article-title":"Opportunities to optimize lifestyle interventions in combination with glucagon-like peptide-1-based therapy","volume":"26","author":"Dash","year":"2024","journal-title":"Diabetes Obes. Metab."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"102475","DOI":"10.1016\/j.eclinm.2024.102475","article-title":"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","volume":"69","author":"Jensen","year":"2024","journal-title":"eClinicalMedicine"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"100283","DOI":"10.1016\/j.metop.2024.100283","article-title":"Effectiveness of a hybrid approach in integrating GLP-1 agonists and lifestyle guidance for obesity and pre-diabetes management: RWE retrospective study","volume":"22","author":"Zakaria","year":"2024","journal-title":"Metabol. Open"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"103464","DOI":"10.1016\/j.eclinm.2025.103464","article-title":"Efficacy of lifestyle modification combined with GLP-1 receptor agonists on body weight and cardiometabolic biomarkers in individuals with overweight or obesity: A systematic review and meta-analysis","volume":"88","author":"Chu","year":"2025","journal-title":"eClinicalMedicine"},{"key":"ref_67","unstructured":"Ozemek, C., Bonikowske, A.R., Christle, J.W., and Gallo, P.M. (2026). ACSM\u2019s Guidelines for Exercise Testing and Prescription, Wolters Kluwer."},{"key":"ref_68","doi-asserted-by":"crossref","unstructured":"American Diabetes Association Professional Practice Committee for Diabetes (2026). 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes: Standards of Care in Diabetes\u20142026. Diabetes Care, 49, S89\u2013S131.","DOI":"10.2337\/dc26-S005"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"e13254","DOI":"10.1111\/obr.13254","article-title":"Reports of the EASO physical activity working group: Diverse insights, evidence-based recommendations, and future perspectives","volume":"22","author":"Muller","year":"2021","journal-title":"Obes. Rev."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1007\/s13679-023-00534-z","article-title":"The role of lifestyle modification with second-generation anti-obesity medications: Comparisons, questions, and clinical opportunities","volume":"12","author":"Wadden","year":"2023","journal-title":"Curr. Obes. Rep."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1038\/s41574-019-0174-x","article-title":"Physical activity and muscle-brain crosstalk","volume":"15","author":"Pedersen","year":"2019","journal-title":"Nat. Rev. Endocrinol."},{"key":"ref_72","doi-asserted-by":"crossref","unstructured":"Moretti, A., Tomaino, F., Paoletta, M., Liguori, S., Migliaccio, S., Rondanelli, M., Di Iorio, A., Pellegrino, R., Donnarumma, D., and Di Nunzio, D. (2025). Physical exercise for primary sarcopenia: An expert opinion. Front. Rehabil. Sci., 6.","DOI":"10.3389\/fresc.2025.1538336"},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"1510","DOI":"10.1249\/MSS.0b013e3181a0c95c","article-title":"American College of Sports Medicine Position Stand. Exercise and physical activity for older adults","volume":"41","author":"Proctor","year":"2009","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"100121","DOI":"10.1016\/j.obpill.2024.100121","article-title":"Dietary intake by patients taking GLP-1 and dual GIP\/GLP-1 receptor agonists: A narrative review and discussion of research needs","volume":"11","author":"Christensen","year":"2024","journal-title":"Obes. Pillars"},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"100222","DOI":"10.1016\/j.obpill.2025.100222","article-title":"Optimizing GLP-1 therapies for obesity and diabetes management","volume":"16","author":"Noronha","year":"2025","journal-title":"Obes. Pillars"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"2050313X251388724","DOI":"10.1177\/2050313X251388724","article-title":"Preservation of lean soft tissue during weight loss induced by GLP-1 and GLP-1\/GIP receptor agonists: A case series","volume":"13","author":"Tinsley","year":"2025","journal-title":"Sage Open Med. Case Rep."},{"key":"ref_77","doi-asserted-by":"crossref","unstructured":"Johnson, B., Milstead, M., Thomas, O., McGlasson, T., Green, L., Kreider, R., and Jones, R. (2025). Investigating nutrient intake during use of glucagon-like peptide-1 receptor agonist: A cross-sectional study. Front. Nutr., 12.","DOI":"10.3389\/fnut.2025.1566498"},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1007\/s00592-025-02611-2","article-title":"Muscle loss and GLP-1R agonists use","volume":"63","author":"Rossi","year":"2025","journal-title":"Acta Diabetol."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"100209","DOI":"10.1016\/j.obpill.2025.100209","article-title":"Dietary supplement considerations during glucagon-like peptide-1 receptor agonist treatment: A narrative review","volume":"16","author":"Johnson","year":"2025","journal-title":"Obes. Pillars"},{"key":"ref_80","first-page":"351","article-title":"Nutrition support whilst on glucagon-like peptide-1 based therapy. Is it necessary?","volume":"28","author":"Chavez","year":"2025","journal-title":"Curr. Opin. Clin. Nutr. Metab. Care"},{"key":"ref_81","unstructured":"ukactive Research Institute (2026, March 25). GLP-1 Medications and Muscle Mass Preservation: Implications and Recommendations. Available online: https:\/\/ukactive.com\/resources\/glp-1-medications-and-muscle-mass-preservation\/."},{"key":"ref_82","unstructured":"World Health Organization (WHO) (2026, January 15). WHO Issues Global Guideline on the Use of GLP-1 Medicines in Treating Obesity. Available online: https:\/\/files.magicapp.org\/guideline\/6536c5ab-d6c8-4908-8a4c-0189ef096766\/published_guideline_10807-1_1.pdf."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"1475","DOI":"10.1002\/oby.24336","article-title":"Nutritional priorities to support GLP-1 therapy for obesity: A joint advisory from the American College of Lifestyle Medicine, the American Society for Nutrition, the Obesity Medicine Association, and the Obesity Society","volume":"33","author":"Mozaffarian","year":"2025","journal-title":"Obesity"},{"key":"ref_84","unstructured":"United States Department of Agriculture (USDA) (2026, February 01). Dietary Guidelines for Americans: 2025\u20132030, Available online: https:\/\/cdn.realfood.gov\/DGA.pdf."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"1849","DOI":"10.1016\/j.clnu.2023.08.010","article-title":"A focus on leucine in the nutritional regulation of human skeletal muscle metabolism in ageing, exercise and unloading states","volume":"42","author":"Ely","year":"2023","journal-title":"Clin. Nutr."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"111797","DOI":"10.1016\/j.nut.2022.111797","article-title":"Elucidating the underlying mechanism of amino acids to regulate muscle protein synthesis: Effect on human health","volume":"103\u2013104","author":"Lv","year":"2022","journal-title":"Nutrition"},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1016\/j.clnu.2024.09.035","article-title":"Greater energy surplus promotes body protein accretion in healthy young men: A randomized clinical trial","volume":"43","author":"Hatamoto","year":"2024","journal-title":"Clin. Nutr."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1007\/s40279-018-1009-y","article-title":"Food-first approach to enhance the regulation of post-exercise skeletal muscle protein synthesis and remodeling","volume":"49","author":"Burd","year":"2019","journal-title":"Sports Med."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"100205","DOI":"10.1016\/j.obpill.2025.100205","article-title":"Application of nutrition interventions with GLP-1 based therapies: A narrative review of the challenges and solutions","volume":"16","author":"Fitch","year":"2025","journal-title":"Obes. Pillars"},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"1337","DOI":"10.1152\/japplphysiol.00394.2002","article-title":"Early postexercise muscle glycogen recovery is enhanced with a carbohydrate-protein supplement","volume":"93","author":"Ivy","year":"2002","journal-title":"J. Appl. Physiol."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"e2825","DOI":"10.7717\/peerj.2825","article-title":"Pre- versus post-exercise protein intake has similar effects on muscular adaptations","volume":"5","author":"Schoenfeld","year":"2017","journal-title":"PeerJ"},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"568","DOI":"10.3945\/jn.110.135038","article-title":"Enhanced amino acid sensitivity of myofibrillar protein synthesis persists for up to 24 h after resistance exercise in young men","volume":"141","author":"Burd","year":"2011","journal-title":"J. Nutr."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"911","DOI":"10.2519\/jospt.2018.0615","article-title":"Is there a postworkout anabolic window of opportunity for nutrient consumption? Clearing up controversies","volume":"48","author":"Schoenfeld","year":"2018","journal-title":"J. Orthop. Sports Phys. Ther."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"2319","DOI":"10.1113\/jphysiol.2012.244897","article-title":"Timing and distribution of protein ingestion during prolonged recovery from resistance exercise alters myofibrillar protein synthesis","volume":"591","author":"Areta","year":"2013","journal-title":"J. Physiol."},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"1180","DOI":"10.1001\/jamainternmed.2025.1133","article-title":"I am taking a GLP-1 weight-loss medication-what should I know?","volume":"185","author":"Mehrtash","year":"2025","journal-title":"JAMA Intern. Med."},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1186\/s12970-018-0215-1","article-title":"How much protein can the body use in a single meal for muscle-building? Implications for daily protein distribution","volume":"15","author":"Schoenfeld","year":"2018","journal-title":"J. Int. Soc. Sports Nutr."},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"e70070","DOI":"10.1111\/cob.70070","article-title":"Micronutrient and nutritional deficiencies associated with GLP-1 receptor agonist therapy: A narrative review","volume":"16","author":"Urbina","year":"2026","journal-title":"Clin. Obes."},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"100186","DOI":"10.1016\/j.obpill.2025.100186","article-title":"Nutritional deficiencies and muscle loss in adults with type 2 diabetes using GLP-1 receptor agonists: A retrospective observational study","volume":"15","author":"Sulo","year":"2025","journal-title":"Obes. Pillars"},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"e10575","DOI":"10.1002\/jbm4.10575","article-title":"Vitamin D and skeletal muscle: Current concepts from preclinical studies","volume":"5","author":"Girgis","year":"2021","journal-title":"JBMR Plus"},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1530\/EC-17-0008","article-title":"Vitamin D induces myogenic differentiation in skeletal muscle derived stem cells","volume":"6","author":"Braga","year":"2017","journal-title":"Endocr. Connect."},{"key":"ref_101","first-page":"628","article-title":"Vitamin D and its role in skeletal muscle","volume":"12","author":"Ceglia","year":"2009","journal-title":"Curr. Opin. Clin. Nutr. Metab. Care"},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"953241","DOI":"10.1155\/2015\/953241","article-title":"Vitamin D: A review on its effects on muscle strength, the risk of fall, and frailty","volume":"2015","author":"Halfon","year":"2015","journal-title":"Biomed. Res. Int."},{"key":"ref_103","first-page":"136","article-title":"Skeletal muscle protein turnover and mitochondrial responses to omega-3 fatty acid supplementation: An update","volume":"29","author":"Hayden","year":"2026","journal-title":"Curr. Opin. Clin. Nutr. Metab. Care"},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1016\/j.advnut.2022.11.005","article-title":"The influence of n-3PUFA supplementation on muscle strength, mass, and function: A systematic review and meta-analysis","volume":"14","author":"Esteves","year":"2023","journal-title":"Adv. Nutr."},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/j.clnesp.2024.03.019","article-title":"Effects of omega-3 fatty acids supplementation and resistance training on skeletal muscle","volume":"61","author":"Uchida","year":"2024","journal-title":"Clin. Nutr. Espen"},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"e131","DOI":"10.1093\/nutrit\/nuae055","article-title":"The effects of omega-3 polyunsaturated fatty acids on muscle and whole-body protein synthesis: A systematic review and meta-analysis","volume":"83","author":"Therdyothin","year":"2025","journal-title":"Nutr. Rev."},{"key":"ref_107","doi-asserted-by":"crossref","unstructured":"Wax, B., Kerksick, C.M., Jagim, A.R., Mayo, J.J., Lyons, B.C., and Kreider, R.B. (2021). Creatine for exercise and sports performance, with recovery considerations for healthy populations. Nutrients, 13.","DOI":"10.3390\/nu13061915"},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"111791","DOI":"10.1016\/j.nut.2022.111791","article-title":"Influence of age, sex, and type of exercise on the efficacy of creatine supplementation on lean body mass: A systematic review and meta-analysis of randomized clinical trials","volume":"103\u2013104","author":"Delpino","year":"2022","journal-title":"Nutrition"},{"key":"ref_109","doi-asserted-by":"crossref","unstructured":"Naeini, E.K., Eskandari, M., Mortazavi, M., Gholaminejad, A., and Karevan, N. (2025). Effect of creatine supplementation on kidney function: A systematic review and meta-analysis. BMC Nephrol., 26.","DOI":"10.1186\/s12882-025-04558-6"},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.clnu.2018.08.002","article-title":"GLIM criteria for the diagnosis of malnutrition\u2014A consensus report from the global clinical nutrition community","volume":"38","author":"Cederholm","year":"2019","journal-title":"Clin. Nutr."},{"key":"ref_111","doi-asserted-by":"crossref","unstructured":"Yamada, Y., Nishizawa, M., Uchiyama, T., Kasahara, Y., Shindo, M., Miyachi, M., and Tanaka, S. (2017). Developing and validating an age-independent equation using multi-frequency bioelectrical impedance analysis for estimation of appendicular skeletal muscle mass and establishing a cutoff for sarcopenia. Int. J. Environ. Res. Public Health, 14.","DOI":"10.20944\/preprints201706.0081.v1"},{"key":"ref_112","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1016\/S0261-5614(03)00048-7","article-title":"Validation of a bioelectrical impedance analysis equation to predict appendicular skeletal muscle mass (ASMM)","volume":"22","author":"Kyle","year":"2003","journal-title":"Clin. Nutr."},{"key":"ref_113","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1016\/S0140-6736(14)62000-6","article-title":"Prognostic value of grip strength: Findings from the Prospective Urban Rural Epidemiology (PURE) study","volume":"386","author":"Leong","year":"2015","journal-title":"Lancet"},{"key":"ref_114","doi-asserted-by":"crossref","unstructured":"Beaudart, C., McCloskey, E., Bruyere, O., Cesari, M., Rolland, Y., Rizzoli, R., Araujo de Carvalho, I., Amuthavalli Thiyagarajan, J., Bautmans, I., and Bertiere, M.C. (2016). Sarcopenia in daily practice: Assessment and management. BMC Geriatr., 16.","DOI":"10.1186\/s12877-016-0349-4"},{"key":"ref_115","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1080\/02701367.1999.10608028","article-title":"A 30-s chair-stand test as a measure of lower body strength in community-residing older adults","volume":"70","author":"Jones","year":"1999","journal-title":"Res. Q. Exerc. Sport"},{"key":"ref_116","doi-asserted-by":"crossref","unstructured":"Wang, W., Green, D., Ibrahim, R., Abdelnabi, M., Pham, H.N., Forst, B., Allam, M., Sarkis, P., Bcharah, G., and Farina, J. (2025). Navigating sarcopenia risks in GLP-1RA therapy for advanced heart failure. Biomedicines, 13.","DOI":"10.3390\/biomedicines13051108"},{"key":"ref_117","doi-asserted-by":"crossref","unstructured":"Gross, K., and Brinkmann, C. (2024). Why you should not skip tailored exercise interventions when using incretin mimetics for weight loss. Front. Endocrinol., 15.","DOI":"10.3389\/fendo.2024.1449653"},{"key":"ref_118","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1111\/jgs.70187","article-title":"GLP-1 receptor agonist therapy and cardiorenal outcomes in patients \u226580 years old with type 2 diabetes","volume":"74","author":"Chen","year":"2026","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_119","doi-asserted-by":"crossref","first-page":"pzaf061","DOI":"10.1093\/ptj\/pzaf061","article-title":"Transforming care: Implications of glucagon like peptide-1 receptor agonists on physical therapist practice","volume":"105","author":"Mulcahy","year":"2025","journal-title":"Phys. Ther."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/15\/5870\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T14:30:28Z","timestamp":1785162628000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/15\/5870"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,27]]},"references-count":119,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["jcm15155870"],"URL":"https:\/\/doi.org\/10.3390\/jcm15155870","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,27]]}}}