Effects of creatine supplementation on lean mass, muscle size and muscle performance during immobilisation and rehabilitation: A systematic review.
5 affiliations
- 1School of Sport and Exercise Sciences, Manchester Metropolitan University Institute of Sport, Manchester, UK.
- 2Faculty of Kinesiology and Health Studies, University of Regina, Regina, Saskatchewan, Canada.
- 3Department of Health, Nutrition and Exercise Science, Messiah University, Mechanicsburg, Pennsylvania, USA.
- 4Department of Physical Education Studies, Brandon University, Brandon, Manitoba, Canada.
- 5Department of Musculoskeletal and Ageing Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.
Abstract
Creatine monohydrate (CrM) supplementation has established benefits in exercising populations; however, its efficacy during disuse and subsequent rehabilitation remains unclear. This systematic review assessed the effects of CrM supplementation on muscle size, lean mass and muscle performance (strength, power, endurance) during periods of disuse and rehabilitation. PubMed, Scopus, Web of Science and Cochrane Library were searched from inception to March 2026 following PRISMA guidelines. Six randomised placebo-controlled trials were included (n = 118, mean ages: 15-24 years, disuse model: 1-2 weeks limb-immobilisation). Two studies reported comparable reductions in quadriceps cross-sectional area (CSA; assessed via CT or NMR imaging) between CrM and placebo during disuse (-5.6% vs. -5.5%; -11.0% vs. -9.4%), whereas two reported smaller reductions from CrM supplementation in lower-limb lean mass (-5.6% vs. -8.9%) or preserved upper-limb lean mass (0.9% vs. -3.7%) (assessed via bioelectrical impedance analysis (BIA) or dual energy X-ray absorptiometry (DXA)). These contrasting findings may reflect limitations of BIA/DXA, including hydration effects, rather than preservation of muscle tissue. Effects on muscle performance were inconsistent, with favourable findings from CrM supplementation in upper- but not lower-limb models. Four studies included recovery, three of which used resistance-based rehabilitation. Two reported greater increases with CrM supplementation across quadriceps CSA (21.3% vs. 14.3%), lower-limb lean mass (5.6% vs. 3.8%), power (52.2% vs. 35.2%) and strength (28.7% vs. 22.8%). Current evidence does not unanimously support CrM supplementation as an effective countermeasure to mitigate disuse-induced muscle atrophy, lean mass loss or declines in muscle performance. Whether CrM supplementation meaningfully influences rehabilitation following disuse, particularly in older adults and clinical populations at greater risk of disuse atrophy and incomplete recovery, warrants further investigation.
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BibTeX
@article{pratt2026effects,
title = {{Effects of creatine supplementation on lean mass, muscle size and muscle performance during immobilisation and rehabilitation: A systematic review.}},
author = {Jedd Pratt and Darren G Candow and Eric S Rawson and Scott C Forbes and Konstantinos Prokopidis},
journal = {Experimental physiology},
year = {2026},
month = oct,
doi = {10.1113/ep093965},
url = {https://europepmc.org/article/MED/42952382},
note = {CC BY},
}
RIS
TY - JOUR
TI - Effects of creatine supplementation on lean mass, muscle size and muscle performance during immobilisation and rehabilitation: A systematic review.
AU - Jedd Pratt
AU - Darren G Candow
AU - Eric S Rawson
AU - Scott C Forbes
AU - Konstantinos Prokopidis
PY - 2026
DA - 2026/10/29
JO - Experimental physiology
DO - 10.1113/ep093965
UR - https://europepmc.org/article/MED/42952382
AB - Creatine monohydrate (CrM) supplementation has established benefits in exercising populations; however, its efficacy during disuse and subsequent rehabilitation remains unclear. This systematic review assessed the effects of CrM supplementation on muscle size, lean mass and muscle performance (strength, power, endurance) during periods of disuse and rehabilitation. PubMed, Scopus, Web of Science and Cochrane Library were searched from inception to March 2026 following PRISMA guidelines. Six randomised placebo-controlled trials were included (n = 118, mean ages: 15-24 years, disuse model: 1-2 weeks limb-immobilisation). Two studies reported comparable reductions in quadriceps cross-sectional area (CSA; assessed via CT or NMR imaging) between CrM and placebo during disuse (-5.6% vs. -5.5%; -11.0% vs. -9.4%), whereas two reported smaller reductions from CrM supplementation in lower-limb lean mass (-5.6% vs. -8.9%) or preserved upper-limb lean mass (0.9% vs. -3.7%) (assessed via bioelectrical impedance analysis (BIA) or dual energy X-ray absorptiometry (DXA)). These contrasting findings may reflect limitations of BIA/DXA, including hydration effects, rather than preservation of muscle tissue. Effects on muscle performance were inconsistent, with favourable findings from CrM supplementation in upper- but not lower-limb models. Four studies included recovery, three of which used resistance-based rehabilitation. Two reported greater increases with CrM supplementation across quadriceps CSA (21.3% vs. 14.3%), lower-limb lean mass (5.6% vs. 3.8%), power (52.2% vs. 35.2%) and strength (28.7% vs. 22.8%). Current evidence does not unanimously support CrM supplementation as an effective countermeasure to mitigate disuse-induced muscle atrophy, lean mass loss or declines in muscle performance. Whether CrM supplementation meaningfully influences rehabilitation following disuse, particularly in older adults and clinical populations at greater risk of disuse atrophy and incomplete recovery, warrants further investigation.
SN - 0958-0670
SN - 1469-445X
ER -