Have you ever thought something was helping only to find out it might actually be holding you back? That’s the curious case with metformin and exercise in older adults. Metformin is one of the most prescribed medications for type 2 diabetes and is widely used across senior living communities. While it’s often praised for its glucose-lowering effects, research has shown that it works in part by improving insulin sensitivity and reducing hepatic glucose production. Still, new studies are calling attention to how it may interfere with the benefits of exercise, one of the best tools we have for improving quality of life.
In a randomized trial published in Diabetes, Obesity and Metabolism, older adults who took metformin during a structured exercise program experienced less improvement in cardiorespiratory fitness compared to those who exercised without the medication. This supports earlier evidence shared by a Medscape article, which reported that metformin might reduce the insulin-sensitizing effects of exercise in adults at risk for diabetes. That’s no small concern when both metformin and exercise are commonly used together to support metabolic health.
New findings from the Journal of Clinical Endocrinology & Metabolism add another layer, suggesting the interaction between metformin and physical activity may disrupt mitochondrial function, the energy centers of our cells. When this happens, especially in older adults, it could reduce the muscle-building and endurance benefits typically gained from regular movement. This may help explain why some residents engaged in physical therapy or exercise programs are not showing the expected improvements in strength and stamina.
This doesn’t mean metformin needs to be stopped across the board. But as caregivers, we need to examine whether the medications we’re using are supporting or limiting the outcomes we want. If a resident’s glucose is controlled but their physical performance isn’t improving, it may be time to revisit their care plan. A thoughtful medication review during your next QAPI meeting could uncover combinations that deserve a closer look.
Just as we’ve grown more proactive about reviewing fall-risk-increasing drugs, it’s time we apply that same lens to the interaction between metformin and exercise in older adults. Resident care is dynamic and evolving, and it calls for ongoing collaboration between your medical director, pharmacist, and care staff to ensure that everything in a resident’s plan is working in harmony.
Stay well and stay informed!
