The impact of glucagon-like peptide-1 receptor agonists on objective physical activity in adults: a systematic review...

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are effective pharmacological treatments for obesity, through appetite suppression and weight reduction. However, their potential influence on physical activity (PA), a key determinant of long-term energy balance, remains unclear. This review aimed to evaluate whether GLP-1 RA treatment affects objectively measured PA in adults with overweight or obesity. A systematic review and exploratory meta-analysis were conducted in accordance with PRISMA guidelines. PubMed and Embase were searched from inception to March 10, 2026. Eligible studies included randomized and non-randomized controlled trials examining objectively measured PA outcomes (e.g., step counts, sedentary time, and intensity-specific PA). Narrative synthesis was performed across all studies, and a random-effects meta-analysis was conducted for studies reporting comparable free-living PA outcomes. Seven studies from six independent trials (n = 924) were included. Most studies reported no statistically significant differences in PA between GLP-1 RA and control groups. However, five studies (71.4%) showed numerically lower free-living PA in GLP-1 RA-treated groups, with one study reporting a significant reduction in daily step counts (-1144 steps/day, p = 0.01). Structured exercise-related outcomes, including adherence and prescribed exercise duration, were comparable between groups. Meta-analysis of three RCTs showed no significant pooled effect (Hedges' g = -0.11, 95% CI -0.30 to 0.09, I² = 0.0%). Sensitivity analyses suggested a modest reduction in PA (Hedges' g = -0.24, 95% CI -0.46 to -0.02, p = 0.035, I² = 34.3%), influenced by study design and outcome heterogeneity. GLP-1 RA treatment does not significantly alter overall PA but may be associated with a small reduction in free-living PA, while structured exercise participation remains unaffected. These findings suggest a potential influence on spontaneous, non-obligatory activity rather than exercise capacity. Further studies using standardized objective PA measures are needed.