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Effect of 16 Weeks of Strength Training and Creatine Supplementation on Strength and Cognition in Older Adults: A Pilot Study

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André De Camargo Smolarek at Universidade Estadual do Centro-Oeste do Paraná (UNICENTRO) campus Irati/PR
André De Camargo Smolarek
  • Universidade Estadual do Centro-Oeste do Paraná (UNICENTRO) campus Irati/PR
Steven R Mcanulty at Appalachian State University
Steven R Mcanulty
Luis Henrique Boiko Ferreira at Universidade Federal do Paraná
Luis Henrique Boiko Ferreira
Gabriel Ribeiro Cordeiro at State University of Ponta Grossa
Gabriel Ribeiro Cordeiro
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Abstract and Figures

The purpose of this study was to determine the effect of 16 wks of resistance training and creatine supplementation on strength and cognition in 26 older adults (5 male and 21 female) who were randomly assigned to the Control Group (CG, n=13) or the Intervention Group (IG, n=13). Weight and height were measured. The JAMAR™ hand dynamometer was used for the dominant and nondominant handgrip. Cognitive performance was measured with the MoCa questionnaire. Resistance training plus 5 g•d-1 of creatine supplementation were applied as the intervention protocol for 16 consecutive wks. After the 16 wks of intervention, the IG improved in both the handgrip strength (P<0.05) and cognitive performance (P<0.05). The findings indicate that 16 wks of resistance training and creatine monohydrate supplementation improved older adults' handgrip strength and cognitive performance.
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88
JEPonline
Effect of 16 Weeks of Strength Training and Creatine
Supplementation on Strength and Cognition in Older
Adults: A Pilot Study
André C. Smolarek1,2, Steven R. McAnulty3, Luis H. Ferreira1,
Gabriel R. Cordeiro2, Alana Alessi2, Denise B. Rebesco2, Ilma C.
Honorato2, Erivelton F. Laat2, Luis P. Mascarenhas2, Tácito P.
Souza-Junior1
1GPMENUTF / UFPR / Curitiba, PR, Brazil, 2LABE / UNICENTRO /
Irati, PR, Brazil, 3Appalachian State University, Boone, NC, USA
ABSTRACT
Smolarek AC, McAnulty SR, Ferreira LH, Cordeiro GR, Alessi A,
Rebesco DB, Honorato IC, Laat EF, Mascarenhas LP, Souza-
Junior TP. Effect of 16 Weeks of Strength Training and Creatine
Supplementation on Strength and Cognition in Older Adults: A Pilot
Study. JEPonline 2020;23(4):88-94. The purpose of this study was
to determine the effect of 16 wks of resistance training and creatine
supplementation on strength and cognition in 26 older adults (5 male
and 21 female) who were randomly assigned to the Control Group
(CG, n=13) or the Intervention Group (IG, n=13). Weight and height
were measured. The JAMAR™ hand dynamometer was used for the
dominant and nondominant handgrip. Cognitive performance was
measured with the MoCa questionnaire. Resistance training plus 5
g∙d-1 of creatine supplementation were applied as the intervention
protocol for 16 consecutive wks. After the 16 wks of intervention, the
IG improved in both the handgrip strength (P<0.05) and cognitive
performance (P<0.05). The findings indicate that 16 wks of
resistance training and creatine monohydrate supplementation
improved older adults’ handgrip strength and cognitive performance.
Key Words: Cognition, Creatine Supplementation, Handgrip,
Strength Training
Journal of Exercise Physiologyonline
August 2020
Volume 23 Number 4
Editor-in-Chief
Tommy Boone, PhD, MBA
Review Board
Todd Astorino, PhD
Julien Baker, PhD
Steve Brock, PhD
Lance Dalleck, PhD
Eric Goulet, PhD
Robert Gotshall, PhD
Alexander Hutchison, PhD
M. Knight-Maloney, PhD
Len Kravitz, PhD
James Laskin, PhD
Yit Aun Lim, PhD
Lonnie Lowery, PhD
Derek Marks, PhD
Cristine Mermier, PhD
Robert Robergs, PhD
Chantal Vella, PhD
Dale Wagner, PhD
Frank Wyatt, PhD
Ben Zhou, PhD
Official Research Journal
of the American Society of
Exercise Physiologists
ISSN 1097-9751
Official Research Journal of
the American Society of
Exercise Physiologists
ISSN 1097-9751
89
INTRODUCTION
The loss of neuromuscular function and brain aging are prevalent in older adults, leading to a
progressive reduction of functional independence (2). This study involved adults over 60 yrs
of age who underwent strength training after demonstrated loss of strength, functionality in
physical tests, daily activities, and cognitive ability (18,19). Recently, studies show that
physical exercise has a positive effect on cognition through certain mechanisms, such as a
change in brain volume, connectivity, cerebral perfusion, synaptic plasticity, neurogenesis,
and regulation of trophic factors (1).
A growing collection of evidence supports that creatine supplementation may improve health
status as individuals age (7,12,15). In this regard, creatine supplementation has been
reported to positively influence cognitive function (12,15) and in some instances serve as an
anti-depressant (17,20).
Some studies have shown that creatine supplementation can increase brain creatine content
by 5 to 15% (5,14). Moreover, creatine supplementation can reduce mental fatigue. McMorris
and co-workers (11) found that creatine supplementation (20 g∙d-1 for 7 days) after sleep
deprivation provided significantly less decrement in performance in random movement
generation, choice reaction time, balance and mood state in elderly subjects. This suggests
that creatine improves cognitive function in response to sleep deprivation. McMorris et al.
(11) also examined the effects of creatine supplementation on cognitive function in elderly
participants and found that creatine supplementation significantly improved performance on
random number generation, forward spatial recall, and long-term memory tasks.
The effects of creatine supplementation on the cognitive performance of the elderly are also
not thoroughly clear since creatine deficiency is recognized for decreasing cognitive capacity
in humans (4). The amount and time of supplementation, and the responsible brain areas still
need attention. Comparing the effects of resistance training with creatine supplementation on
handgrip and cognitive aspects in the elderly is essential because these indicators have a
strong relationship with diseases such as dinapenia, dementia, and Alzheimer's, which are
rather common in aging. Thus, the purpose of this study was to verify the effect of 16 wks of
resistance training with creatine supplementation on strength and cognitive performance in
older adults.
METHODS
Subjects
The study included 26 adults over 60 yrs of age (mean ± SD, 68.9 ± 6.8) residing in a long-
term care center for the elderly. Only older people with full physical and mental capacities
were part of the study, allowing the choice to be a member of the sample or not. All subjects
signed an informed consent form.
Procedures
Design
This study was a cross-sectional study of 16 wks. The subjects were randomly distributed
into either a Control Group or an Intervention Group who performed resistance training and
90
received 5 g∙d-1 of creatine monohydrate supplementation (Dymatize™). The subjects
engaged in resistance training sessions 2 times∙wk-1 with the intensity being progressive from
65 to 75% of the test of 10 maximum repetitions (16). The exercises consisted of a biceps
curl, shoulder abduction, squat, and leg extension. Each series of exercises consisted of 10
repetitions with a total volume of 30 repetitions. The intervals utilized were 1 min within sets
of exercises and 2 min between exercises. The velocity of execution of the movements
remained 2 sec in the eccentric phase and 2 sec in the concentric phase.
Tests
To evaluate body mass, a Beurer™ scale with a 0.1 kg resolution was used. The accuracy
was 100 g. Height was determined using a Sanny™ stadiometer with a scale of 0.1 cm
following the Frankfurt plane (6). A handgrip dynamometer JAMAR™ with a capacity of 100
N/kgf and resolution of 1 N/kgf was applied. The subject chose the best position of the arm
that could remain abducted with the forearm remaining in a neutral position to produce hand
tension for both the dominant hand and the nondominant hand (9). Each analysis of cognitive
capacity was estimated by using the Montreal Cognitive Assessment (MoCA) questionnaire
that included cross-cultural validation for the Brazilian Portuguese language (13).
Statistical Analyses
Descriptive techniques were used to describe the sample. A Kolmogorov Smirnov normality
test was applied to check the data distribution. A one-way ANOVA analysis of variance with a
Tukey post hoc was used with a 95% confidence interval and an alpha level of P<0.05 for
statistical significance. All data collected were analyzed utilizing SPSS™ software version
22.0, (Chicago,IL, USA). All analyses were performed pre and post-intervention.
RESULTS
Descriptive, handgrip, and MoCA data, as well as, the pre- and post-intervention with
resistance training and 5 g∙d-1 of creatine supplementation results are depicted in Table 1.
Table 1. Description, Handgrip, and MoCA Data Pre and Post 16 wks of Intervention.
Variables
Control Group
(SD) n=13
Intervention Group
(SD) n=13
F
Pre
Post
Pre
Post
Weight (kg)
68.7 13.1
67.6 14.0
71.9 23.2
68.5 14.1
1.0
Height (m)
1.5 0.1
1.5 0.1
1.6 0.1
1.6 0.1
2.2
Dominant Hand (N/Kgf)
22.30 7.9
22 6.4
28.6 11.6
28.8 12.8a
3.0*
Nondominant Hand (N/Kgf)
19.69 9.0
18.6 7.8
26.6 13.9
30.5 14.3
3.7*
MoCA (points)
10.69 4.4a
6.6 4.7
10.7 3.2
17.4 4.4
6.3*
a = Significant Difference between Control Group and G1. *P<0.05. MoCA = Montreal Cognitive
Assessment
91
No significant results were observed after intervention in weight and height variables.
However, for the dominant hand, non-dominant hand, and MoCA differences were identified
(P<0.05) when the Control Group was compared with the Intervention Group.
DISCUSSION
The purpose of the study was to determine the effect of 16 wks of resistance training and
creatine supplementation on the handgrip strength and cognitive capacity in elderly men and
women. The main findings of the present study were a significant increase in the handgrip
strength and cognitive capacity of the elderly. In a recent review, it was suggested that
resistance training promotes improvements in several geriatric diseases and physical
exercise programs specific to strength with satisfactory outcomes in physical performance,
functional activity, and in avoiding falls (8).
In addition to aging, the lack and/or reduction of physical activity can result in less muscle
stimulus, which can reflect neuromuscular system dysfunction, decreasing strength capacity,
and a dinapenia phenomenon (3). In support, our results suggest that 16 wks of a resistance
training program and 5 g∙d-1 of creatine monohydrate supplementation will have a positive
effect on the handgrip strength (correlating with strength capacity and cognition), and
associated with functional autonomy.
In the human body, Twycross-Lewis et al. (21) indicates that 95% of creatine is located in the
sarcoplasm, either in the phosphorylated form (PCr) or free creatine (Cr) form. As an
increase in Cr consumption occurs, this can increase the content of PCr and Cr in the brain,
resulting in the maintenance of brain function and providing for conditions of higher cognitive
activity in the elderly. In fact, the results of the present study indicate improvement in the
MoCa questionnaire, which reflects an improvement in the subjects’ cognition performance
after resistance training combined with 5 g∙d-1 of creatine supplementation in older adults.
When older people develop strength such as with the handgrip exercise, there is a
relationship with cognitive capacity that is reflected by more powerful older people having
higher scores and performance on cognitive examinations (10). Even though we did not
examine a relationship between handgrip strength to MoCA, we noticed progress in both the
older adults’ strength and MoCA score after 16 wks of intervention with the combine
treatment of resistance training and 5 g∙d-1 creatine supplementation.
Limitations in this Study
One of the limitations of the present study is the number of subjects, which is small even for a
pilot study. Another limitation is in regards to the design of the study that did not permit
comparison between the outcome of the intervention with a group that only trained for
strength and/or only utilized creatine supplementation with a nutritional strategy. It is
important that the future studies consider these limitations and examine the role of each in
older adults.
92
CONCLUSIONS
Our results indicate improvements in the handgrip strength and cognitive performance
through increases in MoCA score after 16 wks of resistance training and 5 g∙d-1 creatine
supplementation in older adults.
ACKNOWLEDGMENTS
This study was financed in part by the “Coordenação de Aperfeiçoamento de Pessoal de
Nível Superior – Brasil” (CAPES) - Finance Code 001.
Address for correspondence: Andre C Smolarek, 1220, Coronel Pires, Irati, Parana, Brazil,
84500-059, Email: andrecsk@gmail.com
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Disclaimer
The opinions expressed in JEPonline are those of the authors and are not attributable to
JEPonline, the editorial staff or the ASEP organization.
... In addition, understanding the link or cross-talk between muscle, bone, and brain will be critical in an aging population (Kirk et al. 2020). Moreover, based on the available evidence that creatine augments resistance training and improves muscle health (Candow et al. 2019a;Candow et al. 2019b;Chilibeck et al. 2017;Smolarek et al. 2020), bone (Chilibeck et al. 2015), and brain function (Smolarek et al. 2020), future research is critically needed to enhance participation and adherence to exercise (Bennie et al. 2020), especially an older population (Bull et al. 2020). Surprisingly, despite the well-known benefits of combining creatine on muscle and bone in healthy adults, there is a minimal amount of research on participants with diagnosed sarcopenia Gualano et al. 2014;Pinto et al. 2016) with no randomized controlled trials exist in osteosarcopenic adults. ...
... In addition, understanding the link or cross-talk between muscle, bone, and brain will be critical in an aging population (Kirk et al. 2020). Moreover, based on the available evidence that creatine augments resistance training and improves muscle health (Candow et al. 2019a;Candow et al. 2019b;Chilibeck et al. 2017;Smolarek et al. 2020), bone (Chilibeck et al. 2015), and brain function (Smolarek et al. 2020), future research is critically needed to enhance participation and adherence to exercise (Bennie et al. 2020), especially an older population (Bull et al. 2020). Surprisingly, despite the well-known benefits of combining creatine on muscle and bone in healthy adults, there is a minimal amount of research on participants with diagnosed sarcopenia Gualano et al. 2014;Pinto et al. 2016) with no randomized controlled trials exist in osteosarcopenic adults. ...
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Full-text available
  • Feb 2021
Sarcopenia, defined as age-related reduction in muscle mass, strength, and physical performance, is associated with other age-related health conditions such as osteoporosis, osteosarcopenia, sarcopenic obesity, physical frailty, and cachexia. From a healthy aging perspective, lifestyle interventions that may help overcome characteristics and associated comorbidities of sarcopenia are clinically important. One possible intervention is creatine supplementation (CR). Accumulating research over the past few decades shows that CR, primarily when combined with resistance training (RT), has favourable effects on aging muscle, bone and fat mass, muscle and bone strength, and tasks of physical performance in healthy older adults. However, research is very limited regarding the efficacy of CR in older adults with sarcopenia or osteoporosis and no research exists in older adults with osteosarcopenia, sarcopenic obesity, physical frailty, or cachexia. Therefore, the purpose of this narrative review is (1) to evaluate and summarize current research involving CR, with and without RT, on properties of muscle and bone in older adults and (2) to provide a rationale and justification for future research involving CR in older adults with osteosarcopenia, sarcopenic obesity, physical frailty, or cachexia.
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Exercise for Brain Health: An Investigation into the Underlying Mechanisms Guided by Dose
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  • Jun 2019
There is a strong link between the practice of regular physical exercise and maintenance of cognitive brain health. Animal and human studies have shown that exercise exerts positive effects on cognition through a variety of mechanisms, such as changes in brain volume and connectivity, cerebral perfusion, synaptic plasticity, neurogenesis, and regulation of trophic factors. However, much of this data has been conducted in young humans and animals, raising questions regarding the generalizability of these findings to aging adults. Furthermore, it is not clear at which doses these effects might take place, and if effects would differ with varying exercise modes (such as aerobic, resistance training, combinations, or other). The purpose of this review is to summarize the evidence on the effects of exercise interventions on various mechanisms believed to support cognitive improvements: cerebral perfusion, synaptic neuroplasticity, brain volume and connectivity, neurogenesis, and regulation of trophic factors. We synthesized the findings according to exposure to exercise (short- [1 day-16 weeks], medium- [24-40 weeks], and long-term exercise [52 weeks and beyond]) and have limited our discussion of dose effects to studies in aging adults and aged animals (when human data was not available).
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Effects of physical activity interventions in frail and prefrail community-dwelling people on frailty status, muscle strength, physical performance and muscle mass—a narrative review
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Full-text available
  • Apr 2019
Background: Frailty is a geriatric syndrome, which is highly prevalent in community-dwelling older adults and is associated with a variety of unwanted health outcomes, including dependency and institutionalization. Physical activity (PA) interventions may be of great importance in frail people to improve the frailty status, muscle strength, physical performance and muscle mass. Methods: A narrative review of randomized-controlled trails was performed, including frail and prefrail community-dwelling older adults. Included were studies with different PA interventions, such as aerobic activity, strength and balance training, stretching, and a combination of these methods. Results: Overall, 14 studies were included. The PA interventions led to a significant reduction in the frailty status (3/5 studies), to an increase in muscle strength (4/8 studies), to improved physical performance (7/11 studies), and to an increase in muscle mass (1/4 studies), when compared to the control group. The studies analyzed differed in various aspects of study protocols (training protocol, intensity, frequency, follow-up time, measuring tools) and delivery method of intervention (health professionals, lay volunteers, at home in health care institutions). Conclusions: Although it was not consistently reported in the studies that PA interventions are successful in increasing muscle mass in frail and prefrail older people, the results support the effectiveness of PA interventions on the reduction of frailty, and the increase in muscle strength and physical performance.
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Association among handgrip strength, body mass index and decline in cognitive function among the elderly women
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Background: The association between handgrip strength combined with body mass index (BMI) and cognitive impairment has not been thoroughly examined. We aimed to investigate whether the relationship between handgrip strength and risk of cognitive impairment is altered by the presence of obesity in older women. Methods: A total of 544 older women aged over 65 years without cognitive impairment from the Korean Longitudinal Study of Aging (KLoSA) were included in the study. Handgrip strength was classified in a binary manner (weak or strong) or in tertiles and obesity was defined as a BMI ≥ 25 kg/m2, in accordance with the Asia-Pacific World Health Organization criteria. Incident cognitive impairment was defined as a Korean Mini-mental State Examination (K-MMSE) score of less than 24 after eight years of follow-up. Results: Strong handgrip strength was associated with reduced likelihood of developing cognitive impairment compared to weak handgrip strength in obese women (adjusted odds ratio, aOR 0.23, 95% confidence interval, CI 0.08-0.66). The highest tertile of handgrip strength was associated with reduced risk of incident cognitive impairment (aOR 0.16, 95% CI 0.04-0.70), compared to the lowest tertile of handgrip strength in obese women, with a significant linear trend (p for trend = 0.016). Furthermore, the highest tertile of handgrip strength was significantly associated with smaller decline in K-MMSE scores compared to the lowest tertile of handgrip strength in obese women (p value = 0.009). There was no association between handgrip strength and incident cognitive impairment in non-obese women. Conclusions: Strong handgrip strength was associated with reduced risk of cognitive impairment among obese women, but not in non-obese women. Handgrip strength may be a simple and useful marker for predicting future cognitive impairment among obese women.
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The effects of strength training on cognitive performance in elderly women
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Aging is a degenerative process marked by recognized functional, physiological, and metabolic impairments, such as dynapenia and diminished cognitive capacity. Therefore, the search for innovative strategies to prevent/delay these physiological and cognitive disorders is essential to guarantee the independence and life quality of an elderly population. The aim of this work is to verify the effect of a 12-week resistance exercise program on the general physical aptitude and cognitive capacities of elderly and sedentary women. Twenty-nine women (65.87±5.69 years) were divided into two groups. The control group was composed of eight elderly women who met the same inclusion criteria of the study and the strength training group was composed of 29 elderly women who were subjected to a resistance exercise program defined by 12 upper and lower limb exercises combined in 3×10 repetitions with 1-minute interval between repetitions and two resting minutes between exercises (three times/ week). Weight loads were fixed between 60% and 75% of the apparent 1 repetition maximum, which was estimated by the test of 10 maximum repetitions. The direct curl was performed for upper body strength evaluation with 2.3 kg dumbbells for 30 seconds, whereas the chair test was used for lower body evaluation (total sit–stand movements in 30 seconds). The cognitive capacities of subjects were evaluated by " The Montreal Cognitive Assessment " questionnaire. After 12 weeks, the elderly group showed significant increases in the average upper body strength (58%), lower body strength (68%), and cognitive capacity (19%). The present study demonstrated that regular resistance exercises could provide significant gains on the upper and lower body strength concomitant to positive improvements on cognitive capacities of elderly women, bringing enhanced life quality.
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Creatine supplementation in the aging population: effects on skeletal muscle, bone and brain
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This narrative review aims to summarize the recent findings on the adjuvant application of creatine supplementation in the management of age-related deficits in skeletal muscle, bone and brain metabolism in older individuals. Most studies suggest that creatine supplementation can improve lean mass and muscle function in older populations. Importantly, creatine in conjunction with resistance training can result in greater adaptations in skeletal muscle than training alone. The beneficial effect of creatine upon lean mass and muscle function appears to be applicable to older individuals regardless of sex, fitness or health status, although studies with very old (>90 years old) and severely frail individuals remain scarce. Furthermore, there is evidence that creatine may affect the bone remodeling process; however, the effects of creatine on bone accretion are inconsistent. Additional human clinical trials are needed using larger sample sizes, longer durations of resistance training (>52 weeks), and further evaluation of bone mineral, bone geometry and microarchitecture properties. Finally, a number of studies suggest that creatine supplementation improves cognitive processing under resting and various stressed conditions. However, few data are available on older adults, and the findings are discordant. Future studies should focus on older adults and possibly frail elders or those who have already experienced an age-associated cognitive decline.
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The effects of creatine supplementation on thermoregulation and physical (cognitive) performance: a review and future prospects
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Creatine (Cr) is produced endogenously in the liver or obtained exogenously from foods, such as meat and fish. In the human body, 95 % of Cr is located in the cytoplasm of skeletal muscle either in a phosphorylated (PCr) or free form (Cr). PCr is essential for the immediate rephosphorylation of adenosine diphosphate to adenosine triphosphate. PCr is rapidly degraded at the onset of maximal exercise at a rate that results in muscle PCr reservoirs being substantially depleted. A well-established strategy followed to increase muscle total Cr content is to increase exogenous intake by supplementation with chemically pure synthetic Cr. Most Cr supplementation regimens typically follow a well-established loading protocol of 20 g day(-1) of Cr for approximately 5-7 days, followed by a maintenance dose at between 2 and 5 g day(-1) for the duration of interest, although more recent studies tend to utilize a 0.3-g kg(-1) day(-1) supplementation regimen. Some studies have also investigated long-term supplementation of up to 1 year. Uptake of Cr is enhanced when taken together with carbohydrate and protein and/or while undertaking exercise. Cr supplementation has been shown to augment muscle total Cr content and enhance anaerobic performance; however, there is also some evidence of indirect benefits to aerobic endurance exercise through enhanced thermoregulation. While there is an abundance of data supporting the ergogenic effects of Cr supplementation in a variety of different applications, some individuals do not respond, the efficacy of which is dependent on a number of factors, such as dose, age, muscle fiber type, and diet, although further work in this field is warranted. Cr is increasingly being used in the management of some clinical conditions to enhance muscle mass and strength. The application of Cr in studies of health and disease has widened recently with encouraging results in studies involving sleep deprivation and cognitive performance.
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Creatine supplementation post-exercise does not enhance training-induced adaptations in middle to older aged males
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The present study evaluated the effects of creatine monohydrate (CrM) consumption post-exercise on body composition and muscle strength in middle to older males following a 12-week resistance training program. In a double-blind, randomized trial, 20 males aged between 55 and 70 years were randomly assigned to consume either CrM-carbohydrate (CHO) [20 g days(-1) CrM + 5 g days(-1) CHO × 7 days, then 0.1 g kg(-1) CrM + 5 g CHO on training days (average dosage of ~8.8 g)] or placebo CHO (20 g days(-1) CHO × 7 days, then 5 g CHO on training days) while participating in a high intensity resistance training program [3 sets × 10 repetitions at 75 % of 1 repetition maximum (1RM)], 3 days weeks(-1) for 12 weeks. Following the initial 7-day "loading" phase, participants were instructed to ingest their supplement within 60 min post-exercise. Body composition and muscle strength measurements, blood collection and vastus lateralis muscle biopsy were completed at 0, 4, 8 and 12 weeks of the supplement and resistance training program. A significant time effect was observed for 1RM bench press (p = 0.016), leg press (p = 0.012), body mass (p = 0.03), fat-free mass (p = 0.005) and total myofibrillar protein (p = 0.005). A trend for larger muscle fiber cross-sectional area in the type II fibers compared to type I fibers was observed following the 12-week resistance training (p = 0.08). No supplement interaction effects were observed. Post-exercise ingestion of creatine monohydrate does not provide greater enhancement of body composition and muscle strength compared to resistance training alone in middle to older males.
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Cognitive Effects of Creatine Monohydrate Adjunctive Therapy in Patients With Bipolar Depression: Results From a Randomized, Double-Blind, Placebo-Controlled Trial
Article
  • Nov 2016
Background: Depressive episodes and cognitive impairment are major causes of morbidity and dysfunction in individuals suffering from bipolar disorder (BD). Novel treatment approaches that target clinical and cognitive aspects of bipolar depression are needed, and research on pathophysiology suggests that mitochondrial modulators such as the nutraceutical creatine monohydrate might have a therapeutic role for this condition. Methods: Eighteen (N=18) patients with bipolar depression according to DSM-IV criteria who were enrollled in a 6-week, randomized, double-blind, placebo-controlled trial of creatine monohydrate 6g daily as adjunctive therapy were submitted to neuropsychological assessments (Wisconsin Card Sorting Test, Digit Span subtest of the Wechsler Adult Intelligence Scale-Third Edition, Stroop Color-Word Test, Rey-Osterrieth complex figure test, FAS Verbal Fluency Test) at baseline and week 6. Results: There was a statistically significant difference between the treatment groups of the change on the total scores after 6 weeks in the verbal fluency test, with improvement in the group receiving adjunctive treatment with creatine. We did not find significant differences between the groups of the changes on other neuropsychological tests. Limitations: Small sample and lack of a control group of healthy subjects. Conclusions: Our trial, which was the first to investigate the cognitive effects of creatine monohydrate on bipolar depression, indicates that supplementation with this nutraceutical for 6 weeks is associated with improvement in verbal fluency tests in patients with this condition.
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Diagnostic Methods and Recommendations for the Cerebral Creatine Deficiency Syndromes.
Article
  • Dec 2014
Primary care pediatricians and a variety of specialist physicians strive to define an accurate diagnosis for children presenting with impairment of expressive speech and delay in achieving developmental milestones. Within the past two decades, a group of disorders featuring this presentation have been identified as cerebral creatine deficiency syndromes (CCDS). Patients with these disorders were initially discerned using proton magnetic resonance spectroscopy of the brain within a magnetic resonance imaging (MRI) examination. The objective of this review is to provide the clinician with an overview of the current information available on identifying and treating these conditions. We explain the salient features of creatine metabolism, synthesis and transport required for normal development. We propose diagnostic approaches for confirming a CCDS diagnosis. Finally, we describe treatment approaches for managing patients with these conditions.Pediatric Research (2014); doi:10.1038/pr.2014.203.
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Muscle architecture and strength: Adaptations to short term resistance training.
Article
Introduction: Muscle morphology and architecture changes in response to 6 weeks of progressive resistance training were examined in healthy older adults. Methods: In this randomized, controlled design, muscle strength, quality, and architecture were evaluated with knee extension, DEXA, and ultrasound, respectively, in 25 older adults. Results: Resistance training resulted in significant increases in strength and muscle quality of 32% and 31%, respectively. Cross-sectional area of the vastus lateralis increased by 7.4% (p ≤ 0.05). Physiological cross-sectional area (PCSA) of the thigh, a composite measure of muscle architecture, was related significantly to strength (r = 0.57; p ≤ 0.01) and demonstrated a significant interaction after training (p ≤ 0.05). Change in PCSA of the vastus lateralis was associated with change in strength independent of any other measure. Conclusions: Six weeks of resistance training was effective at increasing strength, muscle quality, and muscle morphology in older adult men and women.
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