Introduction: Cachexia is a syndrome characterized by body weight loss, muscle wasting, and metabolic abnormalities, that frequently complicates the management of people affected by chronic diseases. No effective therapy is actually available, although several drugs are under clinical evaluation. Altered energy metabolism markedly contributes to the pathogenesis of cachexia; it can be improved by exercise, able to both induce anabolism and inhibit catabolism.Areas covered in this review: This review will focus on exercise mimetics and on their potential inclusion in combined protocols to treat cachexia, with particular reference to the cancer-associated one.Expert opinion: Despite exercise improves muscle phenotype, most patients retain sedentary habits quite difficult to disrupt. Moreover, they frequently present with chronic fatigue and co-morbidities that reduce exercise tolerance. For these reasons drugs mimicking exercise could be beneficial also in the absence of patient compliance to the practice of physical activity. Different exercise mimetics are now available and, yet some of them may exert serious side-effects, investigating their effectiveness on muscle phenotype will provide a new tool for the management of cachexia.4