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Creatine Supplementation and Lower Limb Strength Performance: A Systematic Review and Meta-Analyses

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Abstract

Background

Creatine is the most widely used supplementation to increase strength performance. However, the few meta-analyses are more than 10 years old and suffer from inclusion bias such as the absence of randomization and placebo, the diversity of the inclusion criteria (aerobic/endurance, anaerobic/strength), no evaluation on specific muscles or group of muscles, and the considerable amount of conflicting results within the last decade.

Objective

The objective of this systematic review was to evaluate meta-analyzed effects of creatine supplementation on lower limb strength performance.

Methods

We conducted a systematic review and meta-analyses of all randomized controlled trials comparing creatine supplementation with a placebo, with strength performance of the lower limbs measured in exercises lasting less than 3 min. The search strategy used the keywords “creatine supplementation” and “performance”. Dependent variables were creatine loading, total dose, duration, the time-intervals between baseline (T0) and the end of the supplementation (T1), as well as any training during supplementation. Independent variables were age, sex, and level of physical activity at baseline. We conducted meta-analyses at T1, and on changes between T0 and T1. Each meta-analysis was stratified within lower limb muscle groups and exercise tests.

Results

We included 60 studies (646 individuals in the creatine supplementation group and 651 controls). At T1, the effect size (ES) among stratification for squat and leg press were, respectively, 0.336 (95 % CI 0.047–0.625, p = 0.023) and 0.297 (95 % CI 0.098–0.496, p = 0.003). Overall quadriceps ES was 0.266 (95 % CI 0.150–0.381, p < 0.001). Global lower limb ES was 0.235 (95 % CI 0.125–0.346, p < 0.001). Meta-analysis on changes between T0 and T1 gave similar results. The meta-regression showed no links with characteristics of population or of supplementation, demonstrating the creatine efficacy effects, independent of all listed conditions.

Conclusion

Creatine supplementation is effective in lower limb strength performance for exercise with a duration of less than 3 min, independent of population characteristic, training protocols, and supplementary doses and duration.

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References

  1. Tscholl P, Alonso JM, Dolle G, et al. The use of drugs and nutritional supplements in top-level track and field athletes. Am J Sports Med. 2010;38(1):133–40.

    Article  PubMed  Google Scholar 

  2. Dempsey RL, Mazzone MF, Meurer LN. Does oral creatine supplementation improve strength? A meta-analysis. J Fam Pract. 2002;51(11):945–51.

    PubMed  Google Scholar 

  3. Nissen SL, Sharp RL. Effect of dietary supplements on lean mass and strength gains with resistance exercise: a meta-analysis. J Appl Physiol (1985). 2003;94(2):651–9.

    Article  CAS  Google Scholar 

  4. Branch JD. Effect of creatine supplementation on body composition and performance: a meta-analysis. Int J Sport Nutr Exerc Metab. 2003;13(2):198–226.

    CAS  PubMed  Google Scholar 

  5. Gastin PB. Energy system interaction and relative contribution during maximal exercise. Sports Med. 2001;31(10):725–41.

    Article  CAS  PubMed  Google Scholar 

  6. Pollo A, Carlino E, Benedetti F. Placebo mechanisms across different conditions: from the clinical setting to physical performance. Philos Trans R Soc Lond B Biol Sci. 2011;366(1572):1790–8.

    Article  PubMed Central  PubMed  Google Scholar 

  7. Begg C, Cho M, Eastwood S, et al. Improving the quality of reporting of randomized controlled trials. The CONSORT statement. JAMA. 1996;276(8):637–9.

    Article  CAS  PubMed  Google Scholar 

  8. DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7(3):177–88.

    Article  CAS  PubMed  Google Scholar 

  9. Citrome L, Magnusson K. Paging Dr Cohen, Paging Dr Cohen…an effect size interpretation is required STAT!: visualising effect size and an interview with Kristoffer Magnusson. Int J Clin Pract. 2014;68(5):533–4.

    Article  CAS  PubMed  Google Scholar 

  10. Ayoama R, Hiruma E, Sasaki H. Effects of creatine loading on muscular strength and endurance of female softball players. J Sports Med Phys Fit. 2003;43(4):481–7.

    CAS  Google Scholar 

  11. Azizi M. The effect of a short-term creatine supplementation on some of the anaerobic performance and sprint swimming records of female competitive swimmers. Procedia Soc Behav Sci. 2011;15:1626–9.

    Article  Google Scholar 

  12. Brenner M, Walberg Rankin J, Sebolt D. The effect of creatine supplementation during resistance training in women. J Strength Cond Res. 2000;14(2):207–13.

    Google Scholar 

  13. Ferguson TB, Syrotuik DG. Effects of creatine monohydrate supplementation on body composition and strength indices in experienced resistance trained women. J Strength Cond Res. 2006;20(4):939–46.

    PubMed  Google Scholar 

  14. Kambis KW, Pizzedaz SK. Short-term creatine supplementation improves maximum quadriceps contraction in women. Int J Sport Nutr Exerc Metab. 2003;13(1):87–96.

    CAS  PubMed  Google Scholar 

  15. Larson-Meyer DE, Hunter GR, Trowbridge CA, et al. The effect of creatine supplementation on muscle strength and body composition during off-season training in female soccer players. J Strength Cond Res. 2000;14(4):434–42.

    Google Scholar 

  16. Vandenberghe K, Goris M, Van Hecke P, et al. Long-term creatine intake is beneficial to muscle performance during resistance training. J Appl Physiol. 1985;83(6):2055–63.

    Google Scholar 

  17. Burke DG, Silver S, Holt LE, et al. The effect of continuous low dose creatine supplementation on force, power, and total work. Int J Sport Nutr Exerc Metab. 2000;10(3):235–44.

    CAS  PubMed  Google Scholar 

  18. Burke DG, Chilibeck PD, Parise G, et al. Effect of creatine and weight training on muscle creatine and performance in vegetarians. Med Sci Sports Exerc. 2003;35(11):1946–55.

    Article  CAS  PubMed  Google Scholar 

  19. Bermon S, Venembre P, Sachet C, et al. Effects of creatine monohydrate ingestion in sedentary and weight-trained older adults. Acta Physiol Scand. 1998;164(2):147–55.

    Article  CAS  PubMed  Google Scholar 

  20. Juhasz I, Gyore I, Csende Z, et al. Creatine supplementation improves the anaerobic performance of elite junior fin swimmers. Acta Physiol Hung. 2009;96(3):325–36.

    Article  CAS  PubMed  Google Scholar 

  21. Brose A, Parise G, Tarnopolsky MA. Creatine supplementation enhances isometric strength and body composition improvements following strength exercise training in older adults. J Gerontol A Biol Sci Med Sci. 2003;58(1):11–9.

    Article  PubMed  Google Scholar 

  22. Candow DG, Little JP, Chilibeck PD, et al. Low-dose creatine combined with protein during resistance training in older men. Med Sci Sports Exerc. 2008;40(9):1645–52.

    Article  CAS  PubMed  Google Scholar 

  23. Gotshalk LA, Volek JS, Staron RS, et al. Creatine supplementation improves muscular performance in older men. Med Sci Sports Exerc. 2002;34(3):537–43.

    Article  CAS  PubMed  Google Scholar 

  24. Rawson ES, Wehnert ML, Clarkson PM. Effects of 30 days of creatine ingestion in older men. Eur J Appl Physiol Occup Physiol. 1999;80(2):139–44.

    Article  CAS  PubMed  Google Scholar 

  25. Stout J, Eckerson J, Noonan D, et al. Effects of 8 weeks of creatine supplementation on exercise performance and fat-free weight in football players during training. Nutr Res. 1999;19(2):217–25.

    Article  CAS  Google Scholar 

  26. Camic CL, Housh TJ, Zuniga JM, et al. The effects of polyethylene glycosylated creatine supplementation on anaerobic performance measures and body composition. J Strength Cond Res. 2014;28(3):825–33.

    Article  PubMed  Google Scholar 

  27. Van Schuylenbergh R, Van Leemputte M, Hespel P. Effects of oral creatine-pyruvate supplementation in cycling performance. Int J Sports Med. 2003;24(2):144–50.

    Article  PubMed  Google Scholar 

  28. Gilliam JD, Hohzorn C, Martin D, et al. Effect of oral creatine supplementation on isokinetic torque production. Med Sci Sports Exerc. 2000;32(5):993–6.

    Article  CAS  PubMed  Google Scholar 

  29. Preen D, Dawson B, Goodman C, et al. Effect of creatine loading on long-term sprint exercise performance and metabolism. Med Sci Sports Exerc. 2001;33(5):814–21.

    Article  CAS  PubMed  Google Scholar 

  30. Havenetidis K, Bourdas D. Creatine supplementation: effects on urinary excretion and anaerobic performance. J Sports Med Phys Fitness. 2003;43(3):347–55.

    CAS  PubMed  Google Scholar 

  31. Kirksey B, Stone MH, Warren BJ, et al. The effects of 6 weeks of creatine monohydrate supplementation on performance measures and body composition in collegiate track and field athletes. J Strength Cond Res. 1999;13(2):148–56.

    Google Scholar 

  32. Burke LM, Pyne DB, Telford RD. Effect of oral creatine supplementation on single-effort sprint performance in elite swimmers. Int J Sport Nutr. 1996;6(3):222–33.

    CAS  PubMed  Google Scholar 

  33. Cornish SM, Chilibeck PD, Burke DG. The effect of creatine monohydrate supplementation on sprint skating in ice-hockey players. J Sports Med Phys Fit. 2006;46(1):90–8.

    CAS  Google Scholar 

  34. Greenhaff PL, Casey A, Short AH, et al. Influence of oral creatine supplementation of muscle torque during repeated bouts of maximal voluntary exercise in man. Clin Sci (Lond). 1993;84(5):565–71.

    Article  CAS  PubMed  Google Scholar 

  35. Izquierdo M, Ibanez J, Gonzalez-Badillo JJ, et al. Effects of creatine supplementation on muscle power, endurance, and sprint performance. Med Sci Sports Exerc. 2002;34(2):332–43.

    Article  CAS  PubMed  Google Scholar 

  36. Javierre C, Barbany JR, Bonjorn VM, et al. Creatine supplementation and performance in 6 consecutive 60 meter sprints. J Physiol Biochem. 2004;60(4):265–71.

    Article  CAS  PubMed  Google Scholar 

  37. Law YL, Ong WS, GillianYap TL, et al. Effects of two and five days of creatine loading on muscular strength and anaerobic power in trained athletes. J Strength Cond Res. 2009;23(3):906–14.

    Article  PubMed  Google Scholar 

  38. Oopik V, Paasuke M, Timpmann S, et al. Effects of creatine supplementation during recovery from rapid body mass reduction on metabolism and muscle performance capacity in well-trained wrestlers. J Sports Med Phys Fitness. 2002;42(3):330–9.

    CAS  PubMed  Google Scholar 

  39. Syrotuik DG, Bell GJ, Burnham R, et al. Absolute and relative strength performance following creatine monohydrate supplementation combined with periodized resistance training. J Strength Cond Res. 2000;14(2):182–90.

    Google Scholar 

  40. Green JM, McLester JR, Smith JE, et al. The effects of creatine supplementation on repeated upper- and lower-body Wingate performance. J Strength Cond Res. 2001;15(1):36–41.

    CAS  PubMed  Google Scholar 

  41. Oopik V, Paasuke M, Timpmann S, et al. Effect of creatine supplementation during rapid body mass reduction on metabolism and isokinetic muscle performance capacity. Eur J Appl Physiol Occup Physiol. 1998;78(1):83–92.

    Article  CAS  PubMed  Google Scholar 

  42. Ostojic SM. Creatine supplementation in young soccer players. Int J Sport Nutr Exerc Metab. 2004;14(1):95–103.

    CAS  PubMed  Google Scholar 

  43. Syrotuik DG, Game AB, Gillies EM, et al. Effects of creatine monohydrate supplementation during combined strength and high intensity rowing training on performance. Can J Appl Physiol. 2001;26(6):527–42.

    Article  CAS  PubMed  Google Scholar 

  44. Wilder N, Gilders R, Hagerman F, et al. The effects of a 10-week, periodized, off-season resistance-training program and creatine supplementation among collegiate football players. J Strength Cond Res. 2002;16(3):343–52.

    PubMed  Google Scholar 

  45. Hutton J, Cochrane T. Influence of creatine supplementation on performance in sprint athletes. Sports Exerc Injury. 1998;4(4):199–203.

    Google Scholar 

  46. Aguiar AF, Januario RSB, Junior RP, et al. Long-term creatine supplementation improves muscular performance during resistance training in older women. Eur J Appl Physiol. 2013;113(4):987–96.

    Article  CAS  PubMed  Google Scholar 

  47. Bemben MG, Witten MS, Carter JM, et al. The effects of supplementation with creatine and protein on muscle strength following a traditional resistance training program in middle-aged and older men. J Nutr Health Aging. 2010;14(2):155–9.

    Article  CAS  PubMed  Google Scholar 

  48. Candow DG, Chilibeck PD, Chad KE, et al. Effect of ceasing creatine supplementation while maintaining resistance training in older men. J Aging Phys Act. 2004;12(3):219–31.

    PubMed  Google Scholar 

  49. Lamontagne-Lacasse M, Nadon R, Goulet ED. Effect of creatine supplementation on jumping performance in elite volleyball players. Int J Sports Physiol Perform. 2011;6(4):525–33.

    PubMed  Google Scholar 

  50. Rawson ES, Stec MJ, Frederickson SJ, et al. Acute creatine supplementation in older men. Nutrition. 2011;27(4):451–5.

    Article  CAS  PubMed  Google Scholar 

  51. Rawson ES, Volek JS. Effects of creatine supplementation and resistance training on muscle strength and weightlifting performance. J Strength Cond Res. 2003;17(4):822–31.

    PubMed  Google Scholar 

  52. Chilibeck PD, Stride D, Farthing JP, et al. Effect of creatine ingestion after exercise on muscle thickness in males and females. Med Sci Sports Exerc. 2004;36(10):1781–8.

    Article  CAS  PubMed  Google Scholar 

  53. Herda TJ, Beck TW, Ryan ED, et al. Effects of creatine monohydrate and polyethylene glycosylated creatine supplementation on muscular strength, endurance, and power output. J Strength Cond Res. 2009;23(3):818–26.

    Article  PubMed  Google Scholar 

  54. Fukuda DH, Smith AE, Kendall KL, et al. The possible combinatory effects of acute consumption of caffeine, creatine, and amino acids on the improvement of anaerobic running performance in humans. Nutr Res. 2010;30(9):607–14.

    Article  CAS  PubMed  Google Scholar 

  55. Kerksick CM, Wilborn CD, Campbell WI, et al. The effects of creatine monohydrate supplementation with and without d-pinitol on resistance training adaptations. J Strength Cond Res. 2009;23(9):2673–82.

    Article  PubMed  Google Scholar 

  56. O’Connor DM, Crowe MJ. Effects of six weeks of beta-hydroxy-beta-methylbutyrate (HMB) and HMB/creatine supplementation on strength, power, and anthropometry of highly trained athletes. J Strength Cond Res. 2007;21(2):419–23.

    PubMed  Google Scholar 

  57. Birch R, Noble D, Greenhaff PL. The influence of dietary creatine supplementation on performance during repeated bouts of maximal isokinetic cycling in man. Eur J Appl Physiol Occup Physiol. 1994;69(3):268–76.

    Article  CAS  PubMed  Google Scholar 

  58. Chilibeck PD, Magnus C, Anderson M. Effect of in-season creatine supplementation on body composition and performance in rugby union football players. Appl Physiol Nutr Metab. 2007;32(6):1052–7.

    Article  PubMed  Google Scholar 

  59. Mujika I, Padilla S, Ibanez J, et al. Creatine supplementation and sprint performance in soccer players. Med Sci Sports Exerc. 2000;32(2):518–25.

    Article  CAS  PubMed  Google Scholar 

  60. Pluim BM, Ferrauti A, Broekhof F, et al. The effects of creatine supplementation on selected factors of tennis specific training. Br J Sports Med. 2006;40(6):507–11 (discussion 511–502).

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  61. Stone MH, Sanborn K, Smith LL, et al. Effects of in-season (5 weeks) creatine and pyruvate supplementation on anaerobic performance and body composition in American football players. Int J Sport Nutr. 1999;9(2):146–65.

    CAS  PubMed  Google Scholar 

  62. Zuniga JM, Housh TJ, Camic CL, et al. The effects of creatine monohydrate loading on anaerobic performance and one-repetition maximum strength. J Strength Cond Res. 2012;26(6):1651–6.

    PubMed  Google Scholar 

  63. LeLorier J, Gregoire G, Benhaddad A, et al. Discrepancies between meta-analyses and subsequent large randomized, controlled trials. N Engl J Med. 1997;337(8):536–42.

    Article  CAS  PubMed  Google Scholar 

  64. Bogdanis GC, Nevill ME, Lakomy HKA, et al. The effects of oral creatine supplementation on power output during repeated treadmill sprinting. J Sports Sci. 1996;14(1):65–6.

    Google Scholar 

  65. Urbanski RL, Vincent WJ, Yaspelkis BB 3rd. Creatine supplementation differentially affects maximal isometric strength and time to fatigue in large and small muscle groups. Int J Sport Nutr. 1999;9(2):136–45.

    CAS  PubMed  Google Scholar 

  66. Gualano B, Macedo AR, Alves CR, et al. Creatine supplementation and resistance training in vulnerable older women: a randomized double-blind placebo-controlled clinical trial. Exp Gerontol. 2014;53:7–15.

    Article  CAS  PubMed  Google Scholar 

  67. Miura A, Kino F, Kajitani S, et al. The effect of oral creatine supplementation on the curvature constant parameter of the power-duration curve for cycle ergometry in humans. Jpn J Physiol. 1999;49(2):169–74.

    Article  CAS  PubMed  Google Scholar 

  68. Demant TW, Rhodes EC. Effects of creatine supplementation on exercise performance. Sports Med. 1999;28(1):49–60.

    Article  CAS  PubMed  Google Scholar 

  69. Harris RC, Soderlund K, Hultman E. Elevation of creatine in resting and exercised muscle of normal subjects by creatine supplementation. Clin Sci. 1992;83(3):367–74.

    Article  CAS  PubMed  Google Scholar 

  70. Green AL, Hultman E, Macdonald IA, et al. Carbohydrate ingestion augments skeletal muscle creatine accumulation during creatine supplementation in humans. Am J Physiol. 1996;271(5 Pt 1):E821–6.

    CAS  PubMed  Google Scholar 

  71. Casey A, Constantin-Teodosiu D, Howell S, et al. Creatine ingestion favorably affects performance and muscle metabolism during maximal exercise in humans. Am J Physiol. 1996;271(1):E31–7.

    CAS  PubMed  Google Scholar 

  72. Greenhaff PL, Bodin K, Soderlund K, et al. Effect of oral creatine supplementation on skeletal muscle phosphocreatine resynthesis. Am J Physiol. 1994;266(5 Pt 1):E725–30.

    CAS  PubMed  Google Scholar 

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Acknowledgments

Frédéric Dutheil contributed to the conception and design. Charlotte Lanhers conducted all literature searches and collated the abstracts. Charlotte Lanhers and Frédéric Dutheil separately reviewed the abstracts and, based on the selection criteria, decided the suitability of the articles for inclusion. All authors then reviewed the eligible articles. Bruno Pereira performed the statistical analysis. Charlotte Lanhers drafted the manuscript. Frédéric Dutheil and Geraldine Naughton revised the manuscript. All authors read and approved the final manuscript. The authors declare no conflict of interest. No sources of funding were used to assist in the preparation of this systematic review.

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Authors and Affiliations

  1. School of Exercise Science, Australian Catholic University, Melbourne, VIC, Australia

    Geraldine Naughton & Frédéric Dutheil

  2. Preventive and Occupational Medicine, University Hospital of Clermont-Ferrand (CHU), 58 rue Montalembert, Clermont-Ferrand, France

    Charlotte Lanhers & Frédéric Dutheil

  3. Clinical research and innovation direction, University Hospital of Clermont-Ferrand (CHU), Clermont-Ferrand, France

    Bruno Pereira

  4. Neurophysiology of stress, Armies’ Biomedical Research Institute, Armies’ Health Service, Bretigny sur Orge, France

    Marion Trousselard

  5. Occupational Medicine, University Hospital CHU, Montpellier, France

    François-Xavier Lesage

  6. Laboratory of Metabolic Adaptations to Exercise in Physiological and Pathological Conditions EA3533, Blaise Pascal University, Clermont-Ferrand, France

    Frédéric Dutheil

  7. Research Centre in Human Nutrition (CRNH) Auvergne, Clermont-Ferrand, France

    Frédéric Dutheil

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  1. Charlotte Lanhers
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Correspondence to Frédéric Dutheil.

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Lanhers, C., Pereira, B., Naughton, G. et al. Creatine Supplementation and Lower Limb Strength Performance: A Systematic Review and Meta-Analyses. Sports Med 45, 1285–1294 (2015). https://doi.org/10.1007/s40279-015-0337-4

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