🦀 Issue 124 - Old News

This week we’re talking geriatrics as part of an occasional series I’m going to call Old News. Even if you don’t treat geriatrics, you probably treat geriatrics. Let’s face it, people are old. This really hit home for me as I’m living in Portland with my parents during my last clinical and realized that they both fall within the age criteria of these studies. But my parents aren’t old, right? Wrong. They’re old. Oldness happens younger than you’d think.

So this week we’re looking at ways to help oldness be less about being hunched over and tired and more dynamic, functional, and fit. The three pieces I summarized look across the spectrum of geriatrics, from one about hands-on guarding with the FGA, another on creatine supplementation in this population (remember, nutrition education is within our scope), and a third on the long-term (3 years!) effects of a 3 month long anti-kyphosis exercise program. As free subscribers, you’ll see the second one, all about creatine supplementation. Become a supporter of PT Crab to get all 3 and my eternal gratitude. Thanks! Sign up here.

Also this week, we’ve passed midwinter! That was February 3rd this year, jsyk and we’re on our way to spring. I do my best to enjoy every season and every type of weather given to me. Embrace the natural flow of the world. But I will admit I’m tired of being wet and muddy so I’m kinda looking forward to winter being over, what about you?

With that, let’s dive in!

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Creatine - Good for your bones, muscles, and brain, bad for your tummy.

The Gist - I’ve heard about creatine, you’ve heard about creatine, we’ve all heard about creatine. But like, what is it and is it useful for people over 65? This systematic review set out to answer those questions, looking into the additive effect of creatine monohydrate when combined with exercise in folks over 65. The long and short of it is that it improves exercise outcomes. Quite a bit both men and women. And it irritated stomachs, a bit in both men and women. They looked into strength, functional capacity, endurance, body composition, cognition, and averse effects, so let’s do that too.

1. Strength - There were about a dozen studies that looked into this with most showing significant strength gains measured by 1 rep max of bench press, bicep curl, leg press, dorsiflexion, and a couple more. The studies that had daily ingestion of creatine demonstrated effects more consistently than those that only took it on training days and all studies were 12 weeks o longer of both creatine and training. Most doses were around 5g per day or 0.3g/kg/day.
2. Functional capacity - They used tests like the 30-second chair-stand test or the floor to stand test to measure this. Three studies on just women demonstrated significantly increased capability in the group that took creatine while on e on men and women didn’t show any difference. Details are complicated, obviously so you’ll have to see the paper for dosages and whatnot, but it has great tables!
3. Endurance - Both a 1 week and 6 month trial showed basically no difference in HR, VO2, diastolic BP at threshold, and more.
4. Body composition - “Three of the 4 studies conducted in older females reported significant body composition effects with creatine supplementation during RT compared with placebo”. One also showed significant decrease in bone loss at the femoral neck compared to the other group and an increase in femoral shaft width. The 8 studies in men showed significant differences in lean mess as well.
5. Cognition - One study checked this out and founded no effect.
6. Adverse effects - One study showed “mild constipation, diarrhea, heart burn, irritable bowel, and nausea” along with muscle cramps. Another one found significant loose stools and increased muscle cramping.

Phew. That was a lot.

Tell Me More - Well, if you insist. This is a great paper that has a whole lot more including the details of creatine mechanisms in women, which is very cool, so we’ll just look at how to actually use this information clinically. For one, like I said and reiterate ever again, nutrition is in our scope. PTs can advise on nutrition though not to “treat a specific health condition.” Since being older and at increased risk for muscle loss, bone loss, strength loss, etc aren’t specific health conditions, we can definitely advise on creatine use for geriatric patients. For dosage, daily dosage of about 5g seems standard and effective across these studies. In really tiny or really big people, obvs scale up or down. And DAILY is key, not just with exercise. Most studies that had it just with exercise didn’t really show results. The daily ones were usually stronger.

Lastly creatine does cause some water retention that can cause some weight gain so that’s important to point out to people who are very weight-conscious. They may expect to gain a bit of weight when they start taking creatine but not much. Oh, and also you don’t need to cycle creatine like you do other anabolic thingies. Js to the yk.

Paper? You finally asked. It here.

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From the Archive: Crossfit for Healthy Aging

The Gist - We probably underload most of our patients. It’s just a thing. PTs are working on it, but lots of research trickling out over the last few years has shown that we do it. This pilot study wanted to see just how far we could push older people (average age of 71) in an 8 week High Intensity Functional Training program. HIFT is a large category of exercises, of which Crossfit is one version, but HIFT in general doesn’t have to be Crossfit (square is a rectangle, rectangle not a square kinda thing) and includes squatting, lifting, and pulling exercises at high intensity.

The folks in this study performed these activities twice per week for 60 minutes at a time. Before and after, they assessed ADL performance via the “Outpatient Physical Therapy Improvement in Movement Assessment Log” (O.P.T.I.M.A.L., how cute), and their fitness via the lift and carry test, the TUG, and the 6MWT.

After the 8 weeks, the mean session attendance was 83% and all four participants (of the 9 total) who answered the followup questions reported liking the whole thing. Unfortunately, their OPTIMAL scores didn’t significantly improve, nor did their TUGs, LC, or 6MWT.

So why do we care? Read on.

Tell Me More - I mean, you’ve already spotted the problems. Only 9 people, no outcome measure increases, etc. But this study does matter. They took 9 people who weren’t all jazzed about Crossfit and got them into it with no adverse events and general liking of the process. That’s not bad. Not amazing, but not bad.

So why weren’t there changes? If you take people who aren’t exercising and make them exercise for 8 weeks, they should have changes. Well. Remember what I said earlier about underloading? The researchers believe that the mistake they made was underloading these clients and recommend that a more client-specific exercise program is used next time.

Paper? Indeed.

And that’s our week. Please do click through and subscribe to the Newsette. Clicking on our ads is the easiest way to support the Crab and in this case you just need to sign up to help out. I’d really appreciate your help.

Thanks!

Luke