Scientific Programme
Plenary Session
PS-PL03 - Exercise science and medicine in the era of incretins and exercise mimetics
Date: 04.07.2025, Time: 16:15 - 17:30, Session Room: Anfiteatro
Description
This talk will address recent global issues arising from novel pharmacological approaches to modify physiology, behaviour and metabolic health in humans. The potentially critical role of exercise, particularly resistance-based training, during incretin (Ozempic) therapies will be considered in the context of the effect of these blockbuster new therapies which radically alter body composition. The past decade has also witnessed growing scientific and commercial interest in the identification of bioactive oral compounds that mimic or potentiate the effects of exercise, so-called 'exercise mimetics.' This has raised the controversial issue of whether such agents may one day replace exercise as treatments for a number of chronic diseases in humans. These issues will be explored in the context of the future role of exercise specialists in guiding personalised exercise prescription that optimises preventative outcomes in healthcare systems that are currently focussed on service provision that occurs after diseases have manifested and are difficult and expensive to treat.
Chair(s)
Maureen MacDonald
McMaster University, Kinesiology
Canada
Speaker A
Daniel Green
The University of Western Australia, School of Human Sciences (Sports and Exercise Science)
Australia
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The Ozempic Olympics: Exercise training and chronic disease prevention in the incretin era
The world is embracing an exciting new era of chronic disease prevention and management: the age of Ozempic or Incretin therapies. There has never been a class of drugs that so effectively targets brain and behaviour to induce profound, rapid and life-changing decreases in body weight. Early intervention targeting obesity, a recognised gateway to multiple chronic diseases, can impact fatness, with beneficial pleiotropic impacts on blood pressure, cholesterol, blood glucose, insulin, heart and artery function, and perhaps even cognition. Beyond the glucagon-like peptide-1 receptor agonists (GLP-1ra) which induce rapid and substantial weight loss (liraglutide and semaglutide), newer and perhaps even more effective weight loss therapies are co-targeting glucose-dependent insulinotropic polypeptide (GIP) receptors (tirzepatide - dual agonist), and glucagon receptors (retatrutide - triple agonist). However, these agents cause rapid and significant loss of lean mass, comparable to a decade of ageing. Maintaining muscle mass and function as humans age is crucial to avoiding sarcopenia and frailty, which are strongly linked to morbidity and mortality. This talk will discuss the results of contemporary studies showing that supervised resistance exercise training interventions elicit increases in lean mass and strength in men and women across the lifespan. A compelling rationale will be presented for including strategies that retain lean mass during incretin therapy, to enhance fat loss and blunt body weight (and fat) re-gain on cessation of weight loss pharmacotherapy. De-prescribing is an important but challenging and complex goal for patients who achieve target changes in body composition. This talk will also address the global impact of targeted and personalised exercise interventions, during and after incretin therapy, in the prevention of chronic disease in humans. Insights derived from the Tirzepatide and Resistance Exercise (T-REX) trial, focussed on the impact of combined exercise and incretin therapy in older overweight and obese adults, will also be shared. Finally, the talk will conclude by considering the opportunity afforded by this once-in-a-generation class of drugs for the development of Clinical Exercise Physiology (CEP) as an allied health profession globally. To this end, a strategic roadmap will be presented based on the Australian and more recent UK experiences of establishing national CEP regulatory frameworks, practitioner registries, proficiency standards, and higher education curricula for the global advancement of this nascent allied health profession, which is so crucial to future cost-effective preventative healthcare delivery worldwide.
Speaker B
John Hawley
Mary Mackillop Institute for Health Research, Exercise & Nutrition Research Program
Australia
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Exercise Mimetics: A “polypill” to combat the erosion of physical activity in the 21st century?
Almost two decades ago it was reported that an oral ‘exercise mimetic’ (GW1516, an AMP-activated protein kinase agonist) administered to sedentary mice for 4 weeks induced a muscle ‘endurance gene signature’ and enhanced treadmill running capacity by 44%. Since publication of that study there has been growing scientific and commercial interest in the identification of bioactive oral compounds that mimic or potentiate the effects of exercise, so-called exercise pills or exercise mimetics. This pursuit has been driven, in part, by the application of molecular techniques to exercise biology that have provided greater understanding of the complexity of cellular networks involved in exercise responses and increased our knowledge of the mechanisms by which muscle ‘communicates’ with other organs and mediates the beneficial effects of exercise on health. As such, the first part of this talk considers how this myocentric approach has often failed to consider the wide-ranging effects that exercise exerts in tissues and organs other than skeletal muscle. Indeed, it is both perplexing and frustrating to many exercise scientists that the focus of these ‘mimetics’ has been exclusively on promoting mitochondrial biogenesis in skeletal muscle, when there is a much larger and more compelling landscape for the benefits of exercise in humans While the idea of taking a pill (or a ‘polypill’) to acquire the benefits of exercise in the absence of voluntary physical movement and energy expenditure has great appeal for many sedentary individuals who, for a variety of reasons, do not obtain sufficient physical activity to improve their general health, it is also attractive for ‘big pharma’ who view physical inactivity as an ever-growing market to be medicated for profit. As such, the second part of this talk will examine whether an exercise pill is a bio plausible, realistic or desirable goal. It will be argued that exercise training provokes widespread perturbations in numerous cells, tissues and organs, conferring multiple health-promoting benefits, with the multiplicity (and redundancy) of these responses and adaptations making it highly improbable that any single pharmacological approach could ever mimic such wide-ranging effects. Finally, given that some calls for an ‘exercise pill’ stem from a response to the perceived failure of the majority of the population to comply with national recommendation for exercise prescription, the last part of this talk will address potential barriers that underpin the global decline in physical inactivity and novel strategies to overcome them.