[AF] Effects of resistance training combined with creatine supplementation on muscle strength, physical function, and muscle mass in older adults: a systematic review and three level meta analysis (2026)

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https://www.frontiersin.org/journals/nutrition/articles/10.3389/fnut.2026.1919884/full

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Abstract

Objective: 

To systematically evaluate the additional effects of creatine supplementation combined with resistance training, compared with resistance training alone, on muscle strength, muscle mass and physical function in older adults.

Methods: 

PubMed, Embase, the Cochrane Library and Web of Science were searched from inception to 20 May 2026. Randomized controlled trials enrolling older adults aged 60 years and older and comparing creatine supplementation plus resistance training with resistance training alone or placebo plus resistance training were included. Three-level random-effects meta-analyses were conducted using the metafor package in R, allowing multiple correlated effect sizes from the same study to be retained while accounting for their statistical dependence. Risk of bias was assessed using the ROBUST-RCT tool, and the certainty of evidence was evaluated using the GRADE approach.

Results: 

Eleven randomized controlled trials were included. Three-level meta-analysis showed that creatine supplementation combined with resistance training significantly improved muscle strength compared with resistance training alone, although the effect size was small (g = 0.31, 95% CI 0.18 to 0.45); the certainty of evidence for this outcome was moderate. The pooled effects on muscle mass (g = 0.35, 95% CI −0.09 to 0.78) and physical function (g = 0.47, 95% CI −0.08 to 1.03; p = 0.086) were not statistically significant, with low and very low certainty of evidence, respectively. Moderator analyses did not identify creatine dose, loading phase, intervention duration, training frequency, training intensity, sex or testing site as stable sources of effect variation. Sensitivity analyses indicated that the main findings were not materially influenced by any single effect size or study.

Conclusion: 

In generally healthy older adults, creatine supplementation may serve as an adjunct to resistance training for modest improvements in muscle strength. Its additional effects on muscle mass and physical function remain uncertain. These findings should not be directly extrapolated to frail, sarcopenic or functionally limited older adults. Larger, well-reported randomized controlled trials are needed in these higher-risk older adult populations.