The emerging and evolving evidence supporting creatine as an ergogenic aid: history and applications

TL;DR

Creatine is a well-researched supplement that improves exercise performance, recovery, and health across various populations, including athletes and military personnel.

Contribution

This review synthesizes decades of research to highlight creatine's broad applications and safety across diverse groups and performance contexts.

Findings

Creatine improves high-intensity exercise performance, lean body mass, and strength through enhanced energy availability.

Emerging evidence supports creatine's benefits for endurance and team-sport athletes via improved glycogen resynthesis and recovery.

Creatine is safe, with no greater adverse events than placebo, and may offer neuroprotective and cardiometabolic benefits.

Abstract

Creatine is one of the most extensively studied ergogenic aids, with over three decades of research supporting its role in exercise performance, recovery, and health.

This narrative review summarizes the historical development of creatine supplementation and evaluates evidence regarding its mechanisms, efficacy across active, athletic populations (e.g. strength, endurance, team-sport), and tactical (e.g. military, law enforcement) populations, and its safety profile.

The evidence suggests that creatine enhances phosphocreatine resynthesis and cellular energy availability, resulting in consistent improvements in high-intensity exercise performance, training adaptations, lean body mass, strength, and power. Additional findings indicate that creatine may attenuate exercise-induced muscle damage and inflammation, support recovery, and improve functional outcomes following strenuous activity. Emerging research suggests benefits for endurance and team-sport athletes through enhanced glycogen resynthesis, calcium handling, oxidative stress mitigation, and repeated-sprint performance. In tactical populations, creatine may support occupational readiness by improving strength, hydration status, thermoregulation, cognition, sleep quality, and recovery, with possible neuroprotective and cardiometabolic implications. Soccer-specific evidence demonstrates improvements in repeated-sprint ability and tolerance to high training loads, with preliminary data suggesting protective effects against neurotrauma and gut barrier disruption. Importantly, pooled analyses from hundreds of clinical trials report no greater incidence of adverse events compared with placebo, reinforcing creatine's established safety profile.

Overall, the evidence suggests that creatine is a versatile supplement with strong evidence to enhance performance and recovery across diverse populations. Future research should prioritize individualized dosing strategies, long-term outcomes in underrepresented groups, and exploration of novel therapeutic applications in health and disease

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