Database: Ovid MEDLINE(R) <1966 to January Week 3 2004> Search Strategy: (Role of Creatine in Sports Performance) -------------------------------------------------------------------------------1 Creatine/ (4206) 2 Creatine Kinase/ (17671) 3 exp sports/ or exp exertion/ (111424) 4 performance.tw. (201558) 5 1 and 3 and 4 (128) 6 2 and 3 and 4 (89) 7 5 or 6 (213) 8 *Creatine/ or *Creatine Kinase/ (8387) 9 7 and 8 (128) 10 limit 9 to (human and english language) (124) 11 limit 10 to ovid full text available (19) 12 limit 10 to yr=1996-2004 (108) 13 limit 12 to review (17) 14 limit 12 to local holdings (25) 15 11 or 13 or 14 (57) 16 (performance and creatine).ti. and 12 (61) 17 16 not 15 (34) 18 from 17 keep 3-5,8,11,16-19,22-27,29,31,33-34 (19) 19 15 or 18 (76) 20 limit 18 to yr=2000-2004 (9) 21 15 or 20 (66) 22 limit 21 to yr=1998-2004 (54) 23 from 22 keep 1-54 (54) 24 from 22 keep 1-54 (54) *************************** <1> Unique Identifier 9715740 Authors Maganaris CN. Maughan RJ. Institution University Medical School, University of Aberdeen, Foresterhill, UK. Title Creatine supplementation enhances maximum voluntary isometric force and endurance capacity in resistance trained men. Source Acta Physiologica Scandinavica. 163(3):279-87, 1998 Jul. Abstract The present study examined the hypothesis that creatine (Cr) supplementation can increase the performance of isometric exercise in subjects engaged in a strength training program. Ten male subjects were tested in three experimental trials 7 days apart (days 1, 8 and 15). In each trial the subjects' maximum voluntary force of contraction (MVC) was measured in both legs and isometric endurance capacity at 80, 60, 40 and 20% of MVC of their stronger leg (knee extensor group) was measured with a 4-min rest between contractions. Additionally, the subjects' isometric endurance capacity at 80% of MVC of their weaker leg was measured in 10 repeated bouts interspersed with 2-min rest. A double-blind cross-over design was adopted for administering Cr or placebo. Subjects were randomized into either the Cr-placebo (Group A: days 2-6: 10 g day-1 of Cr; days 9-13: 10 g day-1 of glucose polymers) or the placebo-Cr group (Group B reverse supplementation order). The daily diet was analysed, and urine samples from 24-h collections were subjected to Cr and creatinine analysis. In each subject, approximately 18 g (35%) of Cr was eliminated in the urine during the Cr supplementation period. MVC increased by about 10% (P < 0.01 in the weaker leg, P < 0.05 in the stronger leg) and body mass increased by 1.7 +/- 0.4 kg (2.3%, P < 0.01) and 1.8 +/- 0.3 kg (2.1%, P < 0.01) in groups A and B, respectively, after Cr supplementation, while energy intake and diet composition remained constant throughout the study. The subjects' endurance capacity increased (P < 0.05) in all the bouts after Cr supplementation. Muscle hypertrophy in response to Cr supplementation and weight training may explain the findings of the present study. <2> Unique Identifier 10208711 Authors Apgar B. Title Do 'health products' really help athletic performance?. Source American Family Physician. 59(7):1990, 1992, 1999 Apr 1. <3> Unique Identifier 10919967 Authors Casey A. Greenhaff PL. Institution Centre for Human Sciences, Defence Evaluation and Research Agency, Farnborough, United Kingdom. acasey@dera.gov.uk Title Does dietary creatine supplementation play a role in skeletal muscle metabolism and performance?. [Review] [59 refs] Source American Journal of Clinical Nutrition. 72(2 Suppl):607S-17S, 2000 Aug. Abstract Fatigue sustained during short-term, high-intensity exercise in humans is associated with the inability of skeletal muscle to maintain a high rate of anaerobic ATP production from phosphocreatine hydrolysis. Ingestion of creatine monohydrate at a rate of 20 g/d for 5-6 d was shown to increase the total creatine concentration of human skeletal muscle by approximately 25 mmol/kg dry mass, some 30% of this in phosphorylated form as phosphocreatine. A positive relation was then shown between muscle creatine uptake and improvements in performance during repeated bouts of maximal exercise. However, there is no evidence that increasing intake > 20-30 g/d for 5-6 d has any potentiating effect on creatine uptake or performance. In individuals in whom the initial total creatine concentration already approached 150 mmol/kg dry mass, neither creatine uptake nor an effect on phosphocreatine resynthesis or performance was found after supplementation. Loss of ATP during heavy anaerobic exercise was found to decline after creatine ingestion, despite an increase in work production. These results suggest that improvements in performance are due to parallel improvements in ATP resynthesis during exercise as a consequence of increased phosphocreatine availability. Creatine uptake is augmented by combining creatine supplementation with exercise and with carbohydrate ingestion. [References: 59] <4> Unique Identifier 12501003 Authors Lemon PW. Institution Exercise Nutrition Research Laboratory, the University of Western Ontario, London, ON. Title Dietary creatine supplementation and exercise performance: why inconsistent results?. [Review] [61 refs] Source Canadian Journal of Applied Physiology. 27(6):663-81, 2002 Dec. Abstract Over the past few years there has been considerable interest in both the use of creatine (Cr) supplementation by athletes and the documentation of its effects by scientists. Some believe that this nitrogen-containing compound found in meat and fish has a performance-enhancing capability as important for brief intense exercise efforts as dietary carbohydrate is for activities where glycogen supplies limit performance. The mechanisms thought to be responsible for any ergogenic effect of acute (few d) Cr supplementation include: increased stores of muscle phosphocreatine (PCr), faster regeneration of PCr during exercise recovery, enhanced adenosine triphosphate (ATP) production from glycolysis secondary to increased hydrogen ion buffering, and/or possible shortened post contraction muscle relaxation time. With chronic (wk mo) supplementation when combined with strength training, Cr may alter muscle protein metabolism directly (via decreasing protein breakdown or increasing synthesis) and/or indirectly as a result of a greater training load made possible by its acute ergogenic effects on strength and power. Cr supplementation is not banned by the International Olympic Committee and, with the exception of a small increase in body mass (approximately 1 kg) over the initial 36 d, does not appear to have any adverse side effects, at least with short-term use. Few scientific data are available for more prolonged use (mo or y) but considering the large numbers of athletes using Cr over the past 6+ y and the absence of reported problems, it may be that the often discussed somewhat nebulous long term adverse effects are presently being overestimated. Intakes of 285-300 mg Cr/kg body mass 1 over 36 d or 3050 mg/kg body mass 1 over approximately 4 wk are sufficient to produce benefits (muscle mass and high intensity power gains); however, not all study results are consistent. The focus of this review is to outline some possible explanations for the inconsistent observations reported in the literature. Clearly, if proven to be consistent the benefits of Cr supplementation could extend far beyond the athletic arena to include individuals who experience muscle weakness for a variety of other reasons (e.g., age/disuse, muscle disease, exposure to microgravity, etc). [References: 61] <5> Unique Identifier 10638338 Authors Jacobs I. Institution Defence and Civil Institute of Environmental Medicine, Toronto, Ontario. Title Dietary creatine monohydrate supplementation. [Review] [56 refs] Source Canadian Journal of Applied Physiology. 24(6):503-14, 1999 Dec. Abstract This paper summarizes and interprets the research published about physiological aspects of dietary supplementation with creatine monohydrate and the effects on physical performance. A nitrogenous molecule that occurs naturally in the flesh consumed by meat-eaters, creatine is also synthesized endogenously and is stored primarily in skeletal muscle. The research literature in which direct measurements of muscle creatine content have been reported indicates that most, but not all, subjects respond to "creatine loading" by increasing the total intramuscular concentration of creatine, including the concentration of phosphocreatine. The factors that affect muscle creatine stores are reviewed, as are the widely ranging results on physical performance. The mechanism of action by which increased intramuscular creatine could enhance performance is not yet clear. Original speculation was that increased phosphocreatine levels prior to commencing exercise, in conjunction with higher free creatine concentration, would prolong the time required until performancelimiting levels of phosphocreatine were reached during intense exercise. It was also speculated that restoration of phosphocreatine levels between bouts of such exercise would be more rapid. More recent studies question such speculation. This review includes a discussion of what is known about the health risks and side-effects associated with creatine loading. The paper concludes with speculation about the unprecedented attention given to creatine supplementation by recreational and competitive athletes and the media. [References: 56] <6> Unique Identifier 9884793 Authors Juhn MS. Tarnopolsky M. Institution Department of Family Medicine, University of Washington School of Medicine, Seattle, USA. Title Oral creatine supplementation and athletic performance: a critical review.[see comment][erratum appears in Clin J Sport Med 1999 Apr;9(2):62]. [Review] [67 refs] Comments Comment in: Clin J Sport Med. 1999 Apr;9(2):119; PMID: 10442629 Source Clinical Journal of Sport Medicine. 8(4):286-97, 1998 Oct. Abstract OBJECTIVE: To review and summarize the current data on oral creatine supplementation regarding its potential efficacy in athletic performance, mechanism of action, and metabolism. DATA SOURCES AND STUDY SELECTION: Medline was searched using terms relating creatine supplementation to athletic performance. Studies that evaluated the effects of oral creatine supplementation on exercise performance in humans were selected for inclusion. Selected studies on muscle metabolism and exercise physiology were included if they provided useful information relative to creatine. Additional references were reviewed from the bibliographies of selected studies. DATA EXTRACTION AND SYNTHESIS: To summarize efficacy, extracted data were listed in table format, grouping studies together by type of activity and efficacy on performance. Whenever possible, the effect of creatine supplementation was quantified. Proposed explanations for creatine's efficacy or lack thereof in a particular type of activity were formulated. CONCLUSIONS: In laboratory settings, creatine supplementation is ergogenic in repeated 6-30-second bouts of maxima stationary cycling sprints. The data on a single sprint or first-bout sprint of any kind are inconsistent. The data regarding creatine's ergogenic effects on mass-dependent activities, such as running and swimming, are not convincing, perhaps because of the side effect of weight gain from water retention. Studies on weight lifting suggest that creatine improves strength possibly by increasing myofibrillar protein synthesis however, more study is needed to prove this. No ergogenic effects on submaximal or endurance exercise are evident Individual response to creatine supplementation can vary greatly. [References: 67] <7> Unique Identifier 12546637 Authors van Loon LJ. Oosterlaar AM. Wagenmakers AJ. Institution Hartgens F. Hesselink MK. Snow RJ. Nutrition and Toxicology Research Institute Maastricht (NUTRIM), Department of Human Biology, Maastricht University, Maastricht, The Netherlands. L.vanLoon@HB.Unimaas.nl Title Effects of creatine loading and prolonged creatine supplementation on body composition, fuel selection, sprint and endurance performance in humans. Source Clinical Science. 104(2):153-62, 2003 Feb. Abstract Most research on creatine has focused on short-term creatine loading and its effect on high-intensity performance capacity. Some studies have investigated the effect of prolonged creatine use during strength training. However, studies on the effects of prolonged creatine supplementation are lacking. In the present study, we have assessed the effects of both creatine loading and prolonged supplementation on muscle creatine content, body composition, muscle and wholebody oxidative capacity, substrate utilization during submaximal exercise, and on repeated supramaximal sprint, as well as endurance-type time-trial performance on a cycle ergometer. Twenty subjects ingested creatine or a placebo during a 5-day loading period (20 g.day(-1)) after which supplementation was continued for up to 6 weeks (2 g.day(-1)). Creatine loading increased muscle free creatine, creatine phosphate (CrP) and total creatine content ( P <0.05). The subsequent use of a 2 g.day(-1) maintenance dose, as suggested by an American College of Sports Medicine Roundtable, resulted in a decline in both the elevated CrP and total creatine content and maintenance of the free creatine concentration. Both short- and long-term creatine supplementation improved performance during repeated supramaximal sprints on a cycle ergometer. However, whole-body and muscle oxidative capacity, substrate utilization and time-trial performance were not affected. The increase in body mass following creatine loading was maintained after 6 weeks of continued supplementation and accounted for by a corresponding increase in fat-free mass. This study provides definite evidence that prolonged creatine supplementation in humans does not increase muscle or whole-body oxidative capacity and, as such, does not influence substrate utilization or performance during endurance cycling exercise. In addition, our findings suggest that prolonged creatine ingestion induces an increase in fat-free mass. <8> Unique Identifier 10410847 Authors Kraemer WJ. Volek JS. Institution Department of Physical Education, Biology, Physiology, and Health Science, Ball State University, Muncie, Indianapolis, Indiana, USA. wkraemer@bsu.edu Title Creatine supplementation. Its role in human performance. [Review] [66 refs] Source Clinics in Sports Medicine. 18(3):651-66, ix, 1999 Jul. Abstract Creatine supplementation is the most popular nutritional supplement today. Although many questions remain regarding the use and benefits of creatine supplementation, a fast-growing body of literature is starting to define both its acute and chronic effects on human and physiologic performance. The initial data indicate that this energetic boost of the phosphagen energy system also helps to enhance strength and power training. Few documented side effects have been demonstrated in the medical and scientific literature, but further investigation is still required as to long-term use (i.e., beyond several months). [References: 66] <9> Unique Identifier 11085837 Authors Tarnopolsky MA. Institution Dept of Neurology/Neurological Rehabilitation, McMaster University Medical Center, Hamilton, Ontario, Canada. tarnopol@fhs.mcmaster.ca Title Potential benefits of creatine monohydrate supplementation in the elderly. [Review] [65 refs] Source Current Opinion in Clinical Nutrition & Metabolic Care. 3(6):497-502, 2000 Nov. Abstract Creatine plays a role in cellular energy metabolism and potentially has a role in protein metabolism. Creatine monohydrate supplementation has been shown to result in an increase in skeletal muscle total and phosphocreatine concentration, increase fat-free mass, and enhance high-intensity exercise performance in young healthy men and women. Recent evidence has also demonstrated a neuroprotective effect of creatine monohydrate supplementation in animal models of Parkinson's disease, Alzheimer's disease, amyotrophic lateral sclerosis, and after ischemia. A low total and phosphocreatine concentration has been reported in human skeletal muscle from aged individuals and those with neuromuscular disorders. A few studies of creatine monohydrate supplementation in the elderly have not shown convincing evidence of a beneficial effect with respect to muscle mass and/or function. Future studies will be required to address the potential for creatine monohydrate supplementation to attenuate agerelated muscle atrophy and strength loss, as well as to protect against agedependent neurodegenerative disorders such as Parkinson's disease and Alzheimer's disease. [References: 65] <10> Unique Identifier 12831718 Authors Farquhar WB. Zambraski EJ. Institution HRCA Research and Training Institute, Harvard Division on Aging, 1200 Centre Street, Boston, MA 02131, USA. farquhar@mail.hrca.harvard.edu Title Effects of creatine use on the athlete's kidney. [Review] [26 refs] Source Current Sports Medicine Reports. 1(2):103-6, 2002 Apr. Abstract With regard to athletes attempting to improve their performance, at the present time creatine monohydrate is clearly the most widely used dietary supplement or ergogenic aid. Loading doses as high as 20 g/d are typical among athletes. The majority (> 90%) of the creatine ingested is removed from the plasma by the kidney and excreted in the urine. Despite relatively few isolated reports of renal dysfunction in persons taking creatine, the studies completed to date suggest that in normal healthy individuals the kidneys are able to excrete creatine, and its end product creatinine, in a manner that does not adversely alter renal function. This situation would be predicted to be different in persons with impaired glomerular filtration or inherent renal disease. The question of whether long-term creatine supplementation (ie, months to years) has any deleterious affects on renal structure or function can not be answered at this time. The limited number of studies that have addressed the issue of the chronic use of creatine have not seen remarkable changes in renal function. However, physicians should be aware that the safety of long-term creatine supplementation, in regard to the effects on the kidneys, cannot be guaranteed. More information is needed on possible changes in blood pressure, protein/albumin excretion, and glomerular filtration in athletes who are habitual users of this compound. [References: 26] <11> Unique Identifier 10929216 Authors Deutekom M. Beltman JG. de Ruiter CJ. de Koning JJ. de Haan A. Institution Institute for Fundamental and Clinical Human Movement Sciences, Vrije University, Amsterdam, The Netherlands. Title No acute effects of short-term creatine supplementation on muscle properties and sprint performance. Source European Journal of Applied Physiology. 82(3):223-9, 2000 Jun. Abstract In a double-blind, placebo, controlled study, we investigated the acute effects of short-term oral creatine supplementation (20 g.day-1 for 6 days) on muscle activation, fatigue and recovery of the m. quadriceps femoris during electrical stimulation, and on maximal performance during sprint cycling. The quadriceps muscles of 23 well-trained rowers were stimulated at different frequencies (10, 20, 50, 100, 150 and 200 Hz). Furthermore, 40 repetitive, electrically stimulated (duration 220 ms, stimulation frequency 150 Hz) concentric contractions were imposed at a constant angular velocity of 180 degrees.s-1 over a range of 50 degrees (from 90 to 140 degrees knee angle), each extension/flexion cycle lasting 1200 ms. To determine recovery, torque was measured at 20, 50, 80, 120, 180 and 300 s after the last contraction. In addition, two maximal 30-s sprints were performed on a cycle ergometer with 4 min rest in between. Following short-term creatine supplementation, body mass [mean (SEM)] increased (P < 0.05) from 85.7 (2.7) kg to 87.3 (2.9) kg. Creatine supplementation had no effect on maximal voluntary isometric torque and muscle activation, or on fatigue and recovery of dynamic exercise. There was also no significant effect on peak power, time to peak power and work to peak power, or total work during both sprints on the cycle ergometer. It was concluded that short-term oral creatine supplementation resulted in increased body mass, but did not enhance muscle performance or maximal output during sprint cycling. <12> Unique Identifier 11482548 Authors Wiroth JB. Bermon S. Andrei S. Dalloz E. Hebuterne X. Dolisi C. Institution Laboratoire de Physiologie, Faculte de Medecine, Nice, France. wiroth@unice.fr Title Effects of oral creatine supplementation on maximal pedalling performance in older adults. Source European Journal of Applied Physiology. 84(6):533-9, 2001 Jun. Abstract This study was conducted to investigate the effects of giving short-term doses of creatine by mouth to healthy older male subjects, taking into account their training status. A group of 42 volunteers was divided into three: a sedentary group composed of elderly sedentary men [n = 14, mean age 70.1 (SEM 1.2) years], a trained group composed of elderly trained cyclists [n = 14, mean age 66.4 (SEM 1.4) years] and a young group composed of young sedentary men [n = 14, mean age 26.0 (SEM 1.2) years]. In each group, double-blind randomization was carried out: one half was given creatine (3x5 g x day(-1)), and the other was given an iso-nitrogenated placebo (3x10 g x day(-1)). Before and after the 5 days during which the supplements were given, all subjects performed five all-out 10-s sprints separated by 60-s intervals of passive recovery, seated on a cycle ergometer. Power output, work done and heart rate data were recorded during each sprint. The elderly and the young sedentary subgroups given creatine showed significant (P < 0.05) improvements in maximal power (+3.7% and +2.0%, respectively) and work done (+4.1% and +5.1%, respectively) in the subsequent tests. In contrast, no significant change in pedalling performances was observed in the trained elderly subjects. The creatine did not change the exercise and recovery heart rate profiles, in any group. Our study suggested that creatine given by mouth increases the anaerobic power and work capacity of sedentary people of different ages during maximal pedalling tasks. However, the level of physical activity seems to be a determinant of the ergogenic effect of creatine in older subjects. <13> Unique Identifier 10958375 Authors Shomrat A. Weinstein Y. Katz A. Institution Department of Physiology and Pharmacology, Tel-Aviv University, Ramat-Aviv, Israel. Title Effect of creatine feeding on maximal exercise performance in vegetarians. Source European Journal of Applied Physiology. 82(4):321-5, 2000 Jul. Abstract The effect of creatine supplementation on exercise performance in vegetarians was examined. Creatine was ingested for 1 week by a group of vegetarians (VC) and meat-eaters (MC); a control group of meat-eaters was fed only glucose (MG). Exercise performance during three, 20-s maximal cycling tests (modified Wingate anaerobic test, WAnT) was determined before and after creatine supplementation. Blood samples were also drawn before and after exercise prior to and after supplementation. Basal plasma creatine (after an overnight fast) averaged (SE) 11 (2) microM in VC, and 24 (2) and 23 (7) microM in MG and MC, respectively (P < 0.05 for VC vs meat-eaters). These findings were expected, since most of the body's exogenous creatine source is meat. There was no significant difference in any other parameter between groups prior to supplementation. Creatine feedings significantly increased body mass (approximately 1 kg) and mean power output during the WAnTs (approximately 5%) to a similar extent in the VC and MC groups (P < 0.05-0.001). These parameters were not affected by supplementation in the MG group. Peak power output was also significantly increased by supplementation in MC (approximately 5%, P < 0.05), but not in VC. It is concluded that vegetarians and meat-eaters respond to creatine feedings with similar increases in mean power output during short-term, maximal exercise. <14> Unique Identifier 12945830 Authors Branch JD. Institution Department of Exercise Science, Physical Education, and Recreation at Old Dominion University, Norfolk, VA 23529-0196, USA. Title Effect of creatine supplementation on body composition and performance: a meta-analysis. Source International Journal of Sport Nutrition & Exercise Metabolism. 13(2):198226, 2003 Jun. Abstract BACKGROUND: Creatine supplementation (CS) has been reported to increase body mass and improve performance in high-intensity, short-duration exercise tasks. Research on CS, most of which has come into existence since 1994, has been the focus of several qualitative reviews, but only one meta-analysis, which was conducted with a limited number of studies. PURPOSE: This study compared the effects of CS on effect size (ES) for body composition (BC) variables (mass and lean body mass), duration and intensity (< or = 30 s, [ATP-PCr = A]; 30-150 s [glycolysis = G]; >150 s, [oxidative phosphorylation = O]) of the exercise task, type of exercise task (single, repetitive, laboratory, field, upper-body, lowerbody), CS duration (loading, maintenance), and subject characteristics (gender, training status). METHODS: A search of MEDLINE and SPORTDiscus using the phrase "creatine supplementation" revealed 96 English-language, peer-reviewed papers (100 studies), which included randomized group formation, a placebo control, and human subjects who were blinded to treatments. ES was calculated for each body composition and performance variable. RESULTS: Small, but significant (ES > 0, p < or = .05) ES were reported for BC (n=163, mean +/- SE=0.17 +/- 0.03), ATP-PCr (n=17, 0.24 +/- 0.02), G (n=135, 0.19 +/- 0.05), and O (n=69, 0.20 +/- 0.07). ES was greater for change in BC following a loading-only CS regimen (0.26 +/- 0.03, p=.0003) compared to a maintenance regimen (0.04 +/- 0.05), for repetitive-bout (0.25 +/- 0.03,p=.028) compared to single-bout (0.18 +/- 0.02) exercise, and for upper-body exercise (0.42 +/- 0.07, p<.0001) compared to lower (0.21 +/- 0.02) and total body (0.13 +/- 0.04) exercise. ES for laboratory-based tasks (e.g., isometric/isotonic/isokinetic exercise, 0.25 +/- 0.02) were greater (p=.014) than those observed for field-based tasks (e.g., running, swimming, 0.14 +/0.04). There were no differences in BC or performance ES between males and females or between trained and untrained subjects. CONCLUSION: ES was greater for changes in lean body mass following short-term CS, repetitive-bout laboratory-based exercise tasks < or = 30 s (e.g., isometric, isokinetic, and isotonic resistance exercise), and upper-body exercise. CS does not appear to be effective in improving running and swimming performance. There is no evidence in the literature of an effect of gender or training status on ES following CS. <15> Unique Identifier 12945828 Authors Chwalbinska-Moneta J. Institution Department of Applied Physiology in the Medical Research Centre of Polish Academy of Sciences, 02-106 Warsaw, Poland. Title Effect of creatine supplementation on aerobic performance and anaerobic capacity in elite rowers in the course of endurance training. Source International Journal of Sport Nutrition & Exercise Metabolism. 13(2):173-83, 2003 Jun. Abstract The effect of oral creatine supplementation on aerobic and anaerobic performance was investigated in 16 elite male rowers during 7-day endurance training. Before and after the daily ingestion of 20 g creatine monohydrate for 5 days (Cr-Group, n=8) or placebo (Pl-Group, n=8), subjects performed two exercise tests on a rowing ergometer: (a) incremental exercise consisting of 3min stage durations and increased by 50 W until volitional exhaustion; (b) an all-out anaerobic exercise performed against a constant load of 7 W/kg. Heart rate and blood lactate concentrations were determined during exercise and recovery. Maximal power output did not significantly differ after the treatment in either group. The mean individual lactate threshold rose significantly after Cr treatment from 314.3 +/- 5.0 W to 335.6 +/- 7.1 W (p<.01), as compared with 305.0 +/- 6.9 W and 308.9 +/- 5.9 W (ns), before and after placebo ingestion, respectively. During the anaerobic test, the athletes supplemented with creatine were able to continue rowing longer (mean increase, 12.1 +/- 4.5 s; p<.01) than Pl-Group (2.4 +/- 8.2 s; ns). No significant differences were found between groups in blood LA after the all-out exercise. The results indicate that in elite rowers, creatine supplementation improves endurance (expressed by the individual lactate threshold) and anaerobic performance, independent of the effect of intensive endurance training. <16> Unique Identifier 11099372 Authors Tarnopolsky MA. MacLennan DP. Institution Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada L8N 3Z5. Title Creatine monohydrate supplementation enhances high-intensity exercise performance in males and females. Source International Journal of Sport Nutrition & Exercise Metabolism. 10(4):452-63, 2000 Dec. Abstract Creatine monohydrate supplementation has been shown to enhance high-intensity exercise performance in some but not all studies. Part of the controversy surrounding the ergogenic effect(s) of creatine monohydrate supplementation may relate to design issues that result in low statistical power. A further question that remains unresolved in the creatine literature is whether or not males and females respond in a similar manner to supplementation. We studied the effect of creatine supplementation upon high intensity exercise performance in 24 subjects (n = 12 males, n = 12 females). Creatine monohydrate (Cr; 5g, 4x/d 3 4d) and placebo (Pl; glucose polymer 3 4d) were provided using a randomized, doubleblind crossover design (7 week washout). Outcome measures included: 2 3 30-s anaerobic cycle test, with plasma lactate pre- and post-test; dorsi-flexor: maximal voluntary contraction (MVC), 2-min fatigue test, and electrically stimulated peak and tetanic torque; isokinetic knee extension torque and 1-min ischemic handgrip strength. Significant main effects of Cr treatment included: increased peak and relative peak anaerobic cycling power ( 3.7%; p <. 05), dorsi-flexion MVC torque ( 6.6%; p <.05), and increased lactate ( 20.8%; p <.05) with no gender specific responses. We concluded that short-term Cr supplementation can increase indices of high-intensity exercise performance for both males and females. <17> Unique Identifier 10727076 Authors Francaux M. Demeure R. Goudemant JF. Poortmans JR. Institution Institut d'Education Physique et de Readaptation, Universite Catholique de Louvain, Louvain-la-Neuve, Belgium. marc.francaux@edph.ucl.ac.be Title Effect of exogenous creatine supplementation on muscle PCr metabolism. Source International Journal of Sports Medicine. 21(2):139-45, 2000 Feb. Abstract 31P NMR was used to assess the influence of two weeks creatine supplementation (21g x d(-1)) on resting muscle PCr concentration, on the rate of PCr repletion (R(depl)), and on the half-time of PCr repletion (t 1/2). Body mass (BM) and volume of body water compartments were also estimated by impedance spectroscopy. Fourteen healthy male subjects (20.8+/-1.9 y) participated in this double-blind study. PCr was measured using a surface coil placed under the calf muscle, at rest and during two exercise bout the duration of which was 1 min. They were interspaced by a recovery of 10 min. The exercises comprised of 50 plantar flexions-extensions against weights corresponding to 40% and 70% of maximal voluntary contraction (MVC), respectively. Creatine supplementation increased resting muscle PCr content by approximately 20% (P= 0.002). R(depl) was also increased by approximately 15% (P< 0.001) and approximately 10% (P = 0.026) during 40% and 70% MVC exercises, respectively. No change was observed in R(repl) and t1/2. BM and body water compartments were not influenced. These results indicate that during a standardized exercise more ATP is synthesized by the CK reaction when the pre-exercise level in PCr is higher, giving some support to the positive effects recorded on muscle performance. <18> Unique Identifier 9839847 Authors Vandebuerie F. Vanden Eynde B. Vandenberghe K. Hespel P. Institution Faculty of Physical Education and Physiotherapy, Department of Kinesiology, Katholieke Universiteit Leuven, Belgium. Title Effect of creatine loading on endurance capacity and sprint power in cyclists. Source International Journal of Sports Medicine. 19(7):490-5, 1998 Oct. Abstract The effect of creatine loading on endurance capacity and sprint performance was investigated in elite cyclists according to a double-blind cross-over study design. Subjects (n = 12) underwent on 3 occasions and separated by 5 week washout periods, a 2 h 30 min standardized endurance protocol on their own race bicycle, which was mounted on an electromagnetically braked roller-system, whereupon they cycled to exhaustion at their predetermined 4 mmol lactate threshold. Immediately thereafter they performed 5 maximal 10 second sprints, separated by 2 min recovery intervals, on a Monark bicycle ergometer at 6 kg resistance on the flywheel. Before the exercise test, subjects were either creatine loaded (C: 25 g creatine monohydrate/day, 5 days) or were creatine loaded plus ingested creatine during the exercise test (CC: 5 g/h), or received placebo (P). Compared with P, C but not CC increased (p<0.05) peak and mean sprint power output by 8-9% for all 5 sprints. Endurance time to exhaustion was not affected by either C or CC. It is concluded that creatine loading improves intermittent sprint capacity at the end of endurance exercise to fatigue. This ergogenic action is counteracted by high dose creatine intake during exercise. <19> Unique Identifier 11719888 Authors Romer LM. Barrington JP. Jeukendrup AE. Institution Sports Medicine and Human Performance Unit, School of Sport and Exercise Sciences, The University of Birmingham, Edgbaston, Birmingham, UK. Title Effects of oral creatine supplementation on high intensity, intermittent exercise performance in competitive squash players. Source International Journal of Sports Medicine. 22(8):546-52, 2001 Nov. Abstract The purpose of this study was to determine the effects of oral creatine supplementation on high intensity, intermittent exercise performance in competitive squash players. Nine squash players (mean +/- SEM VO2max = 61.9 +/2.1 ml x kg(-1) x min(-1); body mass = 73 +/- 3 kg) performed an on-court "ghosting" routine that involved 10 sets of 2 repetitions of simulated positional play, each set interspersed with 30 s passive recovery. A double blind, crossover design was utilised whereby experimental and control groups supplemented 4 times daily for 5 d with 0.075 g x kg(-1) body mass of creatine monohydrate and maltodextrine, respectively, and a 4 wk washout period separated the crossover of treatments. The experimental group improved mean set sprint time by 3.2 +/- 0.8% over and above the changes noted for the control group (P = 0.004 and 95% Cl = 1.4 to 5.1%). Sets 2 to 10 were completed in a significantly shorter time following creatine supplementation compared to the placebo condition (P < 0.05). In conclusion, these data support existing evidence that creatine supplementation improves high intensity, intermittent exercise performance. In addition, the present study provides new evidence that oral creatine supplementation improves exercise performance in competitive squash players. <20> Unique Identifier 12669262 Authors Van Schuylenbergh R. Van Leemputte M. Hespel P. Institution Exercise Physiology and Biomechanics Laboratory, Department of Kinesiology, Faculty of Physical Education and Physiotherapy, Katholieke Universiteit Leuven, Tervuursevest 101, B-3001 Leuven, Belgium. Title Effects of oral creatine-pyruvate supplementation in cycling performance. Source International Journal of Sports Medicine. 24(2):144-50, 2003 Feb. Abstract A double-blind study was performed to evaluate the effects of oral creatinepyruvate administration on exercise performance in well-trained cyclists. Endurance and intermittent sprint performance were evaluated before (pretest) and after (posttest) one week of creatine-pyruvate intake (Cr(pyr), 2 x 3.5 g x d-1, n = 7) or placebo (PL, n = 7). Subjects first performed a 1-hour time trial during which the workload could be adjusted at 5-min intervals. Immediately they did five 10-sec sprints interspersed by 2-min rest intervals. Tests were performed on an individual race bicycle that was mounted on an ergometer. Steady-state power production on average was about 235-245 W, which corresponded to blood lactate concentrations of 4-5 mmol x l -1 and heart rate in the range of 160-170 beats x min -1. Power outputs as well as blood lactate levels and heart rates were similar between Cr(pyr) and PL at all times. Total work performed during the 1-h trial was 872 +/- 44 KJ in PL versus 891 +/- 51 KJ in CR pyr. During the intermittent sprint test power peaked at about 800-1000 watt within 2-3 sec, decreasing by 15-20 % towards the end of each sprint. Peak and mean power outputs were similar between groups at all times. Peak lactate concentrations after the final sprint were approximately 11 mmol x l -1 in both groups during both the pretest and the posttest. It is concluded that one week of creatine-pyruvate supplementation at a rate of 7 g x d -1 does not beneficially impact on either endurance capacity or intermittent sprint performance in cyclists. <21> Unique Identifier 10683103 Authors Rawson ES. Clarkson PM. Institution Department of Exercise Science, University of Massachusetts, Amherst 01003, USA. erawson@excsci.umass.edu Title Acute creatine supplementation in older men. Source International Journal of Sports Medicine. 21(1):71-5, 2000 Jan. Abstract The hypothesis of this study was that short term creatine (Cr) ingestion in older individuals would increase body mass and exercise performance, as has been shown in younger subjects. Seventeen males 60-78 years old were randomly placed into two groups, Cr and placebo (P), and supplemented in double-blind fashion for 5 days. Subjects ingested either 5 g of Cr plus 1 g of sucrose 4x per day or 6 g of a sucrose placebo 4x per day. Isometric strength of the elbow flexors was assessed using a modified preacher bench attached to a strain gauge. Isokinetic exercise performance was assessed using an intermittent fatigue test of the knee extensors. Subjects performed 3 sets of 30 repetitions with 60 sec rest between sets. There was a small (0.5 kg) but statistically significant increase in body mass (p < 0.05) in the Cr group after supplementation. There was a significant overall interaction between groups in isokinetic performance from pre to post supplementation (group x time x set, p < 0.05). However, analysis of the groups separately revealed that the subjects in the Cr group demonstrated a small nonsignificant increase in isokinetic performance while subjects in the P group demonstrated a small non-significant performance decrement. There was no significant difference in isometric strength between groups from pre to post supplementation. These data suggest that acute oral Cr supplementation does not increase isometric strength and only produces small increases in isokinetic performance and body mass in men over the age of 60. <22> Unique Identifier 10601174 Authors McKenna MJ. Morton J. Selig SE. Snow RJ. Institution Department of Human Movement, Recreation, and Performance, Centre for Rehabilitation, Exercise, and Sports Science, Victoria University of Technology, Melbourne, Victoria 8001, Australia. michael.mckenna@vu.edu.au Title Creatine supplementation increases muscle total creatine but not maximal intermittent exercise performance. Source Journal of Applied Physiology. 87(6):2244-52, 1999 Dec. Abstract This study investigated creatine supplementation (CrS) effects on muscle total creatine (TCr), creatine phosphate (CrP), and intermittent sprinting performance by using a design incorporating the time course of the initial increase and subsequent washout period of muscle TCr. Two groups of seven volunteers ingested either creatine [Cr; 6 x (5 g Cr-H(2)O + 5 g dextrose)/day)] or a placebo (6 x 5 g dextrose/day) over 5 days. Five 10-s maximal cycle ergometer sprints with rest intervals of 180, 50, 20, and 20 s and a resting vastus lateralis biopsy were conducted before and 0, 2, and 4 wk after placebo or CrS. Resting muscle TCr, CrP, and Cr were unchanged after the placebo but were increased (P < 0.05) at 0 [by 22.9 +/- 4.2, 8.9 +/- 1.9, and 14.0 +/- 3.3 (SE) mmol/kg dry mass, respectively] and 2 but not 4 wk after CrS. An apparent placebo main effect of increased peak power and cumulative work was found after placebo and CrS, but no treatment (CrS) main effect was found on either variable. Thus, despite the rise and washout of muscle TCr and CrP, maximal intermittent sprinting performance was unchanged by CrS. <23> Unique Identifier 9572815 Authors Snow RJ. McKenna MJ. Selig SE. Kemp J. Stathis CG. Zhao S. Institution Department of Biomedical Sciences, Centre for Rehabilitation, Exercise, and Sport Science, and Victoria University of Technology, Melbourne 8001, Australia. Title Effect of creatine supplementation on sprint exercise performance and muscle metabolism. Source Journal of Applied Physiology. 84(5):1667-73, 1998 May. Abstract The aim of the present study was to examine the effect of creatine supplementation (CrS) on sprint exercise performance and skeletal muscle anaerobic metabolism during and after sprint exercise. Eight active, untrained men performed a 20-s maximal sprint on an air-braked cycle ergometer after 5 days of CrS [30 g creatine (Cr) + 30 g dextrose per day] or placebo (30 g dextrose per day). The trials were separated by 4 wk, and a double-blind crossover design was used. Muscle and blood samples were obtained at rest, immediately after exercise, and after 2 min of passive recovery. CrS increased the muscle total Cr content (9.5 +/- 2.0%, P < 0.05, mean +/- SE); however, 20-s sprint performance was not improved by CrS. Similarly, the magnitude of the degradation or accumulation of muscle (e.g., adenine nucleotides, phosphocreatine, inosine 5'-monophosphate, lactate, and glycogen) and plasma metabolites (e.g. , lactate, hypoxanthine, and ammonia/ammonium) were also unaffected by CrS during exercise or recovery. These data demonstrated that CrS increased muscle total Cr content, but the increase did not induce an improved sprint exercise performance or alterations in anaerobic muscle metabolism. <24> Unique Identifier 12485548 Authors Dempsey RL. Mazzone MF. Meurer LN. Institution Dept of Family Community Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA. rdempsey@mcw.edu Title Does oral creatine supplementation improve strength? A meta-analysis. Source Journal of Family Practice. 51(11):945-51, 2002 Nov. Abstract OBJECTIVES: Oral creatine is the most widely used nutritional supplement among athletes. Our purpose was to investigate whether creatine supplementation increases maximal strength and power in healthy adults. STUDY DESIGN: Metaanalysis of existing literature. DATA SOURCES: We searched MEDLINE (1966-2000) and the Cochrane Controlled Trials Register (through June 2001) to locate relevant articles. We reviewed conference proceedings and bibliographies of identified studies. An expert in the field was contacted for sources of unpublished data. Randomized or matched placebo controlled trials comparing creatine supplementation with placebo in healthy adults were considered. OUTCOMES MEASURED: Presupplementation and postsupplementation change in maximal weight lifted, cycle ergometry sprint peak power, and isokinetic dynamometer peak torque were measured. RESULTS: Sixteen studies were identified for inclusion. The summary difference in maximum weight lifted was 6.85 kg (95% confidence interval [CI], 5.24-8.47) greater after creatine than placebo for bench press and 9.76 kg (95% CI, 3.37-16.15) greater for squats; there was no difference for arm curls. In 7 of 10 studies evaluating maximal weight lifted, subjects were young men (younger than 36 years) engaged in resistance training. There was no difference in cycle ergometer or isokinetic dynamometer performance. CONCLUSIONS: Oral creatine supplementation combined with resistance training increases maximal weight lifted in young men. There is no evidence for improved performance in older individuals or women or for other types of strength and power exercises. Also, the safety of creatine remains unproven. Therefore, until these issues are addressed, its use cannot be universally recommended. <25> Unique Identifier 12094124 Authors Oopik V. Paasuke M. Timpmann S. Medijainen L. Ereline J. Gapejeva J. Institution Institute of Exercise Biology, University of Tartu, Tartu, Estonia. vahuro@ut.ee Title Effects of creatine supplementation during recovery from rapid body mass reduction on metabolism and muscle performance capacity in well-trained wrestlers. Source Journal of Sports Medicine & Physical Fitness. 42(3):330-9, 2002 Sep. Abstract BACKGROUND: The aim of the study was to test the hypothesis that creatine supplementation with concomitant carbohydrate ingestion during recovery period after rapid body mass reduction accelerates the restoration of body mass and physical performance in well-trained wrestlers. METHODS: A double-blind, placebo-controlled cross-over study was conducted on five young healthy male wrestlers, who reduced their body mass by 4.5-5.3% in two series of investigations separated by one month. During 17 hrs recovery period they consumed controlled diet supplemented in random order with glucose (GL trial) or with glucose plus creatine (GL+CR trial). The capacity of the subjects to perform submaximal and maximal (W(max)) intensity work was measured using 5 min intermittent intensity test exercise at the Cybex II device before (Test 1) and after body mass loss (Test 2), also after the recovery (Test 3) on both trials. RESULTS: There was no effect of treatment on the extent of body mass regain during 17 hrs recovery. A significant increase (19.2%) in W(max) from Test 2 to Test 3 was observed in GL+CR trial whereas no change was evident with GL treatment. A strong correlation (r=0.92) was established between the whole body creatine retention and the extent of change in W(max) from Test 2 to Test 3. CONCLUSIONS: The results suggest that creatine supplementation with concomitant glucose ingestion during 17 hrs recovery from rapid body mass loss does not accelerate the restoration of body mass but still stimulates the regain of physical performance in maximal intensity efforts in well-trained wrestlers. <26> Unique Identifier 11726268 Authors Unnithan VB. Veehof SH. Institution Vella CA. Kern M. Exercise Science, Syracuse University, Syracuse, NY 13244, USA. Title Is there a physiologic basis for creatine use in children and adolescents?. [Review] [30 refs] Source Journal of Strength & Conditioning Research. 15(4):524-8, 2001 Nov. Abstract The purported ergogenic benefits of creatine for the adult population have been well documented. In able-bodied children and adolescents, there is a paucity of data on creatine use and the purported ergogenic effects of creatine. Only 1 study to date has investigated the ergogenic properties of creatine in the adolescent population. The purpose of this review was to try to establish a rationale for creatine use in the child and adolescent population. The limited literature available in this area did not provide a strong enough rationale from either a physiologic or performance perspective for creatine supplementation in these populations. However, significantly more research is required before definitive conclusions can be made. [References: 30] <27> Unique Identifier 9627907 Authors Williams MH. Branch JD. Institution Department of Exercise Science, Physical Education, and Recreation, Old Dominion University, Norfolk, Virginia 23529-0196, USA. Title Creatine supplementation and exercise performance: an update.[see comment]. [Review] [71 refs] Comments Comment in: J Am Coll Nutr. 1998 Jun;17(3):205-6; PMID: 9627905 Source Journal of the American College of Nutrition. 17(3):216-34, 1998 Jun. Abstract Creatine, a natural nutrient found in animal foods, is alleged to be an effective nutritional ergogenic aid to enhance sport or exercise performance. Research suggests that oral creatine monohydrate supplementation may increase total muscle creatine [TCr], including both free creatine [FCr] and phosphocreatine [PCr]. Some, but not all, studies suggest that creatine supplementation may enhance performance in high-intensity, short-term exercise tasks that are dependent primarily on PCr (i.e., < 30 seconds), particularly laboratory tests involving repeated exercise bouts with limited recovery time between repetitions; additional corroborative research is needed regarding its ergogenic potential in actual field exercise performance tasks dependent on PCr. Creatine supplementation has not consistently been shown to enhance performance in exercise tasks dependent on anaerobic glycolysis, but additional laboratory and field research is merited. Additionally, creatine supplementation has not been shown to enhance performance in exercise tasks dependent on aerobic glycolysis, but additional research is warranted, particularly on the effect of chronic supplementation as an aid to training for improvement in competitive performance. Short-term creatine supplementation appears to increase body mass in males, although the initial increase is most likely water. Chronic creatine supplementation, in conjunction with physical training involving resistance exercise, may increase lean body mass. However, confirmatory research data are needed. Creatine supplementation up to 8 weeks has not been associated with major health risks, but the safety of more prolonged creatine supplementation has not been established. Creatine is currently legal and its use by athletes is not construed as doping. [References: 71] <28> Unique Identifier 10609446 Authors Graham AS. Hatton RC. Institution Genentech, Inc., South San Francisco, CA 94080, USA. graham.angie@gene.com Title Creatine: a review of efficacy and safety. [Review] [69 refs] Source Journal of the American Pharmaceutical Association. 39(6):803-10; quiz 875-7, 1999 Nov-Dec. Abstract OBJECTIVE: To provide an overview of the data on the efficacy and safety of the nutritional supplement creatine. DATA SOURCES: Human studies in English in MEDLINE, Current Contents, BIOSIS, Science Citation Index, and the popular media (including a LEXIS-NEXIS search and information from the World Wide Web and lay media) for 1966 to July 1999 using the search terms creatine, creatine supplement#, creatine monophosphate, and creatine NOT kinase. DATA SYNTHESIS: Creatine use is common among professional athletes. Its use has spread to college athletes, recreational athletes, and even children. Most creatine supplement regimens include a loading dose of 20 to 30 grams divided in 4 equal doses for 5 to 7 days, followed by a 2 gram per day maintenance dose. The increased creatine in the muscle may allow larger stores of phosphocreatine to build, and provide extra energy in the form of adenosine triphosphate. Despite the many clinical trials, high-quality research is lacking. Laboratory investigations of endurance isotonic exercises, strength and endurance during isotonic exercises, isokinetic torque, isometric force, and ergometer performance have yielded roughly an equal number of published studies showing a positive effect or lack of effect. Field studies (i.e., on subjects participating in sports activities) are less impressive than laboratory studies. Performance was more often improved for short-duration, high-intensity activities. Reports have linked creatine to weight gain, cramping, dehydration, diarrhea, and dizziness. Creatine may decrease renal function, but only two case reports of this effect have been published. Creatine appears to be well tolerated in short-term trials. CONCLUSION: While creatine may enhance the performance of high-intensity, short-duration exercise, it is not useful in endurance sports. Because commercially marketed creatine products do not meet the same quality control standards of pharmaceuticals, there is always a concern of impurities or doses higher or lower than those on the labeling. Consumers should balance the quality of information supporting the use of creatine with the known and theoretical risks of using the product, including possible renal dysfunction. [References: 69] <29> Unique Identifier 12394880 Authors Sandhu RS. Como JJ. Scalea TS. Betts JM. Institution R Adams Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore 21201, USA. Title Renal failure and exercise-induced rhabdomyolysis in patients taking performance-enhancing compounds. Source Journal of Trauma-Injury Infection & Critical Care. 53(4):761-3; discussion 763-4, 2002 Oct. <30> Unique Identifier 11126833 Authors Smith J. Dahm DL. Institution Department of Physical Medicine and Rehabilitation, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA. smith.jay@mayo.edu Title Creatine use among a select population of high school athletes. Source Mayo Clinic Proceedings. 75(12):1257-63, 2000 Dec. Abstract OBJECTIVE: To determine the prevalence, frequency, and patterns of creatine use among a local population of high school athletes. SUBJECTS AND METHODS: Male and female high school athletes completed an anonymous questionnaire on creatine use during the August 1999 preparticipation examinations at a single institutional sports medicine center. RESULTS: A total of 328 students (182 males and 146 females) aged 14 to 18 years (mean +/- SD 15.2 +/- 1.3 years) completed the survey (100% response rate), although not all athletes answered each question. Twenty-seven athletes (8.2% of total group), 1 of whom was female, reported creatine use. Of these 27 athletes, 14 (52%) were taking creatine at the time of the survey. The frequency of creatine use among past and current users was equally distributed among rarely (30%), weekly (35%), and daily (35%). Creatine users were older than nonusers (mean 16.5 +/- 1.2 vs 15.0 +/- 1.3 years; P < .001). Of creatine users, 21 (78%) were male football players. Nineteen of 24 respondents (79%) believed creatine improved their performance. Overall, 78% of users either did not know how much creatine they were taking (12/22 respondents) or were taking greater than the recommended doses (5/22 respondents). Minor gastrointestinal side effects or muscle cramps were reported by 5 (20%) of 25 respondents. Creatine users were more likely than nonusers to know other creatine users (81% vs 22%; P < .001) and to use other supplements (67% vs 9%; P < .001). Creatine users obtained creatine information primarily from friends (74%) and purchased creatine predominantly from health food stores (86%). CONCLUSIONS: High school male and female athletes as young as 14 years use creatine. Of high school athletes participating in our study, 8.2% reported creatine use. Relatively minor side effects, diarrhea, cramps, and loss of appetite, were reported. Creatine users seem to believe that creatine improves their performance, but they may lack sufficient information to make informed decisions regarding creatine use. Further larger scale study is warranted. <31> Unique Identifier 10694109 Authors Mihic S. MacDonald JR. McKenzie S. Tarnopolsky MA. Institution Department of Kinesiology, McMaster University, Hamilton, Ontario, Canada. Title Acute creatine loading increases fat-free mass, but does not affect blood pressure, plasma creatinine, or CK activity in men and women. Source Medicine & Science in Sports & Exercise. 32(2):291-6, 2000 Feb. Abstract Creatine monohydrate (CrM) administration may enhance high intensity exercise performance and increase body mass, yet few studies have examined for potential adverse effects, and no studies have directly considered potential gender differences. PURPOSE: The purpose of this study was to examine the effect of acute creatine supplementation upon total and lean mass and to determine potential side effects in both men and women. METHODS: The effect of acute CrM (20 g x d(-1) x 5 d) administration upon systolic, diastolic, and mean BP, plasma creatinine, plasma CK activity, and body composition was examined in 15 men and 15 women in a randomized, double-blind experiment. Additionally, ischemic isometric handgrip strength was measured before and after CrM or placebo (PL). RESULTS: CrM did not affect blood pressure, plasma creatinine, estimated creatinine clearance, plasma CK activity, or handgrip strength (P > 0.05). In contrast, CrM significantly increased fat-free mass (FFM) and total body mass (P < 0.05) as compared with PL, with no changes in body fat. The observed mass changes were greater for men versus women. CONCLUSIONS: These findings suggest that acute CrM administration does not affect blood pressure, renal function, or plasma CK activity, but increases FFM. The effect of CrM upon FFM may be greater in men as compared with that in women. <32> Unique Identifier 10694120 Authors Rico-Sanz J. Mendez Marco MT. Institution Department of Biochemistry and Molecular Biology, Faculty of Sciences, University Autonoma of Barcelona, Spain. j.rico-sanz@proton.uab.es Title Creatine enhances oxygen uptake and performance during alternating intensity exercise. Source Medicine & Science in Sports & Exercise. 32(2):379-85, 2000 Feb. Abstract PURPOSE: The main purpose of the present study was to measure the total oxygen consumed, accumulation of blood metabolites, and performance during alternating intensity exercise before and after a period of creatine (Cr) loading in welltrained humans. METHODS: Fourteen males were randomly assigned to two groups of seven males and were tested before and after 5 d of placebo (PL) or Cr monohydrate (CR) loading (20 g x d(-1)). Oxygen uptake was measured using a breath-by-breath system during bicycle exercise alternating every 3 min between bouts at 30%(-30%) and 90% (-90%) of the maximal power output to exhaustion. Blood samples were also obtained at rest, before the end of each cycling load, at exhaustion, and 5-min postexercise. RESULTS: The oxygen consumed during 1-90% (5.08 +/- 0.39 L) and 2-90% (5.32 +/- 0.30 L) was larger after CR (5.67 +/- 0.34 and 5.78 +/- 0.35 L, P < 0.01 and P < 0.05, respectively). Blood ammonia accumulation at the end of 1-90% (23.1 +/- 6.5 micromol x L(-1)) and 3-30% (64.7 +/- 15.2 micromol x L(-1)) was lower after CR (P < 0.05), whereas plasma uric acid accumulation was lower at exhaustion (P < 0.05) and 5-min postexercise (P < 0.01). Time to exhaustion increased (P < 0.05) from 29.9 +/- 3.8 to 36.5 +/- 5.7 min after CR, whereas it remained the same after PL. CONCLUSIONS: The results indicate that Cr feeding increases the capacity of human muscle to perform work during alternating intensity contraction, possibly as a consequence of increased aerobic phosphorylation and flux through the creatine kinase system. <33> Unique Identifier 10613426 Authors Kamber M. Koster M. Kreis R. Walker G. Boesch C. Hoppeler H. Institution Institute of Sport Sciences, Swiss Sports School, Magglingen. Title Creatine supplementation--part I: performance, clinical chemistry, and muscle volume. Source Medicine & Science in Sports & Exercise. 31(12):1763-9, 1999 Dec. Abstract PURPOSE: Our purpose was to study the effects and side effects of creatine (Cr) supplementation on high-intensity, short-term muscle work, on biochemical parameters related to Cr metabolism in blood and urine, and on muscle volume of the lower limb muscles. METHODS: A cycling ergometer was used in a double-blind, cross-over study on 10 well-trained male physical education students to measure physical performance with 10 repetitive ergometer sprints (6-s duration, 30-s rest) before and after supplementation (5 d, 20 g x d(-1), washout period 61 +/8 d, mean +/- SEM, minimum 28 d) with Cr or placebo. Before and after supplementation, blood and urine were taken and the muscle volume of the lower limb was determined by magnetic resonance imaging (MRI). RESULTS: A significant (P << 0.05) increase in performance (+7%) at the end [4-6 s] of the later sprints (4-7 and 8-10) was observed combined with a lower production of blood lactate (-1 mmol x L(-1)) with Cr supplementation. The concentration of Cr was increased significantly in urine (P < 0.001) and serum (P = 0.005), whereas creatinine (Crn) was increased in serum (P < 0.001). Crn in urine and Crn clearance did not change significantly with Cr intake. There were no significant changes in the analyzed blood enzyme activities. A significant gain of body weight (pre-Cr 76.5 +/- 1.7 kg to 77.9 +/- 1.7 kg post-Cr) with Cr supplementation was measured, but no accompanying increase of muscle mass in a limited volume of the lower limb was observed by MRI. CONCLUSION: Cr supplementation is effective in improving short-term performance, and the methods used show no detrimental side effects with this supplementation protocol. <34> Unique Identifier 10694141 Authors Mujika I. Padilla S. Ibanez J. Izquierdo M. Gorostiaga E. Institution Departamento de Investigacion y Desarrollo, Servicios Medicos, Athletic Club de Bilbao, Basque Country, Spain. imujika@grn.es Title Creatine supplementation and sprint performance in soccer players. Source Medicine & Science in Sports & Exercise. 32(2):518-25, 2000 Feb. Abstract PURPOSE: This investigation examined the effects of creatine (Cr) supplementation on intermittent high-intensity exercise activities specific to competitive soccer. METHODS: On two occasions 7 d apart, 17 highly trained male soccer players performed a counter-movement jump test (CMJT), a repeated sprint test (RST) consisting of six maximal 15-m runs with a 30-s recovery, an intermittent endurance test (IET) consisting of forty 15-s bouts of highintensity running interspersed by 10-s bouts of low-intensity running, and a recovery CMJT consisting of three jumps. After the initial testing session, players were evenly and randomly included in a CREATINE (5 g of Cr, four times per day for 6 d) or a PLACEBO group (same dosage of maltodextrins) using a double-blind research design. RESULTS: The CREATINE group's average 5-m and 15-m times during the RST were consistently faster after the intervention (0.95 +/0.03 vs 0.97 +/- 0.02 s, P < 0.05 and 2.29 +/- 0.08 vs 2.32 +/- 0.07 s, P = 0.07, respectively). Neither group showed significant changes in the CMJT or the IET. The CREATINE group's recovery CMJT performance relative to the resting CMJT remained unchanged postsupplementation, whereas it tended to decrease in the PLACEBO group. CONCLUSION: In conclusion, acute Cr supplementation favorably affected repeated sprint performance and limited the decay in jumping ability after the IET in highly trained soccer players. Intermittent endurance performance was not affected by Cr. <35> Unique Identifier 10449017 Authors Volek JS. Duncan ND. Mazzetti SA. Staron RS. Putukian M. Gomez AL. Pearson DR. Fink WJ. Kraemer WJ. Institution Department of Kinesiology/Center for Sports Medicine, The Pennsylvania State University, University Park 16802, USA. Title Performance and muscle fiber adaptations to creatine supplementation and heavy resistance training. Source Medicine & Science in Sports & Exercise. 31(8):1147-56, 1999 Aug. Abstract PURPOSE: The purpose of this study was to examine the effect of creatine supplementation in conjunction with resistance training on physiological adaptations including muscle fiber hypertrophy and muscle creatine accumulation. METHODS: Nineteen healthy resistance-trained men were matched and then randomly assigned in a double-blind fashion to either a creatine (N = 10) or placebo (N = 9) group. Periodized heavy resistance training was performed for 12 wk. Creatine or placebo capsules were consumed (25 g x d(-1)) for 1 wk followed by a maintenance dose (5 g x d(-1)) for the remainder of the training. RESULTS: After 12 wk, significant (P < or = 0.05) increases in body mass and fat-free mass were greater in creatine (6.3% and 6.3%, respectively) than placebo (3.6% and 3.1%, respectively) subjects. After 12 wk, increases in bench press and squat were greater in creatine (24% and 32%, respectively) than placebo (16% and 24%, respectively) subjects. Compared with placebo subjects, creatine subjects demonstrated significantly greater increases in Type I (35% vs 11%), IIA (36% vs 15%), and IIAB (35% vs 6%) muscle fiber cross-sectional areas. Muscle total creatine concentrations were unchanged in placebo subjects. Muscle creatine was significantly elevated after 1 wk in creatine subjects (22%), and values remained significantly greater than placebo subjects after 12 wk. Average volume lifted in the bench press during training was significantly greater in creatine subjects during weeks 5-8. No negative side effects to the supplementation were reported. CONCLUSION: Creatine supplementation enhanced fat-free mass, physical performance, and muscle morphology in response to heavy resistance training, presumably mediated via higher quality training sessions. <36> Unique Identifier 9475647 Authors Kreider RB. Ferreira M. Wilson M. Grindstaff P. Plisk S. Reinardy J. Cantler E. Almada AL. Institution Department of Human Movement Sciences & Education, The University of Memphis, TN 38152, USA. kreider.richard@coe.memphis.edu Title Effects of creatine supplementation on body composition, strength, and sprint performance. Source Medicine & Science in Sports & Exercise. 30(1):73-82, 1998 Jan. Abstract PURPOSE: To determine the effects of 28 d of creatine supplementation during training on body composition, strength, sprint performance, and hematological profiles. METHODS: In a double-blind and randomized manner, 25 NCAA division IA football players were matched-paired and assigned to supplement their diet for 28 d during resistance/agility training (8 h x wk[-1]) with a Phosphagen HP (Experimental and Applied Sciences, Golden, CO) placebo (P) containing 99 g x d(-1) of glucose, 3 g x d(-1) of taurine, 1.1 g x d(-1) of disodium phosphate, and 1.2 g x d(-1) of potassium phosphate (P) or Phosphagen HP containing the P with 15.75 g x d(-1) of HPCE pure creatine monohydrate (HP). Before and after supplementation, fasting blood samples were obtained; total body weight, total body water, and body composition were determined; subjects performed a maximal repetition test on the isotonic bench press, squat, and power clean; and subjects performed a cycle ergometer sprint test (12 x 6-s sprints with 30-s rest recovery). RESULTS: Hematological parameters remained within normal clinical limits for active individuals with no side effects reported. Total body weight significantly increased (P < 0.05) in the HP group (P 0.85 +/- 2.2; HP 2.42 +/- 1.4 kg) while no differences were observed in the percentage of total body water. DEXA scanned body mass (P 0.77 +/- 1.8; HP 2.22 +/- 1.5 kg) and fat/bone-free mass (P 1.33 +/- 1.1; HP 2.43 +/- 1.4 kg) were significantly increased in the HP group. Gains in bench press lifting volume (P -5 +/- 134; HP 225 +/- 246 kg), the sum of bench press, squat, and power clean lifting volume (P 1,105 +/- 429; HP 1,558 +/- 645 kg), and total work performed during the first five 6-s sprints was significantly greater in the HP group. CONCLUSION: The addition of creatine to the glucose/taurine/electrolyte supplement promoted greater gains in fat/bone-free mass, isotonic lifting volume, and sprint performance during intense resistance/agility training. <37> Unique Identifier 10731017 Authors Terjung RL. Clarkson P. Eichner ER. Greenhaff PL. Hespel PJ. Israel RG. Kraemer WJ. Meyer RA. Spriet LL. Tarnopolsky MA. Wagenmakers AJ. Williams MH. Institution Biomedical Sciences, College of Veterinary Medicine, University of Missouri, Columbia 65211, USA. TerjungR@missouri.edu Title American College of Sports Medicine roundtable. The physiological and health effects of oral creatine supplementation. Source Medicine & Science in Sports & Exercise. 32(3):706-17, 2000 Mar. Abstract Creatine (Cr) supplementation has become a common practice among professional, elite, collegiate, amateur, and recreational athletes with the expectation of enhancing exercise performance. Research indicates that Cr supplementation can increase muscle phosphocreatine (PCr) content, but not in all individuals. A high dose of 20 g x d(-1) that is common to many research studies is not necessary, as 3 g x d(-1) will achieve the same increase in PCr given time. Coincident ingestion of carbohydrate with Cr may increase muscle uptake; however, the procedure requires a large amount of carbohydrate. Exercise performance involving short periods of extremely powerful activity can be enhanced, especially during repeated bouts of activity. This is in keeping with the theoretical importance of an elevated PCr content in skeletal muscle. Cr supplementation does not increase maximal isometric strength, the rate of maximal force production, nor aerobic exercise performance. Most of the evidence has been obtained from healthy young adult male subjects with mixed athletic ability and training status. Less research information is available related to the alterations due to age and gender. Cr supplementation leads to weight gain within the first few days, likely due to water retention related to Cr uptake in the muscle. Cr supplementation is associated with an enhanced accrual of strength in strength-training programs, a response not independent from the initial weight gain, but may be related to a greater volume and intensity of training that can be achieved. There is no definitive evidence that Cr supplementation causes gastrointestinal, renal, and/or muscle cramping complications. The potential acute effects of high-dose Cr supplementation on body fluid balance has not been fully investigated, and ingestion of Cr before or during exercise is not recommended. There is evidence that medical use of Cr supplementation is warranted in certain patients (e.g.. neuromuscular disease); future research may establish its potential usefulness in other medical applications. Although Cr supplementation exhibits small but significant physiological and performance changes, the increases in performance are realized during very specific exercise conditions. This suggests that the apparent high expectations for performance enhancement, evident by the extensive use of Cr supplementation, are inordinate. <38> Unique Identifier 10795791 Authors Gilliam JD. Hohzorn C. Martin D. Trimble MH. Institution Department of Physical Therapy, University of Florida, Gainesville 32610, USA. gilliam@ufl.edu Title Effect of oral creatine supplementation on isokinetic torque production. Source Medicine & Science in Sports & Exercise. 32(5):993-6, 2000 May. Abstract PURPOSE: This study was conducted to examine the effect of oral creatine supplementation on the decline in peak isokinetic torque of the quadriceps muscle group during an endurance test. METHODS: Twenty-three active, but untrained, male subjects performed isokinetic strength tests on a Cybex II dynamometer at 180 degrees x s(-1). The protocol consisted of pre- and posttests with five sets of 30 maximum volitional contractions with a 1-min rest period between sets. Subjects returned to perform the posttest after 5 d of placebo (4 x 6 g glucose x d(-1), N = 12) or creatine (4 x 5 g creatine + 1 g glucose x d(-1), N = 11) supplementation. Supplements and testing were administered in a double blind fashion. Peak torque was measured during each contraction and the 30 contractions were averaged for each set. RESULTS: A three-way mixed ANOVA with one between factor (placebo vs creatine) and two within factors (pre/post supplementation and sets 1-5) revealed no significant interactions, P > 0.05. The placebo vs creatine main effect was also nonsignificant, whereas the pre/post and set effects were significant (P < 0.05). Peak torque increased (approximately 3%) from pre- to post-testing, (P = 0.04), but the absolute magnitude of the differences is unlikely to be of any practical significance. Peak torque decreased from sets 1 to 4, whereas sets 4 and 5 were not different. A priori contrasts comparing the creatine group's performance pre vs post test for the fourth and fifth sets were nonsignificant (P > 0.05). CONCLUSIONS: Based on within and between group comparisons, we were unable to detect an ergogenic effect of oral creatine supplementation on the decline in peak torque during isokinetic exercise at 180 degrees x s(-1). <39> Unique Identifier 11194113 Authors Rockwell JA. Rankin JW. Toderico B. Institution Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg 24061-0430, USA. Title Creatine supplementation affects muscle creatine during energy restriction. Source Medicine & Science in Sports & Exercise. 33(1):61-8, 2001 Jan. Abstract INTRODUCTION: Anaerobic performance and body protein may decrease with energy restriction practiced by some athletes for weight loss. METHODS: This investigation examined the effects of creatine (Cr) supplementation during energy restriction on muscle Cr, exercise performance (10 sprints of 6 s, with 30-s rest), nitrogen balance, and body composition in male resistance trainers. Creatine supplemented (CrS, 20 g x d(-1) of Cr) and those given a placebo (P1) consumed a formula diet of 75.3 kJ (18 kcal) x kg(-1) x d(-1) (54.7% C, 21.3% P, 24% F) for 4 d. A control group was unsupplemented and continued their normal diet. There were no changes in body composition or performance of the control group. RESULTS: CrS and P1 demonstrated similar decreases in body weight and percent body fat. The percent change in fat-free mass was more for P1 (2.4+/0.3% reduction) than CrS (1.4+/-0.4%), but urinary nitrogen losses were similar. Significant increases in muscle total Cr and CrP of 15-16% were demonstrated by CrS over the energy restriction period, whereas P1 had no changes in muscle Cr. Total work done during the sprints expressed per body weight tended to be 3.8% higher in CrS and 0.5% less in P1 after the energy restriction (P = 0.058). CONCLUSION: It was concluded that Cr supplementation increased muscle Cr during short-term energy restriction but did not affect body fat or protein loss. The change in muscle creatine was reflected in a tendency for higher total sprint work for the Cr group. <40> Unique Identifier 11323554 Authors Preen D. Dawson B. Goodman C. Lawrence S. Beilby J. Ching S. Institution Department of Human Movement and Exercise Science, The University of Western Australia, Crawley, W.A., 6009, Australia. dpreen@mbox.com.au Title Effect of creatine loading on long-term sprint exercise performance and metabolism. Source Medicine & Science in Sports & Exercise. 33(5):814-21, 2001 May. Abstract PURPOSE: This study examined whether creatine (Cr) supplementation could enhance long-term repeated-sprint exercise performance of approximately 80 min in duration. METHODS: Fourteen active, but not well-trained, male subjects initially performed 10 sets of either 5 or 6 x 6 s maximal bike sprints, with varying recoveries (24, 54, or 84 s between sprints) over a period of 80 min. Work done (kJ) and peak power (W) were recorded for each sprint, and venous blood was collected preexercise and on four occasions during the exercise challenge. Muscle biopsies (vastus lateralis) were obtained preexercise as well as 0 min and 3 min postexercise. Subjects were then administered either 20 g.d-1 Cr.H2O (N = 7) or placebo (N = 7) for 5 d. Urine samples were collected for each 24 h of the supplementation period. Subjects were then retested using the same procedures as in test 1. RESULTS: Total work done increased significantly (P < 0.05) from 251.7 +/- 18.4 kJ presupplementation to 266.9 +/- 19.3 kJ (6% increase) after Cr ingestion. No change was observed for the placebo group (254.0 +/- 10.4 kJ to 252.3 +/- 9.3 kJ). Work done also improved significantly (P < 0.05) during 6 x 6 s sets with 54-s and 84-s recoveries and approached significance (P = 0.052) in 5 x 6 s sets with 24-s recovery in the Cr condition. Peak power was significantly increased (P < 0.05) in all types of exercise sets after Cr loading. No differences were observed for any performance variables in the placebo group. Resting muscle Cr and PCr concentrations were significantly elevated (P < 0.05) after 5 d of Cr supplementation (Cr: 48.9%; PCr: 12.5%). Phosphocreatine levels were also significantly higher (P < 0.05) immediately and 3 min after the completion of exercise in the Cr condition. CONCLUSION: The results of this study indicate that Cr ingestion (20 g.day-1 x 5 d) improved exercise performance during 80 min of repeated-sprint exercise, possibly due to an increased TCr store and improved PCr replenishment rate. <41> Unique Identifier 11445756 Authors Volek JS. Mazzetti SA. Farquhar WB. Barnes BR. Gomez AL. Kraemer WJ. Institution The Human Performance Laboratory, Ball State University, Muncie, IN 47306, USA. jvolek@bsu.edu Title Physiological responses to short-term exercise in the heat after creatine loading. Source Medicine & Science in Sports & Exercise. 33(7):1101-8, 2001 Jul. Abstract PURPOSE: This investigation was designed to examine the influence of creatine (Cr) supplementation on acute cardiovascular, renal, temperature, and fluidregulatory hormonal responses to exercise for 35 min in the heat. METHODS: Twenty healthy men were matched and then randomly assigned to consume 0.3 g.kg(1) Cr monohydrate (N = 10) or placebo (N = 10) for 7 d in a double-blind fashion. Before and after supplementation, both groups cycled for 30 min at 6070% VO2(peak) immediately followed by three 10-s sprints in an environmental chamber at 37 degrees C and 80% relative humidity. RESULTS: Body mass was significantly increased (0.75 kg) in Cr subjects. Heart rate, blood pressure, and sweat rate responses to exercise were not significantly different between groups. There were no differences in rectal temperature responses in either group. Sodium, potassium, and creatinine excretion rates obtained from 24-h and exercise urine collection periods were not significantly altered in either group. Serum creatinine was elevated in the Cr group but within normal ranges. There were significant exercise-induced increases in cortisol, aldosterone, renin, angiotensin I and II, atrial peptide, and arginine vasopressin. The aldosterone response was slightly greater in the Cr (263%) compared with placebo (224%) group. Peak power was greater in the Cr group during all three 10-s sprints after supplementation and unchanged in the placebo group. There were no reports of adverse symptoms, including muscle cramping during supplementation or exercise. CONCLUSION: Cr supplementation augments repeated sprint cycle performance in the heat without altering thermoregulatory responses. <42> Unique Identifier 11740297 Authors Tarnopolsky MA. Parise G. Yardley NJ. Ballantyne CS. Olatinji S. Phillips SM. Institution Department of Medicine (Neurology and Neurological Rehabilitation), Rm. 4U4, McMaster University Medical Center, 1200 Main Street W., Hamilton, Ontario, Canada, L8N 3Z5. tarnopol@mcmaster.ca Title Creatine-dextrose and protein-dextrose induce similar strength gains during training. Source Medicine & Science in Sports & Exercise. 33(12):2044-52, 2001 Dec. Abstract BACKGROUND: Creatine supplementation during resistance exercise training has been reported to induce greater increases in fat-free mass (FFM), muscle fiber area, and strength when compared with a placebo. We have recently shown that timing of nutrient delivery in the postexercise period can have positive effects on whole body protein turnover (B. D. Roy et al., Med Sci Sports Exerc. 32(8):1412-1418, 2000). PURPOSE: We tested the hypothesis that a postexercise protein-carbohydrate supplement would result in similar increases in FFM, muscle fiber area, and strength as compared with creatine monohydrate (CM), during a supervised 2-month resistance exercise training program in untrained men. METHODS: Young healthy male subjects were randomized to receive either CM and glucose (N = 11; CM 10 g + glucose 75 g [CR-CHO] (CELL-Tech)) or protein and glucose (N = 8; casein 10 g + glucose 75 g [PRO+CHO]), using double-blinded allocation. Participants performed 8 wk of whole body split-routine straight set weight training, 1 h.d(-1), 6 d.wk(-1). Measurements, pre- and post-training were made of fat-free mass (FFM; DEXA), total body mass, muscle fiber area, isokinetic knee extension strength (45 and 240 degrees.s(-1)), and 1 repetition maximal (1RM) strength for 16 weight training exercises. RESULTS: Total body mass increased more for CR-CHO (+4.3 kg, 5.4%) as compared with PRO-CHO (+1.9 kg, 2.4%) (P < 0.05 for interaction) and FFM increased after training (P < 0.01) but was not significantly different between the groups (CR-CHO = +4.0 kg, 6.4%; PRO-CHO = +2.6 kg, 4.1%) (P = 0.11 for interaction). Muscle fiber area increased similarly after training for both groups (approximately 20%; P < 0.05). Training resulted in an increase in 1RM for each of the 16 activities (range = 14.239.9%) (P < 0.001), isokinetic knee extension torque (P < 0.01), with no treatment effects upon any of the variables. CONCLUSIONS: We concluded that postexercise supplementation with PRO-CHO resulted in similar increases in strength after a resistance exercise training program as compared with CR-CHO. However, the greater gains in total mass for the CR-CHO group may have implications for sport-specific performance. <43> Unique Identifier 11740307 Authors Chrusch MJ. Chilibeck PD. Chad KE. Davison KS. Burke DG. Institution College of Kinesiology, University of Saskatchewan, 105 Gymnasium Place, Saskatoon, Saskatchewan, S7N 5C2, Canada. Title Creatine supplementation combined with resistance training in older men. Source Medicine & Science in Sports & Exercise. 33(12):2111-7, 2001 Dec. Abstract PURPOSE: To study the effect of creatine (Cr) supplementation combined with resistance training on muscular performance and body composition in older men. METHODS: Thirty men were randomized to receive creatine supplementation (CRE, N = 16, age = 70.4 +/- 1.6 yr) or placebo (PLA, N = 14, age = 71.1 +/- 1.8 yr), using a double blind procedure. Cr supplementation consisted of 0.3-g Cr.kg(-1) body weight for the first 5 d (loading phase) and 0.07-g Cr.kg(-1) body weight thereafter. Both groups participated in resistance training (36 sessions, 3 times per week, 3 sets of 10 repetitions, 12 exercises). Muscular strength was assessed by 1-repetition maximum (1-RM) for leg press (LP), knee extension (KE), and bench press (BP). Muscular endurance was assessed by the maximum number of repetitions over 3 sets (separated by 1-min rest intervals) at an intensity corresponding to 70% baseline 1-RM for BP and 80% baseline 1-RM for the KE and LP. Average power (AP) was assessed using a Biodex isokinetic knee extension/flexion exercise (3 sets of 10 repetitions at 60 degrees.s(-1) separated by 1-min rest). Lean tissue (LTM) and fat mass were assessed using dual energy x-ray absorptiometry. RESULTS: Compared with PLA, the CRE group had significantly greater increases in LTM (CRE, +3.3 kg; PLA, +1.3 kg), LP 1-RM (CRE, +50.1 kg; PLA +31.3 kg), KE 1-RM (CRE, +14.9 kg; PLA, +10.7 kg), LP endurance (CRE, +47 reps; PLA, +32 reps), KE endurance (CRE, +21 reps; PLA +14 reps), and AP (CRE, +26.7 W; PLA, +18 W). Changes in fat mass, fat percentage, BP 1-RM, and BP endurance were similar between groups. CONCLUSION: Creatine supplementation, when combined with resistance training, increases lean tissue mass and improves leg strength, endurance, and average power in men of mean age 70 yr. <44> Unique Identifier 11828245 Authors Izquierdo M. Ibanez J. Gonzalez-Badillo JJ. Gorostiaga EM. Institution Centro de Investigacion y Medicina del Deporte, Gobierno de Navarra, Navarra, Spain. mizquierdo@jet.es Title Effects of creatine supplementation on muscle power, endurance, and sprint performance. Source Medicine & Science in Sports & Exercise. 34(2):332-43, 2002 Feb. Abstract PURPOSE: To determine the effects of creatine (Cr) supplementation (20 g x d(1) during 5 d) on maximal strength, muscle power production during repetitive high-power-output exercise bouts (MRPB), repeated running sprints, and endurance in handball players. METHODS: Nineteen trained male handball players were randomly assigned in a double-blind fashion to either creatine (N = 9) or placebo (N = 10) group. Before and after supplementation, subjects performed one-repetition maximum half-squat (1RM(HS) and bench press (1RM(BP)), 2 sets of MRPB consisting of one set of 10 continuous repetitions (R10) followed by 1 set until exhaustion (R(max)), with exactly 2-min rest periods between each set, during bench-press and half-squat protocols with a resistance equal to 60 and 70% of the subjects' 1RM, respectively. In addition, a countermovement jumping test (CMJ) interspersed before and after the MRPB half-squat exercise bouts and a repeated sprint running test and a maximal multistage discontinuous incremental running test (MDRT) were performed. RESULTS: Cr supplementation significantly increased body mass (from 79.4 +/- 8 to 80 +/- 8 kg; P < 0.05), number of repetitions performed to fatigue, and total average power output values in the R(max) set of MRPB during bench press (21% and 17%, respectively) and half-squat (33% and 20%, respectively), the 1RM(HS) (11%), as well as the CMJ values after the MRPB half-squat (5%), and the average running times during the first 5 m of the six repeated 15-m sprints (3%). No changes were observed in the strength, running velocity, or body mass measures in the placebo group during the experimental period. CONCLUSION: Short-term Cr supplementation leads to significant improvements in lower-body maximal strength, maximal repetitive upper- and lower-body high-power exercise bouts, and total repetitions performed to fatigue in the R(max) set of MRPB, as well as enhanced repeated sprint performance and attenuated decline in jumping ability after MRPB in highly trained handball players. Cr supplementation did not result in any improvement in upper-body maximal strength and in endurance running performance. <45> Unique Identifier 12131259 Authors Kilduff LP. Vidakovic P. Paul L. Pitsiladis YP. Institution Cooney G. Twycross-Lewis R. Amuna P. Parker M. Centre for Exercise Science and Medicine, Institute of Biomedical and Life Sciences, University of Glasgow, Glasgow, UK. Title Effects of creatine on isometric bench-press performance in resistance-trained humans. Source Medicine & Science in Sports & Exercise. 34(7):1176-83, 2002 Jul. Abstract PURPOSE: The purpose of this study was to investigate the effects of creatine (Cr) supplementation on force generation during an isometric bench-press in resistance-trained men. METHODS: 32 resistance-trained men were matched for peak isometric force and assigned in double-blind fashion to either a Cr or placebo group. Subjects performed an isometric bench-press test involving five maximal isometric contractions before and after 5 d of Cr (20 g.d-1 Cr + 180 g.d-1 dextrose) or placebo (200 g.d-1 dextrose). Body composition was measured before and after supplementation. Subjects completed 24-h urine collections throughout the study period; these were subsequently analyzed to provide total Cr and creatinine excretion. RESULTS: The amount of Cr retained over the supplementation period was 45 +/- 18 g (mean +/- SD), with an estimated intramuscular Cr storage of 43 (13-61) mmol x kg(-1) x dry weight muscle (median [range]). Four subjects in the Cr group were classified as "nonresponders" (< or =21 mmol x kg(-1) x dry weight muscle increase following Cr supplementation) and the remaining 17 subjects were classed as "responders" (> or =32 mmol x kg(-1) x dry weight muscle). For the Cr group, peak force and total force pre- or postsupplementation were not different from placebo. However, when the analysis was confined to the responders, both the change in peak force [Repetition 2: 59(81) N vs -26(85) N; Repetition 3: 45(59) N vs -26(64) N) and the change in total force (Repetition 1: 1471(1274) N vs 209(1517) N; Repetition 2: 1575(1254) N vs 196(1413) N; Repetition 3: 1278(1245) N vs -3(1118) N; Repetition 4: 918(935) N vs -83(1095) N] post-supplementation were significantly greater compared with the placebo group (P < 0.01). For the Cr group, estimated Cr uptake was inversely correlated with training status (r = -0.68, N = 21, P = 0.001). Cr significantly increased body weight (84.1 +/- 8.6 kg pre- vs 85.3 +/- 8.3 kg post-supplementation) and fat-free mass (71.8 +/- 6.0 kg pre- vs 72.6 +/- 6.0 kg post-supplementation), with the magnitude of increase being significantly greater in the responder group than in the placebo group. CONCLUSION: Five days of Cr supplementation increased body weight and fat-free body mass in resistance-trained men who were classified as responders. Peak force and total force during a repeated maximal isometric bench-press test were also significantly greater in the responders compared to the placebo group. <46> Unique Identifier 11725330 Authors Bennett T. Bathalon G. Armstrong D 3rd. Martin B. Coll R. Beck R. Barkdull T. O'Brien K. Deuster PA. Institution Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814-4799, USA. Title Effect of creatine on performance of militarily relevant tasks and soldier health. Source Military Medicine. 166(11):996-1002, 2001 Nov. Abstract PURPOSE: Determine the short-term effects of creatine supplementation on performance of military tasks, thermoregulation, and health risks. METHODS: Male military personnel were randomly assigned to a creatine (CR; N = 8) or a placebo (CON; N = 8) supplementation group. Testing was conducted at baseline, after a 6-day load phase (20 g/d), and after 4 weeks of taking 6 g/d. Measurements included body composition, liver/kidney function tests, core body temperatures during a 10-mile march and 5-mile run, and performance on physical tasks. RESULTS: Serum and urine creatine increased significantly in the CR group. Body mass and number of pull-ups performed increased significantly in the CR group but not the CON group by week 4. No significant differences between the CR and CON groups were found for other performance measures, body composition, core body temperature, or other biochemical measures. CONCLUSION: Creatine supplementation increased body mass and pull-up performance but did not cause acute health problems. Creatine did not increase core temperature compared with placebo under the environmental conditions of the study, and it is unlikely that creatine will enhance the overall readiness or performance of soldiers. <47> Unique Identifier 12701815 Authors Kreider RB. Institution Exercise and Sport Nutrition Laboratory, Center for Exercise, Nutrition and Preventive Health Research, Department of Health, Human Performance and Recreation, Baylor University, Waco, TX 76798-7313, USA. Richard_Kreider@baylor.edu Title Effects of creatine supplementation on performance and training adaptations. [Review] [66 refs] Source Molecular & Cellular Biochemistry. 244(1-2):89-94, 2003 Feb. Abstract Creatine has become a popular nutritional supplement among athletes. Recent research has also suggested that there may be a number of potential therapeutic uses of creatine. This paper reviews the available research that has examined the potential ergogenic value of creatine supplementation on exercise performance and training adaptations. Review of the literature indicates that over 500 research studies have evaluated the effects of creatine supplementation on muscle physiology and/or exercise capacity in healthy, trained, and various diseased populations. Short-term creatine supplementation (e.g. 20 g/day for 5-7 days) has typically been reported to increase total creatine content by 10-30% and phosphocreatine stores by 10-40%. Of the approximately 300 studies that have evaluated the potential ergogenic value of creatine supplementation, about 70% of these studies report statistically significant results while remaining studies generally report non-significant gains in performance. No study reports a statistically significant ergolytic effect. For example, short-term creatine supplementation has been reported to improve maximal power/strength (5-15%), work performed during sets of maximal effort muscle contractions (5-15%), single-effort sprint performance (1-5%), and work performed during repetitive sprint performance (5-15%). Moreover, creatine supplementation during training has been reported to promote significantly greater gains in strength, fat free mass, and performance primarily of high intensity exercise tasks. Although not all studies report significant results, the preponderance of scientific evidence indicates that creatine supplementation appears to be a generally effective nutritional ergogenic aid for a variety of exercise tasks in a number of athletic and clinical populations. [References: 66] <48> Unique Identifier 10763500 Authors Felber S. Skladal D. Wyss M. Kremser C. Koller A. Sperl W. Institution Department of Radiology II and Magnetic Resonance, University of Innsbruck, Children's Hospital, LKH Salzburg, Austria. Title Oral creatine supplementation in Duchenne muscular dystrophy: a clinical and 31P magnetic resonance spectroscopy study. Source Neurological Research. 22(2):145-50, 2000 Mar. Abstract The decrease in intracellular creatine concentration in Duchenne muscular dystrophy may contribute to the deterioration of intracellular energy homeostasis and may thus be one of the factors aggravating muscle weakness and degeneration. Oral creatine supplementation should have potential in alleviating the clinical symptoms. To test this hypothesis, creatine was orally administered over a period of 155 days to a 9-year-old patient with Duchenne muscular dystrophy. In accordance with previous investigations on normal subjects and trained athletes, the patient experienced improved muscle performance during creatine supplementation. Further evidence supporting this hypothesis derived from plasma creatine kinase and lactate dehydrogenase activities and repeated 31P magnetic resonance spectroscopy of the gastrocnemius muscle. These preliminary observations indicate a potential role for creatine supplementation in the symptomatic therapy of patients with muscle disease. <49> Unique Identifier 11985944 Authors Ziegenfuss TN. Rogers M. Lowery L. Mullins N. Mendel R. Antonio J. Lemon P. Institution Human Nutrition Research Laboratory, Kent State University, Kent, Ohio 44242, USA. tzphd@hotmail.com Title Effect of creatine loading on anaerobic performance and skeletal muscle volume in NCAA Division I athletes. Source Nutrition. 18(5):397-402, 2002 May. Abstract OBJECTIVE: We measured the effect of 3 d of creatine (Cr) supplementation on repeated sprint performance and thigh muscle volume in elite power athletes. METHODS: Ten male (mean +/- standard deviation of body mass and percentage of fat (81.1 +/- 10.5 kg and 9.8 +/- 3.5) and ten female (58.4 +/- 5.3 kg and 15.0 +/- 3.4) athletes were matched for sex and 10-s cycle sprint scores, paired by rank, and randomly assigned to the Cr or placebo (P) group. Subjects completed six maximal 10-s cycle sprints interspersed with 60 s of recovery before and after 3 d of Cr (0.35 g/kg of fat-free mass) or P (maltodextrin) ingestion. Before and after supplementation, 10 contiguous transaxial images of both thighs were obtained with magnetic resonance imaging. RESULTS: Cr supplementation resulted in statistically significant increases in body mass (0.9 +/- 0.1 kg, P < 0.03), total work during the first sprint (P < 0.04), and peak power during sprints 2 to 6 (P < 0.10). As expected, total work and peak power values for males were greater than those for their female counterparts during the initial sprint (P < 0.02); however, the reverse was true during the last three sprints (P < 0.01). Imaging data showed a 6.6% increase in thigh volume in five of six Cr subjects (P = 0.05). CONCLUSION: These data indicate that 3 d of Cr supplementation can increase thigh muscle volume and may enhance cycle sprint performance in elite power athletes; moreover, this effect is greater in females as sprints are repeated. <50> Unique Identifier 10675277 Authors Benzi G. Institution Department of Physiology and Pharmacology, Faculty of Science, University of Pavia, Pavia, Italy. Title Is there a rationale for the use of creatine either as nutritional supplementation or drug administration in humans participating in a sport?. [Review] [79 refs] Source Pharmacological Research. 41(3):255-64, 2000 Mar. Abstract Even though no unambiguous proof for enhanced performance during highintensity exercise has yet been reported, the creatine administration is charged to improve physical performance and has become a popular practice among subjects participating in different sports. Appropriate creatine dosage may be also used as a medicinal product since, in accordance with the Council Directive 65/65/CEE, any substance which may be administered with a view to restoring, correcting or modifying physiological functions in human beings is considered a medicinal product. Thus, quality, efficacy and safety must characterize the substance. In biochemical terms, creatine administration enhances both creatine and phosphocreatine concentrations, allowing for an increased total creatine pool in skeletal muscle. In thermodynamics terms, creatine interferes with the creatine-creatine kinase-phosphocreatine circuit, which is related to the mitochondrial function as a highly organized system for the energy control of the subcellular adenylate pool. In pharmacokinetics terms, creatine entry into skeletal muscle is initially dependent on the extracellular concentration, but the creatine transport is subsequently down-regulated. In pharmacodynamics terms, the creatine enhances the possibility to maintain power output during brief periods of high-intensity exercises. In spite of uncontrolled daily dosage and long-term administration, no research on creatine safety in humans has been set up by specific standard protocol of clinical pharmacology and toxicology, as currently occurs in phase I for the products for human use. More or less documented side effects induced by creatine are weight gain; influence on insulin production; feedback inhibition of endogenous creatine synthesis; longterm damages on renal function. A major point that related to the quality of creatine products is the amount of creatine ingested in relation to the amount of contaminants present. During the production of creatine from sarcosine and cyanamide, variable amounts of contaminants (dicyandiamide, dihydrotriazines, creatinine, ions) are generated and, thus, their tolerable concentrations (ppm) must be defined by specific toxicological researches. Creatine, as the nutritional factors, can be used either at supplementary or therapeutic levels as a function of the dose. Supplementary doses of nutritional factors usually are of the order of the daily turnover, while therapeutic ones are three or more times higher. In a subject with a body weight of 70 kg with a total creatine pool of 120 g, the daily turnover is approximately 2 g. Thus, in healthy subjects nourished with a fat-rich, carbohydrate-, protein-poor diet and participating in a daily recreational sport, the oral creatine supplementation should be on the order of the daily turnover, i.e. less than 2.5-3 g per day, bringing the gastrointestinal absorption to account. In healthy athletes submitted daily to high-intensity strength- or sprint-training, the maximal oral creatine supplementation should be on the order of two times the daily turnover, i.e. less than 5-6 g per day for less than 2 weeks, and the creatine supplementation should be taken under appropriate medical supervision. The oral administration of more than 6 g per day of creatine should be considered as a therapeutic intervention because the dosage is more than three times higher than the creatine daily turnover and more than six times higher than the creatine daily allowance. In this case, creatine administration should be prescribed by physicians only in the cases of suspected or proven deficiency, or in conditions of severe stress and/or injury. 2000 Academic Press@p$hr Copyright 2000 Academic Press. [References: 79] <51> Unique Identifier 11092026 Authors Pecci MA. Lombardo JA. Institution Department of Family Medicine, Boston Medical Center, Massachusetts, USA. Title Performance-enhancing supplements. [Review] [56 refs] Source Physical Medicine & Rehabilitation Clinics of North America. 11(4):949-60, 2000 Nov. Abstract Supplements that are marketed as ergogenic aids have achieved widespread use in the United States. In image-conscious society, these agents are not only being consumed by athletes, but also by those looking for a quick fix to enhance their appearance. Many assume that the performance claims made by the manufacturers are based on actual data, and that these agents must be safe because they are sold to the general public. Unfortunately, in most cases these assumptions are false. Creatine has become very popular, particularly among college and high school athletes. Studies within the last 5 years have shown that creatine does seem to have certain ergogenic benefits in a laboratory setting. It is not currently known whether these benefits actually can be transferred to the playing field. Although creatine has not consistently been shown to cause any major side effects, there is some question regarding creatine's effect on the kidneys, particularly with long-term use. Also, the safety of supplementation in children and adolescents has not been examined at all; its use in this population should be discouraged until there are more data. Androstenedione is an agent that has received a large amount of popular press in the last year, and this has led to an surge in its usage. It is believed to exert its ergogenic effects through conversion to testosterone. But what limited data are available suggest that at the recommended dosage, it does not cause any measurable change in testosterone levels, or provide any ergogenic benefit in inexperienced weight lifters. Also, it has yet to be determined whether androstenedione causes any of the side effects often attributed to use of the illegal anabolic steroids. Its mechanism of action suggests it has the potential to cause many of these negative effects. Studies are just beginning to appear in the literature, and certainly more data need to be gathered before androstenedione supplementation can be recommended for use as an ergogenic aid. [References: 56] <52> Unique Identifier 10461712 Authors Demant TW. Rhodes EC. Institution School of Human Kinetics, University of British Columbia, Vancouver, Canada. Title Effects of creatine supplementation on exercise performance. [Review] [60 refs] Source Sports Medicine. 28(1):49-60, 1999 Jul. Abstract While creatine has been known to man since 1835, when a French scientist reported finding this constitutent of meat, its presence in athletics as a performance enhancer is relatively new. Amid claims of increased power and strength, decreased performance time and increased muscle mass, creatine is being hailed as a true ergogenic aid. Creatinine is synthesised from the amino acids glycine, arginine and methionine in the kidneys, liver and pancreas, and is predominantly found in skeletal muscle, where it exists in 2 forms. Approximately 40% is in the free creatine form (Crfree), while the remaining 60% is in the phosphorylated form, creatine phosphate (CP). The daily turnover rate of approximately 2 g per day is equally met via exogenous intake and endogenous synthesis. Although creatine concentration (Cr) is greater in fast twitch muscle fibres, slow twitch fibres have a greater resynthesis capability due to their increased aerobic capacity. There appears to be no significant difference between males and females in Cr, and training does not appear to effect Cr. The 4 roles in which creatine is involved during performance are temporal energy buffering, spatial energy buffering, proton buffering and glycolysis regulation. Creatine supplementation of 20 g per day for at least 3 days has resulted in significant increases in total Cr for some individuals but not others, suggesting that there are 'responders' and 'nonresponders'. These increases in total concentration among responders is greatest in individuals who have the lowest initial total Cr, such as vegetarians. Increased concentrations of both Crfree and CP are believed to aid performance by providing more short term energy, as well as increase the rate of resynthesis during rest intervals. Creatine supplementation does not appear to aid endurance and incremental type exercises, and may even be detrimental. Studies investigating the effects of creatine supplementation on short term, high intensity exercises have reported equivocal results, with approximately equal numbers reporting significant and nonsignificant results. The only side effect associated with creatine supplementation appears to be a small increase in body mass, which is due to either water retention or increased protein synthesis. [References: 60] <53> Unique Identifier 12427051 Authors Mesa JL. Ruiz JR. Gonzalez-Gross MM. Gutierrez Sainz A. Castillo Garzon MJ. Institution Department of Physiology, School of Medicine, University of Granada, Granada, Spain. Title Oral creatine supplementation and skeletal muscle metabolism in physical exercise. [Review] [377 refs] Source Sports Medicine. 32(14):903-44, 2002. Abstract Creatine is the object of growing interest in the scientific literature. This is because of the widespread use of creatine by athletes, on the one hand, and to some promising results regarding its therapeutic potential in neuromuscular disease on the other. In fact, since the late 1900s, many studies have examined the effects of creatine supplementation on exercise performance. This article reviews the literature on creatine supplementation as an ergogenic aid, including some basic aspects relating to its metabolism, pharmacokinetics and side effects. The use of creatine supplements to increase muscle creatine content above approximately 20 mmol/kg dry muscle mass leads to improvements in high-intensity, intermittent high-intensity and even endurance exercise (mainly in nonweightbearing endurance activities). An effective supplementation scheme is a dosage of 20 g/day for 4-6 days, and 5 g/day thereafter. Based on recent pharmacokinetic data, new regimens of creatine supplementation could be used. Although there are opinion statements suggesting that creatine supplementation may be implicated in carcinogenesis, data to prove this effect are lacking, and indeed, several studies showing anticarcinogenic effects of creatine and its analogues have been published. There is a shortage of scientific evidence concerning the adverse effects following creatine supplementation in healthy individuals even with long-term dosage. Therefore, creatine may be considered as a widespread, effective and safe ergogenic aid. [References: 377] <54> Unique Identifier 10999421 Authors Poortmans JR. Francaux M. Institution Physiological Chemistry, Higher Institute of Physical Education and Readaptation, Free University of Brussels, Bruxelles, Belgium. jrpoortm@ulb.ac.be Title Adverse effects of creatine supplementation: fact or fiction?. [Review] [113 refs] Source Sports Medicine. 30(3):155-70, 2000 Sep. Abstract The consumption of oral creatine monohydrate has become increasingly common among professional and amateur athletes. Despite numerous publications on the ergogenic effects of this naturally occurring substance, there is little information on the possible adverse effects of this supplement. The objectives of this review are to identify the scientific facts and contrast them with reports in the news media, which have repeatedly emphasised the health risks of creatine supplementation and do not hesitate to draw broad conclusions from individual case reports. Exogenous creatine supplements are often consumed by athletes in amounts of up to 20 g/day for a few days, followed by 1 to 10 g/day for weeks, months and even years. Usually, consumers do not report any adverse effects, but body mass increases. There are few reports that creatine supplementation has protective effects in heart, muscle and neurological diseases. Gastrointestinal disturbances and muscle cramps have been reported occasionally in healthy individuals, but the effects are anecdotal. Liver and kidney dysfunction have also been suggested on the basis of small changes in markers of organ function and of occasional case reports, but well controlled studies on the adverse effects of exogenous creatine supplementation are almost nonexistent. We have investigated liver changes during medium term (4 weeks) creatine supplementation in young athletes. None showed any evidence of dysfunction on the basis of serum enzymes and urea production. Short term (5 days), medium term (9 weeks) and long term (up to 5 years) oral creatine supplementation has been studied in small cohorts of athletes whose kidney function was monitored by clearance methods and urine protein excretion rate. We did not find any adverse effects on renal function. The present review is not intended to reach conclusions on the effect of creatine supplementation on sport performance, but we believe that there is no evidence for deleterious effects in healthy individuals. Nevertheless, idiosyncratic effects may occur when large amounts of an exogenous substance containing an amino group are consumed, with the consequent increased load on the liver and kidneys. Regular monitoring is compulsory to avoid any abnormal reactions during oral creatine supplementation. [References: 113]