Adding creatine to resistance training in older women

This article is part of our special edition Healthy Aging from May 2022. Download the full edition here.

reference

dos Santos EEP, de Araújo RC, Candow DG, et al. Effectiveness of creatine supplementation in combination with resistance training on muscle strength and muscle mass in older women: a systematic review and meta -analysis. nutrients. 2021; 13 (11): 3757.

study goal

Determination of the influence of creatine and resistance training on muscle strength and mass in older women through systemic review and meta -analysis

Key to take away

Supplementation with creatine is a promising and safe intervention to support resistance training in older women to reduce dynapenia.

draft

Systematic review and meta -analysis

participant

In the systematic review, the test doctors included 10 randomized controlled studies. The number of participants was 211. The investigators initially identified a total of 543 studies and 2 additional studies from gray literature, but only 12 fulfilled the suitability criteria after the screening.

The studies met the criteria if they only compared creatine (in contrast to a combination of ingredients) and resistance training with placebo in older women (over 60 years) and used the result dimensions of muscle strength and/or muscle mass.

Studies that did not contain a placebo control group were excluded, as were a study that recruited patients with neurodegenerative diseases. Two further studies were not evaluated in meta -analysis due to the lack of access to the raw data.

study parameters evaluated

As far as the quality of the evidence is concerned, the researchers assigned a pedro score to any study included in the analysis. The values ​​ranged from 6 to 9 with an average pedro value of 7.7. Pedro scores refer to the Physiotherapy Evidence Database and are evaluated with values ​​between 0 and 11, where 11 represents the highest quality of evidence. A high imprecision was found in the meta-analysis, and the quality of the evidence according to the degree (Grading of Recommendations, Assessment, Development and Evaluation) was low, which indicates a limited trust in the effect size. Large confidence intervals and sample scale of less than 300 contributed to this quality assessment.

The risk of bias has been minimized because studies with low pedro scores were not used, and a publication bias due to the use of fewer than 10 studies was not seen in this analysis.

important knowledge

Overall, creatine significantly increased the upper body (7 studies with 142 participants [ p = 0.04]), but had no effect on the power of the lower body or the muscle mass of the upper or lower body. However, if studies had a period of more than 24 weeks, both the upper body ( p = 0.05) and lower body ( p = 0.03) were increased in the creatine groups, in turn without significant changes in muscle mass.

transparency

as disclosed by the authors: "DGC carried out research on creating supplementation sponsored by industry, creates creative donations for scientific studies and travel support for presentations for creating supplementation at scientific conferences. In addition, DGC is a member of the scientific advisory board of Alzchem (a company that creates creatine). Creatine sold. “

Effects and restrictions in practice

increased risks for disabilities, frailty and falls are relevant for aging patients, partly due to the physiological and functional deterioration associated with sarcopenia, which includes the loss of muscle mass and strength.1 Dynapenia is especially the loss of muscle strength.

The improvement of the strength and the increase in muscle mass also have metabolic advantages, including combating insulin resistance. These 2 advantages alone support the recommendation of resistance training in aging patients. ^{2 Another promising advantage of resistance training is the support of the mitochondrial function within the muscle cells, which also decreases with increasing age.}

physical activity and movement are established countermeasures against muscle ancillary and the consequences of age -related acceptance of muscle mass, strength and regeneration ability as well as impairments of muscle metabolism. 4 The maximization of this effect by additional nutrition, lifestyle or additional support is often a strategy used by clinicians for integrative medicine. Creatine (creatine monohydrate) is a considerable intervention.

Both in primary care and in specialized facilities, the use of creatine often triggers discussions about security, especially in terms of kidney and liver function. In a statement by the International Society of Sports Nutrition, however, a review of the available evidence suggests that both a short-term and a long-term nutritional supplement from healthy people is safe and well tolerated. ^{5 This review also came to the conclusion that older adults tolerate a creatine supplementation well.}

dynapenia is especially the loss of muscle strength. ”

Most studies that evaluated creatine supplementation do not report unwanted events, even if the kidney and liver function have been assessed.

An earlier systemic review and meta -analysis came to the conclusion that postmenopausal women can use additional creatine. ⁹ In the awareness of their own responsibility towards the individual patient, the doctor can trust in security through surveillance with liver function tests (old [alanine aminotransferase] AST [Aspartate aminootransferase]) and kidney function tests (BUN [Blood urea nitroogen], creatinine). The individualization of patient management requires the doctor's judgment.

For older women, the recommendation of resistance exercises 2 to 3 times a week with compound or multi -joint movements such as breast press, bench press, leg press and hack squat is a relevant intervention. Statistical significance for the force was achieved in this meta -analysis of creatine plus resistance training, but the effect size only has a limited trust. Therefore, it is a bit difficult to understand a patient how much creatine's addition can help and whether it is worth developing a new habit.

In the studies included in this review, the dosage of creatine of 5 g daily (typical preservation dose) daily for 5 to 7 days, followed by 5 g daily or a weight-based dosage of 0.1 g per kg daily (for a 150 pound person, this corresponds to 6.8 g). Optimal or preferred dosage was not determined.

From this overview, it can be seen that the greatest muscle power advantage indicates a training period of more than 24 weeks, but some advantages in relation to the power of the upper body can be reached in just 12 weeks. Perhaps the most relevant clinical implication from this systematic overview and meta -analysis is that the monitoring of the progress of resistance training and a creative cure in older women should concentrate on muscle strength and not on muscle mass. Improvements in the upper body power are probably noticed earlier than the lower body force. Similar examinations in older adults previously indicated improvements to both muscle strength and muscle mass, but these examinations included both men and women. ^{8 The addition of creatine to strength training recommendations in older women is promising, but is still largely based on the patient's preference and the individualization of care.}