The Effects of Creatine Supplementation Combined with Resistance Training on Regional Measures of Muscle Hypertrophy: A Systematic Review with Meta-Analysis

Abstract

The purpose of this paper was to carry out a systematic review with a meta-analysis of randomized controlled trials that examined the combined effects of resistance training (RT) and creatine supplementation on regional changes in muscle mass, with direct imaging measures of hypertrophy. Moreover, we performed regression analyses to determine the potential influence of covariates. We included trials that had a duration of at least 6 weeks and examined the combined effects of creatine supplementation and RT on site-specific direct measures of hypertrophy (magnetic resonance imaging (MRI), computed tomography (CT), or ultrasound) in healthy adults. A total of 44 outcomes were analyzed across 10 studies that met the inclusion criteria. A univariate analysis of all the standardized outcomes showed a pooled mean estimate of 0.11 (95% Credible Interval (CrI): −0.02 to 0.25), providing evidence for a very small effect favoring creatine supplementation when combined with RT compared to RT and a placebo. Multivariate analyses found similar small benefits for the combination of creatine supplementation and RT on changes in the upper and lower body muscle thickness (0.10–0.16 cm). Analyses of the moderating effects indicated a small superior benefit for creatine supplementation in younger compared to older adults (0.17 (95%CrI: −0.09 to 0.45)). In conclusion, the results suggest that creatine supplementation combined with RT promotes a small increase in the direct measures of skeletal muscle hypertrophy in both the upper and lower body.

Impact of Short-Term Creatine Supplementation on Muscular Performance among Breast Cancer Survivors

“…As an extension of the above, it is well understood that the ergogenic effects of creatine supplementation on muscular performance are most potent when combined with resistance training and consumed chronically [64,65]. For example, the results of a recent metaanalysis indicated that creatine supplementation resulted in great increases in lean tissue mass, leg press strength, and chest press strength during resistance training compared to resistance training alone in older adults [66].…”

Resistance Exercise and Creatine Supplementation on Fat Mass in Adults < 50 Years of Age: A Systematic Review and Meta-Analysis

“…For example, several meta-analyses have been performed collectively showing that the combination of creatine supplementation and resistance exercise increases measures of whole-body lean tissue mass by ~1.37 kg (as measured by dual-energy X-ray absorptiometry, air-displacement plethysmography, hydrodensitometry, and bioelectrical impedance analysis) compared to placebo and resistance exercise [28][29][30][31][32]. Furthermore, Burke et al [33] performed a systematic review and meta-analysis involving 10 studies and found significant improvements in direct measures of limb muscle hypertrophy (0.10-0.16 cm; as measured using ultrasound and peripheral quantitative computed tomography {pQCT}) in the upper-and lower-body from creatine supplementation and resistance exercise compared to resistance exercise and placebo. Interestingly, the lone study that used pQCT showed that creatine supplementation (52 weeks) increased lower-limb muscle density (∆ + 0.83 ± 1.15 mg•cm −3 ; p = 0.016) compared to placebo (∆ −0.16 ± 1.56 mg•cm −3 ).…”

Creatine supplementation protocols with or without training interventions on body composition: a GRADE-assessed systematic review and dose-response meta-analysis

“…However, due to the limited number of included studies that used BIA as body composition measurement tools (8 of 143 studies) or provided body water data, more studies are needed to confirm body water retention changes following creatine supplementation. A recent systematic review and meta-analysis involving 10 studies showed that the combination of creatine supplementation and resistance training increased regional measures of muscle accretion (0.10 to 0.16 cm; as measured using ultrasound and peripheral quantitative computed tomography) compared to placebo [ 23 ]. Mechanistically, greater fat-free mass from creatine is likely related to its ability to increase high-energy phosphate, glycogen, calcium, and protein kinetics, stimulation of satellite cells and growth factors, or by decreasing inflammation and oxidative stress over time [ 2 , 179 ].…”

“…To date, two meta-analyses have been performed showing that the combination of creatine supplementation and resistance training results in very small reductions in body fat percentage compared to resistance training alone [ 21 , 22 ]. Lastly, there is evidence that sex [ 12 ] and age [ 23 ] differences may exist regarding muscle changes over time, however, the effects on other indices of body composition are unknown. Collectively, this study aimed to systematically review randomized controlled trials (RCTs) evaluating the effects of creatine supplementation on body composition and to determine if the dosing protocol, exercise type, or alternative forms of creatine, as well as sex and age, influence the results.…”