ORIGINAL ARTICLE

Long-term creatine supplementation improves muscularperformance during resistance training in older women

Andreo Fernando Aguiar • Renata Selvatici Borges Januario • Raymundo Pires Junior •

Aline Mendes Gerage • Fabio Luiz Cheche Pina • Matheus Amarante do Nascimento •

Carlos Roberto Padovani • Edilson Serpeloni Cyrino

Received: 10 April 2012 / Accepted: 25 September 2012 / Published online: 7 October 2012

� Springer-Verlag Berlin Heidelberg 2012

Abstract This study examined the effects of long-term

creatine supplementation combined with resistance training

(RT) on the one-repetition maximum (1RM) strength,

motor functional performance (e.g., 30-s chair stand, arm

curl, and getting up from lying on the floor tests) and body

composition (e.g., fat-free mass, muscle mass, and % body

fat using DEXA scans) in older women. Eighteen healthy

women (64.9 ± 5.0 years) were randomly assigned in a

double-blind fashion to either a creatine (CR, N = 9) or

placebo (PL, N = 9) group. Both groups underwent a

12-week RT program (3 days week-1), consuming an

equivalent amount of either creatine (5.0 g day-1) or pla-

cebo (maltodextrin). After 12 week, the CR group

experienced a greater (P \ 0.05) increase (D%) in training

volume (?164.2), and 1RM bench press (?5.1), knee

extension (?3.9) and biceps curl (?8.8) performance than

the PL group. Furthermore, CR group gained significantly

more fat-free mass (?3.2) and muscle mass (?2.8) and

were more efficient in performing submaximal-strength

functional tests than the PL group. No changes (P [ 0.05)

in body mass or % body fat were observed from pre- to

post-test in either group. These results indicate that long-

term creatine supplementation combined with RT improves

the ability to perform submaximal-strength functional tasks

and promotes a greater increase in maximal strength, fat-

free mass and muscle mass in older women.

Keywords Aging � Creatine � Resistance training �Ergogenic aid � Muscle strength

Introduction

Age-related sarcopenia leads to declining muscular

strength, power, and endurance and results in an impaired

ability to perform daily activities and may ultimately cause

dependence and disability in older adults (Hunter et al.

2004). Several strategies (e.g., hormone replacement ther-

apy, nutritional intervention, and resistance training) have

been used to attenuate the progressive loss of muscle mass

and function that occurs in concert with biological aging

(for review, see Doherty 2003; Fujita and Volpi 2004).

Among these strategies, resistance training (RT) is the most

suitable intervention aimed decreasing the deleterious

effects of sarcopenia (Hunter et al. 2004). For example,

Yarasheski et al. (1995) reported an increase in mixed

muscle protein synthesis (*50 %) and muscle strength in

older men (65–75 years) after 16 weeks of progressive RT.

Communicated by Michael Lindinger.

A. F. Aguiar (&) � R. S. B. Januario � R. P. Junior

Center of Biological and Health Sciences, North University

of Parana (UNOPAR), Avenue Paris, 675 Jardim Piza,

Londrina, PR 86041-120, Brazil

e-mail: andreoaguiar@hotmail.com

R. S. B. Januario � A. M. Gerage � F. L. C. Pina �M. A. do Nascimento � E. S. Cyrino

Group of Study and Research in Metabolism, Nutrition,

and Exercise, Londrina State University (UEL), Londrina, Brazil

A. M. Gerage

Department of Physical Education, Centre of Sport,

Santa Catarina Federal University, Florianopolis, Brazil

M. A. do Nascimento � E. S. Cyrino

Department of Physical Education, Centre for Physical

Education and Sports, Londrina State University (UEL),

Londrina, PR, Brazil

C. R. Padovani

Department of Biostatistics, Sao Paulo State University

(UNESP), Botucatu, SP, Brazil

123

Eur J Appl Physiol (2013) 113:987–996

DOI 10.1007/s00421-012-2514-6

These authors in a later study also reported increased force

production and mixed protein synthetic rate in the vastus

lateralis muscle of 76- to 92-year-old women and men after

3 months of progressive RT [3 days week-1 at 65–100 %

of one-repetition maximal (1RM)] (Yarasheski et al. 1999).

These findings are consistent with other studies that dem-

onstrated an increase in the muscle strength and fat-free

mass of older adults who underwent progressive RT

(Charette et al. 1991; Campbell et al. 1994). Furthermore,

previous studies have observed 20 to 62 % increases in

muscle fiber hypertrophy among older adults after

9–52 weeks of conventional RT (e.g., 2–3 days week-1)

(Bamman et al. 2003; Trappe et al. 2001; Charette et al.

1991; Newton et al. 2002; Taaffe et al. 1996).

While there is no question that RT is a suitable strategy

for attenuating the progressive loss of muscle mass and

strength associated with the natural aging process,

adjunctive strategies to augment these effects may enhance

the overall efficacy of strength training interventions. In

this context, creatine (Cr) supplementation has been iden-

tified as a potent ergogenic aid to prevent the loss of muscle

mass and strength that occurs with aging. Long-term Cr

supplementation ([12 weeks) combined with RT increases

strength and power, enhances fatigue resistance, and

increases fat-free mass in older men (Chrusch et al. 2001).

Additionally, several studies have found beneficial effects

of short-term Cr supplementation on the performance of

daily activities in older adults (Gotshalk et al. 2002, 2008;

Canete et al. 2006). Canete et al. (2006) reported a 12 %

reduction in time required to complete the sit-stand test in

older women (67 years) following 7 days of Cr supple-

mentation (0.3 g kg-1 day-1). Similarly, Gotshalk et al.

(2002, 2008) found reductions in time required to complete

the sit-stand and tandem gait tests in older men (6–9 %

reduction) and women (5–7 % reduction), following 7 days

of Cr supplementation (0.3 g kg-1 day-1). These studies

and many others (Stout et al. 2007) demonstrate that acute

(*7 days) Cr supplementation has the potential to enhance

muscle function (e.g., daily tasks, 1RM strength, and fati-

gue resistance), increase fat-free mass and, potentially,

improve the performance of daily tasks in older adults.

However, it is unclear whether the ergogenic effects of

long-term Cr supplementation combined with RT also

occur specifically in older women.

Based on the positive findings of previous studies

involving acute (*7 days) Cr supplementation, we

hypothesized that long-term Cr supplementation combined

with RT would promote additional beneficial effects on

body composition (e.g., increased fat-free mass and muscle

mass) and muscle strength (e.g., increased 1RM and

functional strength) beyond what is observed with training

alone. Despite an abundance of studies, only one study on

long-term Cr supplementation (8 weeks) in older adults has

included women as subjects (Bermon et al. 1998), and the

authors failed to found any additional beneficial effect of

Cr supplementation on body composition and several

measurement of muscle performance. Failure to detect a

statistically significant effect of Cr supplementation on

performance in older adults may partially be attributed to

insufficient reliability of testing protocols (Bermon et al.

1998). Gotshalk et al. (2008) argue that several (five or

more) familiarization sessions are critical to establish a

control for day-to-day variability and the reliability of

maximal effort performances in order to detect a small

(5–10 %) effect of Cr supplementation in older women.

The present investigation is the first who applied a long

resistance training period (12 weeks) following several

(six) familiarization sessions before the randomization.

This approach can avoid any learning bias and hence

ensures a high reliability of maximal effort performances to

detect statistically significant effects of Cr supplementation

in older women. Furthermore, this is the first study that

attempted to examine the effects of long-term Cr supple-

mentation combined with RT on muscle strength and body

composition in exclusively older women.

Methods

Experimental approach

A randomized, double-blind and placebo-controlled design

with repeated measures was employed to create two groups

(Placebo, N = 9; Creatine N = 9) (Fig. 1). Initially, all

subjects completed six familiarization sessions to receive

instruction on proper techniques and to practice the one-

repetition maximal (1RM) and functional testing protocols

(30-s chair stand, arm curl, and getting up from lying on the

floor tests). Subsequently, all participants underwent a

12-weeks RT program (3 days week-1) to obtain similar

physical fitness levels with regard to muscle performance.

The training regimen aimed to work all the major muscle

groups (e.g., pectoralis, latissimus dorsi, biceps, triceps,

quadriceps, gastrocnemius, and abdominals). After this

initial 12-weeks phase, the subjects were matched

according to age, body mass, and 1RM performance and

then randomly assigned in a double-blind fashion to a

Creatine (CR) or Placebo (PL) group, and they continued

an additional 12 weeks of continuous RT (3 days week-1)

while consuming their appropriate supplements (Fig. 1).

The RT program was designed in accordance with the

ACSM Position Stand guidelines on exercise and physical

activity for older adults (Chodzko-Zajko et al. 2009). To

examine the effects of Cr supplementation on muscle

strength and body composition, both the CR and PL groups

completed a battery of 1RM tests, upper- and lower body

988 Eur J Appl Physiol (2013) 113:987–996

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functional tests, and body composition measurements on

two separate occasions (pre- and post-training program);

the upper- and lower body 1RM tests were performed

alternately to minimize the effects of fatigue. All tests were

performed on the same place, between 2 and 5 pm. We

used a two-group design because of potential problems

with a within-subjects (cross-over) experimental approach

in Cr supplementation studies that examine physical per-

formance. Furthermore, cross-over design studies can be

influenced by the differences in dietary Cr intake and

intersubject variability in Cr accumulation and depletion.

We ensured that the experimental approach used in the

present study would provide an effective way to investigate

the effects of Cr supplementation during long-term RT on

the muscle strength and body composition of older women.

Subjects

Health, nonathletic, women older than 60 years were

invited to attend a meeting aimed at explaining the purpose

and details of the study protocol. To be qualify as partic-

ipants, the women were required to (1) not be vegetarian,

(2) be aged between 60 and 80 years, (3) have not ingested

any ergogenic supplement for the previous 6 months before

the start of study, (4) have not ingested any medication that

could affect muscle growth or the ability to train intensely

during the study, (5) not be involved in the practice of

systematized physical activity (i.e., 2–3 days week-1) for

the previous 6 months before the start of study, (6) have a

detailed description of their lifestyle and daily food intake,

and (7) have medical approval for the practice of physical

exercise. Eighteen women (64.9 ± 5.0 years) who met

these criteria volunteered to participate in the study. After

baseline assessments, the subjects were matched for 1RM

performance in three weight lifting exercises (see strength

assessments) and were then randomly assigned in a double-

blind fashion to either a CR (N = 9) or PL (N = 9) group.

The physical characteristics of the CR and PL groups at

baseline are presented in Table 1. All subjects were

informed of the purpose, procedures and possible risks of

the investigation before they gave written informed consent

to participate in the study. All procedures involved in this

investigation were approved by the Human Research Eth-

ics Committee of the University (project no: 4743; protocol

no: 21750/2006) and were in accordance with the 1964

Declaration of Helsinki.

Resistance training program

The 12 weeks RT program focused on all of the major

muscle groups (e.g., pectoralis, latissimus dorsi, biceps,

triceps, quadriceps, gastrocnemius, and abdominals) and

was designed specifically to increase strength and muscle

size. The RT consisted of eight whole-body exercises pri-

marily using exercise machines (Bad Boy Gym equipment,

Sao Paulo, Brazil), and the exercises were performed in the

following order: (1) vertical bench press, (2) lat pulldown,

(3) biceps curl, (4) triceps pushdown, (5) knee extension,

(6) leg curl, (7) seated calf raise, and (8) abdominal crunch.

Both the CR and PL groups trained under the same training

protocol (3 days week-1; 2 sets of 10–15 repetitions with

60- and 120-s rests between the sets and exercises,

respectively) during the 12-weeks RT program; the only

exceptions were the exercises for the calf (15–20 repeti-

tions) and abdominal muscle groups (20–30 repetitions

with no additional overload) muscle groups. Each training

session began with stretching exercises for whole body.

Qualified personnel supervised individually each partici-

pant during every workout. Each subject received a training

logbook, in which the researchers recorded the weekly

Fig. 1 Experimental design

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training load (weight) used for each exercise. The training

load was adjusted weekly, based on the number of repeti-

tions performed at the end of the second set of each

exercise. Specifically, 1 kg-load was added every one

(lower extremity) or two (upper extremity) repetitions that

exceeded the 15 repetitions of second set of each exercise.

The training volume (weight 9 sets 9 repetitions) was

progressive throughout the training program, and each

participant was able to complete 15 repetitions on the

second set of each exercise. At the end of each session,

approximately 5 min were used for stretching the exercised

muscles on the RT session. The total time of one training

session for each participant was approximately 60 min and

remained the same throughout the 12-weeks training pro-

gram. Sessions were performed between 6 and 11 am. The

1RM and functional fitness tests and the body composition

assessments occurred during the weeks before and after the

RT program.

Maximal dynamic strength

The bench press, knee extension and biceps curl strength

were assessed using a 1RM standard testing procedure

before and after the 12-weeks RT program. A recognized

1RM testing protocol and exercise execution guidelines

were followed, as previously documented (Baechle and

Earle 2008). Briefly, attempts of 1RM with progressively

increasing load were performed with each attempt sepa-

rated by 3- to 5-min rest intervals. Each test exercise was

separated with a 5-min rest break. 1RM was defined as the

greatest load lifted through a full range of motion before

two failed attempts at a given load. Before begin test, the

participants were kept at rest while received guidance from

the instructors, and verbal encouragement was provided

during all 1RM attempts. The reproducibility of the

strength measurements was determined on 8 subjects,

2 weeks apart. The intraclass correlation coefficient

(R) and coefficient of variation (CV) for the 1RM tests

were bench press: R = 0.99, CV = 2.5 %; biceps curl:

R = 0.98, CV = 2.8 %; and knee extension: R = 0.96,

CV = 3.2 %.

Upper- and lower body functional tests

To assess the upper- and lower extremity functional per-

formance, the 30-s chair stand and arm curl tests (Rikli and

Jones 1999a, b) and a test of getting up from lying on the

floor (Kuriansky and Gurland 1976) were performed before

and after the 12-weeks RT program. Briefly, to test the

ability to rise from a chair without using the arms (30-s

chair stand test), a straight-backed chair without arms

(40 cm high) was used. The test began with the participant

seated in the middle of the chair, back straight and feet flat

on the floor, with the arms folded across the chest. The

subjects were instructed to rise to a full standing position

and then return to a fully seated position to complete as

many full stands as possible within the 30-s time limit. The

arm curl test was performed to assess the upper body

strength. The test began with the participant seated on a

chair, back straight and feet flat on the floor, with the

dominant side of the body close to the side edge of the

chair. A 5 lb dumbbell was held at the side in the dominant

hand (handshake grip), with the arm down beside the chair,

perpendicular to the floor. At the signal ‘‘go,’’ the subject

turned the palm up while curling the arm through a full

range of motion and then returned to the fully extended

position. The subjects were encouraged to execute as many

curls as possible within the 30-s time limit. Both the 30-s

chair stand and arm curl tests were performed after a

demonstration by the examiner, and a practice trial of three

repetitions for each participant checked for proper tech-

nique. The test to get up from lying on the floor was per-

formed to assess the ability to rise from the floor using the

arms. The test began with the participant lying on a mat in

the dorsal decubitus position, with the arms extended

beside the body and the legs extended. At the signal ‘‘go,’’

the subjects were encouraged to rise from the floor as

quickly as possible to a full standing position on a line

marked 40 cm in front of the mat. Three trials were con-

ducted, and the fastest time was recorded. Before begin

each test, the participants were kept at rest while received

guidance from the instructors. A digital stopwatch con-

trolled by a technician was used for timing.

Creatine supplementation

After baseline testing, the CR group began consuming

creatine monohydrate (Phosphagen, EAS, Inc., Golden,

CO, USA) in capsules (5.0 g day-1; once per day), while

Table 1 Baseline characteristics

Creatine (N = 9) Placebo (N = 9)

Age (years) 64 ± 4 65 ± 6

Body mass (kg) 60 ± 9 57 ± 7

Height (cm) 156 ± 5 156 ± 6

Fat-free mass (kg) 35 ± 2 35 ± 4

Fat mass (kg) 25 ± 7 22 ± 6

Body fat (%) 41 ± 6 39 ± 7

1RM bench press (kg) 29 ± 5 29 ± 5

1RM biceps curl (kg) 17 ± 2 17 ± 2

1RM knee extension (kg) 26 ± 2 26 ± 5

Values are mean ± SD

There were no differences between the groups

1RM one repetition maximum

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the PL group ingested an identical-looking and equivalent

amount of the placebo, maltodextrin (NeoNutri, MG,

Brazil), during the 12-weeks RT program. To ensure the

double-blind design, an individual who was not involved in

the study was responsible for placing the supplements into

bags and labeling the capsules with the subjects’ names

according to the randomization list. The Cr dose was

chosen based on previously reported intakes by older adults

(Brose et al. 2003; Eijnde et al. 2003). All subjects con-

sumed their supplement capsules dissolved in a carbohy-

drate (CHO) drink immediately after the training session,

as has been previously demonstrated to increase muscle

creatine accumulation (Green et al. 1996a, b) and achieve

optimal muscle adaptation (Cribb and Hayes 2006;

Esmarck et al. 2001).

Nutrient intake

Under the supervision of nutritionists, the subjects com-

pleted 3-day dietary intake records (including 1 weekend

day) before and after the 12-weeks RT program; standard

portions were used to assess the amount of food and drink

consumed. The total energy intake and macronutrient

amounts were calculated using software for nutritional

assessment (Avanutri, version 3.1.4, Rio de Janeiro-RJ,

Brazil). Participants were instructed to maintain their

habitual daily diet but to avoid caffeinated products (e.g.,

coffee, chocolate, mate, guarana, Coca-Cola, and energy

drinks) because caffeine appears to eliminate the effect of

Cr (Vandenberghe et al. 1996). Water intake was ad libi-

tum. The participants were also instructed to report in the

dietary records any adverse events from the supplements

on their health status. No adverse events were reported by

the participants.

Body composition

Total fat-free mass, fat mass and the percentage body fat

were determined using dual-energy X-ray absorptiometry

(DEXA) with a Lunar Prodigy (model GE PRODIGY—

LNR 41.990, GE Medical Systems, Madison, WI, USA).

The same licensed operator performed whole-body scans

on the same apparatus. The quality control calibration and

scanning procedures were performed according to the

manufacturer’s instructions. Participants were scanned at

the same time of day (i.e., in the morning) in a fasted state.

The appendicular lean tissue mass (ALTM) was deter-

mined by summing the lean tissue from the upper- and

lower body extremity. The ALTM values were converted

to muscle mass (MM) using the equation proposed by Kim

et al. (2004), where MM (kg) = 1.19 9 ALTM - 1.65.

For longitudinal studies in which relatively small changes

in body composition need to be detected, whole-body

scanning with this instrument has been demonstrated to be

accurate and reliable (coefficient of variation 0.8–2.8 %)

(Prior et al. 1997). The reproducibility of the DEXA was

determined on 7 subjects, 2 weeks apart. The intraclass

R for fat-free mass and fat tissue mass was 0.98, and the

CVs were 0.86 % for fat-free mass and 1.5 % for fat mass.

Statistical analyses

Statistical analyses were performed using SPSS statistical

analysis software (SPSS version 13.0; Chicago, IL, USA).

To ensure data reliability, the statistical procedures were

performed after the preliminary study of the variables

related to the normality and equality of variance between

groups, with a statistical power of 80 % for the compari-

sons assessed. The percent change (D%) in the maximal

strength and training volume between groups was analyzed

using a two-tailed unpaired t test (Zar 1999). A two (group:

creatine and placebo) 9 two (time: pre- and post-test)

repeated measures ANOVA (Johnson and Wichern 2002)

was used to evaluate the data across time and between

groups. When significant differences were confirmed with

ANOVA, multiple comparisons testing was performed

using Bonferroni post hoc analysis to identify these dif-

ferences. The level of significance was set at P B 0.05.

Data are expressed as the mean ± SD.

Results

Participant characteristics

All participants (CR, N = 9; PL, N = 9) who began the

12-weeks RT program completed the study. The baseline

characteristics of the subjects are presented in Table 1.

Both the CR and the PL groups had similar (P [ 0.05)

baseline physical characteristics. In addition, no significant

(P [ 0.05) differences in the daily dietary intakes were

Table 2 Dietary analyses

Creatine (N = 9) Placebo (N = 9)

Carbohydrate (%)

Pre 67.1 ± 7.8 66.5 ± 5.3

Post 66.7 ± 7.6 65.1 ± 6.2

Protein (%)

Pre 19.5 ± 5.4 20.4 ± 5.1

Post 19.6 ± 5.1 21.1 ± 4.7

Fat (%)

Pre 13.4 ± 4.1 13.1 ± 1.7

Post 13.7 ± 4.4 13.7 ± 2.6

There were no differences between the groups

Eur J Appl Physiol (2013) 113:987–996 991

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observed between the groups before and after the 12-weeks

intervention period (Table 2).

Maximal dynamic strength

The 1RM for each group is presented in Fig. 2. Significant

group-by-time interactions indicated that the delta change

in 1RM strength for the bench press (D%, CR: 14.3 ± 6.7

vs. PL: 9.2 ± 4.4, P \ 0.05), knee extension (D%, CR:

8.6 ± 2.7 vs. PL: 4.7 ± 1.8, P \ 0.05), and biceps curl

(D%, CR: 22.3 ± 7.1 vs. PL: 13.5 ± 3.9, P \ 0.05) were

significantly greater in CR group compared to PL group.

Training volume

A significant group 9 time interaction was observed for

training volume (Fig. 3). The percent change (D%) in the

training volume during the intervention period was more

than twofold greater (P \ 0.01) in the CR group

(294.1 ± 85.8 %) than the PL group (129.9 ± 52.4 %).

The number of sets and repetitions was similar between the

CR and PL groups, so the only difference between the

groups was the training load (weight lifted). The results

indicate that the CR group was able to lift more weight

than the PL group within the same training regimen.

Upper- and lower body functional performance

The functional performance for each group is illustrated in

Fig. 4. Both the CR and PL groups demonstrated a sig-

nificant (P \ 0.01) improvement in the 30-s chair stand

and arm curl (increased number of repetitions) tests and a

greater ability to get up from lying on the floor (decreased

time) from pre- to post-test. Significant group-by-time

interaction indicated that the CR group was 18.7, 10.2, and

10.7 % more efficient (P \ 0.01) in the 30-s chair stand,

arm curl, and getting up from lying on the floor tests at

post-test than PL group.

Body composition

The body mass and body composition are presented in

Table 3. Significant group-by-time interactions indicated

that the CR group gained significantly more fat-free mass

(D%, CR: 3.2 % vs. PL: 0.0 %; P \ 0.01) and muscle mass

(D%, CR: 3.7 % vs. PL: 0.9 %; P \ 0.01) than the PL

group. The body mass, fat mass, and percentage body fat

values were unchanged for the CR and PL groups from pre-

to post-test.

Discussion

To our knowledge, this study the first that has exclusively

examined the effects of long-term Cr supplementation

combined with RT on muscle strength and body compo-

sition in older women. Based on a previous finding

that indicated an ergogenic effect of short-term Cr

Fig. 2 Delta change in one repetition maximum (1RM) bench press

(upper panel), knee extension (middle panel), and biceps curl (lowerpanel) after 12 weeks of resistance training in the creatine and

placebo groups. D% = (pre-post/pre) 9 100. aP \ 0.05 compared to

placebo group

Fig. 3 Percent change (D%) in the training volume after 12 weeks of

resistance training in the creatine and placebo groups. D% = (pre-

post/pre) 9 100. aP \ 0.01 compared to the placebo group

992 Eur J Appl Physiol (2013) 113:987–996

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supplementation in older women (Gotshalk et al. 2008), we

hypothesized that long-term Cr supplementation in con-

junction with RT would promote beneficial effects in older

women, beyond what is observed with training alone. The

major findings of this study were that (1) Cr supplemen-

tation increased the training volume and 1RM bench press,

biceps curl, and knee extension performance; (2) Cr sup-

plementation increased the efficiency to perform submax-

imal-strength functional tests (30-s chair stand, arm curl,

and getting up from lying on the floor tests); and (3) Cr

supplementation in conjunction with RT promoted a

greater increase in fat-free mass and muscle mass com-

pared to RT alone.

The results of the current study indicate that the CR

group was able to train with a greater volume than the PL

group during the 12-weeks RT program. This increase in

the ability to train is perhaps not surprising considering

previously published data on Cr-supplemented younger

(Volek et al. 1999) and older (Chrusch et al. 2001) subjects.

Any creatine dose (e.g., 0.3–5.0 g kg-1 day-1) that is

sufficient to increase the muscle Cr levels (Chrusch et al.

2001; Volek et al. 1999; Vandenberghe et al. 1997) appears

to have the potential to improve the muscles’ ability to

train with high workloads. The additional training volume

observed in CR group resulted in greater 1RM bench press,

biceps curl, or knee extension performance after 12 weeks

of RT. Our results are similar to previous work involving

long- and short-term Cr supplementation in older adults

(Chrusch et al. 2001; Gotshalk et al. 2002, 2008). Chrusch

et al. (2001) reported greater increases in the leg press

1RM (creatine vs. placebo group, respectively) (?50.1 vs.

?31.3 kg) and knee extension 1RM (?14.9 vs. ?10.7 kg)

in older men following 12 weeks of RT. In addition,

Gotshalk et al. (2002) demonstrated significant improve-

ments in the bench press (4.1 ± 1.4 kg) and leg press

Fig. 4 Numbers of repetitions performed during the 30-s chair stand

(upper panel) and arm curl (middle panel) tests and the time required

to complete a test of getting up from lying on the floor (lower panel)in creatine and placebo groups at pre- and post-test. Values are the

mean ± SD. aP \ 0.01 compared to the corresponding pretest value,

and bP \ 0.05 compared to the creatine post-test value

Table 3 Body composition

Creatine (N = 9) Placebo (N = 9)

Body mass (kg)

Pre 60.5 ± 9.4 57.1 ± 7.3

Post 61.2 ± 9.6 57.4 ± 7.5

D% 1.2 0.5

Fat mass (kg)

Pre 25.4 ± 7.4 22.4 ± 5.8

Post 25.0 ± 7.4 22.6 ± 6.4

D% -1.6 1.2

Body fat (%)

Pre 41.3 ± 5.6 38.8 ± 6.6

Post 40.1 ± 5.7 38.9 ± 7.4

D% -2.8 0.4

Fat-free mass (kg)

Pre 35.1 ± 2.3 34.7 ± 4.0

Post 36.2 ± 2.5a 34.7 ± 3.8

D% 3.2 0.0

Muscle mass (kg)

Pre 15.5 ± 1.5 15.4 ± 2.6

Post 16.1 ± 1.4a 15.5 ± 2.5

D% 3.7 0.9

Values are mean ± SD

Delta change (D%) = (pre-post/pre) 9 100a P \ 0.01 compared to the corresponding initial value

Eur J Appl Physiol (2013) 113:987–996 993

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(16.1 ± 4.4 kg) 1RM strength in older men after 7 days of

Cr supplementation (0.3 g kg-1 day-1). In a more recent

study, the authors also reported a greater increase in 1RM

bench press and leg press in Cr-supplemented older women

compared to placebo (Gotshalk et al. 2008). The current

study extends the findings of those previous work (Chrusch

et al. 2001; Gotshalk et al. 2002, 2008) by showing that

long-term Cr supplementation has the potential to increase

maximal strength in older women, which may in turn lead

to increased functional capacity and decreased risk of

injury.

Although improvements in the ability to perform max-

imal strength tests are of obvious interest for young pop-

ulations, Canete et al. (2006) argue that these tests would

be of little practical relevance for older people. The authors

also report that submaximal-strength tests for repeated

contractions (e.g., the sit-stand test or 30-s chair stand test)

may be more appropriate for assessing the effects of Cr

supplementation on the ability to perform daily life tasks in

older populations. In the current study, Cr supplementation

improved the performance of upper- and lower body

functional activities in older women. A direct statistical

comparison supports this interpretation; when compared to

the PL post-test, the CR post-test group was 18.7, 10.2, and

10.7 % more efficient in the 30-s chair stand, arm curl, and

getting up from lying on the floor tests, respectively. Our

data support previous findings of functional-studies that

have reported an improved ability to perform submaximal-

strength tasks (e.g., the sit-stand test) in Cr-supplemented

older women (Canete et al. 2006; Gotshalk et al. 2008).

These studies found 5–12 % reductions in the time

required to complete the sit-stand test among older women

following 7 days of Cr supplementation at a dose of

0.3 g kg-1 day-1; however, they did not confirm whether

long-term Cr supplementation also promotes beneficial

effects in older women. We believe that long-term CR

loading is more important than short-term Cr for main-

taining functional capacity in daily life tasks. Our results

demonstrate for the first time that long-term Cr intake

(5.0 g day-1) may be beneficial for increasing the func-

tional capacity in submaximal-strength activities (30-s

chair stand, arm curl, and getting up from lying on the floor

tests) among older women. These results are clinically

relevant because the increase in the functional ability to

perform daily life tasks is inversely related to mortality

(Beltran et al. 2001; Von Strauss et al. 2003). Furthermore,

the functional tests applied in the current study correlate

reasonably well with major indicators of lower body- (e.g.,

knee flexor strength, stair-climbing ability, walking speed,

and risk of falling) and upper body (e.g., household chores,

carrying groceries, lifting a suitcase, and picking up

grandchildren) strength (Bohannon 1995; Csuka and

McCarty 1985; Rikli and Jones 1999a). Therefore, the high

test–retest reliability of the tests used in the present study

provides strong evidence that long-term Cr supplementa-

tion could be a suitable strategy for improving the perfor-

mance of older women in submaximal-strength tasks

during an RT program.

Additionally, Cr supplementation in conjunction with

RT promoted a greater increase in fat-free mass (D%, CR:

3.2 vs. PL: no change) and muscle mass (D%, CR: 3.7 vs.

PL: 0.9) than RT alone. The increase in fat-free mass fol-

lowing Cr supplementation has been demonstrated in some

(Vandenberghe et al. 1997; Willoughby and Rosene 2001;

Gotshalk et al. 2002, 2008; Brose et al. 2003) but not all

(Eijnde et al. 2003; Bermon et al. 1998) previous studies.

The advantages of the present study compared to previous

studies in this area include the exclusive analysis of older

women. To date, most studies involving older adults have

examined the effects of Cr supplementation in older men

only or in a mixed group of men and women, which could

mask the lack of an ergogenic effect in older women. In

this regard, gender may influence the Cr effects. Mihic

et al. (2000) found a gender-specific ergogenic effect for Cr

supplementation in young subjects; the authors reported an

increase in total body mass for men but not for women

(men: ?1.6 vs. women: ?0.45 kg) and observed a strong

trend toward a smaller increase in fat-free mass for women

(men: ?1.3 vs. women: ?0.44 kg) in response to 5-days Cr

supplementation. In addition, Ferguson and Syrotuik

(2006) have not found any additional effect of Cr supple-

mentation on strength and lean body mass in experienced

resistance trained women after a 10-weeks RT program. It

is possible that women may have a greater muscle total Cr

(TCr) concentration before loading (Forsberg et al. 1991;

Harris et al. 1992), which could attenuate the loading

potential of the female participants (Harris et al. 1992).

Indeed, the increase in fat-free mass has been inversely

related to muscle TCr and phosphocreatine (PCr) contents

before loading (Mihic et al. 2000). Thus, the increase in

fat-free mass and muscle mass found in our study is most

likely explained by the fact that older subjects had lower

muscle TCr (Tarnopolsky Tarnopolsky and MacLennan

2000) and PCr concentrations (Rawson et al. 2002) before

loading, leading to a better ergogenic response of Cr

supplementation.

Surprisingly, the increase in fat-free mass and muscle

mass did not reflect significant changes in body mass in the

CR group compared to the PL group (D%, CR: 1.2 vs. PL:

0.5). In this regard, contradictory results have been

observed on the effects of Cr supplementation on the body

mass of older subjects. While some authors have reported a

significant increase in body mass associated with increased

muscle strength in older men ([60 years) after acute Cr

supplementation (Jakobi et al. 2001; Gotshalk et al. 2002),

others have reported an increase in muscle strength without

994 Eur J Appl Physiol (2013) 113:987–996

123

any significant changes in body mass in older men and

women following a 52-days RT program combined with Cr

supplementation (Bermon et al. 1998). Give that short-term

Cr supplementation promotes increase in body mass in

older adults (Gotshalk et al. 2002, 2008), it is not clear why

the body mass remained unchanged in our subjects after

long-term Cr supplementation. There are two possibilities

that might explain this paradox. First, the women present a

greater muscle total Cr (TCr) concentration before loading

(Forsberg et al. 1991; Harris et al. 1992); this could

attenuate the loading potential of the women participants

(Harris et al. 1992) and, consequently, compromises the

gain in body mass. This hypothesis is supported by studies

that showed a lower increase (e.g., 0.6 vs. 1.9 %) in body

mass in women compared to men after acute Cr supple-

mentation (Mihic et al. 2000). In fact, a 3.2 % increase in

fat-free mass in current study was not enough to provoke

an increment in the total body weight. It is important to

note that in Cr-supplemented older subjects, any increases

in body mass are generally of small magnitude (e.g., *2 %

total body mass) (Canete et al. 2006; Gotshalk et al. 2002,

Rawson et al. 2000) and despite an increase (7 %) in the

total muscle PCr content occurring after Cr supplementa-

tion, no reciprocal change is observed in the body mass

(Rawson et al. 2002). Thus, the lack of a significant

increase in body mass does not necessarily indicate that our

subjects did not experience an increase in the intramuscular

PCr or Cr contents.

Second, the lack of an additional effect of Cr loading in

the body mass could be related to the age-related decline in

the TCr and PCr concentrations (Mesa et al. 2002; Smith

et al. 1998), presumably associated with a decrease in the

type II muscle fiber content during the aging process.

Several studies have confirmed that type II fibers have a

greater ability to uptake and store Cr than type I fibers (for a

review, see Casey and Greenhaff 2000). Although a limi-

tation of our study was that we did not collect muscle

biopsies for TCr and PCr measures, our results indicate that

the potential of Cr supplementation to increase the fat-free

mass and lower- and upper body functional performance in

older women is not necessarily associated with changes in

body mass. Indeed, Cr supplementation resulted in an

increase in the number of repetitions for the 30-s chair stand

(27 % increase) and arm curl (22 % increase) tests and a

19 % reduction in the time required to get up from lying on

the floor. Similar to a previous long-term study (12 weeks)

with young subjects (Volek et al. 1999), our data indicate

that the ergogenic effects of Cr supplementation in older

women extend up to 12 weeks of RT and perhaps longer.

In summary, long-term Cr supplementation combined

with a supervised RT program improved the ability to

perform submaximal-strength functional tasks (e.g., rising

from a chair, bending the arm, and getting up from the floor)

and promoted a greater increase in maximal strength, fat-

free mass and muscle mass in older women than RT alone.

Acknowledgments We address a special thanks to Andrea Diniz for

their great help in the encapsulation of creatine. We are also grateful

to all the participants for their engagement in this study and the

Coordination of Improvement of Higher Education Personnel

(CAPES/Brazil) for the doctoral scholarships conferred to M.A.N.

and A.M.G., and the National Council of Technological and Scientific

Development (CNPq/Brazil) for the grant conceded to E.S.C. Part of

this work was supported by the Araucaria Foundation for the Support

of Scientific and Technological Development of Parana - FAADCT/

Brazil (Protocol number 15466).

Conflict of interest No conflicts of interest, financial or otherwise,

are declared by the author(s).

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