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Effects of creatine supplementation on muscle strength gains—a meta-analysis and systematic review

Haoda Zhang, Tian Lan, Xueru Yan, Haoran Gu, Yanhong Li, Enpeng He
PeerJ 2025 Volume 13, article e20380

Bibliography

PubMed
PMID 41328071
PubMed Central
PMC12665265
DOI
10.7717/peerj.20380
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Watch on YouTube Biohack Blueprint's video walkthrough of this study.
Funding
The Research Startup Fund for Outstanding Young Teachers of Xinjiang Normal University (Grant No. XJNU202211).
Competing interests
The authors declare there are no competing interests.

Study snapshot

DesignMeta-analysis and systematic review utilizing conventional and Robust Variance Estimation (RVE) models.
ModelHuman subjects across varying age groups (young and middle-aged/elderly) and training levels (trained and untrained).
Sample14 included studies encompassing 523 participants (259 in the creatine group and 264 in the control group).
InterventionExogenous creatine powder supplementation compared to a visually and gustatorily similar placebo.
DurationIntervention periods ranged from 4 weeks to 12 months across the included studies.
EndpointsMuscle strength changes evaluated through leg press (LP), squat (SQ), and bench press (BP) maximums in kilograms.

What the study showed, in plain terms

Creatine is a widely used nutritional supplement that facilitates energy production for muscle contraction. This study combined data from 14 trials involving 523 participants to evaluate how creatine improves muscle strength compared to a placebo.

The researchers found that creatine supplementation significantly improved overall muscle strength. Interestingly, individuals who were untrained experienced substantially greater strength gains than those who were already engaged in structured training. Furthermore, taking a lower dose of creatine (under 10 grams per day) was actually more effective for strength gains than taking higher doses (over 15 grams per day).

The analysis also showed that combining creatine with moderate-to-high intensity training yielded better strength results than lower-intensity workouts. However, the available data could not definitively prove whether middle-aged and elderly adults benefit differently from creatine compared to younger populations, indicating a need for more targeted research.

Key findings

  • Creatine supplementation produced a highly significant improvement in post-intervention muscle strength compared to a placebo control (SMD = 0.43, 95% CI: 0.25 to 0.61; P < 0.01).
  • Untrained individuals experienced greater muscle strength gains (SMD = 1.06) than trained populations (SMD = 0.32).
  • Low-dose creatine supplementation (2.5–7.56 g/d) resulted in highly significant strength enhancements (SMD = 0.88) compared to high-dose regimens (19.5–23.55 g/d), which did not show significant differences from placebo (SMD = 0.24).
  • Moderate-to-high intensity training (>75% 1RM) combined with creatine produced significant strength gains (SMD = 0.62), whereas moderate-to-low intensity training did not reach statistical significance.

What this study can and cannot tell us

The meta-analysis is limited by potential design flaws, missing outcome data, and publication biases inherent in the 14 original included studies. Additionally, there was a significant gender bias, resulting in a lack of female participants available for analysis.

High heterogeneity was observed within certain subgroups, specifically the low-dose supplementation group and older adults, suggesting significant individual variability in how people respond to creatine.

Finally, the meta-analysis failed to reach a definitive conclusion regarding the difference in creatine's efficacy between middle-aged/elderly populations and young populations, indicating a need for larger-sample studies to draw clear age-stratified conclusions.

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Dr. Khaled Mahmoud, MBBChCritical Care Medicine, Longevity Science & Editorial Direction Dr. Amr Yasser, PhDCardiometabolic, Musculoskeletal, Gut & Bioavailability Dr. Abdulla Mostafa, PhDCellular Senescence, Neurological, Mitochondrial & Brain-Ageing Biology