Mechanisms of muscular adaptations to creatine supplementation

Creatine supplementation is a widely used and heavily studied ergogenic aid. Athletes use creatine to increase muscle mass, strength, and muscle endurance. While the performance and muscle-building effects of creatine supplementation have been well documented, the mechanisms responsible for these muscular adaptations have been less studied. Objective: The purpose of this review is to examine studies of the mechanisms underlying muscular adaptations to creatine supplementation. Data sources: PubMed and SPORTDiscus databases were searched from 1992 to 2007 using the terms creatine, creatine supplementation, creatine monohydrate, and phosphocreatine. Study selection: Studies of creatine supplementation in healthy adults were included. Data extraction: Due to the small number of studies identified, a meta-analysis was not performed. Data synthesis: Several potential mechanisms underlying muscular adaptations to creatine supplementation were identified, including: metabolic adaptations, changes in protein turnover, hormonal alterations, stabilization of lipid membranes, molecular modifications, or as a general training aid. The mechanisms with the greatest amount of support (metabolic adaptations, molecular modifications, and general training aid) may work in concert rather than independently. Conclusions: Creatine supplementation may alter skeletal muscle directly, by increased muscle glycogen and phosphocreatine, faster phosphocreatine resynthesis, increased expression of endocrine and growth factor mRNA, or indirectly, through increased training volume