Managing Patients on GLP-1 Medications in Physical
Therapy (Recorded Webinar)
Presented by Anna DelaRosby, Julie Mulcahy, and Todd Norwood PT
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Nonfinancial: Julie Mulcahy has no competing nonfinancial interests or relationships with regard to the content presented in this course.
Financial: Anna DelaRosby is an employee of Physera Physical Therapy Group. She receives compensation from MedBridge for this course.
Nonfinancial: Anna DelaRosby has no competing nonfinancial interests or relationships with regard to the content presented in this course.
Financial: Todd Norwood is an employee and shareholder for Omada Health, Inc and an advisor for Nice Healthcare. He receives compensation from MedBridge for this course.
Nonfinancial: Todd Norwood has no competing nonfinancial interests or relationships with regard to the content presented in this course.
Rehabilitation professionals are increasingly likely to manage patients on GLP-1 medications like Ozempic, Wegovy, and Mounjaro, which are revolutionary in their efficacy in promoting weight loss in patients with obesity and improving glycemic control in patients with type 2 diabetes. With nearly one in eight American adults reporting they have used GLP-1s, it is vital for rehabilitation professionals to develop effective management strategies. Their expertise is crucial in addressing complications from obesity and type 2 diabetes, such as diabetic tendinopathy and osteoarthritis, while considering that GLP-1s are associated with muscle mass loss and sustained calorie deficits, increasing injury risk and affecting recovery. Therefore, providers must screen for GLP-1 use, identify injury risks, and promote resistance training and aerobic exercise that patients enjoy to mitigate these risks and foster healthy behaviors. This course highlights the necessity of adopting behavior change principles and providing guidance on resistance training, aerobic conditioning, and injury prevention. Achieving long-term health benefits of GLP-1s requires rehab professionals to be well-informed about these medications’ side effects and to play a vital role in patients’ health journeys through expert exercise guidance and chronic condition management.
Learning Objectives
- Determine the prevalence and impact of obesity on health and the role GLP-1 medications play in managing obesity and obesity-related conditions, including their mechanisms of action and effects on patient care
- Distinguish the specific challenges that GLP-1 medications present in rehabilitation, including their side effects, such as caloric deficit, gastrointestinal issues, loss of muscle mass, challenges of medication discontinuation, glycemic control, and weight regain, and how these factors affect patient management
- Implement effective management strategies for rehab professionals working with patients on GLP-1 medications, encompassing comprehensive screening and intervention strategies, identification and management of red flags, and approaches to mitigate incomplete medication histories
- Construct personalized treatment plans that consider the importance of muscle mass preservation through resistance training, appropriate protein and nutrient intake, and the implementation of lifestyle behavior modifications using principles of behavior change
- Examine the interdisciplinary collaboration opportunities to enhance patient care and support, ensuring rehab professionals can effectively contribute to a holistic healthcare approach for patients using GLP-1 medications
- Analyze the current research and considerations around the effects of GLP-1 medications and implications for rehabilitation practices
Meet your instructors
Anna DelaRosby
Anna has been a physical therapist since receiving her doctorate in physical therapy in 2008 and loves all things PT. Anna became certified in Mechanical Diagnosis and Therapy in 2012, and in 2014, she became a board-certified orthopedic clinical specialist. She is the clinical program manager for Physera Physical…
Julie Mulcahy
Julie received her doctorate in physical therapy from the University of Michigan. For the past 20+ years, she has specialized in orthopedics, sports medicine, and women’s health. She obtained her Certificate of Achievement in Pregnancy and Postpartum Physical Therapy (CAPP-OB) in 2021 and her LAMP Institute for Leadership…
Todd Norwood PT
Todd received his doctorate in physical therapy from the University of Southern California and has a BA in human biology from Stanford University. He is a board-certified clinical specialist in both orthopedic physical therapy and sports physical therapy and is currently the senior director of clinical services at Omada…
Chapters & learning objectives
1. Prevalence of GLP-1 Use, Diabetes, and Obesity
Glucagon-like peptide-1 receptor agonists (GLP-1s) are a groundbreaking class of drugs designed to mimic the glucagon-like peptide-1 hormone, regulating insulin release, reducing appetite, and managing food intake. They are primarily used to combat obesity, control diabetes, and reduce the risk of cardiometabolic diseases. These medications facilitate significant weight loss and health improvements but also demand lifestyle adjustments for optimal efficacy. With the staggering rise in global obesity and the high prevalence of diabetes among patients referred for rehabilitation, it is crucial for rehab professionals to accommodate the metabolic changes and health goals of patients on GLP-1 medications, ensuring a holistic and effective approach to care.
2. The Effects of Obesity and Diabetes on the Musculoskeletal System
Distinguish the specific challenges that GLP-1 medications present in rehabilitation, including their side effects, such as caloric deficit, gastrointestinal issues, loss of muscle mass, challenges of medication discontinuation, glycemic control, and weight regain, and how these factors affect patient management. Rehab professionals are essential in combating the sequelae of obesity and GLP-1 medication side effects, focusing on inflammation management and muscle function, and supporting weight maintenance after medication discontinuation. They address challenges like muscle mass loss and metabolic rate reduction due to GLP-1s through tailored physical activities and lifestyle interventions, emphasizing the importance of a multidisciplinary approach to ensure long-term health improvements and prevent weight regain.
3. Challenges Induced by GLP-1 Medications
GLP-1 medications have demonstrated effectiveness in achieving significant weight loss and improved glycemic control, but they come with side effects, such as caloric deficit, muscle mass loss, slowed gastric emptying, and gastrointestinal issues, which can complicate long-term health maintenance and potentially undermine the medication’s success. Discontinuation of GLP-1s poses challenges, including increased appetite, weight regain, and worsening glycemic control, highlighting the importance of continuous lifestyle interventions, such as diet and exercise, to sustain weight loss achievements and manage potential psychological and behavioral adjustments post medication.
4. Management Strategies for Rehab Professionals
When treating patients on or recently off GLP-1 medications, rehab professionals should focus on preserving and building muscle mass, monitoring injuries, creating individual exercise plans, providing patient education, and collaborating with the interdisciplinary team. Considerations include adjusting for muscle mass reduction due to calorie restrictions, closely monitoring for new or worsening musculoskeletal issues, and tailoring exercise programs to address potential energy deficits and altered metabolism, all while emphasizing the importance of lifestyle changes and coordinating care with other healthcare professionals to ensure holistic patient support.
5. Watchpoints/Conclusion
Research is early and inconsistent regarding the impact of diabetes and weight loss medications on bone density and an increased likelihood of repeat spinal surgeries, with implications for the safety of joint mobilizations, the prognosis of total joint replacements, and overall bone healing. Additionally, these medications may affect healing duration and necessitate specific nutritional or supplemental strategies to support optimal health outcomes.
6. Question and Answer Session
In this chapter, we’ll answer the questions asked during the webinar and provide analysis.