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Background: Creatine supplementation (CS) has been reported to increase body mass and improve performance in high-intensity, short-duration exercise tasks. Research on CS, most of which has come into existence since 1994, has been the focus of several qualitative reviews, but only one meta-analysis, which was conducted with a limited number of studies. Purpose: This study compared the effects of CS on effect size (ES) for body composition (BC) variables (mass and lean body mass), duration and intensity (≤30 s, [ATP-PCr = A]; 30–150 s [glycolysis = G]; >150 s, [oxidative phosphorylation = O]) of the exercise task, type of exercise task (single, repetitive, laboratory, field, upper-body, lower-body), CS duration (loading, maintenance), and subject characteristics (gender, training status). Methods: A search of MEDLINE and SPORTDiscus using the phrase “creatine supplementation” revealed 96 English-language, peer-reviewed papers (100 studies), which included randomized group formation, a placebo control, and human subjects who were blinded to treatments. ES was calculated for each body composition and performance variable. Results: Small, but significant (ES > 0, p ≤ .05) ES were reported for BC (n = 163, mean ± SE = 0.17 ± 0.03), ATP-PCr (n = 17, 0.24 ± 0.02), G (n = 135, 0.19 ± 0.05), and O (n = 69, 0.20 ± 0.07). ES was greater for change in BC following a loading-only CS regimen (0.26 ± 0.03, p = .0003) compared to a maintenance regimen (0.04 ± 0.05), for repetitive-bout (0.25 ± 0.03, p = .028) compared to single-bout (0.18 ± 0.02) exercise, and for upper-body exercise (0.42 ± 0.07, p < .0001) compared to lower (0.21 ± 0.02) and total body (0.13 ± 0.04) exercise. ES for laboratory-based tasks (e.g., isometric/isotonic/isokinetic exercise, 0.25 ± 0.02) were greater (p = .014) than those observed for field-based tasks (e.g., running, swimming, 0.14 ± 0.04). There were no differences in BC or performance ES between males and females or between trained and untrained subjects. Conclusion: ES was greater for changes in lean body mass following short-term CS, repetitive-bout laboratory-based exercise tasks ≤ 30 s (e.g., isometric, isokinetic, and isotonic resistance exercise), and upper-body exercise. CS does not appear to be effective in improving running and swimming performance. There is no evidence in the literature of an effect of gender or training status on ES following CS.

A survey was used to collect anonymous cross-sectional data on demographics, exercise habits, and use of creatine and other supplements by exercisers in civilian (C) and military (M) health clubs. M (n = 133) reported more aerobic training and less use of creatine and protein supplements than C(n = 96, p < .05). Supplement users (SU, n = 194) and nonusers (SNU, n = 35) engaged in similar frequency and duration of aerobic exercise, as well as number of resistance exercise repetitions, but SU completed more sets for each resistance exercise (x̄ ± SE, 5 ± 1) than SNU (3 ± 1, p ≤ .05). Significant (p ≤ .05) associations were observed between SU and resistance training goal of strength (as opposed to endurance), as well as greater frequency of resistance training. Male gender, resistance training goal of strength, lower frequency and duration of aerobic training, and use of protein, ß-hydroxy-ß-methyl butyrate, and androstenedi-one/dehydroepiandrosterone supplements were all associated with creatine use (p < .05). For creatine users, the dose and length of creatine supplementation was 12.2±2.7g•day^·1 for 40 ± 5 weeks. Popular magazines were the primary source of information on creatine (69%) compared to physicians (14%) or dietitians (10%, p ≤ .0001). This study underscores two potential public health concerns: (a) reliance on popular media rather than allied-health professionals for information on creatine, and (b) use of creatine, a popular supplement with unknown long-term effects, in combination with other anabolic supplements of questionable efficacy and/or safety.