A Nutritional Intervention during Pulmonary Rehabilitation in COPD Patients - Assignment Example

Running Head: CREATINE SUPPLEMENTATION A Nutritional Intervention during Pulmonary Rehabilitation in COPD Patients Name: Grade Course: Tutor’s Name: 18th, September, 2009 Literature Review 1. Introduction Pulmonary rehabilitation programs have different ways of providing therapy to patients. The programs for example utilize the multidisciplinary intervention therapy or pure exercise training among others to help find solutions to patients with pulmonary diseases and COPD patients in particular. A multidisciplinary intervention consists of several modalities one of which is exercise training. Several research works have been done to help find ways of improving the modalities of the pulmonary programs. Nutritional supplementation is one of the ways used to improve such modalities and are always used to improve or stimulate muscle growth for the purposes of enhancing exercise performance in patients in pulmonary rehabilitation programs. Examples of nutritional supplements that are always used are creatine and amino acids (L-carnitine and glutamate). Several research findings have revealed that creatine could be used as a nutritional supplement to help enhance muscle activity in the treatment of other patient groups but this is different with chronic obstructive pulmonary disease patients. Pulmonary rehabilitation programs may have adopted this and used this substance as a supplement to help improve the physical exercise of the patients (Hamid et al., 2005). Latest scientific research however reveals that this substance, which was thought that could be very important for patients with COPD in the pulmonary rehabilitation process, does not improve the patients’ exercise activity as expected. This paper aims to describe the controversy in the intervention style used to improve the exercise performance and muscle strength in pulmonary rehabilitation programs involving creatine as well as the controversy in the use of creatine in COPD patients in pulmonary rehabilitation programs. 2. Method Research scientists’ findings introduced the use of creatine as a nutritional supplement in the pulmonary rehabilitation programs, but currently, this substance does not improve exercise performance in COPD patients. This paper aims to explain this by giving information about the use of creatine as a supplement, its use in the COPD programs and its ineffectiveness as compared to the “hard work” (exercise training alone)that it replaced. According to the Science Daily report, creatine has always been used as a substitute for exercise training (Science Daily report, 2008). 3. Discussion As noted earlier, exercise training is a very important component of pulmonary rehabilitation. Improving this component means improving the effectiveness of the pulmonary rehabilitation programs therefore the management of the diseases handled in such programs. Intervention strategies have been based on either making the patients to train at higher intensity or changing the functioning of the underlying skeletal muscles (Hamid et al, 2005). The intervention strategy based on altering the muscle function has sub-interventions such as the use of anabolic steroids, the use of growth hormones and creatine as nutritional supplements. The use of creatine supplementation is one approach that was suggested to improve physical training in patients with COPD especially those who had low baseline exercise capacity and reduced muscle bulk under nutritional supplements. This strategy has also been found to be ineffective in some areas in the rehabilitation program (Kohlstadt, 2009). Therapeutic Importance of Creatine Supplementation There are important factors that led to the decision to include creatine as a dietary supplement in the nutrition of chronic obstructive pulmonary disease patients. According to Griffiths, the availability of skeletal muscle phospho-creatine is increased by inclusion of creatine as a dietary supplement which is caused by creatine monohydrate (Griffiths, 2005). Phospho-creatine stores some high energy phosphate bonds that are important for exercise commencement and after de-phosphorilation creatine is again available for use to form phospho-creatine (Adam & Gayle, 2001). Creatine also increases fat-free mass although the mechanisms through which it accomplishes this are not clear (Griffiths, 2005). These functions led to the use of creatine monohydrate to try to improve athletic exercise performance (Griffiths, 2005). Patients with COPD always have reduced muscle mass which are several and multifarious. Some of the proposed causes of reduced muscle mass in such patients include; low circulating androgen levels, disuse, disproportion use and intake of calories, systemic inflammation and the general effects of glucocorticoid steroid treatment (Adam & Gayle, 2001). Malnutrition due to disability, health and usage services and humanity however, was found to be the real cause of elevated occurrence of low muscle mass in such patients (Adam & Gayle, 2001). Due to the fact that creatine stores some high energy phosphate bonds that are important for exercise commencement and increases fat free mass and to the fact that COPD patients need muscle strength to improve exercise performance, scientists thought creatine supplementation would be helpful to COPD patients in enhancing exercise performance. Several other research findings about the benefits of creatine also led to the trial and recommendation of this substance to be included in the dietary supplement of patients with COPD. Examples include; the use of creatine as a dietary supplement in improving cardiac function due to improved skeletal muscle performance in congestive heart failure, creatine supplementation’s improvement on muscle strength and general wellbeing of lung function in patients with cystic fibrosis and the benefits of creatine supplementation among elderly patients (Bernhardt & Kasko, 2008). These findings encouraged scientists, medics and psychiatrics to recommend the use of creatine in exercise training to enhance patient exercise performance. Previous Study on Creatine’s Effects on COPD Patients (Fuld’s Study) A study carried out in 2005 revealed the effectiveness of creatine in causing improved muscle growth. Based on such a finding, one can assume that the creatine therefore enhances physical exercise performance. According to Kohlstadt, pulmonary rehabilitation programs use nutritional supplements including creatine to improve physical performance in other groups of patients (Kohlstadt, 2009). This nutritional supplement however does not work in COPD patients. This study was a randomized controlled trial aimed at determining the effect of creatine monohydrate on COPD patients’ exercise training performance. It was a study based on exercise training program alone and not on a multidisciplinary rehabilitation program (Griffiths, 2005). It found out that creatine increased fat free mass by an average of 1.1kg but revealed no difference in body exercise as compared to the control group. Improvements were observed on upper and lower limb functions but these improvements were not translated to overall body exercise. There was a 10 meter incremental shuttle walk distance improvement and it was also found that creatine produced improved SGRQ scores that the non-supplemented group (Griffiths, 2005) Based on the results, the researches concluded that the physiological effect of creatine may have been as a result of the availability of phosphate bonds within the muscles that are characterized by high energy. The energy available is used to maintain anaerobic increases in work rate before aerobic oxidation in the muscles can take over and maintain the oxidative metabolism (Griffiths, 2005). According to these researchers, creatine supplementation holds up the bio-energetic responses to work out put alterations. This drives the improvements observed in health status of patients with COPD (Griffiths, 2005). The researches recommended the use of creatine as a nutritional supplement to be used along side exercise training. Current Study on Creatine’s Effects on COPD Patients Another study revealed that creatine is ineffective in enhancing exercise performance and should not replace exercise training. This was a randomized placebo-controlled double blind study which provided evidence that creatine had negligible effect on COPD patients (Science Daily, 2008). According to this study, creatine is absorbed into the muscles of COPD Patients but this does not enhance any kind of training. This study considered the following factors; creatine enhances performance through phosphorylation as described earlier. It can increase muscle bulk and improve exercise training in healthy individuals. Creatine’s intake is increased by exercise and that COPD patients have lower levels of Phospho-creatine. Based on these findings the study aimed to find out the effects of creatine supplements on COPD patients. The study hypothesized that pulmonary rehabilitation could be enhanced by the use of creatine as a dietary supplement in COPD patients. The study involved a placebo control group who were given lactose and the case group that were given creatine supplements. Both Cr and control groups showed noteworthy improvements in muscular and functional performance but no significant differences between the groups. There was also incremental walking improvement in the Cr group but this produced no overall effect changes between itself and the placebo group. Generally, the results showed that creatine does not enhance functional performance in COPD patients (Deacon et al, 2006; Agus, 2008). The researchers concluded that physical training alone absorbed the benefits of creatine validating the postulation that physical exercise previously used in pulmonary rehabilitation programs as an intervention has no substitute. It was recommended that pulmonary rehabilitation programs use physical training alone and should not use creatine supplementation as a substitute for exercise training (Science Daily, 2008). The Controversy Controversy arises in the styles of interventions chosen by different research scientists as well as in the fact that creatine currently has been proved to be ineffective in improving exercise performance. Creatine was previously used as a nutritional supplement with the aim of improving exercise performance in pulmonary rehabilitation programs. This element however does not work in COPD patients yet they are also pulmonary rehabilitation program patients. Some research scientists prefer or recommend the use of nutritional supplements along side exercise training while others recommend the use of exercise training alone. Determination of an efficient way of providing therapy is therefore not easy. According to Hamid and colleagues, pulmonary rehabilitation programs should use nutritional supplements alongside exercises as an intervention (Hamid et al, 2005) while recent research recommendation states that creatine should not be used to replace exercise training (Science Daily, 2008). Previous Study on Creatine’s Effects on COPD Patients indicated a mixture of two interventions in caring for COPD patients in a pulmonary rehabilitation program, that is the use of exercise coupled with nutritional supplements. Fuld’s research however, produced findings based on a single exercise training program alone and did not involve a multidisciplinary pulmonary rehabilitation program (Griffiths, 2005), unlike the current study that which involved a multidisciplinary pulmonary rehabilitation program (Science Daily, 2008). The results produced in both studies are similar except for the difference in the sample of patients and the pulmonary rehabilitation overall intervention style. According to the Science Daily, only one research had been done on the effects of creatine on exercise capacity which produced the following results; that creatine increased peripheral muscle strength and endurance, improved health status and increased fat-free mass, but did not improve exercise capacity (Science Daily, 2008). These similar effects are shown in Kohlstadt’s book confirming that creatine does not improve exercise capacity (Kohlstadt, 2009). The two studies also reveal similar results. If similar results have been produced by the two studies, why should there be a difference in the style of intervention so that one recommends the use of exercise training alone while the other recommends the use of exercise training alongside creatine supplementation. 4. Conclusion Although creatine is a nutritional supplement that can be used to improve exercise performance in pulmonary rehabilitation centers, it does not work in patients with COPD. The above discussion has shown findings from research scientists that have discovered its ineffectiveness in COPD patients irrespective of the fact that it is a nutritional supplement that functions to improve exercise performance in healthy individuals. The reasons why this supplement does not work as expected however is not yet revealed. Further research should be done to find out the reasons so that effective nutritional supplements could be available for COPD patients. The discussion explains the aim of the paper which was to explain the controversy in its use as a nutritional supplement in improving exercise performance in pulmonary rehabilitation programs. The controversy in the pulmonary rehabilitation program styles preferred by different research scientists has also been explained. Generally, creatine should not be used as a nutritional supplement for purposes of improving exercise performance in COPD patients. Reference List Adam M. P. and Gayle A. B. (2001). Clinical Pharmacology of the Dietary Supplement Creatine Monohydrate: Therapeutic usage. The American Society for Pharmacology and Experimental Therapeutics. Retrieved on 17th September, 2009 from: http://pharmrev.aspetjournals.org/cgi/content/full/53/2/161 Agus, Z. S. (2008). Creatine a Bust for Boosting Exercise Benefit in COPD. Retrieved on 17th, September, 2009 from; http://www.medpagetoday.com/Pulmonary/SmokingCOPD/10406 Bernhardt, N.E. and Kasko, A. M. (2008). Nutrition for the Middle Aged and Elderly. Sydney, Australia: Nova Publishers. Deacon, S. J., Vincent, E. M., Singh, S. J., Steiner, M. C. Greenhaff, P., and Morgan, M. D. (2006). Does Creatine Supplementation Enhance the Effects of Physical Training During Pulmonary Rehabilitation in COPD? European Respiratory Review. 15: 187-189. Retrieved on 16th September, 2009 from: http://err.ersjournals.com/cgi/content/full/15/101/187 Griffiths, T. L. (2005). Creatine Supplementation may Enhance Pulmonary Rehabilitation in Patients with COPD, but Larger Trials are needed: Creatine supplementation in COPD. BMJ Journal. BMJ Publishing Group Ltd & British Thoracic Society. Retrieved on 17th September, 2009 from: http://thorax.bmj.com/cgi/content/full/60/7/525. Hamid, Q., Shannon, J. and Martin, J. (2005). Physiologic Basis of Respiratory Disease. Los Angeles, USA: PMPH-USA Ltd. Kohlstadt, I. (2009). Food and Nutrients in Disease Management. Sydney, Australia: CRC Press. Science Daily. (2008). No Substitute For Hard Work: Creatine Supplementation Does Not Improve Exercise Outcomes In COPD. Retrieved on 17th, September, 2009 from: http://www.sciencedaily.com/releases/2008/08/080801074102.htm. Read More