Appl. Physiol. Nutr. Metab. Downloaded from www.nrcresearchpress.com by San Francisco (UCSF) on 03/01/15 For personal use only. This Just-IN manuscript is the accepted manuscript prior to copy editing and page composition. It may differ from the final official version of record.
Page 1 of 27
1 2
Title: Strategic ingestion of creatine supplementation and resistance training in healthy
3
older adults
4 5
Authors: Darren Candow1, Emelie Vogt1, Sarah Johannsmeyer1, Scott Forbes2, Jonathan
6
P. Farthing3
7 8 9
Affiliations: 1Faculty of Kinesiology & Health Studies, University of Regina, Regina, SK Canada S4S 0A2
10
2
Human Kinetics, Okanagan College, Penticton, BC Canada V2A 8E1
11
3
College of Kinesiology, University of Saskatchewan, Saskatoon, SK
12
Canada S7N 5B2
13
Address for Correspondance:
14 15 16 17 18 19 20 21
Darren G. Candow, Ph.D., Associate Professor Associate Dean-Graduate Studies and Research Faculty of Kinesiology & Health Studies University of Regina Regina, SK, Canada S4S 0A2 Tel:(306) 585-4906 Fax: (306) 585-4854
22
Author emails:
23
Darren Candow ([email protected])
24
Emelie Vogt ([email protected])
25
Sarah Johannsmeyer ([email protected])
26
Scott Forbes ([email protected])
27
Jonathan Farthing ([email protected])
28
Appl. Physiol. Nutr. Metab. Downloaded from www.nrcresearchpress.com by San Francisco (UCSF) on 03/01/15 For personal use only. This Just-IN manuscript is the accepted manuscript prior to copy editing and page composition. It may differ from the final official version of record.
Page 2 of 27
1
Abstract
2
Creatine supplementation in close proximity to resistance training may be an important
3
strategy for increasing muscle mass and strength; however, it is unknown whether
4
creatine before or after resistance training is more effective for aging adults. Using a
5
double-blind, repeated measures design, older adults (50-71 yrs) were randomized to one
6
of three groups: Creatine-Before (CR-B: n=15; creatine [0.1g∙kg-1] immediately before
7
resistance training and placebo [0.1g∙kg-1 corn-starch maltodextrin] immediately after
8
resistance training), Creatine-After (CR-A: n=12; placebo immediately before resistance
9
training and creatine immediately after resistance training) or Placebo (PLA: n=12;
10
placebo immediately before and immediately after resistance training) for 32 weeks. Prior
11
to and following the study, body composition (lean tissue, fat mass; dual energy x-ray
12
absorptiometry) and muscle strength (1-repetition maximum leg press and chest press)
13
were assessed. There was an increase over time for lean tissue mass and muscle strength
14
and a decrease in fat mass (p 99.9%).
18
The creatine dosage (0.1g∙kg-1) was chosen because it increases muscle mass and
19
strength, without resulting in adverse effects, in young and older adults (Candow et al.
20
2014b; 2008). Creatine and placebo (Globe Plus 10 DE Maltodextrin, Univar Canada)
21
were identical in taste, texture, color and appearance. An individual not involved in any
22
other aspect of the study was responsible for mixing and packaging up the supplements in
23
large plastic bags and preparing individual study kits. Each study kit contained two
Participants were randomly
AlzChem Trostberg GmbH, Germany) were verified by testing in an
5
Appl. Physiol. Nutr. Metab. Downloaded from www.nrcresearchpress.com by San Francisco (UCSF) on 03/01/15 For personal use only. This Just-IN manuscript is the accepted manuscript prior to copy editing and page composition. It may differ from the final official version of record.
Page 7 of 27
1
individually labeled bags (Bag # 1: BEFORE resistance training, Bag # 2: AFTER
2
resistance training), detailed supplementation instructions and measuring spoons.
3
Participants consumed creatine or placebo with water immediately before (i.e. 5 minutes)
4
and immediately after (i.e. 5 minutes) each resistance training session in the presence of
5
an exercise supervisor, as the purpose of the study was to directly compare the effects of
6
creatine before vs. after resistance training. Adherence with the creatine monohydrate,
7
placebo and resistance training was assessed by training and supplementation compliance
8
logs.
9
Resistance training program
10
Prior to the start of the study, each participant performed 3 familiarization sessions
11
(supervised) with the resistance training equipment in a private laboratory to reduce the
12
amount of learning related to task acquisition, which may contribute to our outcome
13
measures. Previous research has shown that 3 familiarization sessions followed by
14
multiple testing sessions is sufficient to produce reliable strength results in older adults
15
(Phillips et al. 2004). Participants followed the same supervised whole-body resistance
16
training program for 32 weeks in the same private laboratory. Training sessions were
17
supervised as previous research has demonstrated greater gains compared to unsupervised
18
training (Mazzetti et al. 2000). Prior to training sessions, but after the supplement was
19
consumed, each participant performed a 5-minute stationary cycling warm-up at a self-
20
selected intensity. Participants completed 3 sets of 10 repetitions to muscle fatigue with
21
1-2 minutes rest between sets for each exercise at an intensity corresponding to their 10-
22
repetition maximum for each exercise. Resistance exercises performed in order included
23
leg press, chest press, lat pull-down, shoulder press, leg extension, leg curl, triceps
6
Appl. Physiol. Nutr. Metab. Downloaded from www.nrcresearchpress.com by San Francisco (UCSF) on 03/01/15 For personal use only. This Just-IN manuscript is the accepted manuscript prior to copy editing and page composition. It may differ from the final official version of record.
Page 8 of 27
1
extension, biceps curl, calf press, back extension and abdominal curl. We chose to use
2
machine-based resistance training equipment because they are considered safer and easier
3
to learn than free weights (Ratamass et al. 2009) and the use of machine-based equipment
4
lead to greater improvements in machine-based strength tests (Boyer et al. 1990).
5
Participants maintained daily training logs where the load, number of sets and repetitions
6
were recorded. Resistance was increased by 2-10 kg once a participant could complete 3
7
sets of 10 repetitions to muscle fatigue for an exercise. Once the resistance was increased,
8
participants maintained this load until a subsequent 3 sets of 10 repetitions to fatigue
9
were completed.
10
Body composition
11
Lean tissue and fat mass was measured by dual-energy x-ray absorptiometry
12
(Hologic Wi System, Christie Group, Manitoba, Canada) in array mode. Before scanning,
13
participants were required to take off all removable objects containing metal (i.e. jewelry,
14
glasses, clothing with buttons, and/or zippers). Scans were performed with participants
15
lying in a supine position along the scanning table’s centerline longitudinal axis. Feet
16
were taped together at the toes (i.e. phalanges) to immobilize the legs while the hands
17
were maintained in a pronated position within the scanning region. All scans were
18
performed by the same Nuclear Medicine Technologist. The coefficient of variation from
19
previous research is 0.54% for lean tissue mass (Chrusch et al. 2001).
20
Muscle strength
21
Leg press and chest press strength was assessed using a 1-repetition maximum (1-
22
RM) standard testing procedure. Following 5-minutes of cycling on a stationary cycle
23
ergometer, participants performed two warm-up sets in order: 1 set of 10 repetitions using
7
Appl. Physiol. Nutr. Metab. Downloaded from www.nrcresearchpress.com by San Francisco (UCSF) on 03/01/15 For personal use only. This Just-IN manuscript is the accepted manuscript prior to copy editing and page composition. It may differ from the final official version of record.
Page 9 of 27
1
a weight determined by each subject to be comfortable and 1 set of 5 repetitions using
2
increased weight. Two-minutes following the warm-up sets, weight was progressively
3
increased for each subsequent 1-RM attempt with a 2-minute rest interval. The 1-RM was
4
reached in 4-6 trials, independent of the 2 warm-up sets. The coefficients of variation
5
from previous research are 3.0% for the leg press and 3.6% for the chest press (Chrusch
6
et al. 2001).
7
Dietary assessment
8
Dietary intake was recorded during the first and final week of supplementation and
9
resistance training to assess differences in total energy and macronutrient composition
10
between groups. Participants used a 3-day food booklet to record food intake for two
11
weekdays and one weekend day. Participants were instructed to record all food items,
12
including portion sizes consumed for the three designated days. The Interactive Healthy
13
Eating Index (Center for Nutrition Policy and Promotion, United States Department of
14
Agriculture) was used to analyze 3-day food records.
15 16 17
Statistical analysis
18
repeated measures on the second factor was used to determine differences between
19
groups over time for lean tissue mass, Relative Skeletal Muscle Index (sum of
20
appendicular muscle mass [kg] / m2), fat mass, leg press strength, chest press strength,
21
relative strength (strength/lean tissue mass) and diet. If significant interactions were
22
detected, a one-factor ANOVA on change scores (∆ = post mean-pre mean) was
23
conducted. If the one-factor ANOVA was significant, the smallest mean would be
24
considered different than the largest mean and therefore only two additional t-tests were
A 3 (CR-B vs. CR-A vs. PLA) × 2 (pre- and post-test periods) ANOVA with
8
Appl. Physiol. Nutr. Metab. Downloaded from www.nrcresearchpress.com by San Francisco (UCSF) on 03/01/15 For personal use only. This Just-IN manuscript is the accepted manuscript prior to copy editing and page composition. It may differ from the final official version of record.
Page 10 of 27
1
used to compare the smallest and largest mean to the middle mean, with adjustments for
2
multiple comparisons (p 7.26 kg/m2 for males and > 5.5 kg/m2 for females;
15
Baumgartner et al. 1998) while 6 females (CR-B: n=2, CR-A: n=3, PLA: n=1) and 3
16
males (CR-B: n=1, CR-A: n=1, PLA: n=1) were considered sarcopenic. Following the
17
study, only 3 women remained sarcopenic (n=1 from each group). There was an increase
18
in total energy intake (kcal) over time (p
Page 1 of 27
1 2
Title: Strategic ingestion of creatine supplementation and resistance training in healthy
3
older adults
4 5
Authors: Darren Candow1, Emelie Vogt1, Sarah Johannsmeyer1, Scott Forbes2, Jonathan
6
P. Farthing3
7 8 9
Affiliations: 1Faculty of Kinesiology & Health Studies, University of Regina, Regina, SK Canada S4S 0A2
10
2
Human Kinetics, Okanagan College, Penticton, BC Canada V2A 8E1
11
3
College of Kinesiology, University of Saskatchewan, Saskatoon, SK
12
Canada S7N 5B2
13
Address for Correspondance:
14 15 16 17 18 19 20 21
Darren G. Candow, Ph.D., Associate Professor Associate Dean-Graduate Studies and Research Faculty of Kinesiology & Health Studies University of Regina Regina, SK, Canada S4S 0A2 Tel:(306) 585-4906 Fax: (306) 585-4854
22
Author emails:
23
Darren Candow ([email protected])
24
Emelie Vogt ([email protected])
25
Sarah Johannsmeyer ([email protected])
26
Scott Forbes ([email protected])
27
Jonathan Farthing ([email protected])
28
Appl. Physiol. Nutr. Metab. Downloaded from www.nrcresearchpress.com by San Francisco (UCSF) on 03/01/15 For personal use only. This Just-IN manuscript is the accepted manuscript prior to copy editing and page composition. It may differ from the final official version of record.
Page 2 of 27
1
Abstract
2
Creatine supplementation in close proximity to resistance training may be an important
3
strategy for increasing muscle mass and strength; however, it is unknown whether
4
creatine before or after resistance training is more effective for aging adults. Using a
5
double-blind, repeated measures design, older adults (50-71 yrs) were randomized to one
6
of three groups: Creatine-Before (CR-B: n=15; creatine [0.1g∙kg-1] immediately before
7
resistance training and placebo [0.1g∙kg-1 corn-starch maltodextrin] immediately after
8
resistance training), Creatine-After (CR-A: n=12; placebo immediately before resistance
9
training and creatine immediately after resistance training) or Placebo (PLA: n=12;
10
placebo immediately before and immediately after resistance training) for 32 weeks. Prior
11
to and following the study, body composition (lean tissue, fat mass; dual energy x-ray
12
absorptiometry) and muscle strength (1-repetition maximum leg press and chest press)
13
were assessed. There was an increase over time for lean tissue mass and muscle strength
14
and a decrease in fat mass (p 99.9%).
18
The creatine dosage (0.1g∙kg-1) was chosen because it increases muscle mass and
19
strength, without resulting in adverse effects, in young and older adults (Candow et al.
20
2014b; 2008). Creatine and placebo (Globe Plus 10 DE Maltodextrin, Univar Canada)
21
were identical in taste, texture, color and appearance. An individual not involved in any
22
other aspect of the study was responsible for mixing and packaging up the supplements in
23
large plastic bags and preparing individual study kits. Each study kit contained two
Participants were randomly
AlzChem Trostberg GmbH, Germany) were verified by testing in an
5
Appl. Physiol. Nutr. Metab. Downloaded from www.nrcresearchpress.com by San Francisco (UCSF) on 03/01/15 For personal use only. This Just-IN manuscript is the accepted manuscript prior to copy editing and page composition. It may differ from the final official version of record.
Page 7 of 27
1
individually labeled bags (Bag # 1: BEFORE resistance training, Bag # 2: AFTER
2
resistance training), detailed supplementation instructions and measuring spoons.
3
Participants consumed creatine or placebo with water immediately before (i.e. 5 minutes)
4
and immediately after (i.e. 5 minutes) each resistance training session in the presence of
5
an exercise supervisor, as the purpose of the study was to directly compare the effects of
6
creatine before vs. after resistance training. Adherence with the creatine monohydrate,
7
placebo and resistance training was assessed by training and supplementation compliance
8
logs.
9
Resistance training program
10
Prior to the start of the study, each participant performed 3 familiarization sessions
11
(supervised) with the resistance training equipment in a private laboratory to reduce the
12
amount of learning related to task acquisition, which may contribute to our outcome
13
measures. Previous research has shown that 3 familiarization sessions followed by
14
multiple testing sessions is sufficient to produce reliable strength results in older adults
15
(Phillips et al. 2004). Participants followed the same supervised whole-body resistance
16
training program for 32 weeks in the same private laboratory. Training sessions were
17
supervised as previous research has demonstrated greater gains compared to unsupervised
18
training (Mazzetti et al. 2000). Prior to training sessions, but after the supplement was
19
consumed, each participant performed a 5-minute stationary cycling warm-up at a self-
20
selected intensity. Participants completed 3 sets of 10 repetitions to muscle fatigue with
21
1-2 minutes rest between sets for each exercise at an intensity corresponding to their 10-
22
repetition maximum for each exercise. Resistance exercises performed in order included
23
leg press, chest press, lat pull-down, shoulder press, leg extension, leg curl, triceps
6
Appl. Physiol. Nutr. Metab. Downloaded from www.nrcresearchpress.com by San Francisco (UCSF) on 03/01/15 For personal use only. This Just-IN manuscript is the accepted manuscript prior to copy editing and page composition. It may differ from the final official version of record.
Page 8 of 27
1
extension, biceps curl, calf press, back extension and abdominal curl. We chose to use
2
machine-based resistance training equipment because they are considered safer and easier
3
to learn than free weights (Ratamass et al. 2009) and the use of machine-based equipment
4
lead to greater improvements in machine-based strength tests (Boyer et al. 1990).
5
Participants maintained daily training logs where the load, number of sets and repetitions
6
were recorded. Resistance was increased by 2-10 kg once a participant could complete 3
7
sets of 10 repetitions to muscle fatigue for an exercise. Once the resistance was increased,
8
participants maintained this load until a subsequent 3 sets of 10 repetitions to fatigue
9
were completed.
10
Body composition
11
Lean tissue and fat mass was measured by dual-energy x-ray absorptiometry
12
(Hologic Wi System, Christie Group, Manitoba, Canada) in array mode. Before scanning,
13
participants were required to take off all removable objects containing metal (i.e. jewelry,
14
glasses, clothing with buttons, and/or zippers). Scans were performed with participants
15
lying in a supine position along the scanning table’s centerline longitudinal axis. Feet
16
were taped together at the toes (i.e. phalanges) to immobilize the legs while the hands
17
were maintained in a pronated position within the scanning region. All scans were
18
performed by the same Nuclear Medicine Technologist. The coefficient of variation from
19
previous research is 0.54% for lean tissue mass (Chrusch et al. 2001).
20
Muscle strength
21
Leg press and chest press strength was assessed using a 1-repetition maximum (1-
22
RM) standard testing procedure. Following 5-minutes of cycling on a stationary cycle
23
ergometer, participants performed two warm-up sets in order: 1 set of 10 repetitions using
7
Appl. Physiol. Nutr. Metab. Downloaded from www.nrcresearchpress.com by San Francisco (UCSF) on 03/01/15 For personal use only. This Just-IN manuscript is the accepted manuscript prior to copy editing and page composition. It may differ from the final official version of record.
Page 9 of 27
1
a weight determined by each subject to be comfortable and 1 set of 5 repetitions using
2
increased weight. Two-minutes following the warm-up sets, weight was progressively
3
increased for each subsequent 1-RM attempt with a 2-minute rest interval. The 1-RM was
4
reached in 4-6 trials, independent of the 2 warm-up sets. The coefficients of variation
5
from previous research are 3.0% for the leg press and 3.6% for the chest press (Chrusch
6
et al. 2001).
7
Dietary assessment
8
Dietary intake was recorded during the first and final week of supplementation and
9
resistance training to assess differences in total energy and macronutrient composition
10
between groups. Participants used a 3-day food booklet to record food intake for two
11
weekdays and one weekend day. Participants were instructed to record all food items,
12
including portion sizes consumed for the three designated days. The Interactive Healthy
13
Eating Index (Center for Nutrition Policy and Promotion, United States Department of
14
Agriculture) was used to analyze 3-day food records.
15 16 17
Statistical analysis
18
repeated measures on the second factor was used to determine differences between
19
groups over time for lean tissue mass, Relative Skeletal Muscle Index (sum of
20
appendicular muscle mass [kg] / m2), fat mass, leg press strength, chest press strength,
21
relative strength (strength/lean tissue mass) and diet. If significant interactions were
22
detected, a one-factor ANOVA on change scores (∆ = post mean-pre mean) was
23
conducted. If the one-factor ANOVA was significant, the smallest mean would be
24
considered different than the largest mean and therefore only two additional t-tests were
A 3 (CR-B vs. CR-A vs. PLA) × 2 (pre- and post-test periods) ANOVA with
8
Appl. Physiol. Nutr. Metab. Downloaded from www.nrcresearchpress.com by San Francisco (UCSF) on 03/01/15 For personal use only. This Just-IN manuscript is the accepted manuscript prior to copy editing and page composition. It may differ from the final official version of record.
Page 10 of 27
1
used to compare the smallest and largest mean to the middle mean, with adjustments for
2
multiple comparisons (p 7.26 kg/m2 for males and > 5.5 kg/m2 for females;
15
Baumgartner et al. 1998) while 6 females (CR-B: n=2, CR-A: n=3, PLA: n=1) and 3
16
males (CR-B: n=1, CR-A: n=1, PLA: n=1) were considered sarcopenic. Following the
17
study, only 3 women remained sarcopenic (n=1 from each group). There was an increase
18
in total energy intake (kcal) over time (p
