A major shift is occurring in cancer care. Metabolic health, body composition, insulin resistance, blood glucose, inflammation, cardiovascular fitness, and obesity is increasingly being recognized as part of the cancer treatment equation rather than simply a separate medical issue.
A 2026 review in the Journal of Clinical Oncology, “Metabolic Modulation in Cancer Care: The Potential Role of Glucagon-Like Peptide-1 Receptor Agonists,” provides an important framework for this emerging field. The authors examine evidence suggesting that GLP-1 receptor agonists (GLP-1RAs), already widely used for diabetes and obesity, could eventually have roles in cancer prevention, treatment, prehabilitation, and survivorship.
For Exercise Oncology Programs, the larger message may be even more important: metabolic health, muscle health, nutrition, and physical fitness increasingly need to be managed together.
Obesity and Metabolic Dysfunction Are Cancer Issues
The review emphasizes that obesity, hyperglycemia, insulin resistance, and chronic inflammation can contribute to cancer development and progression. Excess adipose tissue can promote inflammatory cytokines, altered insulin and IGF-1 signaling, angiogenesis, immune dysfunction, and a tumor microenvironment favorable to cancer growth.
GLP-1Ras, including semaglutide and related agents, can improve glycemic control, reduce insulin resistance, and produce substantial weight loss. The authors propose that these metabolic changes may help make the biological environment less favorable to cancer.
Large observational studies have associated GLP-1RA use with reduced incidence of several obesity-associated cancers. Importantly, however, much of this evidence remains observational. The authors repeatedly emphasize the need for prospective randomized trials specifically designed around cancer outcomes.
That distinction matters. GLP-1 drugs should not yet be viewed as established anticancer therapies.
A New Concept: Metabolic Optimization During Cancer Treatment
Perhaps one of the most provocative ideas in the publication is using the period before definitive cancer treatment as an opportunity for metabolic optimization.
The authors describe investigation of GLP-1RAs alongside neoadjuvant therapy in rectal cancer, including a planned randomized trial incorporating semaglutide into total neoadjuvant treatment. Outcomes will include weight change, pathologic complete response, survival, recurrence, and treatment-related morbidity and mortality.
This concept has important parallels with cancer prehabilitation.
Instead of simply waiting for surgery, radiation, or systemic therapy, the weeks or months following diagnosis could become a structured period in which patients improve:
- cardiovascular and functional capacity,
- muscular strength and lean body mass,
- metabolic health and glucose control,
- nutritional status,
- and readiness for treatment and recovery.
Exercise Oncology Programs are ideally positioned to participate in this process.
## The Critical Issue: Weight Loss Is Not the Same as Better Fitness
This publication also raises an issue that Exercise Oncology Programs cannot ignore.
Cancer patients do not simply need to lose weight. They need to maintain, or ideally improve, muscle mass, strength, physical function, and nutritional adequacy while metabolic risk is being addressed.
The review notes evidence that GLP-1RA-associated weight reduction may produce favorable body-composition changes and potentially complement enhanced recovery pathways.
But cancer patients present a particularly complex population. Some may already be experiencing treatment-related muscle loss, inadequate nutrition, frailty, or cachexia. Therefore, intentional pharmacologic weight management cannot be separated from assessment of muscle and functional status.
This is where Exercise Oncology becomes essential.
Resistance exercise, aerobic conditioning, adequate protein and nutritional support, and repeated functional assessment can help ensure that the goal is not merely a smaller number on the scale, but a healthier and more treatment-ready patient.
What This Means for the Organization of Exercise Oncology Programs
This publication supports moving Exercise Oncology beyond the traditional model of simply giving patients an exercise prescription.
The next generation of programs should be organized around multidisciplinary metabolic and functional care.
An Exercise Oncology Program should consider developing pathways that include baseline and longitudinal assessment of body composition, strength, aerobic capacity, physical function, nutritional status, metabolic risk, and treatment-related symptoms. Patients receiving GLP-1 therapy may deserve particular attention to nutritional intake, weight-loss trajectory, muscle preservation, and functional performance.
Programs should therefore build collaborative relationships among oncologists, exercise oncology professionals, registered dietitians, obesity-medicine or endocrinology specialists, rehabilitation professionals, surgeons, and primary-care clinicians.
The objective is not for Exercise Oncology professionals to prescribe GLP-1 medications. Rather, their role should be to make exercise and preservation of physical function integral components of a broader metabolic-management strategy.
This also creates an opportunity for data collection. Exercise Oncology Programs could track weight, body composition, muscle strength, functional testing, treatment tolerance, quality of life, surgical outcomes, and adherence. Such real-world information may become increasingly valuable as GLP-1 therapy moves into oncology research.
An Important Note of Caution
The enthusiasm surrounding GLP-1 drugs should remain proportional to the evidence.
The authors describe encouraging epidemiologic and preclinical findings but acknowledge important uncertainties, including inconsistent cancer-specific findings, tumor heterogeneity, safety considerations, cost, access, and the absence of sufficient prospective trials powered for cancer outcomes.
The review ultimately concludes that GLP-1RAs may eventually connect metabolic health with cancer prevention, adjunctive treatment, and survivorship, but further research is necessary.
The CancerFitness.org Perspective: Exercise + Nutrition + Metabolic Medicine
For CancerFitness.org, this publication reinforces an increasingly important principle:
Exercise Oncology should not exist in isolation.
Cancer care is moving toward a model in which exercise, nutrition, body composition, metabolic health, cardiovascular health, and conventional oncology treatment intersect.
GLP-1 medications may become one component of that model. Exercise remains another, and a particularly important one because improving strength, fitness, mobility, and functional reserve addresses outcomes that weight loss alone cannot.
The future Exercise Oncology Program may therefore look less like a fitness service added after cancer treatment and more like an integrated clinical program beginning at diagnosis and extending through treatment into long-term survivorship.
Call to Action
If you are undergoing cancer treatment or living as a cancer survivor, ask your oncology team not only about your weight, but also about your muscle mass, strength, physical fitness, metabolic health, and nutritional status.
If GLP-1 therapy is being considered or already prescribed, discuss how structured resistance and aerobic exercise and appropriate nutritional support can be incorporated safely into your care.
For cancer centers and healthcare organizations, the message is equally important: build Exercise Oncology into multidisciplinary metabolic cancer care from the beginning.
At CancerFitness.org, we believe the goal should not simply be helping patients lose weight. It should be helping people with cancer become stronger, fitter, metabolically healthier, and better prepared for treatment and long-term survivorship.
Reference: Metabolic Modulation in Cancer Care: The Potential Role of Glucagon-Like Peptide-1 Receptor Agonists. Hugo C. Temperley, MB, BCh, BAO MCh, and Michael E. Kelly, PhD, FRCS. Journal of Clinical Oncology ascopubs.org/journal/jco | Volume 44, Issue 23
