Abstract

Creatine monohydrate (Cr) is a popular nutritional supplement in athletes and clinical populations that enhances high-intensity exercise performance and muscular strength and muscle mass in response to resistance training. Supplementing with Cr increases phosphorylcreatine (PCr) stores. This enhances re-synthesis of adenosine triphosphate during intense exercise. Supplementing with Cr has potential to improve recovery from exercise, as it speeds PCr recovery and may also enhance glycogen re-synthesis. When Cr is consumed in conjunction with resistance training there may be increased activation of pathways involved in translation initiation and expression of myogenic regulatory factors, which enhances activation, proliferation, and differentiation of muscle satellite cells. This increases the number of myonuclei in muscle fibres, which increases potential for protein synthesis. Creatine has potential to affect skeletal mass, as it activates cells involved in bone formation (osteoblasts) and may inhibit cells involved in bone resorption (osteoclasts). This chapter provides a detailed review of these mechanisms for enhancement of muscle and bone responses when Cr is supplemented during exercise training and provides direction for future research in the area.