Exercise Shown to Reduce Artery Hardening After Weight Loss in Adults With Obesity
Key Takeaways:
- Regular exercise after weight loss significantly reduces inflammation and improves blood vessel health in adults living with obesity.
- The GLP-1 receptor agonist liraglutide helped participants maintain weight but did not show the same protective effects against artery hardening.
- Researchers emphasise exercise as an essential factor for maintaining cardiovascular health after weight reduction.
Exercise and heart health after weight loss
Maintaining weight loss through regular exercise, rather than relying solely on the glucagon-like peptide-1 receptor agonist (GLP-1RA) liraglutide, appears to protect against atherosclerosis in adults living with obesity, according to new research from the University of Copenhagen. Atherosclerosis—hardening and narrowing of the arteries due to inflammation and fat deposits—is a major underlying cause of cardiovascular disease (CVD).
The findings were presented at the Annual Meeting of the European Association for the Study of Diabetes (EASD) 2025 in Vienna (15–19 September).
“Our findings reveal that regular exercise is crucial to helping people living with obesity get the full cardiovascular benefits after a substantial weight loss,” said Dr Rasmus Sandsdal, lead author of the study from the University of Copenhagen, Denmark.
Understanding the risk
Cardiovascular disease remains the leading cause of death globally. It often begins with atherosclerosis, in which chronic inflammation and lipid accumulation cause the arteries to stiffen and narrow. If left unchecked, these plaques can rupture and trigger life-threatening events such as heart attacks and strokes.
Obesity contributes to chronic low-grade inflammation and endothelial dysfunction—a condition in which blood vessels lose their ability to contract and relax properly—both of which accelerate atherosclerosis.
While both exercise and GLP-1RAs are known to lower cardiovascular event risk in people with obesity, their specific effects on the development of atherosclerosis during weight loss maintenance have remained unclear—until now.
The study design
The Danish research team conducted a randomised placebo-controlled trial involving 215 adults aged 18–65 years (63% female) living with obesity (BMI 32–43 kg/m²) but without diabetes or other serious chronic conditions.
All participants began an eight-week low-calorie diet (800 kcal per day) using the Cambridge Weight Plan. Of these, 195 participants who achieved at least a 5% reduction in body weight (average loss of 12% or 13.1 kg) entered a one-year maintenance phase. They were randomly assigned to one of four groups:
- Exercise (150 minutes/week of moderate-to-vigorous activity) plus placebo
- Liraglutide treatment (3.0 mg per day)
- Exercise combined with liraglutide
- Placebo only
Researchers measured several key biomarkers at three points—before dieting, at the start of weight maintenance, and after one year. These included inflammatory markers (interleukin-6 [IL-6] and interferon-γ [IFN-γ]), endothelial function markers (intercellular adhesion molecule [ICAM-1], vascular adhesion molecule [VCAM-1], and tissue plasminogen activator [tPA]), and carotid artery intima-media thickness [cIMT], an indicator of arterial wall health measured by ultrasound.
Exercise reduced inflammation and improved arterial health
After one year, participants in both the exercise and liraglutide groups successfully maintained their weight loss. However, significant differences emerged in their cardiovascular health profiles.
Those who exercised—whether or not they also received liraglutide—had notably lower levels of inflammatory biomarkers compared with non-exercising participants. On average, IL-6 levels were 21% lower, and IFN-γ levels were 27% lower.
Exercise also had a favourable effect on endothelial function, reflected in a 6% reduction in VCAM-1, 8% reduction in ICAM-1, and 12% reduction in tPA compared to those who did not exercise. Moreover, carotid artery thickness decreased by an average of 0.024 mm, indicating reduced arterial hardening.
In contrast, treatment with liraglutide alone did not yield any measurable improvements in inflammatory or endothelial biomarkers, nor did it affect carotid artery thickness.
“Regular exercise seems to confer a protective effect against the development of atherosclerosis in people trying to maintain weight loss,” said Dr Sandsdal. “Since both exercise and GLP-1RA treatment were successful at keeping weight off, it seems that exercise plays an important role in mitigating cardiovascular risk factors in a weight-independent manner.”
Implications for long-term health
Exercise offers multiple benefits beyond weight control, including improvements in body composition, cardiorespiratory fitness, and metabolic health. Together, these contribute to better long-term cardiovascular outcomes.
“The most important message from our findings is that, for those trying to maintain weight loss, exercise is crucial in improving long-term health,” said Professor Signe Sørensen Torekov, corresponding author from the University of Copenhagen. “Given the substantial societal and economic costs of obesity-related cardiovascular disease, these findings underscore regular exercise as a critical component of weight management and heart health.”
Study limitations and future research
The authors acknowledged several limitations. The study’s sample size was relatively small, and adherence to structured exercise in real-world conditions may be lower than in a supervised trial setting.
Future studies, they suggested, should explore longer-term interventions and evaluate newer GLP-1 receptor agonists—potentially more potent than liraglutide—in combination with consistent exercise to assess whether similar or enhanced cardiovascular benefits can be achieved.
CCH insight:
We have long known that exercise is important for cardiovascular health, so the results of this study should not be a surprise – exercise provides cardiovascular benefits whether or not you are taking a GLP-1 medication. It is also important to remember that GLP-1 receptor agonists are meant to be taken as an adjunct to a healthy diet and lifestyle, including exercise. This is not just about weight management, but also about maximising health benefits and minimising the risk of developing diseases associated with obesity – such as cardiovascular disease.
