+1 to COA_Karl. Especially the point about "Re: Swimming as primary cardio on — the ..." — I have seen the same in my own experience with Swimming as primary.
Want to share my personal experience related to Swimming as primary cardio on since I think it might help others in a similar situation.
I started my GLP-1 journey in March 2025 at 264 lbs with metabolic syndrome. My telehealth provider prescribed semaglutide 0.25mg to start.
Now, 12 months later: I am down 44 lbs, my labs have normalized, and my sleep apnea has improved dramatically. The Swimming as primary aspect specifically was something that made a big difference in my journey.
This forum was my go-to resource throughout.
Dr.NephBHM_UK — that is really helpful context on Swimming as primary. Follow-up question: did you change anything about your diet at the same time?
I am in a similar situation (month 2) and trying to set realistic expectations.
To answer FitDadDave's question specifically:
From a clinical standpoint, Swimming as primary cardio on is well-supported by the literature.
The short answer: follow the standard titration protocol and reassess at 4-6 weeks.
The longer answer involves pharmacokinetic considerations around steady-state concentrations, which I am happy to elaborate on if helpful.
Saving this for reference. Top-tier content.