Document Type

Article

Publication Title

Journal of the International Society of Sports Nutrition

Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

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

Research Highlights

  • The Problem: While creatine monohydrate is a well-established ergogenic aid for high-intensity performance, its efficacy and safety applications are evolving to include endurance sports, tactical occupations, and neuroprotective health. 

  • The Method: This narrative review synthesized over three decades of research, including a comprehensive analysis of 685 clinical trials involving over 26,000 participants and 28.4 million adverse event reports. 

  • Quantitative Finding: Creatine monohydrate supplementation increases intramuscular phosphocreatine levels by 20%–40%; resistance training with creatine leads to an 8% greater increase in muscular strength compared to training alone; a meta-analysis reported a 1.19% reduction in body fat percentage when combined with resistance training; adverse events were reported in 14% of creatine groups versus 13% in placebo groups ($p=0.776$). 

  • Qualitative Finding: Creatine enhances high-intensity exercise capacity and training adaptations; benefits in tactical populations include improved thermoregulation, cognitive resilience during sleep deprivation, and faster recovery from traumatic brain injury; soccer-specific outcomes include improved repeated-sprint ability and potential mitigation of "leaky gut" through enhanced intestinal mucosal integrity.

DOI

https://doi.org/10.1080/15502783.2026.2646627

Publication Date

3-2026

Creative Commons License

Creative Commons Attribution 4.0 International License
This work is licensed under a Creative Commons Attribution 4.0 International License.

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