Creatine and Weight Training for Older Adults

Creatine supplementation during resistance training in older adults-a meta-analysis. Devries MC, Phillips SM. Med Sci Sports Exerc. 2014 Jun;46(6):1194-203.

Abstract
INTRODUCTION:
Age-related sarcopenia and dynapenia have negative effects on strength and the ability to perform activities of daily living. Resistance training (RT) increases muscle mass and strength in older adults and is an established countermeasure for sarcopenia and dynapenia, and creatine may enhance this effect. We aimed to determine whether the addition of Cr to RT increased gains in muscle mass, strength, and function in older adults over RT alone by conducting a systematic review and meta-analysis.

METHODS:
PubMed and Healthstar databases were searched. Randomized, placebo-controlled trials that involved older adults supplemented with Cr and included RT regimens (>6 wk) were included. Data was analyzed using fixed or random (if data were heterogeneous) effects meta-analysis using RevMan 5.

RESULTS:
The meta-analysis comprised 357 older adults (average ± SD Cr: 63.6 ± 5.9 yr, Pl: 64.2 ± 5.4 yr) with 12.6 ± 4.9 wk of RT. Cr + RT increased total body mass (P = 0.004) and fat-free mass (P < 0.0001) with no effect on fat mass as compared with RT alone. Cr + RT increased chest press (P = 0.004) and leg press (P = 0.02) one-repetition maximum to a greater extent than RT alone, with no difference in the effect on knee extension or biceps curl one-repetition maximum, isokinetic or isometric knee extension peak torque. Cr + RT had a greater effect than RT alone on the 30-s chair stand test (P = 0.03).

CONCLUSION:
Retention of muscle mass and strength is integral to healthy aging. The results from this meta-analysis are encouraging towards supporting a role for Cr supplementation during RT in healthful aging by enhancing muscle mass gain, strength, and functional performance over RT alone; however the limited number of studies indicates further work is needed.

My comments:
I do a lot of work with older adults, and just about every study that looks at performance measures after surgery, risk factors leading to surgery, back pain, risk factors for falls, and risk factors for developing arthritis all seem to center on lack of muscle mass and muscle strength as being one of, if not the most, important factors. As such, my patients pretty much all lift a lot of weights. There’s not a lot of massage, stretch bands, or swiss ball action going on in my gym. Even my pain management modalities increase muscle mass.

Ever since writing one of my favorite blogs showing how caloric restriction preserves muscle mass with aging, which is the opposite of what I would have expected, I have been increasingly interested in dietary changes to help with recovery. One might respond, “What’s the deal Chad? You’re not a registered dietitian, why are you giving dietary advice?” Well, mainly because in the 16 years I have been a physical therapist I can count on one hand the number of patients of mine for whom insurance covered a visit to a registered dietitian. If they actually got a visit, it was usually only one, of which they got a diet that was too complicated to follow anyway; nor did a single one of them came back with information about creatine monohydrate, protein supplementation, or intermittent fasting. So now I figure that’s up to me, and that’s what the research seems to be supporting as the cutting edge for a number of conditions, and for general health as well. Mixing the best of nutrition/supplements without being referred to a number of different specialists, who all disagree with one another, is an example of what “integrative medicine” ought to be; as opposed to what integrative medicine generally is, which is a rebranding of ineffective alternative medicine treatments blended with real medicine, so you can’t tell the difference.

This meta-analysis pooled the results of 10 other studies, some of which found creatine combined with resistance training helped, while some didn’t. Overall, the results were in favor of creatine supplementation significantly  increasing total body weight 1.00 kg, significantly increasing lean tissue 1.33 kg, and there was a trend towards losing fat of 0.36 kg, all in an average of 12.6 weeks.  Leg press strength increased 3.25 kg, chest press 1.74 kg,  and function per a 30-s chair stand test of 1.93 stands, all in comparison to subjects on the same exercise program but taking a placebo supplement. Average dose was 5.0 grams of creatine per day, and six of the 10 studies had them load for 18.9 grams per day for the first week. Nine of the 10 studies had them train three days per week, and 8/10 were whole body programs. Two of the 10 studies were women only, four were men only, and four were men and women combined.

They did talk about factors that they thought might contribute to some studies finding a significant effect, while some didn’t.  From the data, they could not tell that differences in exercise intensity as a factor, but they did note that in five trials where carbohydrates were not administered with the creatine, that four did not show positive effects. These notes, to me, show that taking carbohydrates with your creatine might be an important factor. This is interesting to me because I never take my five grams per day with carbs, and they did cite a paper where co-ingestion of carbohydrates increased muscle uptake and decreased excretion. If I recall correctly, the idea is that taking carbs with your creatine spike your insulin levels which then help transport creatine into the muscle cells where it does it’s good. This is a bit of a dilemma for me because I workout at noon and don’t eat any calories till 5-6 pm per my current intermittent fasting protocol, and taking your creatine, which is calorie free, right after a workout is also supposed to help muscle uptake of creatine. What I am most likely going to do is take a jug home so I can take my creatine with my evening meals on rest days, and keep a jug at work to take after training on workout days. As much as I like the creatine, I like intermittent fasting more, so I don’t intend to change my eating schedule.

Overall, the dose of five grams per day sounds right, the results are well in line with the many studies looking at the use of creatine in younger weight trainers and athletes, in line with another paper I reviewed that found creatine helped Parkinson’s patients, and are in line with what I used to do on the weightlifting team at NAU when I first discovered creatine. Back then I loaded on just nine grams a then maintained on three grams and still gained 11 lb, so I kind of feel like loading with 25 grams is overkill. If you ask me, 15 grams loading for a week is probably plenty. That said, creatine is cheap, with my favorite brand Creaform now with a kilo costing just $30-40 a kg. That’s not bad for a >six month supply, even if you waste some.

Also interesting from the introduction, was the mention that protein supplementation was also likely helpful to aid strength and muscle gains. They cited a study, however, that said maximal muscle synthesis in older adults required a dose of 40 grams of protein as opposed to 20 grams in younger people, so I’ll be having to look up and read that paper. I swear every paper read leads to an average of five more to look up. Just found it, just printed it…

As always, if you have any further questions or need for clarifications, please don’t hesitate to ask. Being aware that some of my blog ideas are contentious and occasionally a bit out of the field of my expertise, I encourage my readers to come forth with any questions/comments that are of interest or concern. Your comments are valued and welcomed.

Chad Reilly is a licensed physical therapist, located in North Phoenix, practicing science based medicine with treatment protocols unique and effective enough to proudly serve patients from Phoenix, Scottsdale, Mesa, Chandler, Tempe, Peoria, and Glendale.

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