Creatine supplementation effect on recovery following exercise-induced muscle damage: a systematic review and meta-analysis of randomized controlled trials.

Jiaming Y and Rahimi MH., J Food Biochem. 2021, [epub ahead of print].

Take-Home Message

Creatine supplementation (especially >20g/day) may reduce muscle damage 2 to 4 days after strenuous exercise.


Creatine monohydrate is a common supplement taken to decrease recovery time. Despite numerous clinical trials, we lack a consensus in the literature about whether creatine supplementation effectively reduces recovery time after exercise-induced muscle damage. A meta-analysis of clinical trials may help clarify if create supplementation affects recovery.

Study Goal

Jiaming and colleagues performed a meta-analysis to evaluate the effect of creatine supplementation on recovery after exercise-induced muscle damage.


The researchers completed a comprehensive literature search and identified 823 potential studies. They included studies if the randomized clinical trials included healthy participants who received oral creatine supplementation, reported at least 1 measurement of muscle damage, and included muscle damage indices in both intervention and placebo groups. Study quality was assessed using the Cochrane Collaboration Tool and NutriGrade Scoring System


The researchers found 9 clinical trials published between 1998 and 2018. The creatine dose ranged from 2 to 40g/day, and follow-up lasted 5 to 56 days. Five studies measured the effect of creatine on creatine kinase and lactate dehydrogenase concentrations (indices of muscle damage). In the other 4 trials, the original authors reported only creatine kinase concentrations. Overall, creatine supplementation affected creatine kinase concentration but not lactate dehydrogenase. The effect on creatine kinase was most pronounced 48, 72, or 96 hours after exercise; among untrained participants; and with a dose > 20g/day. The authors reported that these trials had a medium risk of bias and lots of variability. The findings had a moderate confidence at best, which would suggest that more well-designed clinical trials are needed.


This study provides evidence that creatine supplementation may be beneficial in reducing the recovery time of exercise-induced muscle damage. However, the authors recommend that more high-quality randomized controlled trials are needed before more definitive statements can be made. In particular, it may be helpful if future trials assessed how different doses affect recovery with objective measures (e.g., creatine kinase) and patient-reported outcomes.

Clinical Implications

This study suggests that supplementation of creatine may help mitigate muscle damage caused by intense exercise. However, it remains unclear how to optimize the dose, duration, and timing of supplementation.

Questions for Discussion

What experiences do you have with creatine supplementation?

Written by: Kyle Harris
Reviewed by: Jeffrey Driban

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