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Philip D Chilibeck,1 Mojtaba Kaviani,2 Darren G Candow,3 Gordon A Zello4 1College of Kinesiology, University of Saskatchewan, Saskatoon, SK, 2School of Nutrition and Dietetics, Acadia University, Wolfville, NS, 3Faculty of Kinesiology and Health Studies, University of Regina, Regina, 4College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada Abstract: The loss of muscle mass and strength with aging results in significant functional impairment. Creatine supplementation has been used in combination with resistance training as a strategy for increasing lean tissue mass and muscle strength in older adults, but results across studies are equivocal. We conducted a systematic review and meta-analysis of randomized controlled trials of creatine supplementation during resistance training in older adults with lean tissue mass, chest press strength, and leg press strength as outcomes by searching PubMed and SPORTDiscus databases. Twenty-two studies were included in our meta-analysis with 721 participants (both men and women; with a mean age of 57–70 years across studies) randomized to creatine supplementation or placebo during resistance training 2–3 days/week for 7–52 weeks. Creatine supplementation resulted in greater increases in lean tissue mass (mean difference =1.37 kg [95% CI =0.97–1.76]; p

Creatine (Cr) supplementation increases muscle mass, strength, and power. Arginine [alpha]-ketoglutarate (A-AKG) is a precursor for nitric oxide production and has the potential to improve blood flow and nutrient delivery (i.e., Cr) to muscles. This study compared a commercial dietary supplement of Cr, A-AKG, glutamine, taurine, branched-chain amino acids, and medium-chain triglycerides with Cr alone or placebo on exercise performance and body composition. Thirty-five men (~23 yr) were randomized to Cr + A-AKG (0.1 g · kg[-1] · d[-1] Cr + 0.075 g · kg[-1] · d[-1] A-AKG, n = 12), Cr (0.1 g · kg[-1] · d[-1], n = 11), or placebo (1 g · kg[-1] · d[-1] sucrose, n = 12) for 10 d. Body composition, muscle endurance (bench press), and peak and average power (Wingate tests) were measured before and after supplementation. Bench-press repetitions over 3 sets increased with Cr + A-AKG (30.9 +/- 6.6 --> 34.9 +/- 8.7 reps; p < .01) and Cr (27.6 +/- 5.9 --> 31.0 +/- 7.6 reps; p < .01), with no change for placebo (26.8 +/- 5.0 --> 27.1 +/- 6.3 reps). Peak power significantly increased in Cr + A-AKG (741 +/- 112 --> 794 +/- 92 W; p < .01), with no changes in Cr (722 +/- 138 --> 730 +/- 144 W) and placebo (696 +/- 63 --> 705 +/- 77 W). There were no differences in average power between groups over time. Only the Cr-only group increased total body mass (79.9 +/- 13.0 --> 81.1 +/- 13.8 kg; p < .01), with no significant changes in lean-tissue or fat mass. These results suggest that Cr alone and in combination with A-AKG improves upper body muscle endurance, and Cr + A-AKG supplementation improves peak power output on repeated Wingate tests. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine the effects of Red Bull energy drink on Wingate cycle performance and muscle endurance. Healthy young adults (N = 15, 11 men, 4 women, 21 ± 5 y old) participated in a crossover study in which they were randomized to supplement with Red Bull (2 mg/kg body mass of caffeine) or isoenergetic, isovolumetric, noncaffeinated placebo, separated by 7 d. Muscle endurance (bench press) was assessed by the maximum number of repetitions over 3 sets (separated by 1-min rest intervals) at an intensity corresponding to 70% of baseline 1-repetition maximum. Three 30-s Wingate cycling tests (load = 0.075 kp/kg body mass), with 2 min recovery between tests, were used to assess peak and average power output. Red Bull energy drink significantly increased total bench-press repetitions over 3 sets (Red Bull = 34 ± 9 vs. placebo = 32 ± 8, P < 0.05) but had no effect on Wingate peak or average power (Red Bull = 701 ± 124 W vs. placebo = 700 ± 132 W, Red Bull = 479 ± 74 W vs. placebo = 471 ± 74 W, respectively). Red Bull energy drink significantly increased upper body muscle endurance but had no effect on anaerobic peak or average power during repeated Wingate cycling tests in young healthy adults. [ABSTRACT FROM AUTHOR]

Alpha-lipoic acid has been found to enhance glucose uptake into skeletal muscle in animal models. Studies have also found that the co-ingestion of carbohydrate along with creatine increases muscle creatine uptake by a process related to insulin-stimulated glucose disposal. The purpose of this study was to determine the effect of alpha-lipoic acid on human skeletal muscle creatine uptake by directly measuring intramuscular concentrations of creatine, phosphocreatine, and adenosine triphosphate when creatine monohydrate was co-ingested with alpha-lipoic acid. Muscle biopsies were acquired from the vastus lateralis m. of 16 male subjects (18-32 y) before and after the experimental intervention. After the initial biopsy, subjects ingested 20 g x d(-1) of creatine monohydrate, 20 g x d(-1) of creatine monohydrate + 100 g x d(-1) of sucrose, or 20 g x d(-1) of creatine monohydrate + 100 g x d(-1) of sucrose + 1000 mg x d(-1) of alpha-lipoic acid for 5 days. Subjects refrained from exercise and consumed the same balanced diet for 7 days. Body weight increased by 2.1% following the nutritional intervention, with no differences between the groups. There was a significant increase in total creatine concentration following creatine supplementation, with the group ingesting alpha-lipoic acid showing a significantly greater increase (p < .05) in phosphocreatine (87.6 --> 106.2 mmol x kg(-1) dry mass [dm]) and total creatine (137.8 --> 156.8 mmol x kg(-1) dm). These findings indicate that co-ingestion of alpha-lipoic acid with creatine and a small amount of sucrose can enhance muscle total creatine content as compared to the ingestion of creatine and sucrose or creatine alone. [ABSTRACT FROM AUTHOR]

Our purpose was to assess muscular adaptations during 6 weeks of resistance training in 36 males randomly assigned to supplementation with whey protein (W; 1.2 g/kg/day), whey protein and creatine monohydrate (WC; 0.1 g/kg/day), or placebo (P; 1.2 g/kg/day maltodextrin). Measures included lean tissue mass by dual energy x-ray absorptiometry, bench press and squat strength (1-repetition maximum), and knee extension/flexion peak torque. Lean tissue mass increased to a greater extent with training in WC compared to the other groups, and in the W compared to the P group (p <.05). Bench press strength increased to a greater extent for WC compared to W and P (p <.05). Knee extension peak torque increased with training for WC and W (p <.05), but not for P. All other measures increased to a similar extent across groups. Continued training without supplementation for an additional 6 weeks resulted in maintenance of strength and lean tissue mass in all groups. Males that supplemented with whey protein while resistance training demonstrated greater improvement in knee extension peak torque and lean tissue mass than males engaged in training alone. Males that supplemented with a combination of whey protein and creatine had greater increases in lean tissue mass and bench press than those who supplemented with only whey protein or placebo. However, not all strength measures were improved with supplementation, since subjects who supplemented with creatine and/or whey protein had similar increases in squat strength and knee flexion peak torque compared to subjects who received placebo. [ABSTRACT FROM AUTHOR]

Muscle and strength loss will occur during periods of physical inactivity and immobilization. Creatine supplementation may have a favorable effect on muscle mass and strength independently of exercise. The purpose of this study was to determine the effects of creatine supplementation on upper limb muscle mass and muscle performance after immobilization. Before the study, creatine-naïve men (n = 7; 18-25 years) were assessed for lean tissue mass (dual-energy X-ray absorptiometry), strength (1-repetition maximum [1RM] isometric single arm elbow flexion/extension), and muscle endurance (maximum number of single-arm isokinetic elbow flexion/extension repetitions at 60% 1RM). After baseline measures, subjects had their dominant or nondominant (random assignment) upper limb immobilized (long arm plaster cast) at 90 degrees elbow flexion. Using a single-blind crossover design, subjects received placebo (maltodextrin; 4 x 5 gxd-1) during days 1-7 and creatine (4 x 5 gxd-1) during days 15-21. The cast was removed during days 8-14 and 22-29. The dependent measures of lean tissue mass, strength, and endurance were assessed at baseline, postcast, and after the study. During immobilization, compared with isocaloric placebo, creatine supplementation better maintained lean tissue mass (Cr +0.9% vs. PLA 23.7%, p , 0.05), elbow flexor strength (Cr 24.1% vs. PLA 221.5%, p , 0.05), and endurance (Cr 29.6% vs. PLA 243%, p , 0.05), and elbow extensor strength (Cr 23.8% vs. PLA 218%, p , 0.05) and endurance (Cr 26.5% vs. PLA 235%, p , 0.05). These results indicate that short-term creatine supplementation attenuates the loss in muscle mass and strength during upper-arm immobilization in young men. [ABSTRACT FROM AUTHOR]

Purpose: To determine whether low-dose creatine and protein supplementation during resistance training (RT; 3 d·wk[-1]; 10 wk) in older men (59-77 yr) is effective for improving strength and muscle mass without producing potentially cytotoxic metabolites (formaldehyde). Methods: Older men were randomized (double-blind) to receive 0.1 g·kg[-1] creatine + 0.3 g·kg[-1] protein (CP; n = 10), creatine (C; n = 13), or placebo (PLA; n = 12) on training days. Measurements before and after RT included lean tissue mass (air-displacement plethysmography), muscle thickness (ultrasound) of elbow, knee, and ankle flexors and extensors, leg and bench press strength, and urinary indicators of cytotoxicity (formaldehyde), myofibrillar protein degradation [3-methylhistidine (3-MH)],and bone resorption [cross-linked N-telopeptides of type I collagen (NTx)]. Results: Subjects in C and CP groups combined experienced greater increases in body mass and total muscle thickness than PLA (P < 0.05). Subjects who received CP increased lean tissue mass (+5.6%) more than C (+2.2%) or PLA (+1.0%; P < 0.05) and increased bench press strength (+25%) to a greater extent than C and PLA combined (+12.5%; P < 0.05). CP and C did not differ from PLA for changes in formaldehyde production (+24% each). Subjects receiving creatine (C and CP) experienced a decrease in 3-MH by 40% compared with an increase of 29% for PLA (P < 0.05) and a reduction in NTx (-27%) versus PLA (+13%; P = 0.05). Conclusions: Low-dose creatine combined with protein supplementation increases lean tissue mass and results in a greater relative increase in bench press but not leg press strength. Low-dose creatine reduces muscle protein degradation and bone resorption without increasing formaldehyde production. [ABSTRACT FROM AUTHOR]

Purpose of Review: Sarcopenia, generally characterized by the age-related reduction in muscle strength, lean/muscle mass and functional ability, is also associated with reduced bone mass and strength and impaired brain health and function. One potential intervention which has received much 'hype' over the past few decades to countermeasure these negative consequences of biological aging is creatine monohydrate supplementation., Recent Findings: From a skeletal muscle perspective, the combination of creatine monohydrate supplementation and resistance training provides 'hope' for older adults as it improves measures of lean mass, regional (limb) muscle thickness, upper- and lower-body muscle strength and functional ability. Further, there is some evidence that creatine (supplementation or habitual diet) provides a ray of 'hope' for improving some aspects of cognitive function. The majority of research suggests that creatine is more 'hype' than 'hope' for improving measures of bone mass in older adults. Creatine monohydrate supplementation provides some anti-sarcopenic benefits for older adults., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Numerous meta-analyses have assessed the efficacy of creatine supplementation in increasing muscle strength. However, most have not considered the effect of the participants' age, training duration, or other confounding variables on strength outcomes. Therefore, the purpose of this study was to consider the effect of these variables on the potential efficacy of creatine supplementation and resistance training for improving measures of muscle strength., Methods: Four databases were searched (MEDLINE, Scopus, Embase, and SPORTDiscus) with a search end date of 22 May 2024. Twenty-three studies were included, with 20 studies involving males (447 male participants), 2 studies involving females (40 female participants), and 1 study involving both males and females (13 male participants and 9 female participants)., Results: In comparison with a placebo, creatine supplementation combined with resistance training significantly increased upper-body (WMD = 4.43 kg, p < 0.001) and lower-body strength (WMD = 11.35 kg, p < 0.001). Subgroup analyses showed a trend for greater upper-body strength improvements for males on creatine compared with females on creatine ( p = 0.067, Q = 3.366). Additionally, males who consumed creatine combined with resistance training significantly increased both upper- and lower-body strength, whereas females showed no significant gains. There was a trend indicating greater lower-body strength gains from high-dose creatine compared with lower doses ( p = 0.068, Q = 3.341). No other variables influenced the effect of creatine supplementation. In conclusions, creatine supplementation with resistance training enhances upper- and lower-body muscle strength in adults aged < 50, with greater benefits likely to be seen in males than females.

Background/Objectives: Firefighters, tactical police officers, and warriors often engage in periodic, intermittent, high-intensity physical work in austere environmental conditions and have a heightened risk of premature mortality. In addition, tough decision-making challenges, routine sleep deprivation, and trauma exacerbate this risk. Therefore, identifying strategies to bolster these personnel's health and occupational performance is critical. Creatine monohydrate (CrM) supplementation may offer several benefits to firefighters and tactical athletes (e.g., police, security, and soldiers) due to its efficacy regarding physical performance, muscle, cardiovascular health, mental health, and cognitive performance. Methods: We conducted a narrative review of the literature with a focus on the benefits and application of creatine monohydrate among firefighters. Results: Recent evidence demonstrates that CrM can improve anaerobic exercise capacity and muscular fitness performance outcomes and aid in thermoregulation, decision-making, sleep, recovery from traumatic brain injuries (TBIs), and mental health. Emerging evidence also suggests that CrM may confer an antioxidant/anti-inflammatory effect, which may be particularly important for firefighters and those performing tactical occupations exposed to oxidative and physiological stress, which can elicit systemic inflammation and increase the risk of chronic diseases. Conclusions: This narrative review highlights the potential applications of CrM for related tactical occupations, with a particular focus on firefighters, and calls for further research into these populations.

Protein supplementation often refers to increasing the intake of this particular macronutrient through dietary supplements in the form of powders, ready-to-drink shakes, and bars. The primary purpose of protein supplementation is to augment dietary protein intake, aiding individuals in meeting their protein requirements, especially when it may be challenging to do so through regular food (i.e. chicken, beef, fish, pork, etc.) sources alone. A large body of evidence shows that protein has an important role in exercising and sedentary individuals. A PubMed search of "protein and exercise performance" reveals thousands of publications. Despite the considerable volume of evidence, it is somewhat surprising that several persistent questions and misconceptions about protein exist. The following are addressed: 1) Is protein harmful to your kidneys? 2) Does consuming "excess" protein increase fat mass? 3) Can dietary protein have a harmful effect on bone health? 4) Can vegans and vegetarians consume enough protein to support training adaptations? 5) Is cheese or peanut butter a good protein source? 6) Does consuming meat (i.e., animal protein) cause unfavorable health outcomes? 7) Do you need protein if you are not physically active? 8) Do you need to consume protein ≤ 1 hour following resistance training sessions to create an anabolic environment in skeletal muscle? 9) Do endurance athletes need additional protein? 10) Does one need protein supplements to meet the daily requirements of exercise-trained individuals? 11) Is there a limit to how much protein one can consume in a single meal? To address these questions, we have conducted a thorough scientific assessment of the literature concerning protein supplementation.

Background: Despite the robust evidence demonstrating positive effects from creatine supplementation (primarily when associated with resistance training) on measures of body composition, there is a lack of a comprehensive evaluation regarding the influence of creatine protocol parameters (including dose and form) on body mass and estimates of fat-free and fat mass., Methods: Randomized controlled trials (RCTs) evaluating the effect of creatine supplementation on body composition were included. Electronic databases, including PubMed, Web of Science, and Scopus were searched up to July 2023. Heterogeneity tests were performed. Random effect models were assessed based on the heterogeneity tests, and pooled data were examined to determine the weighted mean difference (WMD) with a 95% confidence interval (CI)., Results: From 4831 initial records, a total of 143 studies met the inclusion criteria. Creatine supplementation increased body mass (WMD: 0.86 kg; 95% CI: 0.76 to 0.96, I 2  = 0%) and fat-free mass (WMD: 0.82 kg; 95% CI: 0.57 to 1.06, I 2  = 0%) while reducing body fat percentage (WMD: -0.28 %; 95% CI: -0.47 to -0.09; I 2  = 0%). Studies that incorporated a maintenance dose of creatine or performed resistance training in conjunction with supplementation had greater effects on body composition., Conclusion: Creatine supplementation has a small effect on body mass and estimates of fat-free mass and body fat percentage. These findings were more robust when combined with resistance training.

Females historically experience sleep disturbances and overall poor sleep compared to males. Creatine has been proposed to impact sleep; however, the effects are not well known. The purpose of this study was to examine the effects of creatine supplementation on sleep among naturally menstruating females. Twenty-one participants completed a double-blind, randomized controlled trial in which they consumed 5 g creatine + 5 g maltodextrin or placebo, 10 g maltodextrin, daily for 6 weeks. Participants completed resistance training 2x/week using the TONAL ® (Tonal Systems Inc., San Francisco, CA, USA) at-home gym. Pre- and post-testing assessed body composition, Pittsburgh Sleep Quality Index (PSQI), dietary intake, and muscular strength. Sleep was assessed nightly using an ŌURA ® (Oulu, Finland) ring. Compared to the placebo group, those consuming creatine experienced significant increases in total sleep on training days ( p = 0.013). No significant changes in chronic sleep and PSQI (pre-post) were observed. There was a significant increase in TONAL ® strength score over time ( p < 0.001), with no between-group differences. Participants reduced their total calorie (kcal) ( p = 0.039), protein (g/kg) ( p = 0.009), carbohydrate (g/kg) ( p = 0.023), and fat (g) ( p = 0.036) intake over time. Creatine supplementation increases sleep duration on resistance training days in naturally menstruating females.

Purpose: Hemp contains protein with high concentrations of the branched-chain amino acids leucine, isoleucine, and valine and oils that have anti-inflammatory properties. Our purpose was to investigate the effects of hemp supplementation during resistance training in trained young adults., Methods: Males (n = 22, 29 ± 8y) and females (n = 12, 30 ± 9y) were randomized (double-blind) to receive 60 g/d of hemp (containing 40 g protein and 9 g oil) or 60 g/d of soy (matched for protein and calories) during eight weeks of resistance training (~  4x/week). Before and after the intervention, participants were assessed for whole-body lean tissue and fat mass (dual-energy X-ray absorptiometry), regional muscle hypertrophy (ultrasound), strength (1-repetition maximum leg press, bench press, biceps curl), voluntary activation (interpolated twitch technique), resting twitch properties (single pulse; 0.5 ms) (before and after a fatigue test), markers of inflammation (Interleukin 6 and C-reactive protein), and bone resorption (urinary N-telopeptides)., Results: Hemp supplementation increased elbow flexor muscle thickness in females (2.6 ± 0.4-3.1 ± 0.5 cm, p = 0.012) while soy supplementation increased elbow flexor muscle thickness in males (3.7 ± 0.4-4.0 ± 0.5 cm, p < 0.01). Twitch torque and rate of torque development were preserved after a fatigue test in males consuming hemp compared to males on soy (p < 0.001)., Conclusion: Overall, hemp provides some sex-specific beneficial effects on measures of muscle accretion and torque under fatiguing conditions in resistance trained young adults., Clinicaltrials: gov Identifier: NCT02529917, registered August 11, 2015., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

This exploratory study aimed to investigate the long-term effects of multiple concussions on prefrontal cortex oxygenation during a five-minute hypercapnic challenge using Near Infrared Spectroscopy (NIRS). 55 physically active retired contact sport male athletes with three or more previous concussions (mTBI) were recruited along with 29 physically active males with no concussions history (CTRL). Participants completed five minutes of seated rest prior to the five-minute hypercapnic challenge (20-second breath-hold, 40-second recovery breathing; five times). NIRS measured right and left side oxygenated (O2Hb), deoxygenated (HHb), total (tHb) haemoglobin, and haemoglobin difference (HbDiff) with all parameters analysed through changes in average maximal and minimal values (ΔMAX), Z-scores, and standard deviations. Right prefrontal cortex HbDiff ΔMAX was significantly higher in the mTBI compared to CTRL (p = 0.045) group. Left prefrontal cortex O2Hb ΔMAX (p = 0.040), HHb Z-Scores (p = 0.008), and HbDiff ΔMAX(p = 0.014) were significantly higher in the mTBI group. Within-group right vs left analyses demonstrated significantly lower left HbDiff ΔMAX (p = 0.048) and HbDiff Z-scores (p = 0.002) in the mTBI group, while the CTRL group had significantly lower left HHb Z-scores (p = 0.003) and left tHb Z-scores (p = 0.042). This study provides preliminary evidence that athletes with a history of three or more concussions may have impaired prefrontal cortex oxygenation parameters during a hypercapnic challenge., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Hemodialysis has a detrimental effect on fat-free mass (FFM) and muscle strength over time. Thus, we aimed to evaluate the effect of creatine supplementation on the body composition and Malnutrition-Inflammation Score (MIS) in patients with chronic kidney disease (CKD) undergoing hemodialysis. An exploratory 1-year balanced, placebo-controlled, and double-blind design was conducted with hemodialysis patients (≥18 years). The creatine group (CG) received 5 g of creatine monohydrate and 5 g of maltodextrin per day and the placebo group (PG) received 10 g of maltodextrin per day. MIS and body composition were analyzed at three time points: pre, intermediate (after 6 months), and post (after 12 months). After 6 months, 60% of patients on creatine experienced an increase in FFM compared to a 36.8% increase for those on placebo. Moreover, 65% of patients on creatine increased their skeletal muscle mass index (SMMI) compared to only 15.8% for those on placebo. Creatine increased intracellular water (ICW) in 60% of patients. MIS did not change after the intervention. In the CG, there was an increase in body weight ( p = 0.018), FFM ( p = 0.010), SMMI ( p = 0.022). CG also increased total body water (pre 35.4 L, post 36.1 L; p = 0.008), mainly due to ICW (pre 20.2 L, intermediate 20.7 L, post 21.0 L; p = 0.016). Long-term creatine supplementation in hemodialysis patients did not attenuate the MIS, but enhanced FFM and SMMI, which was likely triggered by an increase in ICW.

Despite the abundance of research investigating the efficacy of caffeine supplementation on exercise performance, the physiological and biochemical responses to caffeine supplementation during intermittent activities are less evident. This study investigated the acute effects of caffeine supplementation on measures of exercise performance, ratings of perceived exertion, and biomarkers of oxidative stress induced by an acute bout of sprint interval training. In a randomized crossover design, 12 healthy males (age: 26 ± 4 years, height: 177.5 ± 6 cm, body mass: 80.7 ± 7.6 kg) ingested 6 mg/kg of caffeine or placebo 60 min prior to performing sprint interval training (12 × 6 s "all-out sprints" interspersed by 60 s of rest). Performance scores and ratings of perceived exertion were assessed after every sprint. Blood samples were collected before supplementation, prior to and following each sprint, and 5 and 60 min after the last sprint. Caffeine had no effect on any performance measures, ratings of perceived exertion, or biomarkers of oxidative stress (p > .05). In conclusion, caffeine supplementation does not improve performance or decrease oxidative stress after an acute bout of sprint interval training.

Preliminary studies demonstrated beneficial effects of dietary creatine across different post-viral fatigue syndromes. Creatine is often co-administered with glucose to improve its potency yet whether glucose boost the efficacy of creatine in long COVID remains currently unknown. In this report, we investigate the effects of 8-wk creatine intake with and without glucose on patient-reported outcomes, exercise tolerance, and tissue creatine levels in patients with long COVID. Fifteen male and female long COVID adult patients (age 39.7±16.0 y; 9 women) with moderate fatigue and at least one of additional long COVID-related symptoms volunteered to participate in this randomized controlled parallel-group interventional trial. All patients were allocated in a double-blind parallel-group design (1 : 1 : 1) to receive creatine (8 g of creatine monohydrate per day), a mixture of creatine and glucose (8 g of creatine monohydrate and 3 g of glucose per day), or placebo (3 g of glucose per day) t.i.d. during an 8-wk intervention interval. Two-way ANOVA with repeated measures (treatment vs. time interaction) revealed significant differences in changes in total creatine levels between the groups, showing an interaction effect at two brain locations (right precentral white matter F=34.740, p=0.008; partial η 2 =0.72; left paracentral grey matter F=19.243, p=0.019; partial η 2 =0.88), with creatine and creatine-glucose outcompeted placebo to elevate creatine levels at these two locations. Several long COVID symptoms (including body aches, breathing problems, difficulties concentrating, headache, and general malaise) were significantly reduced in creatine-glucose group at 8-wk follow-up (p≤0.05); the effect sizes for reducing body aches, difficulties concentrating, and headache were 1.33, 0.80, and 1.12, respectively, suggesting a large effect of creatine-glucose mixture for these outcomes. Our preliminary findings suggest that supplying exogenous creatine with glucose could be recommended as an effective procedure in replenishing brain creatine pool and alleviating long COVID features in this prevalent condition.

There is emerging interest regarding the potential beneficial effects of creatine supplementation on indices of brain health and function. Creatine supplementation can increase brain creatine stores, which may help explain some of the positive effects on measures of cognition and memory, especially in aging adults or during times of metabolic stress (i.e., sleep deprivation). Furthermore, creatine has shown promise for improving health outcome measures associated with muscular dystrophy, traumatic brain injury (including concussions in children), depression, and anxiety. However, whether any sex- or age-related differences exist in regard to creatine and indices of brain health and function is relatively unknown. The purpose of this narrative review is to: (1) provide an up-to-date summary and discussion of the current body of research focusing on creatine and indices of brain health and function and (2) discuss possible sex- and age-related differences in response to creatine supplementation on brain bioenergetics, measures of brain health and function, and neurological diseases., (© 2023. The Author(s).)

Collegiate dance is unique because it requires athletic and academic performance; therefore, optimizing physical and mental function is crucial. Research among athletic populations demonstrate improvements in body composition, performance, and cognition following creatine monohydrate (CR) supplementation, yet dancers have not been investigated. The purpose of this study was to determine the effects of CR supplementation on body composition, performance, and cognitive function in female collegiate dancers. Participants were randomized to CR (CR; n  = 7; 0.1 g·kg -1·day -1 CM +0.1 g·kg -1·day -1 corn-starch maltodextrin) or placebo (PL; n  = 6; 0.2 g·kg -1·day -1 corn-starch maltodextrin) for 42 days. Pre- and post-testing included body composition, total body water (TBW), Depression, Anxiety and Stress Scale, Diet History Questionnaire, the National Institute of Health Toolbox fluid cognition battery and isokinetic strength, vertical jump, medicine ball throw, and Wingate anaerobic power test. CR demonstrated a significant increase in TBW (pre, 32.2 ± 3.5 kg; post, 32.7 ± 3.6 kg; p  = 0.024) and lean mass (LM; pre, 39.8 ± 3.6 kg; post, 41.5 ± 4.5 kg; p  = 0.020). CR supplementation may be an effective strategy to increase TBW and estimates of LM in female collegiate dancers. Although this may optimize aesthetics, larger samples sizes with resistance training are needed to determine if CR supplementation increases muscle mass and translates to improved performance.

Creatine supplementation is an effective ergogenic aid to augment resistance training and improve intense, short duration, intermittent performance. The effects on endurance performance are less known. The purpose of this brief narrative review is to discuss the potential mechanisms of how creatine can affect endurance performance, defined as large muscle mass activities that are cyclical in nature and are >~3 min in duration, and to highlight specific nuances within the literature. Mechanistically, creatine supplementation elevates skeletal muscle phosphocreatine (PCr) stores facilitating a greater capacity to rapidly resynthesize ATP and buffer hydrogen ion accumulation. When co-ingested with carbohydrates, creatine enhances glycogen resynthesis and content, an important fuel to support high-intensity aerobic exercise. In addition, creatine lowers inflammation and oxidative stress and has the potential to increase mitochondrial biogenesis. In contrast, creatine supplementation increases body mass, which may offset the potential positive effects, particularly in weight-bearing activities. Overall, creatine supplementation increases time to exhaustion during high-intensity endurance activities, likely due to increasing anaerobic work capacity. In terms of time trial performances, results are mixed; however, creatine supplementation appears to be more effective at improving performances that require multiple surges in intensity and/or during end spurts, which are often key race-defining moments. Given creatines ability to enhance anaerobic work capacity and performance through repeated surges in intensity, creatine supplementation may be beneficial for sports, such as cross-country skiing, mountain biking, cycling, triathlon, and for short-duration events where end-spurts are critical for performance, such as rowing, kayaking, and track cycling.

Aims: The purpose was to examine the relationship between habitual dietary creatine intake obtained in food and visuospatial short-term memory (VSSM). Methods: Forty-two participants (32 females, 10 males; > 60 yrs of age) completed a 5-day dietary recall to estimate creatine intake and performed a cognitive assessment which included a visuospatial short-term memory test (forward and reverse corsi block test) and a mini-mental state examination (MMSE). Pearson correlation coefficients were determined. Further, cohorts were derived based on the median creatine intake. Results: There was a significant correlation between the forward Corsi ( r    =   0.703, P < 0.001), reverse Corsi ( r    =   0.715, P < 0.001), and the memory sub-component of the MMSE ( r    =   0.406, P = 0.004). A median creatine intake of 0.382 g/day was found. Participants consuming greater than the median had a significantly higher Corsi (P = 0.005) and reverse Corsi (P < 0.001) scores compared to participants ingesting less than the median. Conclusions: Dietary creatine intake is positively associated with measures of memory in older adults. Clinical Implications: Older adults should consider food sources containing creatine (i.e. red meat, seafood) due to the positive association with visuospatial short-term memory., Competing Interests: Declaration of conflicting interestsDGC has conducted industry sponsored research involving creatine supplementation, received creatine donation for scientific studies and travel support for presentations involving creatine supplementation at scientific conferences. In addition, DGC serves on the Scientific Advisory Board for Alzchem (a company which manufactures creatine). SCF has served as a scientific advisor for a company that sells creatine products. EFO, EQB, LFM and MM declare no competing interests.

Purpose of Review: The purpose of this opinion paper is to provide current-day and evidence-based information regarding dietary supplements that support resistance training adaptations or acutely enhance strength-power or endurance performance., Recent Findings: Several independent lines of evidence support that higher protein diets, which can be readily achieved through animal-based protein supplements, optimize muscle mass during periods of resistance training, and this likely facilitates strength increases. Creatine monohydrate supplementation and peri-exercise caffeine consumption also enhance strength and power through distinct mechanisms. Supplements that favorably affect aspects of endurance performance include peri-exercise caffeine, nitrate-containing supplements (e.g., beet root juice), and sodium bicarbonate consumption. Further, beta-alanine supplementation can enhance high-intensity endurance exercise efforts., Summary: Select dietary supplements can enhance strength and endurance outcomes, and take-home recommendations will be provided for athletes and practitioners aiming to adopt these strategies., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

The combination of resistance exercise and creatine supplementation has been shown to decrease body fat percentage in adults ≥ 50 years of age. However, the effect on adults < 50 years of age is currently unknown. To address this limitation, we systematically reviewed the literature and performed several meta-analyses comparing studies that included resistance exercise and creatine supplementation to resistance exercise and placebo on fat mass and body fat percentage Twelve studies were included, involving 266 participants. Adults (<50 years of age) who supplemented with creatine and performed resistance exercise experienced a very small, yet significant reduction in body fat percentage (-1.19%, p = 0.006); however, no difference was found in absolute fat mass (-0.18 kg, p = 0.76). Collectively, in adults < 50 years of age, the combination of resistance exercise and creatine supplementation produces a very small reduction in body fat percentage without a corresponding decrease in absolute fat mass.

Purpose: Our purpose was to examine the effects of 2 yr of creatine monohydrate supplementation and exercise on bone health in postmenopausal women., Methods: Two hundred and thirty-seven postmenopausal women (mean age, 59 yr) were randomized to receive creatine (0.14 g·kg -1 ·d -1 ) or placebo during a resistance training (3 d·wk -1 ) and walking (6 d·wk -1 ) program for 2 yr. Our primary outcome was the femoral neck bone mineral density (BMD), with lumbar spine BMD and proximal femur geometric properties as the secondary outcomes., Results: Compared with placebo, creatine supplementation had no effect on BMD of the femoral neck (creatine: 0.725 ± 0.110 to 0.712 ± 0.100 g·cm -2 ; placebo: 0.721 ± 0.102 to 0.706 ± 0.097 g·cm -2 ), total hip (creatine: 0.879 ± 0.118 to 0.872 ± 0.114 g·cm -2 ; placebo: 0.881 ± 0.111 to 0.873 ± 0.109 g·cm -2 ), or lumbar spine (creatine: 0.932 ± 0.133 to 0.925 ± 0.131 g·cm -2 ; placebo: 0.923 ± 0.145 to 0.915 ± 0.143 g·cm -2 ). Creatine significantly maintained section modulus (1.35 ± 0.29 to 1.34 ± 0.26 vs 1.34 ± 0.25 to 1.28 ± 0.23 cm 3 (placebo), P = 0.0011), predictive of bone bending strength, and buckling ratio (10.8 ± 2.6 to 11.1 ± 2.2 vs 11.0 ± 2.6 to 11.6 ± 2.7 (placebo), P = 0.011), predictive of reduced cortical bending under compressive loads, at the narrow part of the femoral neck. Creatine reduced walking time over 80 m (48.6 ± 5.6 to 47.1 ± 5.4 vs 48.3 ± 4.5 to 48.2 ± 4.9 s (placebo), P = 0.0008) but had no effect on muscular strength (i.e., one-repetition maximum) during bench press (32.1 ± 12.7 to 42.6 ± 14.1 vs 30.6 ± 10.9 to 41.4 ± 14 kg (placebo)) and hack squat (57.6 ± 21.6 to 84.4 ± 28.1 vs 56.6 ± 24.0 to 82.7 ± 25.0 kg (placebo)). In the subanalysis of valid completers, creatine increased lean tissue mass compared with placebo (40.8 ± 5.7 to 43.1 ± 5.9 vs 40.4 ± 5.3 to 42.0 ± 5.2 kg (placebo), P = 0.046)., Conclusions: Two years of creatine supplementation and exercise in postmenopausal women had no effect on BMD; yet, it improved some bone geometric properties at the proximal femur., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American College of Sports Medicine.)

To determine if creatine (Cr) supplementation could influence cognitive performance and whether any changes were related to changes in prefrontal cortex (PFC) activation during such cognitive tasks, thirty (M = 11, F = 19) participants were evenly randomized to receive supplementation with Cr (CR10:10 g/day or CR20:20 g/day) or a placebo (PLA:10 g/day) for 6 weeks. Participants completed a cognitive test battery (processing speed, episodic memory, and attention) on two separate occasions prior to and following supplementation. Functional near-infrared spectroscopy (fNIRS) was used to measure PFC oxyhemoglobin (O 2 Hb) during the cognitive evaluation. A two-way repeated measures ANOVA was used to determine the differences between the groups and the timepoints for the cognitive performance scores and PFC O 2 Hb. In addition, a one-way ANOVA of % change was used to determine pre- and post-differences between the groups. Creatine (independent of dosage) had no significant effect on the measures of cognitive performance. There was a trend for decreased relative PFC O 2 Hb in the CR10 group versus the PLA group in the processing speed test ( p = 0.06). Overall, six weeks of Cr supplementation at a moderate or high dose does not improve cognitive performance or change PFC activation in young adults.

Aims: Sarcopenia generally refers to the age-related reduction in muscle strength, functional ability, and muscle mass. Sarcopenia is a multifactorial condition associated with poor glucose disposal, insulin resistance, and subsequently type 2 diabetes (T2D). The pathophysiological connection between sarcopenia and T2D is complex but likely involves glycemic control, inflammation, oxidative stress, and adiposity., Methods and Results: Resistance exercise and aerobic training are two lifestyle interventions that may improve glycemic control in older adults with T2D and counteract sarcopenia. Further, there is evidence that dietary protein, Omega-3 fatty acids, creatine monohydrate, and Vitamin D hold potential to augment some of these benefits from exercise., Conclusions: The purpose of this narrative review is: (1) discuss the pathophysiological link between age-related sarcopenia and T2D, and (2) discuss lifestyle interventions involving physical activity and nutrition that may counteract sarcopenia and T2D., Competing Interests: Declaration of competing interest D.G.C. has conducted industry-sponsored research involving creatine supplementation and received creatine donations for scientific studies and travel support for presentations involving creatine supplementation at scientific conferences. In addition, D.G.C. serves on the Scientific Advisory Board for Alzchem (a company that manufactures creatine) and as an expert witness/consultant in legal cases involving creatine supplementation., (Copyright © 2023 Research Trust of DiabetesIndia (DiabetesIndia) and National Diabetes Obesity and Cholesterol Foundation (N-DOC). Published by Elsevier Ltd. All rights reserved.)

Background: Branched chain amino acid (BCAA) supplementation may influence glucose metabolism in individuals with an impaired glyceamic profile. This systematic review investigated the effects of isolated BCAA supplementation on measures of glucose homeostasis in individuals with hepatic disorders., Methods: We searched PubMed, Web of Science, Cochrane Library and Scopus for published clinical trials that investigated the effects of isolated BCAA supplementation on measures of glucose homeostasis, including serum glucose and insulin, glycated haemoglobin (HbA1c) levels and homeostatic model assessment for insulin resistance (HOMA-IR) scores., Results: Eleven trials met the inclusion criteria. Only one study revealed a decrease in serum glucose from BCAA supplementation compared to three studies that showed increases. Five studies demonstrated no significant changes in serum glucose, and two studies displayed no changes in HbA1c following BCAA supplementation. Serum levels of insulin were decreased in three studies, remained unchanged in one, and increased in the remaining three studies. BCAA supplementation reduced HOMA-IR scores in two studies, increased HOMA-IR scores in another two, or resulted in no changes in two other studies., Conclusions: BCAA supplementation in isolation had no effect on overall glucose homeostasis in individuals with hepatic disorders, although some improvements on serum insulin levels and HOMA-IR scores were observed. Overall, there is little evidence to support the utilisation of BCAA supplementation as a potential nutritional strategy for improving measures of glucose homeostasis in individuals with hepatic disorders., (© 2022 The Authors. Journal of Human Nutrition and Dietetics published by John Wiley & Sons Ltd on behalf of British Dietetic Association.)

Habitual declines in sleep duration and increased rates of obesity are public health concerns worldwide. Accumulating evidence suggests a prominent link between reduced sleep duration and weight gain. Our cross-sectional study investigated the relationship between sleep duration and body fat distribution in US adults. We extracted data for 5151 participants (2575 men and 2576 women) aged 18-59 years from the US National Health and Nutrition Examination Survey 2011-2012 and 2013-2014. Weekday or workday night-time sleep duration was estimated using an in-home interview questionnaire. Dual-energy x-ray absorptiometry scans were used to determine regional body fat mass (arms, legs, trunk [android and gynoid], and abdominal [subcutaneous and visceral]). Multiple linear regression and restricted cubic spline analyses were performed after adjusting for several demographic, anthropometric, and nutritional covariates. There was a significant negative association between sleep duration and visceral fat mass overall (β: -12.139, P < 0.001) and by sex (men: β: -10.096, P < 0.001; women: β: -11.545, P = 0.038), after adjusting for age, ethnicity, body mass index, total body fat mass, daily energy and alcohol intake, sleep quality and sleep disorder status. Sleep duration and visceral fat appeared to plateau at ≥ 8 h of daily sleep. Sleep duration is negatively associated with visceral fat mass accumulation during adulthood with possibly no benefits beyond 8 h of sleep per day. Mechanistic and prospective studies are required to confirm the effect of sleep duration on visceral adiposity and determine its causes., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

The purpose of this paper was to carry out a systematic review with a meta-analysis of randomized controlled trials that examined the combined effects of resistance training (RT) and creatine supplementation on regional changes in muscle mass, with direct imaging measures of hypertrophy. Moreover, we performed regression analyses to determine the potential influence of covariates. We included trials that had a duration of at least 6 weeks and examined the combined effects of creatine supplementation and RT on site-specific direct measures of hypertrophy (magnetic resonance imaging (MRI), computed tomography (CT), or ultrasound) in healthy adults. A total of 44 outcomes were analyzed across 10 studies that met the inclusion criteria. A univariate analysis of all the standardized outcomes showed a pooled mean estimate of 0.11 (95% Credible Interval (CrI): -0.02 to 0.25), providing evidence for a very small effect favoring creatine supplementation when combined with RT compared to RT and a placebo. Multivariate analyses found similar small benefits for the combination of creatine supplementation and RT on changes in the upper and lower body muscle thickness (0.10-0.16 cm). Analyses of the moderating effects indicated a small superior benefit for creatine supplementation in younger compared to older adults (0.17 (95%CrI: -0.09 to 0.45)). In conclusion, the results suggest that creatine supplementation combined with RT promotes a small increase in the direct measures of skeletal muscle hypertrophy in both the upper and lower body.

Context: From an energy perspective, the brain is very metabolically demanding. It is well documented that creatine plays a key role in brain bioenergetics. There is some evidence that creatine supplementation can augment brain creatine stores, which could increase memory., Objective: A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted to determine the effects of creatine supplementation on memory performance in healthy humans., Data Sources: The literature was searched through the PubMed, Web of Science, Cochrane Library, and Scopus databases from inception until September 2021., Data Extraction: Twenty-three eligible RCTs were initially identified. Ten RCTs examining the effect of creatine supplementation compared with placebo on measures of memory in healthy individuals met the inclusion criteria for systematic review, 8 of which were included in the meta-analysis., Data Analysis: Overall, creatine supplementation improved measures of memory compared with placebo (standard mean difference [SMD] = 0.29, 95%CI, 0.04-0.53; I2 = 66%; P = 0.02). Subgroup analyses revealed a significant improvement in memory in older adults (66-76 years) (SMD = 0.88; 95%CI, 0.22-1.55; I2 = 83%; P = 0.009) compared with their younger counterparts (11-31 years) (SMD = 0.03; 95%CI, -0.14 to 0.20; I2 = 0%; P = 0.72). Creatine dose (≈ 2.2-20 g/d), duration of intervention (5 days to 24 weeks), sex, or geographical origin did not influence the findings., Conclusion: Creatine supplementation enhanced measures of memory performance in healthy individuals, especially in older adults (66-76 years)., Systematic Review Registration: PROSPERO registration no. 42021281027., (© The Author(s) 2022. Published by Oxford University Press on behalf of the International Life Sciences Institute.)

Hyperhomocysteinemia induces oxidative stress and chronic inflammation (both of which are catabolic to bone and muscle); thus, we examined the association between homocysteine and body composition and physical function in middle-aged and older adults. Data from the National Health and Nutrition Examination Survey was used to build regression models. Plasma homocysteine (fluorescence immunoassay) was used as the exposure and bone mineral density (BMD; dual-energy X-ray absorptiometry; DXA), lean mass (DXA), knee extensor strength (isokinetic dynamometer; newtons) and gait speed (m/s) were used as outcomes. Regression models were adjusted for confounders (age, sex, race/Hispanic origin, height, fat mass %, physical activity, smoking status, alcohol intakes, cardiovascular disease, diabetes, cancer and vitamin B12). All models accounted for complex survey design by using sampling weights provided by NHANES. 1480 adults (median age: 64 years [IQR: 56, 73]; 50.3% men) were included. In multivariable models, homocysteine was inversely associated with knee extensor strength (β = 0.98, 95% CI 0.96, 0.99, p = 0.012) and gait speed (β = 0.85, 95% CI 0.78, 0.94, p = 0.003) and borderline inversely associated with femur BMD (β = 0.84, 95% CI 0.69, 1.03, p = 0.086). In the sub-group analysis of older adults (≥ 65 years), homocysteine was inversely associated with gait speed and femur BMD (p < 0.05) and the slope for knee extensor strength and whole-body BMD were in the same direction. No significant associations were observed between homocysteine and total or appendicular lean mass in the full or sub-group analysis. We found inverse associations between plasma homocysteine and muscle strength/physical function, and borderline significant inverse associations for femur BMD., (© 2022. The Author(s).)

Purpose: This study aimed to investigate the long-term effects of multiple concussions on prefrontal cortex oxygenation during a neurovascular coupling activating task using near infrared spectroscopy (NIRS)., Methods: Self-reported physically active males who previously participated in contact team sports at various levels of competition and who previously had experienced at least 3 concussions (n = 55; mTBI) or had no history of concussions (n = 29; CTRL) were recruited. Participants completed a 5 min "Where's Waldo" object identification protocol which consisted of participants closing their eyes for 20-s followed by 40-s (repeated 5 times over 5-min) of searching a computer screen for "Waldo" hidden in a field of distractors. NIRS (μM) was used to measure right and left prefrontal cortex cerebral oxygenation. Oxygenated (O 2 Hb), deoxygenated (HHb), total (tHb) haemoglobin, and haemoglobin difference (HbDiff) were analysed through the change in average maximal and minimal values (ΔMAX), Z-scores, and standard deviations., Results: There were no significant differences in the relative change in cerebral oxygenation of the right prefrontal cortex between groups. In mTBI, left prefrontal cortex HHb ΔMAX (p = 0.031) and tHb ΔMAX (p = 0.044) were significantly lower than in the CTRL group. Within-group, right vs. left prefrontal cortex differences showed significantly lower values in left HbDiff Z-scores (p = 0.019) in only the mTBI group while the CTRL group showed significantly lower values in left HbDiff SD (p = 0.045)., Conclusion: This preliminary study suggests that there are changes in prefrontal cortex oxygenation in males who had a history of experiencing multiple concussions in their past during a neurovascular coupling activating task. These changes may represent potential long-term effects in the brain's ability to adapt cerebral oxygenation during increased neural activity., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Steve Martin reports financial support was provided by 10.13039/100013803Canadian Academy of Sport and Exercise Medicine., (© 2022 The Authors. Published by Elsevier B.V.)

Creatine supplementation has been shown to increase measures of lean body mass (LBM); however, there often is high heterogeneity across individual studies. Therefore, the aim of this study was to systematically review and meta-analyze randomized controlled trials (RCTs) investigating creatine supplementation on LBM. Subanalyses were performed based on age, sex, and type of exercise. Based on PRISMA guidelines, we searched the following databases: Pubmed, SPORTDiscus, Web of Science, and Scopus (PROSPERO register: CRD42020207122) until May 2022. RCTs for investigation of creatine supplementation on LBM were included. Animal studies and studies on individuals with specific diseases were excluded. Thirty-five studies were included, with 1192 participants. Overall (i.e., inclusion of all studies with and without exercise training interventions) revealed that creatine increased LBM by 0.68 kg (95% confidence interval [CI], 0.26-1.11). Subanalyses revealed greater gains in LBM when creatine was combined with resistance training (mean difference [MD], 1.10 kg; 95% CI, 0.56-1.65), regardless of age. There was no statistically significant effect of creatine on LBM when combined with mixed exercise (MD, 0.74 kg; 95% CI, -3.89 to 5.36) or without exercise (MD, 0.03 kg; 95% CI, -0.65 to 0.70). Further subanalyses found that males on creatine increased LBM by 1.46 kg (95% CI, 0.47-2.46), compared with a non-significant increase of 0.29 kg (95% CI, -0.43 to 1.01) for females. In conclusion, the addition of creatine supplementation to a resistance training program increases LBM. During a resistance training program, males on creatine respond more favorably than females., (Copyright © 2022 Elsevier Inc. All rights reserved.)

(1) Background: Cerebral autoregulation is altered during acute mild traumatic brain injury, or concussion. However, it is unknown how a history of concussion can impact cerebral haemodynamic activity during a task that elicits an autoregulatory response. (2) Methods: We assessed cerebral haemodynamic activity in those with a history of three or more concussions. The study included 44 retired athletes with concussion history and 25 control participants. We recorded participants' relative changes in right and left pre-frontal cortex oxygenation collected by near-infrared spectroscopy and continuous beat-to-beat blood pressure measured by finger photoplethysmography. Participants completed a 5-min seated rest followed by a 5-min repeated squat (10-s) stand (10-s) maneuver (0.05 Hz) to elicit a cerebral autoregulatory response. Wavelet transformation was applied to the collected signals, allowing separation into cardiac interval I (0.6 to 2 Hz), respiratory interval II (0.145 to 0.6 Hz), and smooth muscle cell interval III (0.052 to 0.145 Hz). (3) Results: Significant increases at cardiac interval I were found for the wavelet amplitude of oxy-haemoglobin and haemoglobin difference at the right pre-frontal cortex. No significant difference was found at the left pre-frontal cortex or the blood pressure wavelet amplitudes. (4) Conclusions: Contributions from cardiac activity to the pre-frontal cortex oxygenation are elevated when eliciting dynamic cerebral autoregulation in those with a history of three or more concussions.

Background: Ketosis has been exploited for its neuroprotective impact and treatment of neurological conditions via ketone production. Exogenous medium-chain triglyceride (MCT) supplementation may induce nutritional ketosis. The aim of this systematic review is to explore the effects of MCTs on memory function in older adults without cognitive impairment., Methods: A systematic literature search of PubMed, Cochrane Library, Scopus, and Web of Science was employed from inception until April 2022 for randomized controlled trials (RCTs) in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, investigating the impact of MCT oils on components of memory. Risk of bias (RoB2) tool was utilized for quality assessment., Results: Six trials were included for qualitative synthesis, in which two studies examined the effect of MCTs through a ketogenic meal. MCT supplementation compared to controls was associated with improved indices of memory function in 4 out of 6 studies, particularly working memory. A meta-analysis was not employed due to the low number of studies, therefore, a true effect measure of MCT supplementation was not explored., Conclusions: MCT supplementation may enhance working memory in non-demented older adults. These effects may be more prominent in individuals with lower baseline scores, from short and long-term supplementation. Further studies are warranted to confirm these findings in terms of optimal dose and MCTs composition, which may protect from memory decline during aging., (© 2022. The Author(s).)

Sarcopenia refers to the age-related reduction in strength, muscle mass and functionality which increases the risk for falls, injuries and fractures. Sarcopenia is associated with other age-related conditions such as osteoporosis, frailty and cachexia. Identifying treatments to overcome sarcopenia and associated conditions is important from a global health perspective. There is evidence that creatine monohydrate supplementation, primarily when combined with resistance training, has favorable effects on indices of aging muscle and bone. These musculoskeletal benefits provide some rationale for creatine being a potential intervention for treating frailty and cachexia. The purposes of this narrative review are to update the collective body of research pertaining to the effects of creatine supplementation on indices of aging muscle and bone (including bone turnover markers) and present possible justification and rationale for its utilization in the treatment of frailty and cachexia in older adults., (Copyright © 2022 Elsevier Inc. All rights reserved.)

The purpose was to investigate the effects of progressive resistance training (PRT) and creatine supplementation in stroke survivors. Participants were randomized to one of two groups: creatine ( n = 5; 51 ± 16y) or placebo ( n = 3; 73 ± 8y) during 10 weeks of supervised PRT. Prior to and following PRT and supplementation, assessments were made for body composition (lean tissue and fat mass), muscle thickness, muscle strength (1-repetition maximum), functional exercise capacity (6-minute walk test, Berg Balance Scale; BBS), cognition (Montreal Cognitive Assessment; MoCA), and symptoms of anxiety (Generalized Anxiety Disorder Assessment-7; GAD-7) and depression (Center for Epidemiological Studies Depression Scale; CES-D). There were time main effects for leg press strength (increased; p = 0.001), chest press strength (increased; p = 0.003), elbow flexor muscle thickness (increased; p = 0.007), BBS (increased; p = 0.002), MoCA (increased; p = 0.031) and CES-D (decreased; p = 0.045). There was a group x time interaction for the 6 minute walk test ( p = 0.039). The creatine group significantly increased walking distance over time ( p = 0.002) with no change in the placebo group ( p = 0.120). Ten weeks of PRT had some positive effects on measures of muscle strength and size, balance, cognition and depression. The addition of creatine to PRT significantly improved walking performance in stroke survivors.

Background: This study investigated the long-term effects of multiple concussions on prefrontal cortex oxygenation using near-infrared spectroscopy (NIRS) during a squat-stand maneuver that activated dynamic cerebral autoregulation., Methods: Active male retired contact sport athletes with a history of 3+ concussions (mTBI; n = 55), and active retired athletes with no concussion history (CTRL; n = 29) were recruited. Participants completed a 5-min squat-stand maneuve (10-s squat, 10-s stand, 0.05 Hz; 15 times). Oxygenated (O 2 Hb), deoxygenated (HHb), total (tHb) hemoglobin, and hemoglobin difference (HbDiff) were analyzed through the change in maximal and minimal values during the test (∆MAX), Z-scores, and standard deviations., Results: mTBI group showed left prefrontal cortex O 2 Hb ∆MAX (p = 0.046) and HbDiff ∆MAX (p = 0.018) were significantly higher. Within-group analyses showed significantly higher left HHb ∆MAX (p = 0.003) and lower left HbDiff Z-scores (p = 0.010) only in the mTBI group. The CTRL group demonstrated significantly lower left HbDiff SD (p = 0.039), tHb Z-scores (p = 0.030), and HbDiff ∆MAX (p = 0.037) compared to right prefrontal cortex response., Conclusion: These preliminary results suggest changes in prefrontal cortex oxygenation potentially affecting the brain's ability to adapt to changing cerebral perfusion pressure after multiple previous concussions.

Sleep deprivation leads to the deterioration in the physiological functioning of the brain, cognitive decline, and many neurodegenerative diseases, all of which progress with advancing age. Sleep insufficiency and impairments in cognitive function are characterized by progressive neuronal losses in the cerebral cortex. In this study, we analyze gene expression profiles following sleep-deprived murine models and circadian matched controls to identify genes that might underlie cortical homeostasis in response to sleep deprivation. Screening of the literature resulted in three murine ( Mus musculus ) gene expression datasets (GSE6514, GSE78215, and GSE33491) that included cortical tissue biopsies from mice that are sleep deprived for 6 h ( n = 15) and from circadian controls that are left undisturbed ( n = 15). Cortical differentially expressed genes are used to construct a network of encoded proteins that are ranked based on their interactome according to 11 topological algorithms. The analysis revealed three genes-NFKBIA, EZR, and SGK1-which exhibited the highest multi-algorithmic topological significance. These genes are strong markers of increased brain inflammation, cytoskeletal aberrations, and glucocorticoid resistance, changes that imply aging-like transcriptional responses during sleep deprivation in the murine cortex. Their potential role as candidate markers of local homeostatic response to sleep loss in the murine cortex warrants further experimental validation.

Sarcopenia negatively affects skeletal muscle mass and function in older adults. Omega-3 (ω-3) fatty acid supplementation, with or without resistance exercise training (RET), is suggested to play a role as a therapeutic component to prevent or treat the negative effects of sarcopenia. A systematic review and meta-analysis were conducted on the impact of ω-3 fatty acid supplementation with or without RET on measures of muscle mass and function in older adults (≥55 y). The data sources included SPORTDiscus, PubMed, and Medline. All the study types involving ω-3 fatty acid supplementation on measures of muscle mass and function in older adults (without disease) were included. The mean differences (MDs) or standardized mean differences (SMDs) with 95% confidence intervals were calculated and pooled effects assessed. Sixteen studies (1660 females, 778 males) met our inclusion criteria and were included in the meta-analysis. ω-3 fatty acid supplementation did not impact lean tissue mass (SMD 0.09 [-0.10, 0.28]). Benefits were observed for lower body strength (SMD 0.54 [0.33, 0.75]), timed-up-and-go (MD 0.29 [0.23, 0.35]s), and 30-s sit-to-stand performance (MD 1.93 [1.59, 2.26] repetitions) but not walking performance (SMD -0.01 [-0.10, 0.07]) or upper body strength (SMD 0.05 [-0.04, 0.13]). Supplementing with ω-3 fatty acids may improve the lower-body strength and functionality in older adults.

It is well-established that creatine supplementation augments the gains in muscle mass and performance during periods of resistance training. However, whether the timing of creatine ingestion influences these physical and physiological adaptations is unclear. Muscle contractions increase blood flow and possibly creatine transport kinetics which has led some to speculate that creatine in close proximity to resistance training sessions may lead to superior improvements in muscle mass and performance. Furthermore, creatine co-ingested with carbohydrates or a mixture of carbohydrates and protein that alter insulin enhance creatine uptake. The purpose of this narrative review is to (i) discuss the purported mechanisms and variables that possibly justify creatine timing strategies, (ii) to critically evaluate research examining the strategic ingestion of creatine during a resistance training program, and (iii) provide future research directions pertaining to creatine timing., Competing Interests: DC and ER has conducted industry sponsored research involving creatine supplementation and received creatine donations for scientific studies and travel support for presentations involving creatine supplementation at scientific conferences. In addition, DC and ER serve on the Scientific Advisory Board for Alzchem (a company that manufactures creatine) and as an expert witness/consultant in legal cases involving creatine supplementation. JA is the CEO of the International Society of Sports Nutrition (ISSN). The ISSN has received monetary support from companies that sell creatine and/or creatine-containing products. AS-R conducts research on dietary supplements including creatine and serves on the Scientific Advisory Board for Alzchem (a company that manufactures creatine). BG serves on the Scientific Advisory Board for Alzchem (a company that manufactures creatine). SF has received creatine donations for research involving creatine supplementation and has previously served as an academic advisor for a company that sold creatine. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Candow, Forbes, Roberts, Roy, Antonio, Smith-Ryan, Rawson, Gualano and Roschel.)

Due to the important roles of resistance training and protein consumption in the prevention and treatment of sarcopenia, we assessed the efficacy of post-exercise Icelandic yogurt consumption on lean mass, strength and skeletal muscle regulatory factors in healthy untrained older males. Thirty healthy untrained older males (age = 68 ± 4 years) were randomly assigned to Icelandic yogurt (IR; n 15, 18 g of protein) or an iso-energetic placebo (PR; n 15, 0 g protein) immediately following resistance training (3×/week) for 8 weeks. Before and after training, lean mass, strength and skeletal muscle regulatory factors (insulin-like growth factor-1 (IGF-1), transforming growth factor-beta 1 (TGF- β 1), growth differentiation factor 15 (GDF15), Activin A, myostatin (MST) and follistatin (FST)) were assessed. There were group × time interactions ( P < 0·05) for body mass (IR: Δ 1, PR: Δ 0·7 kg), BMI (IR: Δ 0·3, PR: Δ 0·2 kg/m 2 ), lean mass (IR: Δ 1·3, PR: Δ 0·6 kg), bench press (IR: Δ 4, PR: 2·3 kg), leg press (IR: Δ 4·2, PR: Δ 2·5 kg), IGF-1 (IR: Δ 0·5, Δ PR: 0·1 ng/ml), TGF- β (IR: Δ - 0·2, PR: Δ - 0·1 ng/ml), GDF15 (IR: Δ - 10·3, PR: Δ - 4·8 pg/ml), Activin A (IR: Δ - 9·8, PR: Δ - 2·9 pg/ml), MST (IR: Δ - 0·1, PR: Δ - 0·04 ng/ml) and FST (IR: Δ 0·09, PR: Δ 0·03 ng/ml), with Icelandic yogurt consumption resulting in greater changes compared with placebo. The addition of Icelandic yogurt consumption to a resistance training programme improved lean mass, strength and altered skeletal muscle regulatory factors in healthy untrained older males compared with placebo. Therefore, Icelandic yogurt as a nutrient-dense source and cost-effective supplement enhances muscular gains mediated by resistance training and consequently may be used as a strategy for the prevention of sarcopenia.

Objective: This study examined the effects of short-term betaine supplementation on muscle endurance, plasma lactate, testosterone and cortisol levels, and the testosterone to cortisol (T/C) ratio in response to acute resistance exercise (RE)., Method: Using a double-blind, crossover study design, 10 handball players (age ± SD = 16 ± 1 yrs) without prior-structured RE experience performed a high-intensity RE session (leg press followed by bench press; 5 sets to volitional fatigue using 80% baseline 1 repetition maximum (1RM)), before and after 14 days of either placebo (maltodextrin) or betaine (2.5 g·d -1 ) supplementation. A 30-day washout period separated each treatment. 48 h prior to testing sessions, participants recorded their food intake and did not perform strenuous exercise. Venous blood was sampled before supplementation, and before and after each RE session., Results: After betaine supplementation, participants performed more repetitions ( p < 0.001) during the leg press (Betaine: 35.8 ± 4.3; Placebo: 24.8 ± 3.6, Cohen's d = 2.77) and bench press (Betaine: 36.3 ± 2.6; Placebo: 26.1 ± 3.5, Cohen's d = 3.34). Betaine resulted in lower post-exercise cortisol (Betaine: 7.6 ± 1.7; Placebo: 13 ± 3.4 µg.dL -1 , p = 0.003, generalized eta squared ( η G 2 ) = 0.49) and lactate (Betaine: 5.2 ± 0.3; Placebo: 6 ± 0.3 mmol.L -1 , p < 0.001, η G 2 = 0.96) and higher total testosterone (Betaine: 15.2 ± 2.2; Placebo: 8.7 ± 1.7 ng.mL -1 , p < 0.001, η G 2 = 0.87) and T/C ratio (Betaine: 0.21 ± 0.05; Placebo: 0.07 ± 0.02, p < 0.001, = 0.82)., Conclusions: Two weeks of betaine supplementation improved upper- and lower-body muscle endurance and influenced indices of endocrine function following an acute session of high-intensity RE in adolescent handball players., Competing Interests: No potential conflict of interest was reported by the authors., (© 2022 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.)

While the vast majority of research involving creatine supplementation has focused on skeletal muscle, there is a small body of accumulating research that has focused on creatine and the brain. Preliminary studies indicate that creatine supplementation (and guanidinoacetic acid; GAA) has the ability to increase brain creatine content in humans. Furthermore, creatine has shown some promise for attenuating symptoms of concussion, mild traumatic brain injury and depression but its effect on neurodegenerative diseases appears to be lacking. The purpose of this narrative review is to summarize the current body of research pertaining to creatine supplementation on total creatine and phophorylcreatine (PCr) content, explore GAA as an alternative or adjunct to creatine supplementation on brain creatine uptake, assess the impact of creatine on cognition with a focus on sleep deprivation, discuss the effects of creatine supplementation on a variety of neurological and mental health conditions, and outline recent advances on creatine supplementation as a neuroprotective supplement following traumatic brain injury or concussion.