Unfortunately, many people haven't gotten the message that strong is in. Indeed, statistics on strength training are grim: According to the Centers for Disease Control and Prevention (CDC), less than 30 percent of American adults engage in muscle-strengthening activities like lifting weights or doing push-ups at least twice a week—the recommendations set out by the government. 

A maintenance phase of 2g daily appears to technically preserve creatine content in skeletal muscle of responders either inherently or after a loading phase, but in sedentary people or those with light activity, creatine content still progressively declines (although it still higher than baseline levels after six weeks) and glycogen increases seem to normalize. This maintenance dose may be wholly insufficient for athletes, a 5g maintenance protocol may be more prudent.
These effects were noted before in a preliminary study of depressed adolescents (with no placebo group) showing a 55% reduction in depressive symptoms at 4g daily when brain phosphocreatine levels increased.[231] Other prelimnary human studies suggest creatine might lessen unipolar depression[256] and one study on Post-Traumatic Stress Disorder (PTSD) noted improved mood as assessed by the Hamilton Depression Rating Scale.[232]
Do a single set of repetitions. Theories on the best way to approach weight training abound, including countless repetitions and hours at the gym. But research shows that a single set of exercise with a weight that fatigues your muscle after about 12 to 15 repetitions can build muscle efficiently in most people and can be as effective as three sets of the same exercise.
These effects are secondary to creatine being a source of phosphate groups and acting as an energy reserve. The longer a cell has energy, the longer it can preserve the integrity of the cell membrane by preserving integrity of the Na+/K+-ATPase and Ca2+-ATPase enzymes.[241][235][236] Preserving ATP allows creatine to act via a nongenomic response (not requiring the nuclear DNA to transcribe anything), and appears to work secondary to MAPK and PI3K pathways.[226]
I know this goes against the recommendations you often see in stereotypical bodybuilding routines (i.e. the ones that involve having a single “chest day” or “arm day” or “shoulder day” once a week), but that’s just one of the many reasons why those types of routines suck for us natural, genetically-average people, and work best for steroid users with great genetics.
You don’t have to, but you can. The typical creatine dose is 5 grams once or twice per day, but it’s sometimes suggested that one should “load” creatine by taking 20 to 25 grams per day for the first week of usage. This is then followed with 3 to 4 weeks of 5 grams per day, then a break for a week or two, then repeat. This may bring about more acute increases in strength and muscle size — creatine will “work” more quickly, in other words — but it’s not necessary.
You've figured out the exercises you should be doing, but what about the number of sets and repetitions? Your decision should be based on your goals. The American College of Sports Medicine recommends 4 to 6 reps for strength and hypertrophy, 8 to 12 reps for muscular strength and 10 to 15 reps for muscular endurance. They also recommend at least one set of each exercise to fatigue although you'll find that most people perform about 2 to 3 sets of each exercise. In general:
How long and how often? Two or three weekly 20- to 30-minute, weight-training sessions are sufficient to start reaping noticeable benefits within four to 12 weeks, such as improved energy and muscle tone. Within six months, most people increase their strength 40 percent or more. Give your body at least one recovery day between sessions (although some people may need more, especially in the beginning).
Men appear to have higher active creatine-kinase systems, and racial differences favor black people over hispanic people over white people in terms of the activity of the creatine-kinase system. This system is more variable in men, independent of supplementation. Exercise may increase the activity of the creatine-kinase system independent of supplementation.

A meta-analysis found that creatine treatment increased muscle strength in muscular dystrophies, and potentially improved functional performance.[57] Creatine treatment does not appear to improve muscle strength in people who have metabolic myopathies.[57] High doses of creatine lead to increased muscle pain and an impairment in activities of daily living when taken by people who have McArdle disease.[57]
The first open label trial on ALS failed to significantly alter lung function as assessed by FEV (when comparing the rate of decline pretreatment relative to treatment).[545] Creatine has elsewhere failed to benefit lung function at 5g daily for months relative to control[546] and failed to significantly attenuate the rate of lung function deterioration over 16 months at 10g daily[505] and 5g daily over nine months.[507] 

According to the abstract, in the stratified analyses by forms of aerobic exercise, weekly resistance exercise of 1 time or 1-59 minutes was associated with lower risks of total cardiovascular events and cardiovascular disease, regardless of meeting the aerobic exercise guidelines. The analysis showed that resistance training reduced the risk of cardiovascular events in 2 ways: training had a direct association with cardiovascular risk, and resistance training indirectly lowered cardiovascular risk by decreasing body mass index.
Creatine is an organic acid naturally occurring in the body that supplies energy to muscle cells for short bursts of energy (as required in lifting weights) via creatine phosphate replenishment of ATP. A number of scientific studies have shown that creatine can improve strength,[32] energy,[33] muscle mass, and recovery times. In addition, recent studies have also shown that creatine improves brain function.[34] and reduces mental fatigue.[35] Unlike steroids or other performance-enhancing drugs, creatine can be found naturally in many common foods such as herring, tuna, salmon, and beef.
Eat 1.5–3 grams of carbs per pound of your body weight. As with fat, this amount can vary greatly, depending on your personal needs and preferences, so consider these numbers only a starting point. If you’re very skinny and feel that you handle carbs well (i.e. you can eat a lot of them without getting fat), go ahead and eat according to the higher end of the spectrum. The same applies if you’re desperate to gain weight—you should increase your carb intake. If you’re prone to weight gain or feel lethargic on higher carbs, you should eat fewer of them. Again, see our keto guide for more details and options.
Pro Tip: Zane also suggests that directed concentration is exceptionally important to getting the most from your training and is much easier with lower weight. If you can concentrate on the muscle through its whole movement, you will notice that the intensity will be just as strong, without the risk. We teach you this in our “Mind Muscle Connection” Bonus Guide that we include in our Old School Muscle 8-Week Program.
Beach muscles and Olympic lifts draw more attention. But the many little stabilizer muscles around your shoulders, hips, and midsection — collectively the core — provide a strong foundation. Challenging the stability and mobility of these key muscles with medicine balls, physioballs, mini-bands, and rotational movements (lifting, chopping) pays huge dividends.
Most causes of brain injury (calcium influx, excitotoxicity, lipid peroxidation, reactive oxygen intermediates or ROIs) all tend to ultimately work secondary to damaging the mitochondrial membrane and reducing its potential, which ultimately causes cellular apoptosis.[258][259][260][261] Traumatic brain injuries are thought to work vicariously through ROIs by depleting ATP concentrations.[262][263] Creatine appears to preserve mitochondrial membrane permeability in response to traumatic brain injury (1% of the rat’s diet for four weeks),[264] which is a mechanism commonly attributed to its ATP-buffering ability.

You've figured out the exercises you should be doing, but what about the number of sets and repetitions? Your decision should be based on your goals. The American College of Sports Medicine recommends 8-12 reps for muscular strength and 10-15 reps for muscular endurance. They also recommend at least 1 set of each exercise to fatigue although you'll find that most people perform about 2-3 sets of each exercise. In general:
If you touch your phone between exercise sets, it better be to set its timer to 30 to 90 seconds. When lifting for hypertrophy, rest periods of 30 to 90 seconds encourage a quick release in muscle-building hormones (including testosterone and human growth hormone) while also making sure that you really, truly fatigue your muscles, according to Fitzgerald.
It’s not just about lifting—it’s about lifting safely and correctly. And if you’re not performing exercises properly, it’s impossible to make any progress. “When someone is just starting to work out, it can help to work closely with a knowledgeable personal trainer in order to learn proper form,” says Ingram. But that goes for experienced lifters, too. If you aren’t sure about a movement, it’s better to ask. “If you’re not working the correct muscles, you can’t expect them to grow,” explains Ingram.
Due to a combination of its neuroprotective effects and dopaminergic modulatory effects, creatine has been hypothesized in at least one review article to be of benefit to drug rehabilitation.[266] This study used parallels between drug abuse (usually methamphetamines) and traumatic brain injury[267][268] and made note of creatine being able to reduce symptoms of brain trauma, such as headaches, fatigue, and dizziness in clinical settings in two pilot studies.[269][270] No studies currently exist that examine creatine supplementation and drug rehabilitation.
If you’re looking to put on extra muscle mass and build strength, there are a few things that need to occur. The first of these, even though it may seem obvious, is that you will need to have an exercise routine. To stimulate maximum muscle growth, you’ll need to challenge yourself in the gym, forcing your muscles to adapt to heavier workloads by increasing in size and strength.

Spero Karas, MD, assistant professor of orthopaedics in the division of sports medicine at Emory University, says that testosterone, the male hormone responsible for muscle growth, maxes out between the ages of 16 and 18. It reaches a plateau during the 20s and then begins to decline. As a result, muscle building after the adolescent years can be challenging, he says.


THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for general informational purposes only and does not address individual circumstances. It is not a substitute for professional medical advice, diagnosis or treatment and should not be relied on to make decisions about your health. Never ignore professional medical advice in seeking treatment because of something you have read on the WebMD Site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
A muscle imbalance—when one muscle is stronger than its opposing muscle—can limit your ability to exercise effectively, and could lead to injury down the line. “It’s important to recognize whether you’re really working the muscles you think you are and recognize if you’ve developed an imbalance that alters your movement pattern,” says Eric Ingram, physical therapist at Louisiana Physical Therapy Centers of Pineville. One common imbalance in women is stronger quads and weaker, tighter hamstrings, thanks to prolonged sitting, high heels, and improper training. If you suspect you have a muscle imbalance, make an appointment with a physical therapist, who will prescribe exercises to even you out.
While the number of reps you do per set is important, of equal importance is the total number of reps you do per muscle group. The National Strength and Conditioning Association has determined that, to maximize growth, you need approximately 20–70 total reps per muscle group. Depending on which end of a rep range you’re working, this can be done in one session or over a few days (a training week, for instance), but that’s the spread you need to cover to see gains.
Build an effective exercise routine. A good diet is required for your body to be able to maximize your potential, but there's no potential at all until you start the process of tearing down your old muscles and rebuilding them bigger, bulkier, and stronger. The best way to do that is to start at the beginning. If you're not sure where to begin, find a solid workout program online and try it out for a while. Don't immediately jump from one program to the next - you'll end up keeping yourself from making steady progress.
After a tough sweat, it's important to rehydrate your body: "Drink lots of water and thank your body for what it was just able to accomplish," says Davis. A balanced post-workout snack is also a good idea. Go for one with carbs refuel your glycogen stores (one of your body's main energy sources) and about 10 to 20 grams of protein to help build and repair your muscles. "Don’t overcomplicate it," says Davis. If you're lifting and weight loss is one of your goals, though, it's still important to keep calories in mind—a post-workout snack shouldn't be more than 150 to 200 calories. Here's a guide to how many calories you should be eating for weight loss.
However, in the beginning weeks of starting a new workout routine, the majority of strength gains aren't actually a result of this muscle protein synthesis and hypertrophy. Rather, they are a result of the body's neurological system learning when and how to fire the needed muscle cells, explains Abbie E. Smith-Ryan, associate professor of exercise physiology at the department of exercise and sport science at the University of North Carolina–Chapel Hill. Think of it this way: The first time you perform a new exercise, say a bench press, you likely feel pretty shaky. Your arms aren't totally in sync and the weights may sway a bit from side to side. But by the time you perform your second or third set of that same exercise, the practice gets a little smoother. That's your neurological system at work.

There is some research that suggests that creatine can help people with type 2 diabetes by improving insulin sensitivity, glucose uptake into the cells, and glycemic control. This has led many people with T2 to start supplementing their diets with pure creatine to try and reap the benefits. At this time there has been no conclusive research done into the effectiveness of creatine for type 1 diabetics.


de Salles Painelli V, Alves VT, Ugrinowitsch C, et al. Creatine supplementation prevents acute strength loss induced by concurrent exercise. Eur J Appl Physiol 2014;114(8):1749-55.del Favero S, Roschel H, Artioli G, et al. Creatine but not betaine supplementation increases muscle phosphorylcreatine content and strength performance. Amino Acids 2012;42(6):2299-305. View abstract.

How to Take It: So, you want to give it a go? How much should you take and what should you look for in a supplement? Definitely opt for creatine monohydrate, as it performs better in studies than other varieties, as mentioned above. A standard dose is about 5 grams a day. You can try taking this muscle builder for about 4 weeks to boost your levels. Following this time, you can either cut out creatine or lower to a maintenance dose of 3-5 grams per day. However, you’ll notice if you read the fine print that subjects in studies often have a loading phase of five days where the dosage is upped to 20 g per day, prior to adopting a standard dose (7, 8).
One pilot study using 150mg/kg creatine monohydrate for a five day loading phase followed by maintenance (60mg/kg) for the remainder of the five weeks noted that supplementation was associated with fewer muscle symptoms and complaints alongside improved muscular function,[572] yet a later trial trying to replicate the obsevations using 150mg/kg daily for five weeks noted the opposite, that creatine supplementation exacerbated symptoms.[573] 
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