The Effect of Creatine Supplementation on Markers of Exercise-Induced Muscle Damage: A Systematic Review and Meta-Analysis of Human Intervention Trials

Int J Sport Nutr Exerc Metab. 2021 May 1;31(3):276-291. doi: 10.1123/ijsnem.2020-0282. Epub 2021 Feb 24.

Abstract

This systematic review and meta-analysis examined the effects of creatine supplementation on recovery from exercise-induced muscle damage, and is reported according to the PRISMA guidelines. MEDLINE and SPORTDiscus were searched for articles from inception until April 2020. Inclusion criteria were adult participants (≥18 years); creatine provided before and/or after exercise versus a noncreatine comparator; measurement of muscle function recovery, muscle soreness, inflammation, myocellular protein efflux, oxidative stress; range of motion; randomized controlled trials in humans. Thirteen studies (totaling 278 participants; 235 males and 43 females; age range 20-60 years) were deemed eligible for analysis. Data extraction was performed independently by both authors. The Cochrane Collaboration Risk of Bias Tool was used to critically appraise the studies; forest plots were generated with random-effects model and standardized mean differences. Creatine supplementation did not alter muscle strength, muscle soreness, range of motion, or inflammation at each of the five follow-up times after exercise (<30 min, 24, 48, 72, and 96 hr; p > .05). Creatine attenuated creatine kinase activity at 48-hr postexercise (standardized mean difference: -1.06; 95% confidence interval [-1.97, -0.14]; p = .02) but at no other time points. High (I2; >75%) and significant (Chi2; p < .01) heterogeneity was identified for all outcome measures at various follow-up times. In conclusion, creatine supplementation does not accelerate recovery following exercise-induced muscle damage; however, well-controlled studies with higher sample sizes are warranted to verify these conclusions. Systematic review registration (PROSPERO CRD42020178735).

Keywords: antioxidants; exercise recovery; nutrition; oxidative stress; phosphocreatine.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Adult
  • Biomarkers
  • Chi-Square Distribution
  • Confidence Intervals
  • Creatine / administration & dosage
  • Creatine / pharmacology*
  • Creatine Kinase / metabolism
  • Dietary Supplements*
  • Exercise*
  • Female
  • Humans
  • L-Lactate Dehydrogenase / metabolism
  • Male
  • Middle Aged
  • Muscle Proteins / metabolism
  • Muscle Strength / drug effects
  • Myalgia / etiology
  • Myalgia / prevention & control
  • Myositis
  • Oxidative Stress / drug effects
  • Performance-Enhancing Substances / administration & dosage
  • Performance-Enhancing Substances / pharmacology*
  • Publication Bias
  • Randomized Controlled Trials as Topic
  • Range of Motion, Articular / drug effects
  • Range of Motion, Articular / physiology
  • Recovery of Function / drug effects
  • Time Factors
  • Young Adult

Substances

  • Biomarkers
  • Muscle Proteins
  • Performance-Enhancing Substances
  • L-Lactate Dehydrogenase
  • Creatine Kinase
  • Creatine