Author: Prof. Gustavo Humeres (Argentina) 

Editors: Prof. Alexandra Pérez-Idárraga, ND. Mayra Márquez & Prof. Diego A. Bonilla 

The older adult population is considered vulnerable due to various biological and social factors. Therefore, it is crucial to prioritize the identification of cost-effective strategies for improving their physical and cognitive well-being within an integrated management approach.  

Sarcopenia, characterized by a progressive loss of skeletal muscle mass and strength, poses a significant risk to the elderly population, contributing to physical frailty, functional decline, poor quality of life, and premature death [1]. These factors increase the risk of falls, which is a major public health concern with serious consequences for older adults. A poor muscle status, characterized by low muscle strength, mass, and quality, and performance in functional tests, is also associated with a greater risk of many chronic diseases, and mortality from all causes [2]. 

Resistance training has shown promise as an intervention for reversing age-related muscle function loss and deterioration. It is believed to improve functional abilities and overall health in older individuals by increasing muscle mass, strength, power, and bone mineral density (BMD) [3].  

Recent publications have suggested that creatine supplementation has favorable effects on maintaining muscle mass, strength, and bone tissue levels in older individuals, especially when combined with strength-based resistance training. However, studies have shown variations in dosing criteria, making comparisons challenging [4]. These inconsistencies in results may be due to discrepancies between creatine doses and frequency of intake during resistance training programs [5]. 

Forbes et al. [4] conducted a study comparing creatine intake with a placebo group, independent of the dose and frequency of consumption, within a resistance training plan. They measured muscle mass and strength and performed a meta-analysis to evaluate the effects of different creatine dosing strategies (≤5 g/day and >5 g/day), with or without a loading phase (≥20 g/day for 5-7 days). The meta-analysis aimed to determine whether creatine supplementation on strength training days alone influenced muscle mass and strength measurements.  

Previous meta-analyses have shown greater gains in muscle mass and strength when creatine is combined with a resistance training program in older individuals compared to a placebo. These results indicate that creatine, in combination with appropriate physical training, has the potential to counteract sarcopenia [6,7,8].  

Forbes et al. [4] found that regardless of loading, dose, and frequency of intake, creatine supplementation during a resistance training program increased muscle mass and strength compared to placebo in older individuals. The combination of creatine loading followed by a lower dose (≤5 g/day) was effective in increasing chest press strength, while a higher dose of creatine (>5 g/day) was effective in increasing leg press strength. Furthermore, creatine supplementation alone on resistance training days significantly increased muscle mass and strength compared to placebo.   

These findings have practical implications for designing creatine supplementation strategies for the elderly. For improving upper body strength, individuals who undergo creatine loading followed by a lower daily dose experience greater gains compared to those on a placebo. However, supplementation with lower doses alone is not more effective than a placebo. Older adults aiming to improve posture or daily living skills requiring upper body strength may benefit from a creatine loading phase before a low dose (≤5 g) during a strength-based resistance training program.  

On the other hand, if the goals are to reduce the risk of fractures, falls, or improve balance, the focus should be on the lower body. In this case, individuals may benefit from creatine loading before ingesting a higher daily dose (>5 g) during a strength-based resistance training program. Current evidence suggests no counterproductive effects with long-term creatine supplementation, despite some initial concerns [9,10,11,12]. In fact, a very long randomized clinical trial published recently by Chilibeck et al. (2023) showed that two years of creatine supplementation (0.14 g CrM/kg/day – approximately 10 g CrM/day) and exercise in postmenopausal women not only had minimal adverse effects but also improved some bone geometric properties at the proximal femur – it should be noted that no effects were seen on bone mineral density [13]. 

In conclusion, available evidence demonstrates that combining creatine monohydrate supplementation with a resistance exercise program significantly enhances muscle mass and strength in older individuals. This finding is crucial in addressing the primary objective of combating sarcopenia and related conditions such as osteoporosis and physical frailty. The key findings on this topic are summarized in Table 1, which highlights the essential role of a creatine loading phase for older adults aiming to improve muscle strength. Specifically, it is evident that creatine loading followed by a lower daily dose (≤5 g/day) leads to increased strength in the chest press, surpassing the placebo effect (upper limbs). However, higher doses of creatine (>5 g/day or 0.1 g CrM/kg/day), both with and without a loading phase, result in significant improvements in lower limbs strength compared to the placebo. Conversely, when studies involving a loading phase with creatine are excluded from the analysis, creatine supplementation had minimal impact on chest press or leg press strength compared to the placebo.  

Table 1. Creatine ingestion strategies for older adults. 

Creatine supplementation (independent of creatine-loading, maintenance dosage and frequency of ingestion) during a resistance training program increased measures of lean tissue mass and strength compared to the placebo and resistance training in older adults 
The combination of creatine-loading followed by lower-dose creatine (≤5 g/day) was effective for increasing chest press strength 
The combination of creatine-loading and higher-dose creatine (>5 g/day) was effective for increasing leg press strength 
Creatine supplementation only on resistance training days significantly increased measures of lean tissue mass and strength compared to the placebo 

Taken from: Forbes et al. (2021). 


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