A strength training plan for 3 days a week during tirzepatide treatment

Tirzepatide (Mounjaro) reduces appetite and helps you lose weight, but along with fat you also lose fat-free mass, which includes muscle. A trial published in November 2026 included 120 people aged 50-70 who were not very active and did not have diabetes or heart disease. Participants who did supervised strength training three times a week during 40 weeks of tirzepatide treatment lost about 1.1 kg less fat-free mass than those who did not train. Their strength increased, while in people who did not train it fell (1). The three-day-a-week plan described below is intended for someone who has not exercised before. The numbers of sets and reps in the first 8 weeks come from this trial, and the advice on increasing the load after that comes from the recommendations of the Polish Society for the Treatment of Obesity (PTLO) and the American College of Sports Medicine (ACSM) (1-3). If you have heart disease, diabetes treated with insulin or painful joints, talk to your doctor before your first workout.

In brief

• In a trial of 120 people aged 50-70 treated with tirzepatide, supervised strength training three times a week for 40 weeks reduced the loss of fat-free mass from 4.7 to 3.6 kg. Body weight and body fat fell to a similar extent in both groups (1).
• Without training, strength in the arm, back and leg muscles fell by 6.5-9%, whereas in the exercise group it rose by 11-18% (1).
• The PTLO and the World Health Organization (WHO) recommend that people with obesity do at least two strength training sessions a week and 150-300 minutes of moderate activity, such as brisk walking. For people treated with GLP-1 medicines and dual-agonist medicines such as tirzepatide, four American societies suggest three strength training sessions a week (2, 4, 5).
• The starter plan is 7 home exercises, 2 sets each at a light effort. If you have heart disease, or diabetes treated with insulin or a sulfonylurea, talk to your doctor before training, and if your joints hurt, discuss the exercises with a doctor or physiotherapist (1, 2, 6).

How often to do strength training during obesity treatment

The Polish Society for the Treatment of Obesity, like the WHO, recommends that adults with overweight and obesity do at least two strength training sessions a week. The training should cover all the major muscle groups and be of moderate or high intensity. In addition, the recommendations include 150-300 minutes of moderate aerobic activity a week, such as brisk walking, cycling or swimming, or 75-150 minutes of vigorous activity (2, 4).

Strength training during weight loss protects against the loss of muscle tissue (2). In the trial described below, training reduced the loss of fat-free mass but did not stop it (1). The European Association for the Study of Obesity (EASO) also recommends moderate- or high-intensity strength training to preserve fat-free mass during weight loss (7). Four American societies have issued a joint advisory on nutrition and lifestyle for people treated with GLP-1 medicines and dual-agonist medicines such as tirzepatide. In it, they suggest strength training at least three times a week and at least 150 minutes of moderate aerobic activity a week, with a plan matched to the patient's fitness (5). Participants in the trial mentioned above also did three strength training sessions a week (1).

People with a BMI above 35 should choose activity that does not put excessive strain on the joints and spine, such as water-based exercise, an exercise bike or suitably chosen floor or chair exercises (2).

Do I need to talk to a doctor before my first workout?

Physical activity is safe for most people, and its benefits outweigh the risks. However, anyone with other medical conditions or worrying symptoms should consult a doctor or physiotherapist before starting to train (2). Talk to your doctor before your first workout if:

• you have heart or blood vessel disease or another chronic condition, such as high blood pressure. The trial described below did not include people with heart disease (1, 2).
• you have had chest pain or felt faint or fainted during exercise. These symptoms need to be assessed by a cardiologist (2).
• you have diabetes treated with insulin or a sulfonylurea. Taken together with tirzepatide, these medicines increase the risk of low blood sugar (hypoglycaemia), and your doctor may reduce their dose and tell you how to prepare for exercise (6).
• your knees, hips or spine hurt. A doctor or physiotherapist will help you choose exercises that do not overload these areas (2).
• you are 65 or older and are being treated for chronic conditions. Older people are also advised to do balance exercises, such as standing on one leg (2).

A 3-day-a-week strength training plan for complete beginners

The plan includes three strength training sessions a week, with a rest day between them, each made up of 7 whole-body exercises. For the first 4 weeks, you do 2 sets of 12-15 reps of each exercise at a light effort, and in weeks 5-8, 2 sets of 12 reps at a noticeably harder effort. We took the numbers of sets and reps and the effort rating from the first 8 weeks of the trial. We adapted the example exercises from the trial for training at home, without a gym or a trainer (1, 2).

How to spread strength training and walking across the week

A sample week: strength training on Monday, Wednesday and Friday, walking, cycling or swimming on Tuesday, Thursday and Saturday, and rest on Sunday. Older people should rest for at least 48 hours between strength training sessions (2). If three sessions are too much to begin with, start with two, because that is the recommended minimum, and add the third after a few weeks (2, 4).

Increase aerobic activity, such as walking, gradually as well. People who have not been active should start at low intensity and increase the duration or load by no more than 10% a week (2). If you currently walk briskly for 60 minutes a week, add about 6 minutes the following week. A moderate pace is one at which you can talk comfortably but cannot sing (2).

Seven exercises for one home workout

For the exercises, you need a stable chair without wheels, a mat, a resistance band and two full water bottles or light dumbbells. Resistance bands and small weights are enough for strength training at home (2). The exercise names are the same as in the app of the Nasz Gabinet obesity treatment programme.

1. Sit-to-stand with hands on thighs (thighs and buttocks). Sit on the edge of a chair placed with its back against a wall, put your feet flat on the floor, hip-width apart, and rest your hands on your thighs above your knees. Lean forward and stand up, pressing lightly on your thighs with your hands, then sit down slowly to a count of three. Easier version: standing up from a chair with armrests, pushing yourself up with your hands.
2. Table push-up (chest and arms). Place your hands on the edge of a heavy table or kitchen worktop, slightly wider than your shoulders, and step your feet back until your body is straight from heels to head. Bend your elbows, slowly lower your chest towards the worktop and push yourself back up. Easier version: wall push-up, with your hands against a wall.
3. Seated band row (back). Wrap the middle of the band around the leg of a heavy table or bed and sit facing it on a chair without armrests, so that the band is slightly taut when your arms are straight. Pull your elbows back along your sides, squeezing your shoulder blades together, and slowly bring your arms forward again. Easier version: a lighter band.
4. Seated overhead bottle press (shoulders). Sit up straight on a chair with a backrest and lift the bottles or dumbbells to shoulder height. Press the weight overhead without fully straightening your elbows, and lower it slowly. Easier version: the same movement without weights.
5. Hip lift on the floor (buttocks and backs of the thighs). Lie on your back on the mat, bend your knees and put your feet flat on the floor, hip-width apart. Press your heels into the floor, tighten your buttocks and lift your hips no higher than a straight line from your shoulders to your knees, then lower them slowly. Easier version: the same exercise on a bed with a firm mattress, if you find it hard to get down onto the floor or back up.
6. Calf raise holding a chair (calves). Stand behind a chair placed facing a wall, hold the backrest with both hands, slowly rise onto your toes and lower your heels. Easier version: seated heel raise.
7. Lying heel slide (stomach muscles). Lie on your back on a bed with a firm mattress or on a mat, bend your knees, tighten your stomach and press your lower back lightly into the surface. Slowly slide one heel away until the leg is straight, then bring it back the same way, alternating legs. In this exercise, count the reps separately for each leg. Easier version: do not straighten your leg fully.

Start each workout with about 5 minutes of marching on the spot or riding an exercise bike and a few gentle warm-up movements, such as arm circles. In the trial, every session began with a similar warm-up (1). Do the exercises in the order given: first those that work large muscle groups and several joints, then the rest (3). Do them slowly, through the full range of motion your joints allow, because training through a full range of motion helps build strength (8). Rest for 1-2 minutes between sets (3).

How to exercise in weeks 1-4

Do each of the 7 exercises in 2 sets of 12-15 reps. Rate your effort on a scale from 0 to 10, where 0 means no fatigue and 10 means maximum fatigue and unbearable breathlessness. In the first few weeks, your effort should be below 5 (1, 2). During this time you are learning to do the exercises correctly, so if a movement is difficult for you, choose the easier version. If your knees, hips or spine hurt during an exercise, stop it and discuss your choice of exercises with a doctor or physiotherapist (2).

How to exercise in weeks 5-8

Do 2 sets of 12 reps of each exercise with an effort of about 6-7 on the same scale (1). If you rate your effort below 6 after 12 reps, switch to a stronger band or heavier bottles or dumbbells.

How to increase the load from week 9

In the trial, participants added a third set from week 9, and one session a week was harder, with 6-8 reps at an effort of 7-8. Their trainers chose the weights for them (1). For beginners, the ACSM recommends 2-3 sessions a week and a weight you can lift no more than 8-12 times in a row. When you manage 1-2 more reps than planned in every set, increase the load by 2-10% (3). At the start, avoid lifting heavy weights (2). You do not need to train to failure, that is, until you cannot do another rep. In a review of studies, training to failure did not consistently increase strength or muscle mass more than training that stopped earlier (8).

If you want to move on to weights like those in the trial, train with a trainer or physiotherapist and tell them that you are on obesity medication. The trial results were achieved with training under constant supervision (1).

When to stop exercising during tirzepatide treatment

Stop exercising if you have chest pain, feel faint or pass out during exercise. You then need to see a cardiologist before your next workout (2). Chest pain that does not go away at rest needs immediate medical help.

Dizziness and low blood pressure are common side effects of tirzepatide (6). In the trial described below, 24-31% of participants reported dizziness and 2-5% fainted. These symptoms usually went away within 8-10 weeks (1). If you feel dizzy during exercise, stop the set and sit down. If the dizziness keeps coming back in later sessions, tell your doctor.

About half of the trial participants reported nausea (1). Vomiting and diarrhoea during tirzepatide treatment can lead to dehydration and worsening kidney function (6). Drink water before and during your workout, and on days with vomiting or diarrhoea, take a break from exercise and replace lost fluids. Other symptoms that mean you should contact a doctor are described in our article on side effects of obesity medicines.

What strength training achieved in people treated with tirzepatide

According to the authors, this is the first randomised trial (with participants assigned to groups at random) to test strength training combined with tirzepatide. Training did not speed up weight loss, but it limited the loss of fat-free mass and improved muscle strength (1).

Who took part in the trial and what the training involved

The trial was carried out at a single centre, the University of Western Australia in Perth. It included 120 adults: 60 men and 60 postmenopausal women aged 50-70 (58 on average). They had a BMI of at least 30, or at least 27 together with a weight-related condition such as high cholesterol or sleep apnoea. All of them had previously not been very active: in the 3 months before the trial, they had done exercise of at least moderate intensity for less than 60 minutes a week. People with cardiovascular disease or diabetes were excluded, as were people taking blood pressure medicines or statins (1).

All participants received tirzepatide once a week for 40 weeks. Treatment started at a dose of 2.5 mg, which was increased by 2.5 mg every 4 weeks so as to reach 15 mg in week 20, if the participant tolerated the medicine well. Roughly two thirds of participants finished the trial on the 15 mg dose. Everyone was advised to drink enough and not to cut back on protein or on vegetables and fruit, but no special diet was used. A randomly selected half trained three times a week for an hour, in a group, in a gym, supervised by exercise physiologists. The other half came only for injections and measurements (1).

Each session began with about 5 minutes of light activity, for example on an exercise bike, and dynamic stretching. Participants rated their effort on a 10-point Borg scale, where 10 means maximum effort, and the trainers increased the load based on these ratings. The exercises included squats, glute bridges, calf raises, incline push-ups, lat pulldowns and overhead presses, among others. On average, participants attended 91% of the planned sessions (1).

How training affected weight, strength and fat-free mass

After 40 weeks, both groups lost almost the same amount of weight: 22.6 kg without training and 22.3 kg with training. They lost 17.2 and 18.0 kg of body fat respectively. The difference was in fat-free mass, meaning muscle and other tissues that are neither fat nor bone. People who did not train lost 4.7 kg of it, and those who exercised lost 3.6 kg (1).

Fat-free mass was measured every 8 weeks with a whole-body DXA (dual-energy X-ray absorptiometry) scan. DXA does not distinguish muscle from other fat-free tissues. The authors estimate that muscle makes up roughly half of total fat-free mass and about 70% of the fat-free mass in the arms and legs. Total fat-free mass stopped falling in both groups after week 24, but in the arms and legs it kept falling until the end of the trial (1).

Strength was measured as the heaviest weight a participant could lift once (1):

Both groups showed a similar improvement in blood pressure and in blood glucose and cholesterol levels, so training gave no extra benefit in these measurements. In the subset of participants who recorded what they ate for three days, energy and protein intake was similar in both groups (1). How much protein to eat during treatment and how to spread it across your meals is explained in our article on what to eat on obesity medication.

What the trial does not answer

The result cannot automatically be applied to everyone treated with tirzepatide. The trial included people aged 50-70 without diabetes or heart disease who did almost no exercise before the trial. Training took place in a gym, in a group and under constant supervision, and the authors write that it still needs to be studied whether such a programme can be run in routine medical care. Participants knew which group they were in, and the people measuring strength may also have led training sessions. The manufacturer of tirzepatide supplied the medicine for the trial and reviewed the protocol, but according to the authors it did not fund the trial in any other way and had no influence on how it was conducted. The trial looked only at tirzepatide (1).

Strength training in the Nasz Gabinet obesity treatment programme

In the obesity treatment programme, patients have a section in the app called "Your activity" with strength exercises matched to their fitness. The levels start with chair exercises and end with exercises with a band or dumbbells; someone who already trains at a gym or with a trainer chooses their own plan and gets guidance on training during treatment. Every exercise has an easier and a harder version. If the patient marks problems with their knees, hips, spine or shoulders, the app leaves out the versions that put strain on these areas. At the weekly weigh-in, the patient answers how many strength training sessions they did, and their doctor can see the answer. How medicine doses and appetite change during this time is described in our article on the first months of obesity treatment with medication.

Frequently asked questions

Does strength training speed up weight loss during tirzepatide treatment?

In the trial described, strength training did not speed up weight loss during tirzepatide treatment. After 40 weeks, those who exercised lost an average of 22.3 kg and those who did not train 22.6 kg, and both groups lost a similar amount of body fat. However, those who exercised lost less fat-free mass, and their strength increased (1).

Is walking alone enough to avoid losing muscle during obesity treatment with medication?

The authors of the American joint advisory on treatment with GLP-1 medicines write that aerobic exercise alone protects fat-free mass less well during rapid weight loss than strength training or a combination of both types of exercise (5). To preserve fat-free mass, EASO recommends strength training (7). Walking alone is therefore probably not enough, but it is still useful: aerobic exercise is part of the PTLO and WHO recommendations, alongside strength training (2, 4).

Is this plan suitable for people treated with semaglutide?

The trial described looked only at tirzepatide, so it does not tell us whether the effect would be the same in people treated with semaglutide. The recommendations on strength training also cover people treated with semaglutide: the PTLO and the WHO do not tie them to a particular medicine, and the American societies' joint advisory covers all GLP-1 medicines. Agree on your choice of exercises and loads with your doctor (2, 4, 5).

When should you start exercising after starting tirzepatide?

In the trial, participants started strength training with their first dose of tirzepatide, beginning with light effort and learning the technique (1). In the first months of treatment, the dose is increased gradually, no more often than every 4 weeks (6), and the dizziness and fainting reported by trial participants usually went away within 8-10 weeks (1). If you feel dizzy during exercise, stop the set and sit down. If the dizziness keeps coming back in later sessions, tell your doctor. After feeling faint or fainting during exercise, you need to see a cardiologist before your next workout (2).

Can you exercise at a gym during tirzepatide treatment?

Yes. The trial participants trained in a gym, with machines, bands and free weights. For the first 8 weeks, they exercised with light to moderate effort, and they introduced heavier sets gradually, under their trainers' supervision (1). If you are starting at a gym, ask a trainer for a beginner plan, tell them about your medication and drink water during your workout.

Sources

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