The Effects of Creatine Supplementation on Upper- and Lower-Body Strength and Power: A Systematic Review and Meta-Analysis

Background: Creatine supplementation is widely used to enhance exercise performance, mainly resistance training adaptations, yet its differential effects on upper- and lower-body strength and muscular power remain unclear across populations. Objective: This systematic review and meta-analysis aimed to quantify the effects of creatine supplementation in studies that included different exercise modalities or no exercise on upper- and lower-body muscular strength and power in adults. Methods: A comprehensive search of PubMed, Scopus, and Web of Science was conducted through 21 September 2024 to identify randomized controlled trials evaluating the effects of creatine supplementation on strength (bench/chest press, leg press, and handgrip) and power (upper and lower body). Weighted mean differences (WMDs) and 95% confidence intervals (CIs) were calculated using random-effects modeling. Subgroup analyses examined the influence of age, sex, training status, dose, duration, and training frequency. Results: A total of 69 studies with 1937 participants were included for analysis. Creatine plus resistance training produced small but statistically significant improvements in bench and chest press strength [WMD = 1.43 kg, p = 0.002], squat strength [WMD = 5.64 kg, p = 0.001], vertical jump [WMD = 1.48 cm, p = 0.01], and Wingate peak power [WMD = 47.81 Watts, p = 0.004] when compared to the placebo. Additionally, creatine supplementation combined with exercise training revealed no significant differences in handgrip strength [WMD = 4.26 kg, p = 0.10] and leg press strength [WMD = 3.129 kg, p = 0.11], when compared with the placebo. Furthermore, subgroup analysis based on age revealed significant increases in bench and chest press [WMD = 1.81 kg, p = 0.002], leg press [WMD = 8.30 kg, p = 0.004], and squat strength [WMD = 6.46 kg, p = 0.001] for younger adults but not for older adults. Subgroup analyses by sex revealed significant increases in leg press strength [WMD = 9.79 kg, p = 0.001], squat strength [WMD = 6.43 kg, p = 0.001], vertical jump [WMD = 1.52 cm, p = 0.04], and Wingate peak power [WMD = 55.31 Watts, p = 0.001] in males, but this was not observed in females. Conclusions: This meta-analysis indicates that creatine supplementation, especially when combined with resistance training, significantly improves strength in key compound lifts such as the bench or chest press and squat, as well as muscular power, but effects are not uniform across all measures. Benefits were most consistent in younger adults and males, while older adults and females showed smaller or non-significant changes in several outcomes. No overall improvement was observed for handgrip strength or leg press strength, suggesting that the ergogenic effects may be more pronounced in certain multi-joint compound exercises like the squat and bench press. Although the leg press is also a multi-joint exercise, results for this measure were mixed in our analysis, which may reflect differences in study design, participant characteristics, or variability in testing protocols. The sensitivity of strength tests to detect changes appears to vary, with smaller or more isolated measures showing less responsiveness. More well-powered trials in underrepresented groups, particularly women and older adults, are needed to clarify population-specific responses.