The purpose of this paper is to explore the use of Merit Pay and Incentivesas motivators for increased productivity. The key focus is the system atRichmond Memorial Hospital.To do so, one must begin at the beginning..
The use of financial incentives (financial rewards) paid to workers whoseproduction exceeds some predetermined standard was popularized by FrederickTaylor in the late 1800s. As a supervisory employee of the Midvale SteelCompany, he had become concerned with what he called “systematic soldiering”.
This was the tendency of employees to work at the slowest pace possible and thefact that some of these same workers still had the energy to run home and workon their cabins, even after a hard 12-hour day. Taylor knew that if he couldfind some way to harness this energy during the workday, huge productivity gainswould be achieved. Thus was born the concept of motivational andincentive systems.
What is “motivation?” The root word is “move” which would mean that anyonewho is moved to do something is motivated. Therefore, sitting on a tack, or atleast the pain associated with it is a motivator. For those of us in GraduateSchool, we are aware that without a “B” average we will be eliminated from theprogram. Maintaining that average is our motivator. Attaining the certificateof graduation is our incentive. In psychology, at its most basic, a motivator isthat which impels or compels an individual to act toward meeting a need. On aphysiological level, thirst, hunger and sex are motivators or drives. They arebasic needs which must be met.
Relating this to a hospital environment, it is not base compensation whichdrives the employee, but what the base compensation can satisfy in a higherlevel of needs. Money can’t buy love, but it can buy some security such asinsurance benefits.After basic and security needs are met, compensation isnot the motivator, but what compensation represents.
One statement that must be made before continuing is that needs are variedand can occur concurrently or over a period of hours or days, etc. And, needsare mixed. Hunger is a drive: The satisfaction of hunger can take severalforms and, usually, when one is hungry one also is a little thirsty. Then, ifthe book, Tom Jones, was any indicator, food and drink enhancethe sexual drive. Sooner or later, one has to rest…andso it goes. But, do note that a number of needs or motivators may be “acting”at the same time. In hospital settings, especially those that are undergoingrestructuring needs are highly varied. The same employee who is driven by asalary motivator may now be driven by a long term security need as a motivator.
Many times, if one is given a bonus for a job well done, the money is notthe motivator, but the recognition is. Initial motivation can occur with theuse of bonus or profit sharing. However since bonuses and other such incentivecompensations occur perhaps as little as once a year, there must be othermotivators at work to get an individual to work towards established goals. Thisis an important concept which must be understood in order to have any incentivecompensation system work for the company and individuals. Implementing pay for performance plans, good management, and incentiveplans will motivate personnel to perform at the peak levels necessary to bringabout improvement in the bottom line which is what interests most corporations.
With flatter organizations, and in most cases fewer employees, companiesneed to motivate their remaining employees to make a value-added contribution,take ownership, and be held accountable for their work. Historically, employees have been rewarded with increased base pay, promotions,and titles.
However, organizations today are finding other meansof motivating employees. Companies are recognizing the need to change their payphilosophies, from paying for position or title to paying for people. Inaccordance with this changed philosophy, and increasing number of organizationshave taken the step of truly linking pay to performance, through such programsas variable pay, where a percentage of pay is “at risk,” depending on theemployee’s achievement of predetermined measurable production, operations, orother goals..
Merit pay systems which are based on past performance are flawed by theirvery nature and do not work effectively as a reward system. These systemsprovide a supervisor with a means of escape from the proper practice of theirauthorities, accountabilities, and leadership to subordinates. The merit paysystem depends on the reward to produce the effect rather than planning anddesigning the effect at the outset.
The evaluation encompasses a personal evaluation by scoring on particular itemsseparately by the employee and supervisor. Finally a meeting is held in whichboth the employee and supervisor come to agreement over each score and discussany variances. Once the final score is determined, a mathematical equation isinstituted and from that equation is derived a percentage that is applied to theemployees’ base salary. The percentages range from 1 to 10 percent.
It is common knowledge among employees at Richmond Memorial Hospital that thepercentages are manipulated by supervisors to keep salaries within departmentalbudget goals. This means of evaluation has created an environment ofgeneralized apathy amongst employees. Employees have to be coaxed repeatedly tocomplete their portion of the MBD even though it will result in increased pay.
No one wants to spend hours evaluating their own performance to achieve apresumed 3% raise. The MBD further shackles the employee andthe supervisor by requiring documentation for any score above average. Asmanagers, it has been our experience that when one is presented with tenevaluations and documentation is required on all ten, it is easier to just ratethe person as average and not have to provide so much documentation.
Accordingto Dressler(1994), some supervisors grade more stringently than others, sometruly have mostly stars and othersare subject to the traditional rating errors. There is also the problem that ifthere is very little difference in ratings, then superior performers are notreceiving the appropriate reinforcement, and poor performers are not being givenclear expectations of what they must do in order to improve.
This iswhat results when the percentages of the MBD are manipulated for budget goalsand the majority of employees end up with a 3% raise even though the range isfrom 1 to 10 percent. Cleaning up these problems may be a prerequisite forinstallation of an effective incentive plan. The confusion between reward forpast performance and promise to pay for future performance undermines theintegrity of the employees role.
Linking pay increases overtly to future performance and the companiesrequirements for work of a given complexity (i.e., Registered Nurse, LicensedPractical Nurse, Respiratory Therapist, Administrative Assoicate or TechnicalAssociate) removes the confusion from the merit pay system. It putsaccountability where it should have been in the first place, with the employee.
In accordance with this changed philosophy, an increasing numberof organizations have taken the step of truly linking pay for performance,through such programs as variable pay, where a percentage of pay is at risk,depending on the employee’s achievement of predetermined measurable goals(Dressler, 1994). The basic characteristic of all of these at risk pay plans isthat some portion of the employees base salary is at risk. In the Dupont plan,for instance, the employees at risk pya is a maximum of 6 percent. This meanseach employees base pay will be 94 percent of his or her counterparts salary inother “non at risk” Dupont department.
At Saturn, the at risk component was initially designed to be about 20percent but was recently cut back to 5 percent. The at risk approach is aimedin part at paying employees more like they are partners. It isactually similar to much more extensive programs in Japan in which the at riskportion might be 50 to 60 percen tof a persons yearly pay. To the extent thatat risk pay is part of a more comprehensive program aimed at turning employeesinto committee partners-programs stressing values of trust and respect,extensive communications, and participation and opportuniites for advancement,for instance-at risk programs should be successful.
Dressler(1994) also discusses the following types of pay programs: Merit Programs which all salariedemployees receive merit salary increases based on their individual performance.
As opposed to automatic step progression. The performance appraisal process atFederal Express provides the vehicle for rating employees performance and forsharing that information for the individuals development and making pay increaserecommendations based on sustained performance. Another type ofpay system is Pro-Pay where employees can receive lump sum merit bonuses oncethey reach the top of their pay range and is only paid for above averageperformance.
Star/Superstar programs are where employees whorepresent the top ten percent of performers receive lump sum bonuses. Alongwith a Pay for Performance system, there must also be in place a incentivesystem.. Pay perform ; prod “Many US business owners are finding that turning to incentiveprograms is a good way to boost productivity and improve morale.
A properly structured incentive-driven system (IDS) provides severalmethods and levels of compensation. All IDS systems must be tailored to eachorganization. What works in a hospital may not work in academia . It is usually a mistake to implement an incentive plan without inputfrom employees. Management should use a program design team composed ofemployees and supervisors.
On Man Rays Violin DIngres
Man Rays Violin DIngres is a perfect example of a modernist photograph. Man Ray pushes both how photography is perceived and what is possible within a photograph in this example. Man Ray himself was an American, born as Emmanuel Rudnitsky, but moved to Paris and engaged in very non-American photography. Europe lacked the American ideals about what strait photography should be. While American schools of photography believed that an art photograph should only be made with a large negative with maximum depth of field, Europeans were busy experimenting with new uses of the medium as well as experimenting with altering the image in serious ways to change the meaning.
Man Ray was born the son of Jewish immigrants in Philadelphia. He moved to Brooklyn where he was able to learn a broad scope of the arts and have access to all of New Yorks resources. There he met Steiglitz and became interested in the 291-gallery crowd, but it was when he became acquainted with New York Citys Dadaists that exploration of his self such as this became possible.
The time this photograph was taken explains much about why it was taken. The period between the world wars was arguably the most prolific period in photographys history in terms of quantity produced and variety. Modernism in Europe was busy tackling new subject matter and expressing itself in every way possible. Images were manipulated in ways foretelling of much of photographys future, including what is so possible digitally. However, the most important thing is perhaps that this movement was embodied by the belief that expressing yourself in anyway is possible. In other photography movements previously, large groups of people tended to represent similar ideas.
Technically, Man Ray has been known to take use of many formats available to him. He practiced a form of art similar to Photogenic Drawings as well as collage and montage.Determining the technique used in construction of this photograph is difficult, the book makes no mention of it and the photograph is reproduced most likely scaled. It looks as if the negative could have been medium format roll film or large format with the violins f-holes burnt into the final image by placing a large sheet of opaque material over the image with the f-holes cut out. Man Rays intentions are not altogether clear in the photograph as it operates on so many levels. Unless that was his main intent, he points out the irony of the shape of the womens body in comparison to a violin. Man Ray also depicts a portrait of the woman with delicate care given to her back and profile. This work is reminiscent of the painter Inges who also took great care too showing women abstractly focusing on the curves of their back but also with subtle eroticism depicted in the times obsession with orientalism. This is true because like the photograph, his work never revealed all of a womans features. It is also true because the hair wrap and earrings work to make her exotic.
Because Inges was a well-known academy painter, this photograph is assuredly a parody of arts past work. However, as this woman is represented naked before him as an instrument I believe he is making a misogynist statement about himself and women in general. As the woman is represented as in instrument he asserts multiple things about a womans character. He states clearly that women are predictable in nature and one can learn how to manipulate a woman as one would a violin. He also asserts that he is a virtuoso, as this woman is in front of him, nude and portrayed softly with much care to light. Culturally this would make sense of an educated man in Europe at this time.Historically, philosophers like Nietzche and Kierkegaard were being evaluated for their beliefs on women and society in this time period. This may have had much to do with the construction of this photograph. These philosophers were also evaluated thoroughly in Europe more so than in the United States due to changes in political structure.Man Ray, being educated and living in Paris at the time was apt to be politically and socially aware. Especially as he was on the cutting edge of their art scene.
The photograph works well because so much attention is paid to the nude figure. He models her with the care that one would lavish upon an instrument of high craft. Her head and back make up the frame modeled in precision like a violin. Her right arm is just visible, giving the photograph depth. Also working well is the fact that her head, wrapped makes the subject slightly more ambiguous. As a misogynist image he realizes that women have character much like instruments. Revealing even hair type may have been enough to ruin the image in his mind as he wishes to make a statement about the nature of women in general, not of a particular hair type.
With these intentions given I believe that the photograph works. Content does not overrule form or vice versa. This is an important factor as much of the work being produced in this time period was obsessed with form, and I do not always believe the amount of content is sufficient. Man Ray is decisive in his attempts to ironically portray this woman as a general figure but also conduct an accurate portrait of this particular womans soul.
It is also important too realize, that although this photograph is definitive of the times, it is not necessarily pop, because the image still works today. Modern art is not an ambiguous term. It does depict a time past but Man Rays work is still innovative and insightful.
Protein For Muscles
Creatine Information: Creatine is a naturally occurring metabolite found in muscle tissue. It plays an important role in energy metabolism and ATP reformulation. Muscle soreness, lactate buildup, and fatigue are direct results of depleted ATP stores. Creatine replenishes ATP stores, thus prolonging the time to fatigue. Creatine also increases available instant energy, increases muscular strength, improves endurance, and reduces levels of metabolic byproducts such as ammonia (which is produced at high levels during intense exercise and is partially responsible for muscular fatigue). From our experience, Creatine supplementation results in significant muscle accumulation and increased muscular endurance in all of our clients. Weight gains from 4-14 pounds are commonplace with Creatine supplementation. Creatine loading via supplemental feeding can also offer the potential for the following:
Improved Athletic Performance: Maximizing the level of stored Creatine (20% or more) by supplemental ingestion of Creatine Monohydrate has been shown to extend peak athletic performance for longer periods during short-duration, high-intensity exercise. Stockpiling Creatine shortens the time necessary for the body to generate replacement Creatine, thus significantly reducing muscle recovery time between short-duration, high-intensity activities.
Increase Lean Muscle Mass: Inactive or dystrophic muscle (such as occurs as a result of injury) has by nature reduced levels of Creatine. Supplementation with Creatine Monohydrate permits dystrophic muscle to work harder during therapy and rebuild itself to its normal state.
Correct Creatine Deficiencies: Disease or age-related Creatine deficiencies in the brain and skeletal muscle can be improved by the oral administration of Creatine Monohydrate, helping to restore a more active, normal lifestyle.
How to Use Creatine: Loading / Maintenance Phase: Take one to two scoops immediately after the workout. Creatine is best utilized when taken with a high-glycemic substance such as grape juice, Ultra fuel, etc.
Creatine Monohydrate – How Does It Really Work? Glenn Peden offered the following from Tom McCullough via the FEMUSCLE list on Tuesday, 13 June 1995. It was forwarded to me in response to my call for information on Creatine. Glenn: My Dad said he read mail today. Hope he can answer all of your questions. I have been powerlifting for 13 years. I lift in the 242 lb. weight class. I am also ranked #9 in the USA. If you have not tried the Creatine Monohydrate, get some.
Just a quick explanation of its actions. I’m sure you know that in order for a muscle to contract, energy has to be released through the breakdown of ATP. In strength training, you are in an anaerobic system. The only way ATP is made is through anaerobic glycolysis. ATP is also reformed in the anaerobic system when chemical reactions take place in the muscle, forcing the byproducts of ATP breakdown (ADP + Pi) back together so muscular contractions can take place again. Here is where creatine comes into play. The body has to have creatine phosphate to force the ADP + Pi back together to reform ATP for energy. Creatine phosphate is formed when a chemical reaction breaks down creatine monohydrate, a natural dietary substance found in meats. The liver can synthesize creatine in small amounts, but most of the creatine we digest is stored in the muscles and bones for future use.
However, especially in diets low in protein, we do have limited stores, and it does take time to release the creatine stores. Red meat is the best source of creatine. However, there is only about 1 g/lb of meat. By taking creatine supplements, you are supersaturating the body with creatine phosphate stores. This will enable you to have more creatine available to produce more ATP at a faster rate. Thus, more energy is available per muscular contraction, and ATP stores are restored more quickly. This means for weight lifters have more maximum strength and quicker recovery. The instructions for supplementation are 1st 5 days: 5g, 4-6 x per day (this is the loading phase); after 5-8g 30-45 min before workout/5g after a workout. Creatine supplements will also cause, in most individuals, intracellular fluid retention. I have experienced a 10 lb weight gain in the first 2 weeks.
You should also start experiencing strength gains after the first week. These gains won’t be dramatic, like steroids, but you will see a difference. Try it, I think you will like it. Texas A&M experimented with it with a few players last season. This season they are putting the whole team on it because they got such positive results with the few guys who tried it. It can promote further gains in sprint performance (5-8%), as well as gains in strength (5-15%) and lean body mass (1-3%). The only known side effect is increased body weight. More research is needed on individual differences in the response to creatine, periodic or cyclical use of creatine, side effects, and long-term effects on endurance.
Creatine is an amino acid, like the building blocks that make up proteins. Creatine, in the form of phosphocreatine (creatine phosphate), is an important store of energy in muscle cells. During intense exercise lasting around half a minute, phosphocreatine is broken down into creatine and phosphate, and the energy released is used to regenerate the primary source of energy, adenosine triphosphate (ATP). Output power drops as phosphocreatine becomes depleted because ATP cannot be regenerated fast enough to meet the demand of the exercise. It follows that a bigger store of phosphocreatine in muscle should reduce fatigue during sprinting.
Extra creatine in the muscle may also increase the rate of regeneration of phosphocreatine following sprints, which should mean less fatigue with repeated bursts of activity in training or in many sports competitions. So much for the theory, but can you get a bigger store of creatine and phosphocreatine in muscle? Yes, and it does enhance sprint performance, especially repeated sprints. Extra creatine is therefore ergogenic because it may help generate more power output during intense exercise. In addition, long-term creatine supplementation produces greater gains in strength and sprint performance and may increase lean body mass. In this article, I’ll summarize the evidence for and against these claims.
I’ll draw on about 42 refereed research papers and four academic reviews to make conclusions regarding the ergogenic value of creatine supplementation. In addition, I’ll provide 25 references to studies published in abstract form, which report the most recent preliminary findings on creatine supplementation.
Effects of Creatine Supplements on Muscle Creatine, Phosphocreatine, and ATP
The daily turnover of creatine is about 2 g for a 70 kg person. About half of the daily needs of creatine are provided by the body synthesizing creatine from amino acids. The remaining daily need for creatine is obtained from the diet.
Meat or fish is the best natural source. For example, there is about 1 g of creatine in 250 g (half a pound) of raw meat. Dietary supplementation with synthetic creatine is the primary way athletes “load” the muscle with creatine. Daily doses of 20 g of creatine for 5-7 days usually increase the total creatine content in muscle by 10-25%. About one-third of the extra creatine in muscle is in the form of phosphocreatine (Harris, 1992; Balsom et al., 1995).
Extra creatine in muscle does not appear to increase the resting concentration of ATP, but it appears to help maintain ATP concentrations during a single maximal effort sprint. It may also enhance the rate of ATP and phosphocreatine resynthesis following intense exercise (Greenhaff et al., 1993a; Balsom et al., 1995; Casey et al., 1996). There is some evidence that not all subjects respond to creatine supplementation. For example, one study reported that subjects who experienced less of a change in resting muscle creatine (less than 20 mmol/kg dry mass) did not appear to benefit from creatine supplementation (Greenhaff et al., 1994). However, more recent studies indicate that taking creatine with large amounts of glucose increases muscle creatine content by 10% more than when creatine is taken alone (Green et al., 1996a; Green et al., 1996b).
Consequently, ingesting creatine with glucose may increase its ergogenic effect.
Effects on Performance
Researchers first investigated the ergogenic effects of short-term creatine loading. In a typical study, a creatine dose of 5 g is given four times a day for five to seven days to ensure that muscle creatine increases. A control group has given a placebo (glucose or some other relatively inert substance) in a double-blind manner (neither the athletes nor the researchers doing the testing know who gets what until after the tests are performed).
Most studies have shown that speed or power output in sprints — all-out bursts of activity lasting a few seconds to several minutes — is enhanced, typically by 5-8%. Repetitive sprint performance is also enhanced when the rests between sprints don’t allow full recovery. In this case, total work output can be increased by 5-15%. There is also evidence that work performed during sets of multiple repetition strength tests may be enhanced by creatine supplementation, typically by 5-15%. In addition, one-repetition maximum strength and vertical-jump performance may also be increased with creatine supplementation, typically by 5-10%. The improvement in exercise performance has been correlated with the degree to which creatine is stored in the muscle following creatine supplementation, particularly in Type II muscle fibers (Casey et al., 1996).
Researchers have now turned their attention to longer-term creatine supplementation. In these studies, a week of creatine loading of up to 25 g per day is followed by up to three months of maintenance with reduced or similar dosages (2-25 g per day). Training continues as usual in a group given creatine and in a control group given a placebo. Greater gains are now seen in the performance of single-effort sprints, repeated sprints, and strength (5-15%).
Table 1 at the end of this article lists the references to the positive effects of creatine on performance. Theoretically, creatine may affect performance through one or more of the following mechanisms (Table 2): an increase in concentrations of creatine and phosphocreatine in resting muscle cells; an increased rate of resynthesis of phosphocreatine between bouts of activity; enhanced metabolic efficiency (lower production of lactate, ammonia, and/or hypoxanthine); and enhanced adaptations through higher training loads. Creatine supplementation during training may also promote greater gains in lean body mass (see Body Composition below).
Not all studies have reported the ergogenic benefits of creatine supplementation (Table 3). In this regard, a number of equally well-controlled studies indicate that creatine supplementation does not enhance: single or repetitive sprint performance; work performed during sets of maximal effort muscle contractions; maximal strength; or submaximal endurance exercise. What’s more, one study reported that endurance running speed was slower, possibly because of an increase in body mass (Balsom et al., 1993b).
In the analysis of these studies, creatine supplementation appears to be less effective in the following situations: when less than 20 g per day was used for 5 days or less; when low doses (2-3 g per day) were used without an initial high-dose loading period; in crossover studies with insufficient time (less than 5 weeks) to allow washout of the creatine; in studies with relatively small numbers of subjects; and when repeated sprints were performed with very short or very long recovery periods between sprints. It is also possible that subject variability in response to creatine supplementation may account for the lack of ergogenic benefit reported in these studies. In addition, there have been reports that caffeine may negate the benefit of creatine supplementation (Vandenberghe et al., 1996).
Consequently, although most studies indicate that creatine supplementation may improve performance, creatine supplementation may not provide ergogenic value for everyone.
Although some studies have found no effect, most indicate that short-term creatine supplementation increases total body mass by 0.7 to 1.6 kg. With longer use, gains of up to 3 kg more than in matched control groups have been reported (see Table 4 at the end of this article for references). For example, Kreider et al. (1998) reported that 28 days of creatine supplementation (16 g per day) resulted in a 1.1 kg greater gain in lean body mass in college football players undergoing off-season resistance/agility training. In addition, Vandenberghe et al. (1997) reported that untrained females ingesting creatine (20 g per day for 4 days followed by 5 g per day for 66 days) during resistance training observed significantly greater gains in lean body mass (1.0 kg) than subjects ingesting a placebo during training. The gains in lean body mass were maintained while ingesting creatine (5 g per day) during a 10-week period of detraining and in the four weeks after supplementation stopped.
Findings like these suggest that creatine supplementation may promote gains in lean body mass during training, but we don’t yet understand how it works. The two prevailing theories are that creatine supplementation promotes either water retention or protein synthesis. More research is needed before we can be certain about the contribution each of these processes makes to weight gain.
In studies of preoperative and postoperative patients, untrained subjects, and elite athletes, and with dosages of 1.5 to 25 g per day for up to a year, the only side effect has been weight gain (Balsom, Soderlund, & Ekblom, 1994). Even so, concern about possible side effects has been mentioned in lay publications and mailing lists. Before discussing these possible side effects, it should be noted that they emanate from unsubstantiated anecdotal reports and may be unrelated to creatine supplementation. We must be careful to base comments regarding side effects of creatine supplementation on factual evidence, not speculation. But we must also understand that few studies have directly investigated any side effects of creatine supplementation.
Consequently, discussion about possible side effects is warranted. Anecdotal reports from some athletic trainers and coaches suggest that creatine supplementation may promote a greater incidence of muscle strains or pulls.
Theoretically, the gains in strength and body mass may place additional stress on bones, joints, and ligaments. Yet no study has documented an increased rate of injury following creatine supplementation, even though many of these studies evaluated highly trained athletes during heavy training periods. Athletes apparently adapt to the increase in strength, which is modest and gradual. There have been some anecdotal claims that athletes training hard in hot or humid conditions experience severe muscle cramps when taking creatine, and the cramps have been attributed to overheating and/or changes in the amount of water or salts in muscle.
But no study has reported that creatine supplementation causes any cramping, dehydration, or changes in salt concentrations, even though some studies have evaluated highly trained athletes undergoing intense training in hot/humid environments. In my experience with athletes training in the heat (e.g., during 2-a-day football practice in autumn), cramping is related to muscular fatigue and dehydration while exercising in the heat. It is not related to creatine supplementation. Nevertheless, athletes taking creatine while training in hot and humid environments should be aware of this possible side effect and take additional precautions to prevent dehydration.
Some concern has been raised regarding the effects of creatine supplementation on kidney function. The body seems to be able to dispose of the extra creatine without any problem (Poortmans et al., 1997). The extra creatine is eliminated mainly in the urine as creatine, with small amounts broken down and excreted as creatinine or urea. No study has shown that creatine supplementation results in clinically significant increases in liver damage or impaired liver function. It has also been suggested that creatine supplementation could suppress the body’s own creatine synthesis. Studies have reported that it takes about four weeks after cessation of creatine supplementation for muscle creatine (Vandenberghe et al., 1997) and phosphocreatine (Febbraio et al., 1995) content to return to normal. It is unclear whether muscle content falls below normal thereafter. Although more research is needed, there is no evidence that creatine supplementation causes a long-term suppression of creatine synthesis when supplementation stops (Balsom, Soderlund & Ekblom, 1994; Hultman et al., 1996).
Does creatine supplementation have undiscovered long-term side effects? Trials lasting more than a year have not been performed, but creatine has been used as a nutritional supplement for over 10 years. Although long-term side effects cannot be discounted, no significant short-term side effects other than weight gain have been reported. In addition, I am not aware of any significant medical complications that have been linked to creatine supplementation. Furthermore, creatine and phosphocreatine have been used medically to reduce muscle wasting after surgery and to improve heart function and exercise capacity in people with ischemic heart disease (Pauletto & Strumia, 1996; Gordon et al., 1995). Creatine supplementation may even reduce the risk of heart disease by improving blood lipids (Earnest, Almada & Mitchell, 1996; Kreider et al., 1998). On the basis of the available research, I consider creatine supplementation to be a medically safe practice when taken at dosages described in the literature.
Determining whether creatine supplementation has any short- or long-term side effects is an area receiving additional research attention. If there are side effects from long-term creatine supplementation, an important issue will be the liability of coaches, trainers, universities, and athletic governing bodies who provide creatine to their athletes. Anyone advising athletes to take creatine should make it clear that side effects from long-term use cannot be completely ruled out, and that the athletes do not have to take the supplements. It would be wise to have a formal policy for dosages to reduce the chances of athletes taking excessive amounts.
Ethics: Creatine supplementation is not banned, but is a nutritional practice that enhances performance. Nevertheless, is it unethical? Anyone pondering this question should consider that creatine supplementation is a practice similar to carbohydrate loading, which is well-accepted. Some are also concerned that creatine supplementation could cause a carryover effect, whereby athletes who have learned to take creatine are more likely to use dangerous or banned substances. Proper education among athletes, coaches, and trainers regarding acceptable and unacceptable nutritional practices is probably the best way to reduce any carryover.
How to Use Creatine: A typical loading regimen for a 70-kg athlete is a 5-g dose four times a day for a week. Thereafter, the dose can be reduced to 2 to 5 g per day in order to maintain elevated creatine content. This supplementation protocol will increase intramuscular creatine and phosphocreatine content and enhance high-intensity exercise performance. There is now some evidence that taking glucose (100 g) with creatine (5 to 7 g) increases the uptake of creatine into muscle (Green et al., 1996a; Green et al., 1996b). Consequently, I recommend that athletes take creatine with carbohydrates (e.g., with grape juice) or ingest commercially available creatine supplements that combine creatine with glucose. For athletes wanting to promote additional gains in lean body mass, I recommend 15 to 25 g per day for 1 to 3 months.
Although many athletes cycle on or off creatine, no study has determined whether this practice promotes greater gains in fat-free mass or performance than continuous use. More research is needed here. Creatine supplements are good value. Creatine is now being sold for as little as US$30 per kg, or about $0.60 per day when taking 20 g per day. Popular sports drinks are more expensive.