Creatine Supplementation and Exercise Performance

Sep 2

4 min read

Creatine is the one supplement almost nobody in sports science argues about any more. The question worth asking is not whether it works, but how much it works, on which measures, and for whom. Two large meta-analyses answered the first part a decade ago. A 2026 pooled analysis of 37 trials has since sharpened the picture on lean mass and power.

The evidence

Lanhers and colleagues ran two separate systematic reviews of randomised, placebo-controlled trials in which creatine was tested on strength exercises lasting under three minutes. The lower-limb review (2015) pooled 60 studies with 1,297 participants; the upper-limb review (2017) pooled 53 studies with 1,138 participants. Both used meta-regression to check whether age, sex, training status, dose or supplementation length changed the result. Cooper and colleagues (2012) summarised the earlier evidence and the dosing protocols the trials actually used.

What happened

Lower body: creatine beat placebo with a global effect size of 0.24 (95% CI 0.13 to 0.35). Squat: ES 0.34 (0.05 to 0.63). Leg press: ES 0.30 (0.10 to 0.50).
Upper body: global effect size 0.32 (95% CI 0.19 to 0.45). Bench press: ES 0.27 (0.13 to 0.40). Chest press: ES 0.68 (0.15 to 1.21), with a wide interval from fewer studies.
Who it worked for: in both reviews, meta-regression found no relationship between the effect and population characteristics, dose or duration - the small benefit appeared across the board.
Older pooled estimates quoted by Cooper and colleagues put the 1RM advantage over placebo at roughly 8%, and the repetitions-to-fatigue effect at ES 0.64 (a 45% gain versus 23% on placebo).
Dosing used in trials: a loading phase of 20 g/day (four 5 g doses) for 5 to 7 days followed by 3 to 5 g/day, or a no-load protocol of 3 to 6 g/day reaching muscle saturation in roughly 3 to 4 weeks.

The current answer

Gu and colleagues (2026) pooled 37 randomised trials in healthy men aged 18 to 30, from untrained to elite, and split them by whether participants also lifted. With resistance training, creatine added 3.39 kg of fat-free mass (95% CI 1.77 to 5.02) and 2.70 kg of lean body mass (1.56 to 3.85) over placebo; without resistance training the lean-mass effect vanished (-0.89 kg, 95% CI -3.94 to 2.15). Squat 1RM rose 9.58 kg more than placebo in lifters (4.47 to 14.70), Wingate peak power by 71 W (38 to 104), and countermovement jump by 2.7 cm (0.18 to 5.21). Leg press did not reach significance (+3.58 kg, -7.85 to 15.01).

Zhang and colleagues (2025) pooled 14 trials (n = 523, age 19 to 69) for strength alone: overall SMD 0.43 (95% CI 0.25 to 0.61). The gap between untrained (SMD 1.06, 0.67 to 1.45) and trained lifters (SMD 0.32, 0.00 to 0.63) was significant. Ashtary-Larky and colleagues (2025), across 61 controlled trials, found creatine added 0.89 kg of body mass (0.76 to 1.01) and 1.39 kg of fat-free mass (1.07 to 1.70) with no change in fat mass.

How certain is this?

Certainty: high that creatine produces a small, real improvement in short, high-intensity strength work; moderate for the size of the lean-mass gain, because the 2026 analysis rests on 12 trials per outcome and has some heterogeneity. Risk of bias in the newest review was low in two-thirds of trials.

Who this covers: overwhelmingly young men. The Lanhers reviews included mixed-sex samples and found no sex effect, but dedicated female trials remain few, and the 2026 analysis is male-only by design. The effect plausibly transfers to trained women; the magnitude in that group is not well measured.

What would change our mind: a large, placebo-controlled trial in resistance-trained women over 12 or more weeks with MRI-measured muscle. If it showed no lean-mass or strength effect, the population claim would narrow.

Creatine gives a small, consistent edge - a few kilograms on a heavy lift, two to three kilograms of lean mass with training - and the effect is larger the less trained you are.

What this means in practice

Effect size 0.3 is small. On a 100 kg squat that is a few kilograms, not a new athlete. Treat it as a margin, not a transformation.
It only builds lean mass alongside lifting. In the 2026 analysis, creatine without resistance training did nothing for fat-free mass.
Expect early scale weight. Trials consistently show roughly 1 kg of body mass in the first weeks, largely water held in muscle - relevant for anyone managing a weight class.
Trials used two protocols: 20 g/day for 5 to 7 days then 3 to 5 g/day, or a steady 3 to 5 g/day reaching the same saturation in about a month. Meta-regression found no dose effect on the outcome.
Beginners gain the most. Untrained lifters showed roughly three times the standardised effect of trained lifters in the 2025 analysis.
Power matters too. The 2026 pooled Wingate and jump data suggest creatine helps repeated sprint and explosive work, not just 1RM.

Want this applied to your own programme, your sport and your numbers? Book a Private Consultation - a 60-minute direction session with Coach Ohana.

References

Lanhers C, Pereira B, Naughton G, Trousselard M, Lesage FX, Dutheil F. Creatine supplementation and lower limb strength performance: a systematic review and meta-analyses. Sports Med. 2015;45(9):1285-1294. doi:10.1007/s40279-015-0337-4

Lanhers C, Pereira B, Naughton G, Trousselard M, Lesage FX, Dutheil F. Creatine supplementation and upper limb strength performance: a systematic review and meta-analysis. Sports Med. 2017;47(1):163-173. doi:10.1007/s40279-016-0571-4

Cooper R, Naclerio F, Allgrove J, Jimenez A. Creatine supplementation with specific view to exercise/sports performance: an update. J Int Soc Sports Nutr. 2012;9(1):33. doi:10.1186/1550-2783-9-33

Gu J, Li Y, Xiao J, Zhang Y. Creatine supplementation in young men under resistance versus non-resistance training: a systematic review and meta-analysis of strength, performance, and lean mass. Front Nutr. 2026;13:1800546. doi:10.3389/fnut.2026.1800546

Zhang et al. Effects of creatine supplementation on muscle strength gains: a meta-analysis and systematic review. PeerJ. 2025;13:e20380. doi:10.7717/peerj.20380

Ashtary-Larky D, Mohammadi S, Hajizadeh L, Mousavi SAH, Forbes SC, Candow DG, Antonio J. Creatine supplementation and resistance training: a comparison between novice and experienced lifters - a systematic review and dose-response meta-analysis. J Int Soc Sports Nutr. 2025;22(sup1):2586523. doi:10.1080/15502783.2025.2586523

Rawson ES, Miles MP, Larson-Meyer DE. Dietary supplements for health, adaptation, and recovery in athletes. Int J Sport Nutr Exerc Metab. 2018;28(2):188-199. doi:10.1123/ijsnem.2017-0340

Last reviewed: 2 September 2026. Re-review on the next creatine meta-analysis or by September 2028.