In part 1 of “12 reasons why older adults need to do resistance training exercise” I outlined some of the benefits to health that have been shown to occur as a result of partaking in regular resistance training exercise. The scientific evidence supporting the inclusion of resistance training as part of a healthy lifestyle is now indisputable. Whilst improvement of health is an obvious goal of many older athletes, it is the enhancement of sports performance that drives many in a quest to remain competitive, both against fellow competitors, but also – somewhat egocentrically – against their younger self. Even if you aren’t an elite masters athlete these benefits as outlined below can be truly life-changing.
Resistance training exercise remains an integral component of programs of most elite sportspeople. Increased maximal strength and power developed through the application of progressive resistance training has been shown to improve performance above and beyond that achieved by limiting training to sports specific training. This is now recognised by sports scientists, exercise physiologists, strength & conditioning experts and coaches.
Resistance Training Improves Older Athletes Performance (Picture: Pixabay)
Of particular note for older athletes is that the performance benefits may be even greater than that of younger elite athletes. One of the hallmark changes to occur with age is the progressive loss of strength with significant atrophy or loss of skeletal muscle playing a significant role. This fundamental biological change that occurs with ageing manifests in a gradual deterioration of physical function and performance.
However, there is compelling evidence that the trajectory of this decline is modifiable and can be attenuated by lifestyle factors. The data to support regular exercise as a key factor in preserving skeletal muscle and physical function is overwhelming. Resistance training is one of the very best methods currently available for older adults and masters athletes to stimulate the physiological processes required to increase myofibrillar protein synthesis rates, skeletal muscle hypertrophy and muscular strength. These skeletal muscle adaptations lie at the core of why this type of exercise improves the functional performance of older adults and athletic performance of masters athletes.
The following 6 compelling reasons explain why resistance exercise should be included in all training programs of older adults where enhanced performance – for activities of daily living or sporting – are desired.
Resistance training and bone strength (Picture: Pixabay)
Enhance skeletal health. Stronger bones can handle greater training loads and transfer muscular forces more effectively and efficiently. Bone mineral density (BMD) decreases as we age however this can be slowed by regular physical activity and appropriate nutrition. Risk of musculoskeletal injury is increased when bone strength is decreased with age, especially during falls that can cause catastrophic consequences for some.
Resistance training has been shown to be quite a potent stimulus for improving bone mineral density. Some evidence suggests that plyometric-type or jumping activities also provide an excellent training method to stimulate significant and positive bone adaptation which yields increased BMD and therefore stronger bones.
Masters cyclists as a group are unfortunately at an elevated risk of reduced BMD (weaker bones) due to the non-weight bearing nature of cycling. It is strongly recommended that all masters cyclists – in fact, all cyclists – should perform adjunctive resistance exercise in their training program (see links 1, 2, 3, 4 & 5).
Resistance Training And Skeletal Muscle (Picture: Google Images)
Maintain or increase lean body mass (skeletal muscle). Remember muscle is critical to both speed and endurance performance. From age 50 onwards muscle loss accelerates but there is a substantial amount of evidence that this is exacerbated by increased sedentarism (inactivity). Resistance training attenuates muscle mass loss.
Ageing is accompanied by reduced muscle mass and this has been mainly attributed to type II muscle fibre atrophy or reduction in size. It is unlikely that there is substantial muscle fibre loss however this remains to be elucidated. In older adults that have demonstrated substantial lean body mass loss and type II muscle fibre atrophy, prolonged resistance training has demonstrated significant increased muscle mass and this was shown to occur exclusively in type II muscle fibres. Nonetheless, some research has shown both type I and type II muscle fibre hypertrophy so more data is required to ascertain whether such things as age, gender, training status and training program parameters, affect muscle fibre changes and responsiveness to resistance training exercise (see links 1, 2, 3, 4, 5, 6).
Increased muscular strength, power and speed. Research investigating the effects of progressive resistance training programs demonstrate that muscle strength, power and speed improve, and in many case, quite impressively. In fact, even in nonagenarians, skeletal muscle strength and functional mobility assessed by a gait velocity test improved dramatically (>170% and 48% increase, respectively) after only 8 weeks of resistance training.
As mentioned above, the significant atrophy that occurs with age in fast-twitch type II muscle fibres, directly impacts performance of activities that require speed. Resistance training can reverse some of this decline, restore some of the lost contractile protein of these critical muscle fibres, increase maximum skeletal muscle strength and therefore elicit substantial improvements in movement speed of various specific sporting skills.
Older athletes that are avoiding or not adjusting their program to allow a little time to perform some resistance training exercise are missing out on some incredible benefits (see links 1, 2, 3, 4, 5).
Resistance Training And Body Fat
Lose body fat and get leaner. As outlined above, skeletal muscle mass decreases significantly from age 50 with concomitant decreases in resting metabolic rate (RMR). RMR is the largest component of total daily energy expenditure (TDEE) accounting for 60-80%. Whilst reductions in muscle mass account for a significant proportion of the accommodating changes in RMR, decreasing organ mass and decreases to specific metabolic rates of individual tissues also contribute to the decrease in RMR.
These age-related changes in RMR reduce TDEE. This may contribute to increased adiposity as we grow older given that energy intake to maintain body mass decreases proportionally to the degree of reduction in RMR and TDEE. In other words, if dietary habits and energy intake remains constant over time but RMR and TDEE decrease subsequent to the loss of skeletal muscle, positive energy balance may ensue and fat mass may therefore naturally increase.
Resistance training is well known for stimulating muscle hypertrophy or increasing skeletal muscle mass and has been shown to elicit reductions in fat mass in obesity during ad libitum diets. In contrast, aerobic exercise-induced weight loss consistently leads to reductions in lean body mass and RMR which may make the propensity of rebound fat gain more likely.
Inclusion of resistance training exercise in programs of older athletes or non-athletes doesn’t guarantee that there will be body fat loss (nutrition and diet obviously play a key role) but it certainly makes weight management easier and supports weight loss efforts if modifying the diet in an attempt to get leaner. Much of the research that has investigated the utility of resistance training in older adults demonstrates that it is a very effective fat loss strategy when performed with other lifestyle-based interventions aimed at improving physical function and body composition (see links 1, 2, 3, 4, 5).
Resistance Training And Endurance Performance (Picture: Google Images)
Improves endurance. Resistance training that is designed to increase muscle strength and power has been shown to improve endurance performance. More evidence exists to support such exercise in younger adult athletes as there has been limited research exclusively focused on older athletes.
Nonetheless, the research completed to date is strongly suggestive that resistance training enhances endurance in older athletes and non-athletes. A study conducted in 2010 demonstrated that strength training consisting of 10 sets of 10 repetitions of 1RM load, 3 minutes rest between each set, 3 times/week, increased both knee extensor maximal voluntary contraction torque and cycling efficiency. It is reasonable to postulate that had they utilised a program that incorporated more compound, complex, multi-jointed exercises such as squats and deadlifts – such that all major lower body muscle groups were strengthened – significantly greater cycling economical benefit would have been elicited.
When masters endurance runners were studied after following a resistance training program designed to increase maximal strength (4 sets of 3-4 repetitions at 85-90% of 1RM, two times per week), a significant improvement in running economy at marathon pace (6.1%) and dynamic leg strength (16.3%) was achieved.
It is proposed that the following training adaptations may facilitate endurance performance improvement:
the delayed use of the fast-twitch type II muscle fibers;
enhanced neuromuscular efficiency;
increased proportion of more fatigue-resistant fast-twitch type IIa fibres;
improved musculo-tendinous stiffness (see links 1, 2, 3).
Resistance Training and Injury Prevention (Picture: Google Images)
Reduce injury risk. Regularly performed resistance exercise can minimize the musculoskeletal alterations that occur during ageing. It may also contribute to the health and well-being of the older population.
There is strong evidence that suggests such exercise can prevent and control the development of several chronic musculoskeletal diseases. Improvement of physical fitness, function, and independence in older people, plus successful management of musculoskeletal disorders, results in dramatic improvements in quality of life.
Stronger muscles, bones, connective tissue, ligaments and tendons mean our limbs and joints are more able to handle the rigours of training, competing and activities of daily living (see links 1, 2, 3, 4, 5).
In conclusion, based on the 12 reasons that I have explored which demonstrate profound benefits to both the health, functional and sporting performance of older athletes and non-athletes, resistance training is a must-do and should be a pivotal component of any exercise program.
To read “12 reasons why older adults need to do resistance training exercise: part 1” that explores the health-related benefits in older adults see here.
For local Townsville residents interested in FitGreyStrong’s Exercise Physiology services or exercise programs designed to achieve the mentioned benefits or to enhance athletic performance, contact FitGreyStrong@outlook.com or phone 0499 846 955 for a confidential discussion.
For other Australian residents or oversees readers interested in our services, please see here.
Disclaimer: All contents of the FitGreyStrong website/blog are provided for information and education purposes only. Those interested in making changes to their exercise, lifestyle, dietary, supplement or medication regimens should consult a relevantly qualified and competent health care professional. Those who decide to apply or implement any of the information, advice, and/or recommendations on this website do so knowingly and at their own risk. The owner and any contributors to this site accept no responsibility or liability whatsoever for any harm caused, real or imagined, from the use or distribution of information found at FitGreyStrong. Please leave this site immediately if you, the reader, find any of these conditions not acceptable.
Increases strength, power, speed and physical function
Reduces body fat and help maintain body fat loss
Improves endurance performance
Reduces injury risk
Resistance or weight training is a critical component of training programs of most elite athletes irrespective of the sport. The benefits of resistance training – to increase maximal muscle strength and neuromuscular power – has long been recognised by most strength and conditioning experts, coaches and sport scientists as key to sporting performance. Logic would dictate therefore that if elite athletes are doing concurrent training to improve sport specific performance, masters athletes may also reap huge benefits too. There is now compelling evidence to suggest that resistance training can potentially augment athleticism of masters athletes well beyond that achieved by confining training to sports specific training. Furthermore, these significant benefits are not just limited to sprint, speed or power orientated sports but endurance performance may also be enhanced.
However, before I address the athletic performance benefits of resistance training for older athletes and functional enhancement such exercise has in older non-athletes (these will be outlined in part 2), I want to discuss the significant and sometimes life-changing health benefits that have been well documented in research conducted over the last 20 years. There is a great deal of data now to support the use of resistance training to help treat and manage a number of chronic diseases that become more prevalent as we get older. The following outlines 6 key reasons why resistance training exercise should be included in all programs of older athletes and exercise programs of older non-athletes.
Resistance Training Reduces The Risk Of Death
Reduce the risk of death. Evidence continues to accumulate to show that skeletal muscle strength is strongly predictive of longevity. Maximum muscle force in men aged 20-80 is independently and inversely associated with all-cause mortality. Over the age of 60 years, all cause and cancer-associated mortality is twice as likely in individuals with low compared to high skeletal muscle strength. Older adults over 15 years who reported twice/weekly strength training had 46% lower odds of all-cause mortality than those who did not. Resistance training when performed regularly is one of the best methods to increase skeletal muscle strength (see links 1, 2, 3, 4). A recent assessment of the research that has been conducted in older adults showed that resistance training substantially improved health-related quality of life. In other words, resistance training and getting stronger has a direct impact on our perception of how meaningful, manageable and comprehensible life is, and as such, significantly greater promotion of this type of activity is warranted (see here).
Resistance Training And Cardiovascular Health
Helps manage hypertension and decrease heart disease. High blood pressure can still affect masters athletes and resistance training when performed in conjunction with aerobic or endurance training has been shown to have a positive effect and reduce blood pressure. However, data to support resistance training as a stand alone practice is mixed with some studies suggesting improvement in systolic and diastolic blood pressure versus other research that has shown such exercise can increase arterial stiffness. Evidence tends to point to concurrent exercise (resistance training combined with aerobic exercise) as being the most effective for reducing the risk of heart disease (see links 1, 2, 3, 4).
Resistance Training Facilitates Better Sleep
Improves sleep quality and quantity. Problems with sleep are common with advancing years and occur in over half of adults age 65 and older. It has been estimated that insomnia affects about a third of the older population. The evidence to date suggests that poor sleep hygiene directly impacts and worsens many aspects of health including such things as mental health, obesity, heart disease, cognition, memory, executive function, metabolic disturbance and falls to name just a few.
Overall quality of life is thus dramatically reduced. Other factors associated with ageing, such as disease, changes in environment, or concurrent age-related processes also may contribute to problems of sleep. Sleep disturbance and long sleep duration, but not short sleep duration, have been shown to be associated with increases in markers of systemic inflammation. Research has shown that both sleep quality and quantity is improved with increased levels of exercise. Resistance training alone appears to positively impact sleep quality but more data is required to confirm that sleep quantity is equally improved (see links 1, 2, 3).
Diabetes Rates Continue To Increase
Prevent/treat type 2 diabetes & decrease inflammation. Type 2 diabetes mellitus (T2DM) is one of the fastest growing non-communicable diseases worldwide and occurs much more frequently in those that are overweight and obese. However, impaired blood glucose metabolism, one of the hallmarks of T2DM, is an increasingly common problem in those that are not overweight and have relatively normal BMI. A poor and overindulgent diet – high in things like sugar, trans-fats, processed foods, junk foods and that are low in fish (omega-3 fatty acids), vegetables, fruit, fibre and high quality protein – combined with long-term sedentarism has been postulated as playing a leading causative role. Such a combination causes the development of chronic positive energy balance whereby excess energy disposal and adipose storage triggers a significant oxidative pro-inflammatory response referred to as metabolic inflammation.
In obesity, expanding adipose tissue attracts immune cells creating an inflammatory environment within this fatty acid storage organ. Skeletal muscle is the predominant site of insulin-mediated glucose uptake and insulin resistance is considered the primary defect that is evident years before the development of T2DM. Resistance training has consistently been shown to improve the ability of the skeletal muscles to take up and metabolise blood glucose (sugar) and is therefore an important strategy in managing T2DM. Finally, there is now scientific data to show that disorders that arise and are linked to inflammation (e.g. Insulin resistance, obesity, cardiovascular disease, diabetes, cancer, chronic kidney disease, osteoarthritis, Alzheimer’s disease and many more), can be improved or mitigated with resistance training and exercise (see links 1, 2, 3, 4, 5).
Resistance Training Enhances Brain Health
Prevent cognitive decline & neurodegenerative disease Recent research has shown that long-term resistance training in older women promotes executive function, memory, reduced cortical white matter atrophy and increased peak muscle power. Such findings are very exciting as they suggest that exercise and resistance training can modify brain neuroplasticity and help improve brain function. The current thinking is that resistance and physical exercise represents a promising nonpharmaceutical intervention to prevent age-related cognitive decline and neurodegenerative diseases such as dementia and Alzheimers. There is some evidence that the mechanisms behind these alterations may be related to increased levels of Brain-derived neurotrophic factor (BDNF) and IGF-1. BDNF-induced neuroplasticity is speculated to be facilitated by physical exercise but conclusive evidence supporting this mechanism of action has not yet been established (see links 1, 2, 3, 4).
Mental Health Is Significantly Improved with Resistance Training
Improved mental health. There is substantial evidence to demonstrate that resistance training and exercise more generally has a very dramatic and potent effect on improving mental health and treating those that suffer from mental health disorders. For example, research has shown that high-intensity resistance training is more effective than low-intensity resistance training or standard care by a GP in the treatment of depression in older patients. Resistance exercise has also be shown to reduce anxiety, slow the progression of white matter lesions in older women, improve symptomatology and disease severity in severe mental illness and essentially improve overall quality of life and general mental health (see links 1, 2, 3).
To finish up I cannot emphasise enough just how important resistance training exercise is for all older adults including masters athletes. The reasons mentioned above are only some of the many that support resistance training exercise as an essential ingredient of a healthy lifestyle and confirm current recommendations for people to partake in a minimum of 2 resistance training sessions per week.
To read part 2 of “12 reasons why older adults need to do resistance training exercise” which discusses the performance-enhancing benefits for older athletes and the incredible functional improvements that can be achieved in older non-athletes, see here.
For local Townsville residents interested in FitGreyStrong’s Exercise Physiology services or exercise programs designed to achieve the above-mentioned benefits or to enhance athletic performance, contact FitGreyStrong@outlook.com or phone 0499 846 955 for a confidential discussion.
For other Australian residents or oversees readers interested in our services, please see here.
Disclaimer: All contents of the FitGreyStrong website/blog are provided for information and education purposes only. Those interested in making changes to their exercise, lifestyle, dietary, supplement or medication regimens should consult a relevantly qualified and competent health care professional. Those who decide to apply or implement any of the information, advice, and/or recommendations on this website do so knowingly and at their own risk. The owner and any contributors to this site accept no responsibility or liability whatsoever for any harm caused, real or imagined, from the use or distribution of information found at FitGreyStrong. Please leave this site immediately if you, the reader, find any of these conditions not acceptable.
The use of creatine (Cr) can be traced back to the early 1990s when several elite sprint athletes reported performance-enhancing benefits following gold medal winning performances at the 1992 Barcelona Olympic Games (Anderson, 1993). This sparked the birth of a new era with creatine gaining widespread popularity as a legitimate ergogenic aid (Bird, 2003). Creatine is a nitrogenous organic acid abundant in metabolically active muscle, heart and brain tissue. It is synthesised endogenously in the liver and kidneys from the amino acids arginine, glycine and methionine, and absorbed from the diet primarily from red and white meat (Chilibeck et al., 2017; Phillips, 2015). Most creatine is stored intramuscularly as phosphocreatine (PCr) (Candow et al., 2014). PCr functions principally as a temporal energy buffer by donating a high-energy phosphate to ADP through the enzymatic reaction of creatine kinase, which re-synthesises and replenishes ATP stores and thus helps maintain skeletal muscle energy availability during very short, intense anaerobic exercise (Kreider et al.,, 2017; Candow et al., 2014; Candow & Chillibeck, 2010). PCr also acts as a spatial energy buffer shuttling intracellular energy between mitochondria and sites of cellular ATP utilization (Kreider et al., 2017; Gualano et al., 2016).
Older people embrace powerlifting in Castlemaine (Australia) to avoid aged care home (courtesy ABC news)
Creatine supplementation increases the Cr/PCr reservoir by 20-40% (Kreider et al., 2017) and it is posited that this enhances PCr-mediated ATP resynthesis during and after high-intensity exercise bouts (Deane et al., 2017; Close et al., 2016), thereby allowing greater amounts of work to be accomplished (Phillips, 2015). This is particularly relevant for resistance training (RT) given that a dose-response relationship has been shown to exist between training volume and gains in skeletal muscle mass (Schoenfeld et al., 2017a; Schoenfeld et al., 2017b), and muscle strength (Figueiredo et al., 2017; Ralston et al., 2017). Other possible mechanisms to account for creatine ergogenicity are reduced exercise-induced muscle damage, reduced oxidative stress, increased GLUT4 in muscle fibre membranes, increased cell swelling that activates protein synthesis within muscle fibres, and decreased reliance on anaerobic glycolysis/reduced lactate production (Chilibeck et al., 2017; Kreider et al., 2017; Devries and Phillips, 2014). Although the exact mechanisms of action are still to be determined (Phillips, 2015), creatine supplemented RT has been extensively researched, especially in younger populations (Buford et al., 2007; Kreider et al., 2017). Consuming 5 grams of creatine (or 0.3 grams per kilogram body weight) four times daily for 5-7 days is generally viewed as the most effective way to increase muscle creatine stores and can be adequately maintained by consuming 3-5 grams/day following this loading phase (Kreider et al., 2017).
Muscle total creatine stores (figure courtesy of Kreider et al. 2017, J Int Soc Sports Nutr.)
Is creatine effective in older adults?
Three meta-analyses of randomised, placebo-controlled trials (Chilibeck et al., 2017; Candow et al., 2014; Devries and Phillips, 2014) have been published on the effects of creatine supplementation during RT on lean tissue mass and muscle strength in middle-aged and older adults (45-80 years old). No meta-analysis has yet assessed the effectiveness of creatine on RT outcomes in adults specifically 60 years or older. Most recently, Chilibeck et al. (2017, pg219) found significantly greater increases in lean tissue mass (1.4 kg; SMD=1.35), upper (i.e. chest press; SMD=0.37) and lower (i.e. leg press; SMD=0.25) body muscle strength when middle-aged to older adults (50-80 years old) were supplemented with creatine during RT. However, whilst the results of this study are often promoted as evidence that creatine has ergogenic value for this cohort, the standardised mean differences reported for muscle strength were trivial based on the effect sizes proposed by Rhea (2004) to delineate what is, and what is not meaningful following RT. If we apply more traditional effect sizes (Sullivan and Feinn, 2012), these strength improvements still remain small. One of the longest trials to investigate the impact of creatine supplementation and RT in middle-aged and older male adults (49-69 years old) found no additional benefits on measures of bone, muscle or strength after 12 months (Candow et al., 2020). Moreover, Beaudart et al., (2018) concluded that the research findings were equivocal for creatine after conducting a systematic review into the effects of various nutrients on muscle mass, muscle strength and physical performance in older adults (≥60 years old).
Taken from Rhea (2004)
At the time of writing only a handful of studies have assessed the monotherapy supplementation of creatine in older adults (≥60 years) undergoing RT (Smolarek et al., 2020; Gualano et al., 2014; Deacon et al., 2008; Pinto et al 2016; Aguiar et al., 2013; Alves et al., 2013; Brose et al 2003; Chrusch et al., 2001; Bermon et al., 1998). Of those that measured changes in lean tissue mass, participants supplemented with creatine consistently achieved greater benefits compared to placebo (Gualano et al., 2014; Pinto et al 2016; Aguiar et al., 2013; Brose et al 2003; Chrusch et al., 2001). In contrast, the effects of creatine on muscle strength were less consistent with the vast majority of studies showing no additional benefit versus placebo for core RT lower limb exercises i.e. leg press (Deacon et al., 2008; Pinto et al., 2016; Alves et al., 2013; Brose et al 2003; Bermon et al., 1998). Three of the four studies that explored the impact of creatine on physical function found no evidence of performance enhancement compared to placebo for a number of standard tests (Aguiar et al., 2013; Brose et al 2003; Gualano et al. 2014; Deacon et al., 2008); these included the 30-second chair stand test, 30 metre walk time, time to climb 14 stairs, the timed-up-and-go test, and the shuttle walk distance test. No RCTs have yet tested whether creatine supplementation in older adults (≥60 years) positively impacts balance or quality of life. Encouragingly though, Neves et al., (2011) demonstrated improved quality of life and physical function in postmenopausal women (mean age=58 years old) with knee osteoarthritis that took creatine during RT. The only study to have assessed the effect of creatine on dynamic balance found that improvement of balance performance was actually inhibited in older middle-aged adults (Johannsmeyer et al., 2016); those that were randomly allocated to the placebo group during drop-set RT experienced significantly greater improvement in dynamic balance (30.8%) compared to the creatine group (19.4%), with a reduction in balance errors detected for the placebo group only. In sum, creatine supplementation in older adults during RT appears to support increased lean tissue mass, but this has not necessarily translated into appreciable gains in muscle strength, physical function and/or improved balance versus placebo.
Is creatine well tolerated and safe?
Creatine when used in healthy, older adults appears to be well tolerated and safe. There have been no reports or evidence of any adverse effects that are serious in nature (Chilibeck et al., 2017; Goudarzian et al., 2017; Pinto et al., 2016; Gualano et al., 2014; Alves et al., 2013; Brose et al 2003; Chrusch et al., 2001; Bermon et al., 1998) and self-reported issues associated with the use of creatine have been uncommon (Pinto et al 2016; Gualano et al., 2014; Alves et al., 2013; Brose et al., 2003). No adverse events related to, nor changes in either kidney or liver function have been reported from RCTs (Gualano et al., 2014; Tarnopolsky et al., 2007; Brose et al., 2003) and other studies that included both middle-aged and older adults are devoid of any such side-effects (Johannsmeyer et al., 2016; Chilibeck et al., 2015; Lobo et al., 2015; Cornelissen et al., 2010; Eijnde et al., 2003). Some studies have reported that gastrointestinal (GI) distress and muscle cramping and/or muscle strain may be more common in those receiving creatine (Chilibeck et al., 2015; Chrusch et al., 2001). In healthy, older men (mean age=70 years old) loose stools were reported by Chrusch et al., (2001) as a side-effect during the 1-week loading phase and increased muscle cramping/strain occurred between weeks 3 and 5. Middle-aged to older postmenopausal women (mean age=57 years old) taking creatine experienced a higher number of these adverse events when GI complaints and muscle cramping were grouped for assessment (Chilibeck et al., 2015). None of these side-effects led to study discontinuation and appear to be transient in nature with no impairment of exercise training response noted.
What questions do we need further clarification on?
Many questions remain unresolved. Despite the evidence supporting increased lean tissue mass following creatine supplementation, it seems too early to claim definitively that such a strategy substantially and consistently improves muscle strength or physical function in all older adults undergoing RT. Training adaptations, in theory, should be augmented by creatine. It is well acknowledged that ageing causes skeletal muscle atrophy with disproportionately greater reduction in cross-sectional area (CSA) of PCr-rich type-II muscle fibres (Nilwik et al., 2013; Kushmerick et al., 1992), and this results in much lower levels of intramuscular creatine in the quadriceps vastus lateralis (thigh) muscle of older versus younger adults (Chilibeck et al., 2017). Lifestyle changes with ageing – particularly reduced dietary meat intakes, decreased physical activity levels (Chilibeck et al., 2017) and increased sedentary time (Diaz et al., 2017; Dunlop et al., 2015) – may further impact muscle PCr levels and modify any potential benefits of creatine supplementation. Further research is therefore required to establish whether the magnitude and heterogeneity of RT adaptations is modulated by significant inter-individual differences in creatine uptake kinetics, given that training responsiveness is correlated to the change in intramuscular creatine stores. Research by Syrotuik and Bell (2004) provide support for this possibility where it was demonstrated that young, healthy men had 3 different levels of response to a 5-day creatine load as measured by post-supplementation intramuscular creatine levels. Responders to creatine loading possessed a biological profile of the lowest initial muscle Cr/PCr levels, greatest percentage of type-II muscle fibres, largest muscle fibre CSA and lean tissue mass, plus were the only subjects to achieve improvement in 1RM leg press when compared to quasi- and non-responders. It is plausible that this may partially account for the lack of consistency in the research as such inter-individual variation could significantly water down any generalised group benefits. These responder profiles outlined above also raise another potential limitation in those older adults that are most in need of an ergogenic effect (i.e. those with sarcopenia and muscle weakness), as they may be the least likely, by extension, to reap the meaningful benefits of creatine supplementation. Furthermore, it is well accepted that intramuscular post-supplementation creatine levels (at day 28) are comparable for “slow” (3 grams/day for 1 month) and “rapid” load (4×5 grams/day for 5-7 days and 3-5 grams/day thereafter) protocols (Hultman et al., 1996). Thus, it would be prudent to compare whether the slow load approach is better tolerated than the rapid load approach (i.e. reduction of GI-related side-effects and muscle cramping/pulls) based on the evidence where some older adults appear to be more sensitive to large initiation doses of creatine.
Taken from Syrotuik & Bell (2004)
Final comments
It is worth mentioning that besides any possible beneficial effect of creatine on lean tissue mass, skeletal muscle strength or function, there are several other therapeutic reasons that may potentially justify such use in older adults. An increasing amount of data from both human and rodent experiments support multiple other benefits for creatine, including lowering cholesterol and triglyceride levels, reducing liver fat accumulation, decreasing homocysteine levels, having antioxidant properties, improving glycaemic control, slowing tumor growth in some types of cancers, mitigating bone loss, positively affecting cognitive function and in some cases, serving as an antidepressant (Kreider et al., 2017). Consequently, the position stand on the safety and efficacy of creatine supplementation in exercise, sport, and medicine published by the International Society of Sports Nutrition concluded that (2017:11):
Available short and long-term studies in healthy and diseased populations, from infants to the elderly, at dosages ranging from 0.3 to 0.8 g/kg/day for up to 5 years have consistently shown that creatine supplementation poses no adverse health risks and may provide a number of health and performance benefits.
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For local Townsville residents interested in FitGreyStrong’s Exercise Physiology services or exercise programs designed to improve muscular strength, physical function (how you move around during the day) and quality of life or programs to enhance athletic performance, contact FitGreyStrong@outlook.com or phone 0499 846 955 for a confidential discussion.
For other Australian residents or oversees readers interested in our services, please see here.
Disclaimer: All contents of the FitGreyStrong website/blog are provided for information and education purposes only. Those interested in making changes to their exercise, lifestyle, dietary, supplement or medication regimens should consult a relevantly qualified and competent health care professional. Those who decide to apply or implement any of the information, advice, and/or recommendations on this website do so knowingly and at their own risk. The owner and any contributors to this site accept no responsibility or liability whatsoever for any harm caused, real or imagined, from the use or distribution of information found at FitGreyStrong. Please leave this site immediately if you, the reader, find any of these conditions not acceptable.
On a global scale, the number of people over 60 yr is expected to more than double from 841 million in 2012 to more than 2 billion by 2050. This change in demographics will have profound implications for many aspects of life. Furthermore, Government bodies worldwide will be faced with considerable challenges related to aging policy and how best to deal with this new reality.
Of the many things that occur during the ageing process one of the most obvious signs is the loss of skeletal muscle mass (sarcopenia) and strength (dynapenia) with decrements in physical function and potential predisposition to disability. The process whereby there is a gradual loss of muscle mass and concomintant reduction in strength and physical function with ageing – is primarily caused by a loss in number of muscle fibres and preferential loss and atrophy of fast-twitch type-IIx fibres. The loss in fibre number and atrophy and loss of type-IIx fibres may be related to a loss of innervation of muscle fibres and a progressive loss of alpha-motorneurons (see here).
I want to try and explain, therefore, why I think it is so important for anyone over 40 to spend some time in their week lifting weights – or what is more technically known as resistance training (for the short version click here). There has been a significant amount of research conducted to show that one of the very best ways to slow down this process is to perform regular and challenging resistive-based exercise or weight training. Recently, more data has emerged suggesting that an even greater benefit may be achieved with high-velocity power training (see here& here). Such training is slightly different to traditional strength training in that exercises are performed with light-to-moderate loads or weight, but movement speed is performed at fast to very fast speeds. Evidence demonstrates that such activity can even reverse some of the changes seen due to the combination of ageing and sedentariness, by specifically stimulating and increasing the strength and size of these fast twitch type-II muscle fibres (see here).
Over 25 years ago a seminal and ground-breaking research study was conducted which completely questioned our scientific understanding of what was possible when very old frail people were exposed to resistance training. In many ways the findings of this study are at the core of why most, if not all people over 40, should be doing some resistance training – colloquially speaking – “pumping iron”. Whilst weight, strength or resistance training may not be everyone’s cup of tea if there is one form of exercise that can substantially and dramatically improve functional physical capacity it is this form of exercise that promises so much.
Lifting weights helps keep older people young
A pivotal moment in my life occurred whilst doing PhD studies in the early 1990s. My project was to review the literature in a chosen area and my area of interest that I had developed for a while by then was resistance training. I had been introduced to this type of exercise as a means to improve athletic performance as an aspiring junior Track & Field athlete. The dramatic improvement in my performance once I had added this to my training program was extraordinary. Since that point in time I have lifted weights regularly and done countless squats, deadlifts, power cleans, tossed tractor tyres, pulled on pulley’s, performed push-ups, stood on Swiss Balls, jumped over hurdles……………………………………
I chose to focus on and study the morphological (structural) and functional changes that occur in human skeletal muscle as we age and what can be done to attenuate or slow these changes down. The simple answer to that question is to perform regular but challenging resistance training.
It was during this literature review that a very important piece of research came to my attention.
The question that had remained largely unanswered was how much of the biological “age-related” decline in muscle size, strength and function is attributable to ageing per se or to the extremely sedentary lifestyles adopted by many people as they grow older?
It is quite clear that both the ageing process and disuse syndromes (meaning no physical activity) contribute to a preferential loss of muscle fibres, specifically type-IIx fibres, and it is these muscle fibres that are involved in movements that require high amounts of force, power and speed. The critical question is, then, to what degree could intervening with a progressive resistance training program alter the trajectory of this decline in muscle strength and function and is it indeed possible to even reverse some portion of the assumed “age-related” decline seen in older people.
The study that everyone should read
The study that was published in JAMA (The Journal of the American Medical Association) June 13, 1990 by Maria Fiatarone and colleagues (see here) undertook to determine the feasibility and the physiological consequences of high-resistance strength training in the frail elderly. You are probably wondering just how frail. Well, not wanting to mince my words these participants were very frail and were probably coming to the final years or even months of their lives.
Their average age was just over 90, there were 6 women and 4 men, 60% had level 2 pattern of care (meaning they were not independent and required moderate assistance), 8 had a history of falls, 7 habitually used ambulatory assistive devices, there was over 4 chronic diseases per person and daily medications taken per person equated to more than 4. The most common medical diagnoses were osteoarthritis (7 subjects), coronary artery disease (6 subjects), osteoporotic fracture (6 subjects) and hypertension (4 subjects). Four of 10 subjects had anthropometric evidence of undernutrition and a substantial proportion did not obtain the recommended daily allowance for important micronutrients. (Click on graphs for clearer view of results)
Muscle mass versus functional mobility
Muscle accounted for only 31% of the total cross-sectional area of the thigh as determined by CT scans, which meant that there was more fat and bone than muscle and it would be stating the obvious to you that this is not conducive to good balance, strength or functional mobility. Baseline muscle function was terrible with a 6 metre walk taking an average time of 22 seconds to complete with one subject taking almost 1 minute. Many struggled to raise themselves out of a chair without the assistance of their arms. Strength at the beginning of the study was positively correlated with fat-free mass (total muscle) and midthigh muscle area, whereas it was related inversely to time taken to stand from a chair and time to walk 6 metres.
What this means is that those that had more muscle tissue and greater strength at the start of the study (baseline) were able to perform better on the walk test and chair stand by executing these tasks more quickly.
The ageing process can be modified with exercise
Now to the interesting part of the study.
The results
Notwithstanding that there were only 10 elderly people involved, the findings were incredible and well beyond what was expected. What was even more surprising was only one simple exercise was employed: unilateral leg extension (i.e. single-leg) using a standard weight-and-pulley system. The 8-week training program used principles of progressive resistance training (in other words, as they got stronger the relative loads were increased), employed concentric and eccentric muscle contractions (whereby the muscle shortens and lengthens whilst under tension), trained 3 times/week completing 3 sets of 8 repetitions of each leg in 6-9 seconds/rep, with 1- to 2- minute rest periods between sets.
In light of their age, their general health status and the fact that they were only doing one simple exercise that primarily focused on the quadricep muscle (thigh) it would be within reason to think that the outcomes of the program would be quite negligible. However, that did not happen and this basically demonstrates that no matter how old, how injured, how dysfunctional you may be, your body and the skeletal muscle you stimulate – by performing challenging physical movement – will not only respond but it will respond quite robustly.
Muscle strength improvement follows resistance training
Tolerance of the resistance training program was excellent with 90% completion rate (9 out of 10 finished), and no cardiovascular complications were seen. There was occasional hip and knee discomfort and that would be expected but no analgesics were required and no training sessions were missed. Gains in muscle strength were impressive and after just 8 weeks of training average strength had increased by over 170% and responsiveness to training was not different in men vs women. Some subjects made quite extraordinary gains of almost 400%. Muscle size increased in 5 of the 7 of the subjects that were CT scanned for total midthigh muscle area. Of those with stable body weight, the mean muscle area increases were significant with total midthigh muscle area going up 11.7%, the quadriceps up by 14.5% and the hamstrings/adductors by 10.6%.
Functional mobility accompanied the improvements in strength and muscle hypertrophy (growth). The time taken to complete the walking test improved substantially from 44 seconds to 29 seconds representing a 48% improvement. Two subjects no longer needed canes to walk at the end of the study and one of three subjects who could not initially rise from a chair without the use of their arms became able to do so. Importantly, no subjects experienced falls during the study. The physiological and functional improvements were truly incredible. The effects of detraining were assessed too (stopped the program) and what this showed was that the gains made were very quickly lost with a significant 32% decrease in maximum strength after only 4 weeks of ceasing the training.
What are the major implications of these findings?
Strength is fundamental to life
The results clearly demonstrated that progressive resistance training at sufficient loads (greater than 80% 1RM; i.e. lifting 80% of the maximum weight you can lift once) can induce dramatic and substantial increases in muscle strength, size and function in frail men and women up to 96 years of age. Achieving such favourable responses to strength training in these subjects is remarkable when one considers their very advanced age, extremely sedentary lifestyles, multiple chronic diseases and functional disabilities, and nutritional inadequacies. What is clear is that the preservation of fat-free mass (muscle) as one ages is a critical factor and directly affects muscle strength in the older person.
Exercise and resistance training specifically, is able to provide the neuromuscular system the appropriate physiological stimulus to reverse and modify a portion of the muscle weakness and functional loss often and simply put down to old age. Re-read that sentence because that is huge!
The final thing I would like to say on this study which deserves comment is that the results are all the more impressive because the subjects performed only one simple exercise (leg extension done unilaterally). Obviously if one employs resistance training exercises that are more complex, multi-jointed and aim to stimulate all the muscles of the upper and lower extremities (using different exercises) the structural and functional improvements would potentially be even greater.
For local Townsville residents interested in FitGreyStrong’s Exercise Physiology services or exercise programs designed to improve muscular strength, physical function (how you move around during the day) and quality of life or programs to enhance athletic performance, contact FitGreyStrong@outlook.com or phone 0499 846 955 for a confidential discussion.
For other Australian residents or oversees readers interested in our services, please see here.
Disclaimer: All contents of the FitGreyStrong website/blog are provided for information and education purposes only. Those interested in making changes to their exercise, lifestyle, dietary, supplement or medication regimens should consult a relevantly qualified and competent health care professional. Those who decide to apply or implement any of the information, advice, and/or recommendations on this website do so knowingly and at their own risk. The owner and any contributors to this site accept no responsibility or liability whatsoever for any harm caused, real or imagined, from the use or distribution of information found at FitGreyStrong. Please leave this site immediately if you, the reader, find any of these conditions not acceptable.
