What supplements help improve muscle strength in a patient?

Protein Supplementation is the Primary Supplement for Improving Muscle Strength

Protein supplementation, particularly whey protein at doses of 1.2-1.5 g/kg body weight daily combined with resistance training, is the most evidence-based supplement for improving muscle strength in adults. 1

Optimal Protein Supplementation Strategy

Dosing Recommendations

• Target 1.2-1.5 g/kg body weight per day for most adults engaged in resistance training 1
• Higher protein intake (up to 1.5 g/kg/day) promotes muscle protein anabolism and is supported by moderate-quality evidence 1
• For cancer patients specifically, protein intake should be above 1 g/kg/day and ideally up to 1.5 g/kg/day 1

Timing of Protein Intake

• Post-exercise supplementation is most effective for increasing muscle mass (mean difference: 0.54 kg for fat-free mass) 2
• Nighttime protein supplementation is most effective for strength gains (mean difference: 2.85 kg for handgrip strength, 12.12 kg for leg press strength) 2
• Consuming protein immediately before and after resistance exercise sessions enhances muscle circumference, strength, and exercise volume 3

Type of Protein

• Whey protein isolate is the preferred choice, particularly milk-based proteins (whey, casein, milk, yogurt) which show effectiveness for both muscle mass and strength gains 2
• Whey protein supplementation (40g containing hydrolyzed whey) enhances resistance exercise-induced increases in muscle mass and overall muscular strength and endurance 4, 3
• Leucine-enriched supplements may provide additional benefits by stimulating the mTOR pathway for muscle protein synthesis 1, 5

Resistance Training Requirements

Protein supplementation only works when combined with adequate resistance training stimulus. 6

Training Parameters for Strength

• Train at ≥80% of one-repetition maximum (1RM) for experienced lifters to produce greatest strength improvements 7
• For beginners, 60-70% of 1RM is effective 7
• Train each major muscle group 2-3 days per week 7
• Perform 2-4 sets per exercise, with 8-12 repetitions for most adults 7
• Both aerobic and resistance exercise improve muscle strength, but resistance exercise is more effective than aerobic exercise alone 1

Alternative Supplements with Evidence

Creatine Monohydrate

• Loading phase: 20g/day divided into four 5g doses for 5-7 days 8
• Maintenance phase: 3-5g/day for continued supplementation 8
• Increases phosphocreatine stores by ~20%, improving ATP regeneration during high-intensity exercise 8
• Enhances muscle protein synthesis following exercise, though response is approximately 30% lower than resistance exercise alone 8
• Primary side effect is 1-2 kg weight gain from water retention 8

HMB (β-hydroxy-β-methylbutyrate)

• A leucine metabolite that stimulates muscle protein synthesis and inhibits muscle protein breakdown 1
• Systematic reviews show improved muscle mass and strength in various clinical populations at risk of muscle wasting 1
• Limited ICU data, but may have potential in catabolic states 1

Clinical Considerations and Pitfalls

Common Mistakes to Avoid

• Insufficient training intensity: Protein supplementation has minimal impact without adequate resistance training stimulus, particularly in untrained individuals during initial weeks 6
• Inadequate duration: Benefits become more apparent as duration, frequency, and volume of resistance training increase 6
• Ignoring timing: The composition and timing of protein intake are more important than total amount alone 3

Special Populations

• Patients with impaired kidney function (eGFR <30 ml/min/1.73 m²): Reduce protein target to 0.8 g/kg body weight 1
• Patients with eGFR 30-59 ml/min/1.73 m²: Use 1.2-1.5 g/kg body weight targets 1
• Cancer patients: Avoid corticosteroids for appetite stimulation as they cause muscle wasting despite increasing appetite 1

Monitoring Response

• Track muscle thickness via ultrasound or body composition analysis 4, 5
• Measure isokinetic muscle strength (peak torque at 60°/s and 180°/s) 4
• Monitor lean body mass changes using bioelectrical impedance 4, 5

Supplements to Avoid for Muscle Strength

• Growth hormone: Increases lean body mass but does not improve muscle strength, handgrip strength, or exercise capacity 1
• Progestins: Increase appetite and body weight but not fat-free mass; carry risk of thromboembolism 1
• Corticosteroids: Cause muscle wasting, insulin resistance, and myopathy despite transient appetite stimulation 1