---
title: "Creatine plus resistance training improves strength and lean mass: three-level meta-analysis"
id: "pubmed-42765482"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42765482"
content_type: "clinical_feed_article"
specialty: "Pharmacology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42765482/"
doi: "10.1080/15502783.2026.2718316"
published_at: "2026-09-21T16:51:47.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Creatine plus resistance training improves strength and lean mass: three-level meta-analysis
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42765482
- **Specialty:** [Pharmacology](https://medichelpline.com/clinical-feed/pharmacology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42765482/)
- **DOI:** [10.1080/15502783.2026.2718316](https://doi.org/10.1080%2F15502783.2026.2718316)
- **Published At:** 2026-09-21T16:51:47.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- Objective: assess effects of combining **resistance training** with **creatine** supplementation on upper- and lower-body **strength**, and on body composition measures (lean mass, fat mass, body-fat percentage, and body mass). Review also tested participant and protocol moderators (age, sex, training experience, intervention duration, frequency, dosing strategy, daily dose, and supplementation protocol). - Methods: systematic search of PubMed, Web of Science, Cochrane Library, Embase, and EBSCO through April 21, 2025, plus backward citation tracking. Effect sizes were pooled as Hedge’s g using a three-level random-effects meta-analysis (metafor, R). Moderator effects were explored with subgroup analyses and meta-regression. - Included evidence: 63 studies totaling 1,489 participants were included. - Main results: Compared with resistance training alone (RT), resistance training plus creatine (RT + CR) produced significant improvements in upper-body strength (g = 0.54, p < 0.001) and lower-body strength (g = 0.55, p < 0.001). - Body composition results: RT + CR increased **lean mass** (g = 0.30, p < 0.001) and body mass (g = 0.12, p = 0.04) and reduced body-fat percentage (g = −0.14, p = 0.02). No statistically significant effect was found for fat mass (g = −0.10, p = 0.14). - Moderators: Exploratory subgroup analyses suggested **age** may be associated with strength gains; meta-regression indicated an inverse association between age and strength effects (larger effects in younger participants). Age subgroup findings are tentative due to uneven subgroup representation and multiple comparisons. Intervention-protocol variables did not show consistent moderation of outcomes. - Interpretation: The modest increase in total body weight with RT + CR appears mainly attributable to gains in **lean body mass**, with a small reduction in body-fat percentage. No clear effect on fat mass was detected. - Limitations noted by authors: heterogeneity across trials and incompletely reported data on participants’ nutritional intake and training backgrounds, which constrain interpretation of pooled estimates and moderator analyses. - Conclusion: Adding creatine to resistance training significantly enhances muscle strength and lean body mass versus resistance training alone; effects on fat mass are not significant. Age may influence strength responses but requires cautious interpretation.
## Clinical Analysis & Structured Key Points
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Epub 2026 Sep 21. # Resistance training combined with creatine supplementation: a three-level meta-analysis of multidimensional outcomes from strength enhancement to body composition remodeling [Hai Wang](https://pubmed.ncbi.nlm.nih.gov/?term=Wang+H&cauthor_id=42765482)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42765482/#full-view-affiliation-1 "Institute of Physical Education and Training, Capital University of Physical Education and Sports, Beijing, China."), [Hao Wang](https://pubmed.ncbi.nlm.nih.gov/?term=Wang+H&cauthor_id=42765482)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42765482/#full-view-affiliation-1 "Institute of Physical Education and Training, Capital University of Physical Education and Sports, Beijing, China."), [Xianyang Xin](https://pubmed.ncbi.nlm.nih.gov/?term=Xin+X&cauthor_id=42765482)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42765482/#full-view-affiliation-1 "Institute of Physical Education and Training, Capital University of Physical Education and Sports, Beijing, China."), [Zheng Yi](https://pubmed.ncbi.nlm.nih.gov/?term=Yi+Z&cauthor_id=42765482)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42765482/#full-view-affiliation-1 "Institute of Physical Education and Training, Capital University of Physical Education and Sports, Beijing, China.") Affiliations Expand ### Affiliation * 1 Institute of Physical Education and Training, Capital University of Physical Education and Sports, Beijing, China. * PMID: **42765482** * DOI: [ 10.1080/15502783.2026.2718316 ](https://doi.org/10.1080/15502783.2026.2718316) Item in Clipboard Review # Resistance training combined with creatine supplementation: a three-level meta-analysis of multidimensional outcomes from strength enhancement to body composition remodeling Hai Wang et al. J Int Soc Sports Nutr. 2026. Show details Display options Display options Format Abstract PubMed PMID J Int Soc Sports Nutr Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22J+Int+Soc+Sports+Nutr%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22J+Int+Soc+Sports+Nutr%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42765482/) . 2026 Dec 31;23(sup1):2718316. doi: 10.1080/15502783.2026.2718316. Epub 2026 Sep 21. ### Authors [Hai Wang](https://pubmed.ncbi.nlm.nih.gov/?term=Wang+H&cauthor_id=42765482)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42765482/#short-view-affiliation-1 "Institute of Physical Education and Training, Capital University of Physical Education and Sports, Beijing, China."), [Hao Wang](https://pubmed.ncbi.nlm.nih.gov/?term=Wang+H&cauthor_id=42765482)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42765482/#short-view-affiliation-1 "Institute of Physical Education and Training, Capital University of Physical Education and Sports, Beijing, China."), [Xianyang Xin](https://pubmed.ncbi.nlm.nih.gov/?term=Xin+X&cauthor_id=42765482)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42765482/#short-view-affiliation-1 "Institute of Physical Education and Training, Capital University of Physical Education and Sports, Beijing, China."), [Zheng Yi](https://pubmed.ncbi.nlm.nih.gov/?term=Yi+Z&cauthor_id=42765482)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42765482/#short-view-affiliation-1 "Institute of Physical Education and Training, Capital University of Physical Education and Sports, Beijing, China.") ### Affiliation * 1 Institute of Physical Education and Training, Capital University of Physical Education and Sports, Beijing, China. * PMID: **42765482** * DOI: [ 10.1080/15502783.2026.2718316 ](https://doi.org/10.1080/15502783.2026.2718316) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract **Objective:** This study aimed to determine (1) the effects of resistance training combined with creatine supplementation on muscle strength (upper- and lower-body strength) and body composition (lean mass, fat mass, body-fat percentage, and body mass), and (2) whether these effects were moderated by participant characteristics (age, gender, and training experience) and intervention protocols (intervention duration, weekly frequency, dosing strategy, daily dose, and supplementation protocol). **Methods:** We conducted a systematic search of PubMed, Web of Science, Cochrane Library, Embase, and EBSCO from database inception through April 21 2025, and performed backward citation tracking to identify additional relevant trials. Hedge's g (g) served as the summary effect size for each outcome. Meta-analysis was performed using a three-level random-effects model in the metafor package (R). Potential moderators were explored via subgroup analyses and meta-regression. **Results:** Sixty-three studies (_n_ = 1489) were included. Compared with resistance training alone (RT), resistance training plus creatine (RT + CR) produced significant increases in upper-body strength (g = 0.54, _p_ < 0.001), lower-body strength (g = 0.55, _p_ < 0.001), lean mass (g = 0.30, _p_ < 0.001), and body mass (g = 0.12, _p_ = 0.04), and a significant reduction in body-fat percentage (g = -0.14, _p_ = 0.02). No significant difference emerged for fat mass (g = -0.10, _p_ = 0.14). Exploratory subgroup analyses suggested that age may be associated with strength gains, with statistically significant between-subgroup differences observed for both upper- and lower-body strength. These findings should be interpreted cautiously because multiple moderator analyses were conducted and the age subgroups were unevenly represented. Exploratory meta-regression also suggested an inverse association between age and strength effects, with larger effects observed in studies involving younger participants. Neither subgroup nor meta-regression analyses identified consistent moderators for body composition outcomes. **Conclusion:** Compared with resistance training alone, resistance training combined with creatine supplementation significantly enhanced muscle strength and lean body mass, without a significant effect on fat mass. The modest increase in total body weight was primarily attributable to gains in lean body mass, contributing to a slight reduction in body fat percentage. Among participant characteristics, age appeared to be associated with the magnitude of strength effects, although this exploratory finding should be interpreted cautiously given the uneven representation of age subgroups. Intervention-protocol variables did not significantly influence the outcomes. These conclusions should also be interpreted within the context of heterogeneous and incompletely reported nutritional intake and training backgrounds across the included trials. **Keywords:** Resistance training; body composition; creatine; meta-analysis; strength. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Similar articles * [ Folic acid supplementation and malaria susceptibility and severity among people taking antifolate antimalarial drugs in endemic areas. ](https://pubmed.ncbi.nlm.nih.gov/36321557/) Crider K, Williams J, Qi YP, Gutman J, Yeung L, Mai C, Finkelstain J, Mehta S, Pons-Duran C, Menéndez C, Moraleda C, Rogers L, Daniels K, Green P.Crider K, et al.Cochrane Database Syst Rev. 2022 Feb 1;2(2022):CD014217. doi: 10.1002/14651858.CD014217.Cochrane Database Syst Rev. 2022.Update in: [Cochrane Database Syst Rev. 2026 Feb 18;2:CD014217. doi: 10.1002/14651858.CD014217.pub2.](https://pubmed.ncbi.nlm.nih.gov/41705996/)PMID: 36321557Free PMC article.Updated. * [ The Effects of Creatine Supplementation on Upper- and Lower-Body Strength and Power: A Systematic Review and Meta-Analysis. ](https://pubmed.ncbi.nlm.nih.gov/40944139/) Kazeminasab F, Kerchi AB, Sharafifard F, Zarreh M, Forbes SC, Camera DM, Lanhers C, Wong A, Nordvall M, Bagheri R, Dutheil F.Kazeminasab F, et al.Nutrients. 2025 Aug 25;17(17):2748. doi: 10.3390/nu17172748.Nutrients. 2025.PMID: 40944139Free PMC article. * [ Effects of Whey Protein Alone or as Part of a Multi-ingredient Formulation on Strength, Fat-Free Mass, or Lean Body Mass in Resistance-Trained Individuals: A Meta-analysis. ](https://pubmed.ncbi.nlm.nih.gov/26403469/) Naclerio F, Larumbe-Zabala E.Naclerio F, et al.Sports Med. 2016 Jan;46(1):125-137. doi: 10.1007/s40279-015-0403-y.Sports Med. 2016.PMID: 26403469 * [ The Effect of Creatine Supplementation on Resistance Training-Based Changes to Body Composition: A Systematic Review and Meta-analysis. ](https://pubmed.ncbi.nlm.nih.gov/39074168/) Desai I, Wewege MA, Jones MD, Clifford BK, Pandit A, Kaakoush NO, Simar D, Hagstrom AD.Desai I, et al.J Strength Cond Res. 2024 Oct 1;38(10):1813-1821. doi: 10.1519/JSC.0000000000004862. 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