Do metformin and exercise work better together?

In this article:

• Metformin and exercise
• Metformin and athletic performance
• Is exercise required?
• Establishing a routine
• The bottom line

In this article

• Metformin and exercise
• Metformin and athletic performance
• Is exercise required?
• Establishing a routine
• The bottom line

Metformin is one of the most commonly prescribed medications for Type 2 diabetes mellitus, a chronic disease characterized by elevated blood sugar levels (hyperglycemia). It’s very effective for lowering blood sugar by making the body more sensitive to the insulin the body still makes. A side effect is that people taking metformin may lose 2% to 3% of their body weight in the first year of starting the medication, according to Stanford Medicine. Researchers believe that’s because it stimulates the same “anti-hunger” molecule that’s produced after a vigorous workout. Thanks to this effect, it’s increasingly prescribed off-label for nondiabetic weight management and obesity treatment—similar to other diabetes medications, such as Ozempic. If you recently started taking metformin for diabetes or to help manage your weight, you might be wondering whether it’s safe to work out. While there are some caveats, most people experience a range of benefits from pairing consistent movement with this medication.

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Can you work out on metformin?

Not only is it safe to exercise while taking metformin, it’s actively encouraged in most cases. “Metformin and exercise actually complement each other really well when it comes to managing blood sugar, improving insulin sensitivity, and supporting weight loss,” explains Ehsan Ali, MD, internist and founder of Beverly Hills Concierge Doctor. The combination is powerful because metformin treatment and exercise target similar pathways in the body. 

• Exercise improves diabetes symptoms and reduces the risk of diabetes complications, such as high blood pressure. It’s also an essential component of any sustainable weight-loss program. Why? It naturally increases muscle cells’ insulin sensitivity. When your muscles contract, they take in glucose and use it for energy, removing it from the blood.
• Metformin helps improve how cells respond to insulin by improving glycemic control and decreasing insulin resistance. 

Together, they create a one-two punch for managing elevated glucose levels, improving metabolic health, and maintaining a healthy weight. 

Like many other things, when it comes to metformin and exercise, a balanced approach is best. “I usually suggest a mix of both cardio and resistance training,” says Dr. Ali. “Walking, swimming, cycling; those are great starting points. Strength training helps with insulin sensitivity and supports muscle mass, which can be especially important if weight loss is part of the goal.”

Megan Horsham, MD, a medical weight-loss provider at The Sanctuary Wellness Institute, agrees: “Exercise should consist of both cardio and weight-bearing exercise to maximize benefits.” Cardiovascular activity reduces the risk of cardiovascular disease and burns calories, while resistance training builds muscle mass, which increases your metabolic rate even after your workout is finished. By engaging in both types of activities, you can maximize the benefits of taking metformin.

Simply walking 30 minutes a day or doing light resistance training a few times a week is enough to make a significant difference. Once your body has adjusted to the increased activity level, build on intensity or length to continue to reap the rewards of movement.

Does metformin affect athletic performance?

It’s unlikely that metformin will noticeably impact your sweat session. However, according to clinical trials, competitive athletes might experience diminished improvements in how well their muscles use oxygen (skeletal muscle mitochondrial respiration), how fit their hearts and lungs become, or how their bodies respond to insulin after training. 

“For people doing intense strength training or focused on building muscle, previous studies suggest that metformin might slightly blunt some of those gains,” says Dr. Ali. “Still, the impact seems pretty small, and I wouldn’t use that as a reason to avoid the medication, especially if there’s a clear medical reason for being on it.”

If you want to build (or even maintain) muscle mass while taking metformin, proper diet, exercise programming, and adequate rest are key:

• Protein intake: Ensure you’re eating enough protein to fuel muscle growth
• Progressive overload: Consistently challenge your muscles by increasing weight over time
• Adequate recovery: Schedule rest between intense workout sessions, and don’t skimp on the zzz’s.

While most forms of exercise are considered safe while taking metformin, more intense activities like high-intensity interval training (HIIT) classes may require extra monitoring, especially if you’re prone to low blood sugar or dehydration. One of the side effects of metformin is a slightly elevated risk of exercise-induced dehydration, especially with long or intense workouts. So, it’s important to monitor your blood sugar and hydration when adding exercise to the mix.

A dose of metformin doesn’t mean you can’t train hard or achieve real athletic gains, but high-performance athletes and those with other risk factors may want to discuss the risks and any necessary adaptations with their provider.

Do you have to exercise on metformin?

While exercise isn’t required when taking metformin, it’s strongly encouraged and highly beneficial. “Metformin can absolutely work on its own to lower blood sugar, but adding exercise tends to improve results across the board,” explains Dr. Ali. “Think of metformin as one tool in the toolbox; exercise makes it more effective and supports overall health.”

According to medical professionals, those who rely solely on medication without making lifestyle changes are more likely to reach a plateau or regain weight over time. The combination approach—medication plus lifestyle changes—tends to produce more sustainable, long-term benefits.

If you’re unable to exercise due to physical limitations, the medication can still help achieve a healthy glucose tolerance and body mass index (BMI). However, adding even gentle movement, such as walking, gardening, or swimming, will enhance results and benefit overall health.

Combining metformin with exercise for weight loss

Creating a sustainable routine that you can stick with is the key to successfully combining metformin with exercise for weight loss. To do this, follow these tips:

• Prioritize consistency over intensity: Moderate exercise five days a week will lead to more benefits than short bursts of exercise, or hitting the gym intensely twice a week while taking it easy all the other days. 
• Focus on sustainability: If you’re new to exercising, begin with activities you enjoy and can realistically repeat multiple times per week, like taking walks with friends or family or playing fetch with Fido. If you’re already active and engaging in cardio sessions, consider adding resistance training to your weekly schedule. Pay attention to how your body feels, and increase weight or exercise intensity when you feel you reach a new baseline. 
• Combine different types of exercise: While the right amount and level of physical activity will vary person to person, including both aerobic exercise and strength training will help you maximize the crossover benefits of movement while maximizing the effects of metformin. As a general guideline, aim for at least 150 minutes of moderate-intensity cardio per week, plus two strength training sessions. Keep in mind that your current fitness level, other health conditions, and specific goals all influence which workouts you should do and at what intensity, so it’s crucial to listen to your body and pay attention to how you feel during and after exercise training. 
• Monitor your blood sugar: Dr. Ali recommends watching for lightheadedness, shakiness, or fatigue, which are the symptoms of a drop in blood sugar. The best approach to monitoring blood sugar during a workout depends on your diabetes status and other medications. “If you are diabetic and using other diabetic medications such as a sulfonylurea, then closer attention must be paid to blood sugar as these medications together may decrease blood sugar,” explains Dr. Horsham. If you’re doing longer or more intense sweat sessions, a quick blood glucose check before and after a workout can give helpful feedback, especially in the first few weeks of building an exercise regimen. Most insurance companies will not pay for a glucose machine for patients unless they are on insulin. Consider buying a glucose monitoring kit or a continuous glucose monitor if you’d like to monitor your blood sugars more closely. 
• Adjust your metrics: Dr. Horsham notes that metformin may temporarily cause a slight increase in heart rate. While this generally isn’t cause for concern, it’s a factor that should be considered if you use heart rate zones to dictate the intensity of your workouts.

Given the importance of staying active while taking metformin, it’s smart to discuss any concerns you have with your healthcare provider, including how often you should exercise, which activities you engage in, and whether or how you need to monitor your vitals or blood sugars while engaging in those activities.

The bottom line

When done together, the effects of exercise and the glucose-lowering effects of metformin can go a long way in managing blood sugar, supporting mitochondrial function, and managing diabetes care. For most people, not only is it safe to exercise while taking metformin, but doing so enhances blood sugar control and supports weight management more effectively than metformin alone or exercise alone. Whether you’re a beginner or an avid gymgoer, start with activities you can maintain consistently. Even small changes like daily walks or light resistance exercise can provide meaningful benefits.

Sustainable lifestyle adjustments and realistic expectations will take you farther than short-term efforts: Weight loss on metformin can be gradual, so set realistic expectations for your journey and stick with the type of movement that works for you. “It’s not about doing the most, it’s about doing what’s right for your body,” says Dr. Ali. Whether you’re just starting your fitness journey or continuing it while taking a new medication, metformin and exercise can work together safely and synergistically to fuel weight loss. If you have any concerns, don’t hesitate to discuss with your healthcare provider.