The Missing Piece in GLP-1 Care: Habits, Movement, and Occupation

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Transcript

New and seasoned OTs are finding their calling in pelvic health. After all, what's more ADL than sex, peeing, and poop? But here's the question. What does it take to become a successful, fulfilled, and thriving OT in pelvic health? How do you go from beginner to seasoned and everything in between? Those are the questions, and this podcast will give you the answers. We are inspired OTs. We are out of the box OTs. We are pelvic health OTs.

I'm your host, Lindsay Vestal, and welcome to the OTs in Pelvic Health Podcast. 

Hey everybody, welcome back to the OTs in Pelvic Health Podcast. I was just realizing that this is episode number 157, and I have to admit, I don't often look at the number of episodes that we're on just because I am much more tuned into topics and trends and patterns and what are the things that our community really wants to hear about, and I just kind of hit refresh on my screen and took a step back and looked at the details, and I was like, wow, I cannot believe we're up to episode 157.

It has been such a pleasure to be on this podcast journey with you, and I just want to thank, first of all, you, the listener, for being on this roller coaster ride that is podcasting. I so appreciate every episode you listen to. I love when you share it on social media and tag me.

It helps other people learn about the podcast. I really want to thank every single interview, every single guest I've had on this podcast. You're a wealth of knowledge and so brave, and I just so appreciate all that you contribute to helping our community grow.

Okay, that aside, I want to talk today about something that you may be hearing more and more about these days that really is all over every news outlet, and that's GLP-1 meds, and I started reading some more research papers about this topic, specifically how it impacts us as pelvic floor therapists, and so today's article is really going to be referencing an article called Transforming Care, Implications of Glucagon-Like Peptide-1 Receptor Agonist on Physical Therapy Practice. Now, this article was published very recently. It was published April 30th, 2025 within the Physical Therapy Journal, and I know we're going to keep seeing more and more information come out about this topic.

I don't think it's going anywhere, and so I don't think this will be the last episode where we're talking about it. Now, if you want to do a deeper dive into this topic, the amazing Michelle Lyons is putting together a topic called GLP-1s, What Pelvic Rehab Providers Need to Know, this Friday, January 16th. It's being presented by Pelvic Floor University.

Everything Michelle does and Pelvic Floor University does is amazing, so if you want to do a deeper dive into this conversation, definitely check that out. If you're listening to this after the event happened, go over there, check it out. I bet they have some options available.

Okay, without further ado, let's talk about GLP-1 meds and movement, what OTs and PTs need to know for long-term success. Now, it's definitely going to be coming across our caseloads more and more. Things like Ozempic, Wegovi, Monjaro, they're all being used by a growing number of our clients for weight loss and diabetes management.

There's also a subset of our clients who are using micro-dosing of this medicine for things like inflammation, substance abuse, the list goes on and on. So I want to say that while there is a prescriptive dose for weight loss management and diabetes management, you're also going to see a subset of your population that are micro-dosing this peptide for other reasons. I'm going to put that on your radar and we're going to talk more about that and why that's relevant.

So here's the thing, when medication ends, the movement habits must continue. And that's really where we shine as pelvic floor therapists. So in this episode, we're going to talk about what these meds are and how they work, common side effects that impact our therapy plans, and most importantly, how we can use behavior change, movement, and occupation to support long-term outcomes.

Okay, let's get into it. So what are GLP-1 agonists? They are a receptor agonist, which are a class of meds that basically mimic a natural gut hormone. So what they do is help regulate blood sugar, increase insulin, slow down digestion, and reduce appetite cravings and what clients often refer to as food noise.

And they work. People lose 15 to 20 percent of their body weight on average when they're using it at the full dose. They feel fuller longer.

They will tell you they're snacking less. They're just less interested in food. But here's the catch.

These medications were never meant to work alone. They're designed to be used along what we know best as occupational therapists, which are lifestyle changes. So addressing movement, routines, healthy eating, all of that really important adjunct that's completely in our wheelhouse.

So as rehab professionals, we often work with clients who live in bodies that are impacted by obesity, diabetes, chronic fatigue, joint pain. And while GLP-1s reduce weight, they don't automatically rebuild muscle, fix joint degeneration, or rewire daily habits. And so that's where we step in, because most often their prescriber, the person who put them on GLP-1s to begin with, are most likely not talking about these habits and how rebuilding muscle and moving are absolutely critical in the success of using these meds.

So our role is to help our clients preserve muscle mass, because when you have a huge amount of weight loss, very often muscle mass decreases, which means they're not as strong, right? Their muscles aren't as intact and as full of integrity to be able to support them. Our role is to support new routines that outlast the medication. This is going to make a little bit more sense in a moment.

And of course, empower clients to stay consistent through the ups and downs. So weight loss is not the finish line. It's the invitation.

What happens after is where we help our clients thrive. So let's talk a little bit about side effects, not to scare anyone, right? But just to equip ourselves so we understand our role even better. First up, muscle loss.

So GLP-1s can lead to a loss of lean muscle, especially if clients aren't intaking the right amount of protein. Again, I don't think most prescribers are talking about diet and the impact. They're most likely just prescribing the peptide and then not talking about the role of protein.

Again, this is where we're going to shine. This impacts strength, endurance, balance, and glucose regulation, right? So incorporate resistance training with these clients, educate them on protein needs, and pace progression to avoid injury. 

Number two, GI issues and low energy.

A lot of clients are going to experience nausea, constipation, and potentially fatigue, especially during the first four to eight weeks of dose escalation. So our role here is to grade activities, to normalize rest, to have really concrete conversations around constipation. Maybe they had constipation before they went on GLPs, maybe they didn't, but likely now this is an incredibly relevant conversation because while their food cravings have been tamper has been have been reduced, likely so has their desire to drink water.

So if the medicine already is setting them up for constipation, certainly decreased water is doing the same. So talking about fiber, having them do fiber logs, talking about water and water consumption, and really tracking these things. Because again, if their body isn't telling them to drink and eat fiber and protein, this is really where our knowledge is going to help them so much in not only helping them reach their goals, but not develop new side effects that will be very unpleasant.

So here is where we also use motivational interviewing to really meet them where they are. Ask them, right? How does your body feel today? Ask them to ask themselves that every single day. Also, what's one small movement that feels doable for you today, specifically from a strength-based perspective, because we really want them putting on lean muscle.

So these questions invite autonomy, they invite connection, which are two pillars of behavioral change, which is our superpower. This is really where OTs shine, right? Helping people build healthy habits around what matters most to them. And GLP-1 meds create a window where maybe they're really receptive to new changes, maybe the food noise is lower and engagement is higher.

Very often though, it can be temporary. And so what stays is the routines, the movement patterns, and the habits that we help them create for a lifelong healthy relationship to their body. So use motivational interviewing.

Ask them, what's your why beyond the number on the scale? Definitely layer in habit stacking, right? Pair any new behaviors with existing routines. Grading, start small, build up, help them build in slow sequential steps so that becomes a lifelong habit. And then always lean on self-monitoring tools, things like journaling, movement logs, or reflecting in sessions with our clients.

Because remember, when the meds fade, the habits remain. And that's really what our legacy is as therapists, helping them become addicted to the healthy habits. So here are some things that you can integrate right away.

Update your intake forms to ask about GLP-1 use. Screen for muscle loss or fatigue and have concrete conversations with your clients about why that might be happening and the impact it can have on their overall health goals. Educating clients on safe movement, appetite changes, and realistic expectations.

If we need to go in even further, recognize it always takes a village, so get to the amazing, healthy, incredible dietitians or wellness coaches for nutrition support in your area and absolutely coordinate with primary care or whoever their prescriber is to keep them in the loop. Another great option for interdisciplinary care is potentially if you think a client needs to work with a mental health professional for body image, motivation, or food-related trauma, remember the GLP-1 therapies are a tool, but your client's real transformation happens in the day-to-day choices that we help them make. And most importantly, keep it client-centered.

Ask your client, what's working for you right now? What's feeling harder to you since you started the meds? What's a small win you've had this week, right? These questions build motivation from the inside out, especially if we're working on new habits with them. Now, in terms of long-term success and habit formation and goal-setting, many of our clients up to 50% stop GLP-1 meds within a year. And in that scenario, many times appetite, cravings, and weight rebounds.

And so this is where when we support behavioral consistency, really reinforce routines and provide a function-focused therapy session, clients will see less rebounding, right? So when that medication ends, the movement habits must continue. And again, this is really where we shine. Remember that 90% of people with obesity have a musculoskeletal condition, and 58% of people with diabetes have a musculoskeletal condition or a dysfunction.

So while GLP-1s may reduce body weight, the weight loss alone doesn't really fix the muscle loss, the tension rigidity, joint degeneration, fatigue, and low injury. So I want to briefly talk about GLP-1s and inflammation and how their role basically reduces systemic inflammation. So obesity, type 2 diabetes are pro-inflammatory states, meaning the body exists in a constant state of low-grade inflammation.

And GLP-1s have been shown to lower markers of inflammation. So both CRP, C-reactive protein, interleukin 6, as well as tumor necrosis factor alpha. These effects seem to be independent of the weight loss, suggesting that the meds themselves affect inflammation pathways by improving insulin sensitivity, which reduces the overall metabolic stress.

It also decreases oxidative stress, which is a key driver of inflammation. It also modulates the immune system, thereby reducing pro-inflammatory cysticine activity. And then it improves the gut barrier function, which may reduce endotoxin related inflammation.

And so this is also why many folks are going on it in a micro dose level, right? A lot of our clients already have a decent amount of inflammation. And so their functional medicine practitioners, their prescribing practitioners are putting them on for those reasons as well. However, these clients are also seeing many of the side effects that we talked about earlier in this episode with the full dose.

So while overall it could help a lot of their pelvic pain and dysfunction, the chronic constipation, the constipation could still be there and some of the other side effects that we talked about. So that's why I was encouraging you to put it on your intake form, make sure that you're having these conversations with our clients. Because it's helping to reduce inflammation, right? They may actually report less pain and better energy that they can move with greater ease and recover faster.

There's also a significant amount of mental health impacts that we're seeing. Our clients are talking about less fog, less mental fog, more mental clarity. They're talking about emotional regulation and their capacity for taking on bigger challenges.

So there is a lot of positive that we're seeing from our clients in terms of the impacts of inflammation. So using this window while our client are on these meds to build movement routines, support their behavioral change and address function-based goals with less inflammatory interference is huge. So reinforcing our role in supporting sustainable lifestyle changes, monitoring functional changes as the inflammation decreases and collaborating with providers to really support whole person care.

So in closing, GlP1s are absolutely changing the landscape of chronic disease management. I think we're going to see more and more and more, but remember that they're not magic. They open the door and as rehab professionals, we help people walk through that door and keep moving forward.

We have a unique opportunity to preserve function and improve it, support sustainable habit change and really empower lifelong health beyond the prescription pad. So whether your client is just starting the medication, is in the thick of side effects or be beyond all of that, we have a role to play because when the medication ends, the movement habits need to continue. The healthy relationship with food and movement and habits continue and that's where we shine.

Thank you so much for joining me today. If this episode helped you reframe your role, share it with a colleague. As always, keep showing up for your clients and yourself with compassion, creativity and care.

And just another quick shout out to the chat that Michelle Lyons is leading through Pelvic Floor University on Friday, January 16th. I'm sure she'll dive even more into this incredible topic. All right.

See you all next time. Thanks for listening to another episode of OTs and Pelvic Health. If you haven't already, hop onto Facebook and join my group, OTs for Pelvic Health, where we have thousands of OTs at all stages of their pelvic health career journey.

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