The Journal of Nutrition, Health & Aging©

Volume 14, Number 2, 2010

JNHA: CLINICAL TRIALS AND AGING

THE EFFECTS OF SUPPLEMENTATION WITH CREATINE AND PROTEIN

ON MUSCLE STRENGTH FOLLOWING A TRADITIONAL RESISTANCE
TRAINING PROGRAM IN MIDDLE-AGED AND OLDER MEN
M.G. BEMBEN1, M.S. WITTEN2, J.M. CARTER3, K.A. ELIOT4, A.W. KNEHANS4, D.A. BEMBEN1
1. Neuromuscular Lab, Dept. Health & Exercise Science, U. Oklahoma, Norman, OK, 73019; 2. Center on Aging, U. Colorado & Health Science Center, Aurora, CO, 80045; 3. Norman
Regional Hospital Health Club, 3700 W. Robinson, Norman, OK, 73072; 4. Dept. Nutritional Sciences, U. Oklahoma Health Sciences Center, Oklahoma City, OK, 73104. Corresponding
auhtor: Michael G. Bemben, PhD, University of Oklahoma, Department of Health and Exercise Science, 1401 Asp Ave. Room 115 HHC, Norman, OK 73019, [email protected],
Phone: (405) 325-2717

Abstract: Objectives: Creatine and protein supplementation can enhance the training outcomes of young
subjects, but it is not clear if there are benefits for older individuals. Therefore, the purpose of this study was to
determine the effects of creatine and protein supplementation on strength gains following a traditional resistance
training program for middle-aged and older men. Design, Setting, Participants: This study assessed changes in
strength of men aged 48-72 years following 14 weeks of resistance training supplemented with creatine and/or
protein. A double-blind, randomized, placebo-controlled design placed 42 males into one of four groups:
Resistance Trained Placebo (RTP, n=10); Resistance Trained Creatine (RTCr, 5g Cr, n=10); Resistance Trained
Protein (RTPr, 35g whey Pr, n=11); or Resistance Trained Creatine and Protein (RTCrPr, 5g Cr and 35g Pr,
n=11). Intervention: All groups trained 3 days per week for 14 weeks. The resistance training program was based
on progressive overload. Training loads corresponded to 80% 1RM (one repetition maximum strength), 3 sets of
8 repetitions for the following exercises: knee extension/knee flexion; bicep curl/tricep extension; military press;
lat pull down; seated leg press; and bench press. Measurements: 1 RM for each exercise and measures of lean
body mass were assessed prior to and following the 14 week program. Results: Each group significantly (p<0.05)
increased strength and lean body mass, however, there were no significant group effects or group X trial
interactions. Conclusion: Resistance training in middle-aged and older men significantly increased muscular
strength and added muscle mass with no additional benefits from creatine and/or protein supplementation.

Key words: Creatine monohydrate, whey protein, weight training, strength, aging.

Introduction Studies also suggest that creatine (Cr) supplementation can

increase the concentrations of both creatine and
The aging process brings about a number of physiological phosphocreatine in skeletal muscle (14) which may provide the
changes, such as the loss of muscle protein and a concomitant means necessary for improved strength by an increase in
decline in lean body mass, strength, and power, as well as muscle mass when combined with resistance training, however,
increases in fat mass, all of which have been implicated in a less is known when training older participants. It would then
decline of physical performance and function (1). These seem possible that older individuals involved in resistance
changes can ultimately result in an increased dependency on training might benefit from a combined program of Cr and
others, reduced abilities to perform acts of daily living, and protein (Pr) supplementation compared to individual
limit recreational and occupational pursuits (2). supplementation or resistance training without any
Various interventions have been proposed on how to supplements.
effectively improve the rate of protein synthesis and slow the The purpose of this study was to assess changes in upper
rate of protein degradation in order to elicit skeletal muscle body and lower body muscular strength of middle-aged and
hypertrophy and improved strength (3-7). Resistance training older men (age 48-72 yrs) following a 14-week resistance
for older adults has become increasingly popular as an effective training program when combined with Pr and/or Cr
intervention, especially when combined with increased dietary supplementation. We hypothesized that all participants would
protein intake in order to provide an adequate stimulus to benefit from the resistance training program by increasing
improve strength and promote the anabolic development of muscular strength, but those who were supplemented with Cr,
muscle (8-11). Pr, or both, would be able to augment their training
It has been reported that aging results in reduced levels of improvements, especially for the combined Cr and Pr group.
resting phosphocreatine (PCr), perhaps due to a decrease in
Type II muscle fiber number and size. These changes may Subjects and Methods
also, in part, be responsible for the age-related reductions in
skeletal muscle size, mitochondrial enzyme activity, and high- Study Sample
energy phosphate metabolism, all associated with the decline in Forty-two male subjects aged 48-72 years volunteered.
muscle mass, strength, and endurance capacity (12, 13). Following a complete explanation of the purpose and
Received April 15, 2009
Accepted for publication May 16, 2009 155
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THE EFFECTS OF SUPPLEMENTATION WITH CREATINE AND PROTEIN ON MUSCLE STRENGTH

procedures of the investigation, written informed consent was the training program, a standardized one repetition maximum
obtained from each subject as approved by the university’s (1RM) protocol was utilized one week prior to training, at week
Institutional Review Committee (IRB). Subjects were healthy 5 and week 10 of training, and post training. Each subject was
and had not resistance trained for at least the previous 12 instructed on proper lifting technique and the basic
months and those aged 55 and older were required to obtain fundamentals of training. Cybex® isotonic resistance training
medical approval from their own personal physicians. Subjects equipment (Ronkonkoma, New York) was used for all testing
were then randomly assigned into one of four groups; 1) and training. Prior to the initial strength testing, subjects
resistance training placebo (RTP, n=10, mean age 56.1±1.4 warmed up by cycling on a cycle ergometer, or walking on a
years, mean height 177.0±1.8 cm, mean weight 98.0±7.6 kg); treadmill for five minutes, and then performed flexibility
resistance training with creatine (RTCr, n=10, mean age exercises for another five to ten minutes. At each piece of
56.1±1.8 years, mean height 177.4±2.4 cm, mean weight resistance training equipment, the subject warmed up using a
91.1±5.2 kg); resistance training with protein (RTPr, n=11, weight of approximately 50% of their estimated 1RM for a total
mean age 58.2±2.0 years, mean height 175.6±2.0 cm, mean of five to six repetitions. Subjects then attempted to lift a
weight 88.3±4.4 kg); or resistance training with creatine and heavier load until they achieved their maximum weight that
protein (RTCrPr, n=11, mean age 57.2±2.2 years, mean height they were able to lift. Testing was completed within five
179.6±2.3 cm, mean weight 92.6±5.1 kg). Based on numerous attempts and each attempt was separated by one minute of rest.
previous studies (7, 11, 15, 16, 17) it was determined that a The exercises and muscle groups used during the training
minimum of 10 subjects for each group would be needed to protocol, as well as 1RM testing included: knee extensions
achieve a statistical power of 0.80, thus reducing the chance of from a seated position (quadriceps); knee flexion from a seated
making a Type II error for our study (18). position (hamstrings); bicep curls from a seated position
(biceps); tricep extension from a seated position (triceps);
Dietary Analysis and Supplementation Protocol military press from a seated position (deltoids); lat pull downs
Following individual educational sessions utilizing food from a seated position (latissimus dorsi); seated leg press
models, conducted by a registered dietician, total daily energy (gluteus maximus and quadriceps); and bench press (pectoralis
intake was estimated by use of a three-day dietary log at major), using a Smith Press Machine. Day to day reliability for
baseline and at the end of the training program (19). Food 1RM measures for our laboratory are between r=0.95 and
records were analyzed for energy nutrient content using Food r=0.99 with coefficients of variation between trials less than
Works 2.0 nutrition software (McGraw Hill). Based on many 1%.
previously published reports, subjects then began a two week Changes in lean body mass were assessed by Dual Energy
constant loading phase for the supplementation portion of this X-ray Absorptiometry (DXA Lunar DPX-IQ) and were
study (20-24). This was only necessary for the individuals in reported in a separate publication (19). The coefficient of
the two Cr groups (RTCr and RTCrPr); however, to maintain variation for DXA measures of lean body mass is 1.39% for our
the double blind condition, the other two groups (RTP and laboratory.
RTPr) also went through a loading phase consisting only of the
placebo (480 mL of Gatorade™). Gatorade was chosen as the Intervention
placebo since it is commonly consumed during exercise The resistance training program incorporated the overload
sessions and it has no, or only minimal, protein sparing effects principle and was monitored by trained supervisors to ensure
as a potential ergogenic aid. The RTCr and the RTCrPr groups compliance and accuracy. The overload principle ensured that
loaded 7 g of creatine monohydrate with 480 ml of the glucose as strength improved for these individuals, workloads were
solution (Gatorade™) on each of 3 days per week for the 2 increased to ensure continued adaptations occurred. The
weeks prior to the training intervention. Once training began, training groups met three times per week (Monday,
the RTP group consumed the placebo (480 ml of Gatorade™), Wednesday, Friday) and performed three sets of eight
the RTCr group consumed (5g Creatine with 480 ml repetitions at 80% of 1RM for each exercise that was initially
Gatorade™), the RTPr group consumed (35g whey protein strength tested (26). The session began with approximately
(Old Fashioned Natural Products, Santa Ana, CA) with 480 ml five minutes of warm up on a cycle ergometer or treadmill,
of Gatorade™), and the RTCrPr group consumed (5g creatine followed by five to ten minutes of flexibility training.
and 35g whey protein with 480 ml Gatorade™) immediately Following the warm up period, the resistance training protocol
after each supervised training session (25). A research assistant began with subjects beginning with the largest muscle groups
administered supplementation and ensured that each subject and alternating between upper and lower body exercises and
completed the ingestion of their drink in a timely fashion recording the number of completed repetitions and sets.
following the completion of each training session. Training logs were maintained by each participant that indicted
the numbers of repetitions, sets, and loads that were completed
Testing Procedures for any given workout session. These logs were then reviewed
In order to determine baseline levels of muscular strength at the end of each day by the training staff. The sessions ended
and appropriate training loads for each muscle group used in with five to ten minutes of cool down and each session lasted
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JNHA: CLINICAL TRIALS AND AGING

approximately one hour in total. The maximal strength (1RM) (~50%) for knee extension. Percent improvements ranged from
for each exercise was re-assessed at weeks 5 and 10 of the about 30% for the bicep curl (averaged across the four training
training program and the weights were adjusted the following groups) to about 63% for knee extension.
week to ensure progressive overload was maintained
throughout the entire training period. Figure 1a
Percent Changes in Upper Body Muscular Strength from
Statistical Analyses Baseline for each Training Group
All data are reported as means + SE, as well as percent
change [{(post value – pre value)/pre value} X 100]. Statistical
analyses were performed using SPSS 10.0 for Windows.
Baseline comparisons between the groups were accomplished
by a one way ANOVA. Treatment effects on muscular strength
were determined using a two-way (Group (4; RTP, RTCr,
RTPr, RTCrPr) X Trial (4; pre, 5 wks, 10 wks, post)) ANOVA
with repeated measures and a Bonferroni paired samples
procedure was used as a post-hoc test when significant group
effects were found. Group differences for percent (%) change
in the dependent variables following training were determined
by a one-way ANOVA. Statistical significance was set at an
alpha level of p ≤ 0.05.

Results
Figure 1b
Baseline Measures Percent Changes in Lower Body Muscular Strength from
At baseline, there were no significant differences in age, Baseline for each Training Group
height, or weight between the four training groups. As
mentioned earlier, three day food journals were kept by each
participant prior to beginning the resistance training and at the
end of the study. Previously published data reported that there
were no differences (p>0.05) between the four groups at the
beginning of the training study or at the end regarding any of
the dietary parameters of interest (total calories consumed and
percentages of fat, carbohydrate and protein) (19).
Additionally, there were no significant differences (p>0.05)
between the four groups for any baseline measures of isotonic
strength for the eight exercises chosen for the training program
or for measures of bone-free lean body mass as measured by
Dual Energy X-ray Absorptiometry (19).

Training Effects
Significant trial effects (p<0.01), but no significant group Discussion
effects were noted for each muscular strength variable. Only
one group X trial interaction (knee extension, p<0.05) was This study investigated changes in upper body and lower
determined for the eight muscle groups that were trained. The body muscular strength of older men (age 48-72 yrs) following
two Pr supplemented groups (RTPr and RTCrPr) had a 14-week resistance training program combined with whey
significantly larger increases than the other two groups. protein (Pr) and/or creatine monohydrate (Cr) supplementation.
Figures 1a and 1b provide the percent improvements in 1RM The significant increases in muscular strength for the four
strength from baseline to post training for each of the eight groups following training was expected, which indicates a
exercises performed during the training program and for each successful overload stress stimulus during the training period.
of the four groups. There were no differences detected between Resistance training in the young and old has been proven to
the four groups in their improvements for each of the exercises be effective in achieving muscular strength gains, primarily due
performed following the resistance training program with the to adaptations of the neuromuscular system, in as little as a few
exception of the knee extensors, as mentioned above. The 2 Pr weeks of training. In fact, Short and Nair (10) reported one
supplemented groups had a significantly greater increase in week of resistance training alone was sufficient enough to
strength (~75%) compared to the RTP and RTCr groups stimulate protein synthesis and result in improved muscular
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strength in older subjects. Schulte and Yarasheski (9) also just as effective.
reported in only two weeks of vigorous training in older Our results are also somewhat similar to Deldicque et al.
subjects that a doubling in the synthesis rate of myosin heavy (37) who reported that Cr supplementation did not enhance
chain protein synthesis can occur and result in increased protein synthesis more than exercise alone. They reported that
muscular strength. Skeletal muscle hypertrophy, on the other Cr supplementation did increase the expression of IGF-1 at rest
hand, is generally achieved through prolonged training, and but was not increased following exercise and that any increase
was expected with the current protocol. In fact, previously in muscle growth was probably due to the enhancement of the
published data reported the changes in muscular strength in the anabolic status of the cell and involved IGF. On the other
current study were accompanied by significant (p<0.01) hand, Dorofeyeva and Dorofeyev (38) found that amino acid
increases in the bone-free lean body mass of the arms (mean supplementation increased the adaptation of athletes
percent increase = 6.6%) and legs (mean percent increase = undergoing extensive exercise training. However, these
1.8%) for each of the four exercise groups (19). However, the subjects were much younger, highly trained, and exercised at a
lack of an augmented muscle strength or muscle hypertrophy much higher intensity that the subjects in the current study. In
for the Cr and Pr supplemented groups was somewhat a study that augmented Cr supplementation with carbohydrates,
surprising, considering the evidence that the training stimulus, Theodrou et al. (39) reported there was no added advantage to
the duration of the training protocol, and the dietary the carbohydrate plus Cr supplemented group when compared
supplements could be considered sufficient enough to result in to the Cr only group concerning maximal swim times.
greater improvements (27). A possible limitation of our In another study that utilized both Cr and protein
research design which may have affected the group changes in supplementation, Burke et al. (3) reported that young males
strength was that the work performed during any given training who received a whey protein supplement (similar to the current
session was predetermined for each participant. In other words, study) in combination with resistance training had slightly
since each subject followed a specific workout protocol, even if greater increases in lean tissue mass compared to males who
supplementation with Cr, Pr, or both, allowed for a quicker trained and received placebo, while those who supplemented
recovery time between sets or exercises, subjects were not with both Cr and Pr had greater increases in lean tissue mass
allowed to do additional exercise. and strength than those that supplemented with only Pr or a
Many investigators who have examined the influence of Cr placebo. A possible explanation for the current study not
supplementation during resistance training in young subjects, showing similar results could be that older people have been
generally reported significant increases in strength, lean tissue reported to have a lower resting muscle phosphocreatine
mass and body weight (23-31), however, there is the possibility concentration compared to younger people (13). An increase in
that a given subject pool may contain non-responders (32). The the percentage of Type I fibers within skeletal muscle occurs
findings of the current study do agree with Bermon et al. (33) with increased age and may explain reduced resting
and Eijnde et al. (34) who concluded that oral Cr phosphocreatine concentrations found in older subjects.
supplementation did not provide additional benefits for fitness, However, the creatine loading protocol in the current study
maximal dynamic strength, or isometric endurance in healthy, should have been sufficient to ensure that cellular PCr levels
elderly, male or female subjects, when accompanied by an were increased prior to beginning the exercise intervention
effective strength training program. The short, two month (40). There were however, some significant design differences
program in that study could be a primary reason for the lack of between the current study and the Burke et al. study (3) that
significant benefit from the Cr supplemented groups; however, might explain the differences in finding between the two
our program which was twice as long, also found no additional studies. Participants in the Burke et al. study (3) were
benefits of Cr supplementation for this population. significantly younger males, were resistance trained, and the
Additionally, Stevenson and Dudley (24) also indicated that Cr supplement dose differed (8 g Cr per day, and 96 g Pr; Burke et
loading did not augment unilateral strength or multi-set al. (3) versus 5 g Cr per day, and 35 g Pr; current study).
resistance exercise performance when compared to training
done in older adults. Subjects in the current study were only Conclusion
required to supplement on training days, therefore, when
sessions were missed, supplementation was also missed. No In general, strength and hypertrophy designed resistance
beneficial effects of Cr have also been reported in different training programs can be successful for older men (aged 48-72
athletic groups. Ahmun et al. (35) reported no improvement in years) when based on the concept of progressive overload,
rugby players following Cr supplementation (5 g, 4Xdaily, for however, when the training program is tightly controlled
5 days) and Hoffman et al. (36) used 6g/day for 6 days and also regarding loads, sets, and repetitions, there is no indication that
found no effect on power outputs but they did report a this particular age group can augment their exercise benefits by
decreased rate of fatigue. Generally, the literature is not clear supplementing with creatine or protein.
on whether or not daily Cr supplementation during a training
program is necessary in order to achieve maximal benefits from Acknowledgments: We would like to thank the Gatorade Sports Sciences Institute for
partially funding this project.
the training, or if supplementing only on the training days is
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Financial disclosure: None of the authors had any financial interest or support for this 129.
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