Effects of creatine supplementation on exercise performance, physiological outcomes, and body composition in females engaged in exercise or training: a systematic review and multilevel meta-analysis
Abstract
Background: Female-specific creatine trials span different sports, training states and outcome types. The preceding systematic review included 27 studies and provided a narrative synthesis of performance outcomes; the average magnitude of effects across correlated outcomes remained unknown.
Objective: To estimate overall and domain-specific effects of creatine supplementation on exercise and sport performance, physiological outcomes and body composition in females engaged in exercise, sport or structured training.
Methods: PubMed, Scopus, Web of Science, SPORTDiscus and CINAHL were searched for experimental studies published from 1 January 1996 to 5 March 2026. Two reviewers independently screened records, extracted data and appraised risk of bias. Female-specific creatine-vs.-control contrasts were synthesized with multilevel random-effects models and CR2 small-sample robust inference. Sensitivity analyses addressed graph-digitized and reconstructed percentage-change data and plausible within-study sampling correlations. GRADE was applied to the overall estimate and each quantitative domain. The review was retrospectively registered on OSF (https://doi.org/10.17605/OSF.IO/U8V7A).
Results: The search identified 13,244 records; 160 reports were assessed in full text, and 34 studies with 692 female or female-eligible participants entered the systematic review. Twenty-one studies contributed 170 model-compatible effects from 424 analyzable participants. The overall model…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 424 participants or records.
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