# Exercise as it relates to Disease/Strategic creatine supplementation around resistance training to reduce the risk of sarcopenia in older adults

This Wiki page is an analysis of the journal article “Strategic creatine supplementation and resistance training in healthy older adults”, completed by Candow et al, in 2015.

## Background

One of the worst fears among elderly men and women who either live with someone, or live alone, are falls. More often than not, these debilitating falls are the result of an age-related loss of muscle mass and strength, known as Sarcopenia. (1,2) Not only does it cause serious, potentially life threatening injuries, it also dramatically reduces the confidence of the elderly to carry out daily tasks in the fear of falling over. (3) Resistance training has been proven to be an effective retardant of muscle loss in older populations, yet new research is showing that creatine supplementation around these resistance training sessions is having a positive effect on the amount of muscle tissue and strength gained as a result of the training. (1) Therefore, showing that creatine supplementation around resistance training can act as a risk reducer of ongoing Sarcopenia. (1, 4, 5, 6)

## Where is the research from?

The study of “Strategic Creatine supplementation and resistance training in healthy older adults” was undertaken in Canada. (1) There were 3 parties involved;
- Faculty of Kinesiology & Health Studies, University of Regina, Regina, SK S4S 0A2, Canada.
- Human Kinetics, Okanagan College, Penticton, BC V2A 8E1, Canada.
- College of Kinesiology, University of Saskatchewan, Saskatoon, SK S7N 5B2, Canada.

## What kind of research was this?

The study was completed over 32 weeks (3 days per week) in a double-blind, repeated measures format (1), in which participants were randomized on a 1:1:1 basis. These were creatine before, creatine after or placebo before and after training. (1)

## What did the research involve?

The study initially involved a total of 64 males and females 50 years of age or older.
(38 postmenopausal women, 26 men). Males and females were included to increase the applicability and relation of the study to the general public.
However due to time constraints during the study, 25 of the group dropped out, leaving 39 total participants for the study.
39 participants completed the study (22 females, 17 males). 14 male and 16 female were considered Non-Sarcopenic prior to the study, while 6 females and 3 males were considered Sarcopenic.
Conditions for participants undertaking the study (1);
1. No resistance training for 4 months prior to the study.
2. Non-resistance trained individuals only – as they respond better to creatine supplementation and resistance training.
3. Participants were excluded if they had used creatine up to 12 weeks before the study – as aging adults experience ongoing beneficial effects after supplementation ceases.
4. Participants were excluded if they were vegetarian, had pre existing kidney or liver abnormalities, suffered from severe osteoarthritis, or had taken medications that affected their muscle biology up to 12 weeks prior to the start of the study (e.g. corticosteroids).
Participants were instructed not to change their normal daily diet and physical activity levels, or use non-steroidal anti-inflammatory drugs during the study as these factors had the potential to affect protein synthesis.
The participants were randomized into three groups:
1. Creatine Before
2. Creatine After
3. Placebo

## Basic Results

The table below shows pre and post study test measures of leg press strength (kg), chest press strength (kg) and placebo (kg).
| | Creatine Before | Creatine After | Placebo (Training alone) |
| Pre study - Leg Press Strength (kg) | 137.4 ± 55.9 | 144.4 ± 53.9 | 134.6 ± 53.8 |
| Post study - Leg Press Strength (kg) | 174.1 ± 70.4 | 185.2 ± 58.3 | 140.0 ± 35.2 |
| Pre study - Chest Press Strength (kg) | 50.0 ± 35.2 | 43.2 ± 16.3 | 49.3 ± 20.2 |
| Post study - Chest Press Strength (kg) | 65.2 ± 33.6 | 58.9 ± 29.8 | 51.2 ± 16.4 |
| Pre study - Relative Skeletal Muscle Index (kg) | 7.1 ± 1.3 | 7.1 ± 1.2 | 6.6 ± 1.0 |
| Post study - Relative Skeletal Muscle Index (kg) | 7.4 ± 1.6 | 7.7 ± 1.7 | 6.7 ± 1.0 |
Figure 1. Pre and post study measures of tests for leg press strength (kg), chest press strength (kg) and placebo (kg), for Creatine and no Creatine use around resistance training. (1)
It can be seen that resistance training alone made insignificant increases in leg and chest press strength along with relative skeletal muscle index. However, it can be seen that the use of creatine around resistance training maximises the effect that the resistance training has on the exercising muscles. (1) Creatine after resistance training has a slightly better effect on muscle strength and size than before resistance training, possibly due to the increased blood flow to the working muscles allowing improved transport and uptake of Creatine. (1,4,5)

## How did the researchers interpret the results?

The researchers believed that post resistance training creatine consumption had the greatest effect on strength and lean muscle tissue due to the increased blood flow to the skeletal muscle, which results in a greater transport and accumulation/delivery of the creatine immediately post exercise. (1, 5) Even though there was evidence that post resistance training creatine consumption had a greater effect on muscle strength and size, they stated that creatine consumption before or after resistance training would have a greater benefit compared to no creatine consumption at all. (1)

## What conclusions can we take from this research?

Creatine supplementation triggers significantly higher increases in muscle strength and lean tissue muscle mass than resistance training does alone. (1,5,6) After resistance training consumption shows higher increases in these areas, however more research must be done to determine optimal dosage and timing strategies by finding the direct effects of creatine on aging muscles. (1)

## What are the implications of this research?

This research gives the general population that are of 50 years or older, an insight and confidence into the utilisation of creatine supplementation to prevent age related muscle loss, with no unfavourable side effects (1,5). It gives the population a direct outcome from taking creatine, which is to increase strength and lean tissue adaptations made from resistance training, giving the ‘more bang for your buck’ effect. (1,4,5,6)

## Practical Advice

Evidence found in the study and in wider publications, supports the advice to supplement ~8g of creatine immediately after resistance training, to assist in increasing the extent of strength and lean tissue muscle gains. This should not only be done to retard age related muscle loss, but to also make improvements and increases in muscle mass. (1, 5, 6)

## Further information/resources

For a deeper look into Sarcopenia and how it could possibly be treated with creatine supplementation, listed below are a few articles for further reading:
1. Creatine supplementation improves muscular performance in older men - Gotshalk et al. 2001.
2. Timing of creatine or protein supplementation and resistance training in the elderly - D, Candow and P, Chilibeck. 2008.
3. Effects of creatine supplementation on performance and training adaptations. - Kreider, B.R. 2003.

## References

1. Candow, D., Vogt, E., Johannsmeyer, S., Forbes, S. and Farthing, J. (2015). Strategic creatine supplementation and resistance training in healthy older adults. Appl. Physiol. Nutr. Metab.
2. WebMD. (2016). Sarcopenia With Aging. [Online] Available at: http://www.webmd.com/healthy-aging/sarcopenia-with-aging [Accessed 23 Sep. 2016].
3. International Osteoporosis Foundation. (2015). What is Sarcopenia? [Online] Available at: https://www.iofbonehealth.org/what-sarcopenia [Accessed 23 Sep. 2016].
4. Gotshalk, L., Volek, J., Staron, R., Denegar, C., Hagerman, F. And Kraemer, W. (2001). Creatine supplementation improves muscular performance in older men. Medicine & Science in Sports & Exercise.
5. Candow, D. and Chilibeck, P. (2008). Timing of creatine or protein supplementation and resistance training in the elderly. Appl. Physiol. Nutr. Metab.
6. Kreider, B.R. (2003). Effects of creatine supplementation on performance and training adaptations. Molecular and Cellular Biochemistry. Vol 244, Issue 1, PP 89-94.