Creatine and resistance workouts combat sarcopenia

Discover how creatine and resistance training are transforming muscle health and cognitive vitality in older adults.

Study: The power of creatine plus resistance training for healthy aging: enhancing physical vitality and cognitive function. Image Credit: TanyaKim / Shutterstock

A recent study published in the journal Frontiers in Physiology advocates combining resistance training with creatine supplementation as a safe and effective strategy for the prevention and treatment of sarcopenia.

Sarcopenia is an age-related musculoskeletal condition characterized by reduced functional ability, muscle strength, and lean mass. It can lead to adverse outcomes, such as a lower quality of life and impaired physical function, and is also associated with cognitive decline in older individuals. Sarcopenia is a reversible condition, and its prevalence increases with age. Various non-pharmacological interventions are available to counteract sarcopenia progression in older adults.

Physically inactive and sedentary older adults have a lower myofibrillar protein synthesis response to dietary protein, which accelerates sarcopenia progression. Further, muscle anabolic resistance related to age becomes more pronounced with moderate/low protein intake, a typical dietary pattern in older populations. The study emphasizes that a daily intake of at least 1.0 g of protein per kilogram of body weight, rich in essential amino acids such as leucine, is essential to maintain muscle protein balance. In this context, the present study advocates combining resistance training with creatine supplementation as an effective strategy to treat and prevent sarcopenia.

Creatine: Essential for Vitality

Around 95% of creatine is present in the skeletal muscle, with the remaining amount found in tissues with high energy demands. It is naturally found in meat, poultry, and fish and endogenously derived from reactions in the brain and liver. The estimated daily requirement of creatine is about 2 g/day for a 70-kg male. Nevertheless, research suggests that endogenous synthesis of creatine may be inadequate under pathological or certain physiological conditions.

Creatine monohydrate gained widespread popularity as a dietary supplement in Europe and the United States (US) following a landmark study in 1992. It has been approved for inclusion in nutritional supplements in several countries, including Brazil, Australia, Canada, Japan, the European Union, and South Korea. Research has demonstrated that creatine monohydrate is effective and safe for humans and older adults.

Creatine monohydrate supplementation can safely improve exercise capacity and training adaptations, regardless of age, sex, and exercise interventions. Supplementation protocols, such as an initial loading phase of 20 g/day for 5–7 days followed by a maintenance dose of 3–5 g/day, have shown consistent benefits in enhancing muscle performance and lean mass. Increasing intracellular creatine levels via supplementation promotes satellite cell activation, reduces protein degradation, and increases lean mass.

The improvements in cellular bioenergetics resulting from creatine supplementation offer benefits beyond the musculoskeletal tissue, impacting the immune system, vascular system, brain, and heart. Furthermore, studies suggest that creatine supplementation can yield clinically more significant effects when combined with resistance training. Recent evidence also indicates a potential role for creatine in mitigating neurodegenerative conditions, though further research is needed to standardize clinical measurements.

Resistance Training

Resistance training is a form of strength training that involves applying various external forces to augment physical capabilities. It has several physical benefits, such as enhanced endurance, power, muscle strength, and bone mineral density. From a clinical perspective, resistance training improves functionality, contributes to cardiometabolic health, and helps prevent mental health issues and neurodegenerative disorders.

Existing guidelines recommend engaging in resistance training at least twice weekly, with training intensities ranging from moderate to vigorous, and the programs should include progressive weight training, with up to 10 exercises targeting major muscle groups and 8–12 repetitions per exercise. Studies suggest that resistance training should also include multi-joint movements and power/explosive training to optimize benefits in older adults. Recent studies have shown that both high- and low-frequency resistance training can effectively improve skeletal muscle mass, muscle strength, and quality in older females with sarcopenia.

Benefits of Resistance Training and Creatine Supplementation

Combining creatine supplementation during resistance training can preserve both physical and mental capabilities and alleviate sarcopenia and related risks. For example, a recent meta-analysis found that creatine supplementation during resistance training led to approximately 1.4 kg greater lean mass gains compared to resistance training alone. Recent studies have also explored the potential cognitive benefits of creatine, although further research is needed to delineate the underlying mechanisms. Previously, the authors identified plausible biological regulators that mediate the effects of creatine supplementation.

They found that cellular allostasis was highly dependent on the creatine kinase/phosphocreatine system, which is essential to maintaining the balance between cellular mechanics and subcellular energy production. This reliance was clinically evidenced in cerebral high-energy phosphates, processing speed, and cognitive performance after a high dose of creatine monohydrate during sleep deprivation. Furthermore, one study has reported that creatine plays a potential role as a neurotransmitter. These findings suggest a promising avenue for creatine supplementation in addressing age-related cognitive decline, though standardized assessment tools are needed to confirm these benefits.

Concluding Remarks

In sum, creatine supplementation combined with resistance training is an effective and safe approach to treat sarcopenia. Evidence supports that the supplementation of creatine monohydrate during a resistance training program increases strength and lean mass in older adults relative to resistance training alone or placebo, regardless of dose and frequency. Public health initiatives should encourage dietary patterns that include creatine-rich foods, such as fish and meat, and promote accessible resistance training programs tailored to older adults. Therefore, the authors recommend the implementation of public health initiatives that promote the inclusion of creatine-rich foods in the diet.