Background
Obesity Management Medications (OMMs) are reshaping both weight and health management, yet exercise remains inconsistently integrated into patient care. Despite this, the perspectives on exercise uptake and meaningful outcomes from both people with lived experience (PLEs) and healthcare providers (HCPs) are rarely examined. We aimed to explore both perspectives to inform the design of a randomised controlled trial (RCT) investigating the effects of exercise training in people taking OMMs.
Methods
A generative co-design framework was applied with 10 people living with obesity receiving OMMs for weight management (90% F, 56 ± 7 years) and 6 HCPs (3 doctors, 1 endocrinologist, 2 advanced nurse practitioners), incorporating i) ‘framing the issues’ with individual semi-structured interviews, and ii) ‘generative design’ through iterative sharing of ideas. Sessions were audio-recorded, transcribed and key determinants and considerations were discerned by two independent researchers.
Results
PLEs initially viewed exercise as a weight loss tool, a framing previously found ineffective. HCPs instead centred their narrative on muscle preservation, fall prevention and fracture risk. HCPs diverged on exercise timing: some prioritised immediate exercise commencement, others delayed starting until pain or comorbidities were better controlled or early weight loss occurred, leaving PLEs to navigate exercise independently. Both groups identified the word “exercise” as stigmatising, though from opposite perspectives. PLEs through fear of injury, pain and negative exercise experiences, HCPs attempted to counteract this by reframing exercise as an incidental, enjoyable activity. Key design features drawn into the RCT included progressive exercise support, stigma-aware program design, patient-important outcome measures, opportunities to experience exercise success, and improved health literacy about the role of exercise with OMMs.
Conclusion
PLEs' and HCPs' exercise perceptions converged on key topic areas but diverged on the rationale behind them. This alignment points to a muscle-literate, stigma-aware, individualised, achievable program as the design priorities. Integrating these findings has become a valued contribution to our RCT design.