What is the effect of creatine (creatine monohydrate) supplementation on exercise performance?

From the Guidelines

Creatine supplement is a highly effective addition to exercise, particularly resistance training, to enhance performance and muscle growth, and it is recommended to take 3-5 grams of creatine monohydrate daily. Although the provided evidence does not directly discuss creatine, it highlights the importance of careful consideration when using supplements in team sports, such as football, due to the risk of anti-doping rule violations 1.

Key Points to Consider

• The daily dose of creatine monohydrate can be taken consistently, regardless of the exercise schedule, as it works by maintaining elevated muscle stores over time.
• It is not necessary to have a loading phase, but some individuals may choose to start with a higher dose of 20 grams daily for 5-7 days to rapidly saturate muscles.
• Consuming creatine with a meal containing carbohydrates or protein may enhance its uptake.
• Creatine increases phosphocreatine stores in muscles, allowing for more rapid ATP regeneration during high-intensity exercise, which enables individuals to perform more reps or sets before fatigue, ultimately leading to greater training volume and better strength and muscle gains.
• Most people experience a slight weight gain from water retention in muscles, and it is essential to stay hydrated while taking creatine, especially for healthy individuals with an excellent safety profile 1.

Important Considerations for Team Sports

• In team sports like football, extreme caution must be taken when considering supplements for the entire team due to the risk of anti-doping rule violations, as stated by WADA rules 1.
• Sports nutritionists and doctors should carefully evaluate the potential benefits and risks of supplements, including creatine, and ensure compliance with anti-doping regulations.

From the Research

Benefits of Creatine Supplementation

• Creatine supplementation is effective in improving muscle mass, performance, and recovery in athletes and exercising individuals 2, 3, 4
• It produces beneficial effects in older and patient populations, including enhanced postexercise recovery, injury prevention, and rehabilitation 2, 3
• Creatine supplementation is relatively well tolerated, especially at recommended dosages (i.e. 3-5 g/day or 0.1 g/kg of body mass/day) 2

Effects on Endurance Performance

• Creatine supplementation can affect endurance performance by elevating skeletal muscle phosphocreatine (PCr) stores, facilitating a greater capacity to rapidly resynthesize ATP and buffer hydrogen ion accumulation 5
• It can enhance glycogen resynthesis and content when co-ingested with carbohydrates, which is important for high-intensity aerobic exercise 5
• Creatine supplementation may be beneficial for sports that require multiple surges in intensity and/or during end spurts, such as cross-country skiing, mountain biking, and cycling 5

Safety and Potential Adverse Effects

• There is no significant evidence that creatine supplementation causes kidney damage or renal dysfunction in healthy individuals 2, 6
• Short- and long-term creatine supplementation has no known significant effects on different studied indexes of kidney function in healthy athletes and bodybuilders with no underlying kidney diseases 6
• However, it is advisable that creatine supplementation not be used by individuals with pre-existing kidney disease or those with a potential risk for kidney dysfunction 6

Other Considerations

• Creatine supplementation can increase body mass, which may offset the potential positive effects, particularly in weight-bearing activities 5
• The effects of creatine supplementation on intermittent and continuous endurance-type exercise are less clear, with contradictory findings in the literature 4