title: Creatine Supplementation and Upper Limb Strength Performance: A Systematic Review and Meta-Analysis.
abstract: BACKGROUND
  Creatine is the most widely used supplementation to increase performance in strength; however, the most recent meta-analysis focused specifically on supplementation responses in muscles of the lower limbs without regard to upper limbs.
  
  
  OBJECTIVE
  We aimed to systematically review the effect of creatine supplementation on upper limb strength performance.
  
  
  METHODS
  We conducted a systematic review and meta-analyses of all randomized controlled trials comparing creatine supplementation with a placebo, with strength performance measured in exercises shorter than 3 min in duration. The search strategy used the keywords 'creatine', 'supplementation', and 'performance'. Independent variables were age, sex and level of physical activity at baseline, while dependent variables were creatine loading, total dose, duration, time interval between baseline (T0) and the end of the supplementation (T1), and any training during supplementation. We conducted three meta-analyses: at T0 and T1, and on changes between T0 and T1. Each meta-analysis was stratified within upper limb muscle groups.
  
  
  RESULTS
  We included 53 studies (563 individuals in the creatine supplementation group and 575 controls). Results did not differ at T0, while, at T1, the effect size (ES) for bench press and chest press were 0.265 (95 % CI 0.132-0.398; p < 0.001) and 0.677 (95 % CI 0.149-1.206; p = 0.012), respectively. Overall, pectoral ES was 0.289 (95 % CI 0.160-0.419; p = 0.000), and global upper limb ES was 0.317 (95 % CI 0.185-0.449; p < 0.001). Meta-analysis of changes between T0 and T1 gave similar results. The meta-regression showed no link with characteristics of population or supplementation, demonstrating the efficacy of creatine independently of all listed conditions.
  
  
  CONCLUSIONS
  Creatine supplementation is effective in upper limb strength performance for exercise with a duration of less than 3  min, independent of population characteristics, training protocols, and supplementary doses or duration.
authors.affiliation: Preventive and Occupational Medicine, University Hospital of Clermont-Ferrand (CHU), 58 rue Montalembert, Clermont-Ferrand, France.|CNRS UMR 6024, Physiological and Psychosocial Stress, LAPSCO, Clermont-Ferrand, France.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Lanhers
authors.affiliation: Clinical Research and Innovation Direction, University Hospital of Clermont-Ferrand (CHU), Clermont-Ferrand, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Pereira
authors.affiliation: School of Exercise Science, Australian Catholic University, Melbourne, VIC, Australia.
authors.forename: Geraldine
authors.initials: G
authors.lastname: Naughton
authors.affiliation: Neurophysiology of Stress, Armies' Biomedical Research Institute, Armies' Health Service, Bretigny sur Orge, France.
authors.forename: Marion
authors.initials: M
authors.lastname: Trousselard
authors.affiliation: Occupational Medicine, University Hospital of Montpellier (CHU), Montpellier, France.
authors.forename: François-Xavier
authors.initials: FX
authors.lastname: Lesage
authors.affiliation: School of Exercise Science, Australian Catholic University, Melbourne, VIC, Australia. frederic.dutheil@acu.edu.au.|Preventive and Occupational Medicine, University Hospital of Clermont-Ferrand (CHU), 58 rue Montalembert, Clermont-Ferrand, France. frederic.dutheil@acu.edu.au.|CNRS UMR 6024, Physiological and Psychosocial Stress, LAPSCO, Clermont-Ferrand, France. frederic.dutheil@acu.edu.au.|Laboratory of Metabolic Adaptations to Exercise in Physiological and Pathological Conditions EA3533, University Clermont Auvergne, Clermont-Ferrand, France. frederic.dutheil@acu.edu.au.|CRNH Auvergne, Clermont-Ferrand, France. frederic.dutheil@acu.edu.au.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Dutheil
mesh_terms: D003401:Creatine / Q000008:administration & dosage / Q000494:pharmacology*; D019587:Dietary Supplements; D006801:Humans; D035002:Lower Extremity; D053580:Muscle Strength / Q000187:drug effects* / Q000502:physiology; D018482:Muscle, Skeletal / Q000378:metabolism*; D016032:Randomized Controlled Trials as Topic; D034941:Upper Extremity / Q000502:physiology*
chemical_list: D003401:Creatine