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Randomized Controlled Trial of Dietary Creatine as an Adjunct Therapy to Physical Training in Chronic Obstructive Pulmonary Disease

¹ Institute for Lung Health, Department of Respiratory Medicine, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, United Kingdom; and ² Centre for Integrated Systems Biology and Medicine, School of Biomedical Sciences, University of Nottingham Medical School, Queen's Medical Centre, Nottingham, United Kingdom

Correspondence and requests for reprints should be addressed to Sarah J. Deacon, M.D., Institute for Lung Health, Department of Respiratory Medicine, Allergy and Thoracic Surgery, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, LE3 9QP, UK. E-mail: sarah.deacon{at}uhl-tr.nhs.uk

Rationale: Skeletal muscle strength and bulk are reduced in patients with chronic obstructive pulmonary disease (COPD) and influence quality of life, survival, and utilization of health care resources. Exercise training during pulmonary rehabilitation (PR) can reverse some of these effects. In athletes and healthy elderly individuals, dietary creatine supplementation (CrS) has been shown to augment high-intensity exercise training, thereby increasing muscle mass.

Objectives: This article examines the effect of CrS on functional exercise capacity and muscle performance in people with COPD.

Methods: One hundred subjects with COPD (mean [SD] age, 68.2 [8.2] yr; FEV₁, 44.0 [19.6] %predicted) were randomized to a double-blind, placebo-controlled, parallel group trial of CrS during 7 weeks of PR encompassing aerobic and resistance exercises. Subjects ingested creatine (22 g/d loading for 5 d; maintenance, 3.76 g/d throughout PR) or placebo. Baseline, postloading, and postrehabilitation measurements included pulmonary function, body composition, peripheral muscle strength, and functional performance (shuttle walking tests). A volunteer subgroup (n = 44) had pre- and postloading quadriceps muscle biopsies.

Measurements and Main Results: Eighty subjects completed the trial (38 creatine, 42 placebo). All outcome measures significantly improved after PR. There were no significant differences between groups post-PR (mean [SD] change in incremental shuttle walk distance, 84 [79] m in the creatine group vs. 83.8 [60] m in the placebo group; P = 1.0; knee extensor work, 19.2 [16] Nm [Newton meters] in the creatine group vs. 19.5 [17] Nm in the placebo group; P = 0.9). Muscle biopsies showed evidence of creatine uptake.

Conclusions: This adequately powered, randomized, placebo-controlled trial shows that CrS does not augment the substantial training effect of multidisciplinary PR for patients with COPD.

Clinical trial registered with https://portal.nihr.ac.uk/Pages/NRRArchiveSearch.aspx (NO123138126).

Key Words: pulmonary rehabilitation • strength • dietary supplementation

AT A GLANCE COMMENTARY Scientific Knowledge on the Subject It is suggested that creatine supplementation increases fat-free mass, health status, and peripheral muscle strength, but not exercise capacity, in patients with chronic obstructive pulmonary disease. What This Study Adds to the Field Our study confirms the substantial benefits gained during pulmonary rehabilitation in people with chronic obstructive pulmonary disease and that strength training is a beneficial and acceptable addition to endurance training. Creatine supplementation does not augment these benefits.

 

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AJRCCM 2008 178: 215-216. [Full Text]  

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