Efeitos da Suplementação de Creatina

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European Journal of Sport
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The effects of creatine
supplementation: A review
with special regards to
ballgames
Alexander Ferrauti a & Hubert Remmert a
a Department of Applied Training Science in the
Faculty of Sport Science, Ruhr-University Bochum,
44780, Bochum, Germany
Published online: 09 Nov 2010.
To cite this article: Alexander Ferrauti & Hubert Remmert (2003) The effects of
creatine supplementation: A review with special regards to ballgames, European
Journal of Sport Science, 3:3, 1-27, DOI: 10.1080/17461390300073309
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Creatine Supplementation and Ballgames / 1
1
The Effects of Creatine Supplementation:
A Review With Special Regards to Ballgames
Alexander Ferrauti and Hubert Remmert
This short review is based on general knowledge and guidelines about creatine
metabolism and supplementation (CS). These principles provide the starting
point for an attempt at inferring the theoretical effects in ballgames with their
specific workload profiles. The self-reported prevalence of creatine use in
game players ranges from 2% in female volleyball players to 71% in male
American football players. A search on the PubMed database for relevant ar-
ticles related to ballgames resulted in 18 hits, all published in the last 5 years
(soccer 6, American football 5, tennis 2, handball 2, ice hockey 1, squash 1,
softball 1). It is critical that the authors of those articles measure basic condi-
tional aspects in the first place. Only 5 articles try to investigate the effects of CS
under test conditions specifically designed for ballgames. Six of 10 studies
showed that a short-term creatine loading results in an improvement of the
intermittent sprint performance, while 4 studies failed to measure any short-
term effects at all. Longitudinal training studies with game players uniquely
came to the conclusion that CS combined with resistance and sprint condition-
ing improves strength and power at a higher rate than the respective training
routine without supplementation. We conclude that CS increases the basic
conditional performance of game players when combined with a specific train-
ing period. Nevertheless, a careless use of creatine on a regular basis is not
advisable, since the transfer on the ballgame competition performance of these
effects has not yet been clarified sufficiently. It also varies depending on the
workload profile of the game and the player’s individual physical conditions
and demands.
Key Words: creatine/phosphocreatine shuttle, muscle hypertrophy, intermit-
tent sprint performance, ballgames, specific tests
Key Points:
1. The supplement creatine, which is not on the doping list of the International Olym-
pic Committee, is carelessly used by many athletes (10–59% of football players at
American high schools) on a regular basis in popular ballgames.
2. Theoretically, creatine supplementation (CS) can be an ergogenic aid in ballgames
by increasing PCr availability and resynthesis, by reducing muscle acidity, and by
increasing body and muscle mass.
European Journal of Sport Science, vol. 3, issue 3
©2003 by Human Kinetics Publishers and the European College of Sport Science
The authors are with the Department of Applied Training Science in the Faculty of
Sport Science at Ruhr-University Bochum, 44780 Bochum, Germany.
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2 / Ferrauti and Remmert
3. Acute short-term effects of a creatine loading on intermittent sprint performance
was found in 6 out of 10 studies in game players tested. In terms of specific skills,
the performance (shoot and stroke performance) is usually not improved. All 9
longitudinal training studies with game players show an ergogenic effect of CS on
body composition and strength.
4. The combination of CS with resistance training and ballgame-specific condition-
ing increases the ergogenic effects of creatine.
Introduction
The supplement creatine, which is not on the doping list of the International Olym-
pic Committee, is carelessly used by many athletes on a regular basis in popular
ballgames (75), although its ergogenic potential and health risks have not yet been
clarified sufficiently (63). A performance enhancing effect was mainly shown in
laboratory settings during maximal intermittent cycle-ergometer exercise, with
workload periods of 6–30 s and resting periods of 20–300 s (4, 15, 31, 34, 64, 93).
Most of the ballgames are typical high-intensive intermittent exercises and thus
correspond to the exercise modes on which creatine supplementation (CS) might
have an ergogenic effect (126). On the other hand, research studies examining the
effects of creatine in weight-dependent activities are less convincing (18, 20, 47, 59,
88, 94), which can be explained by an initial body mass increase as a result of water
retention (61). Up to now, there is a considerable lack of specific applied research
regarding the effect of CS, particularly in the area of ballgames. Thus, the present
short review pays special attention to studies in ballgames or with gameplayers,
respectively, and leads to practical applications for coaches and athletes.
Creatine Metabolism
The average human dry muscle concentration of creatine is 125 mmol · kg–1 and
ranges individually from 90 to 160 mmol · kg–1 (43, 55). In addition to the ability of
the liver to synthesize creatine from the three essential amino-acids—arginine,
glycine, and methionine—creatine may also be acquired from a normal daily diet,
mostly in fish, meat, and other animal products. Although creatine is present in
various tissues, it is predominantly found in the skeletal muscles, where it is stored
as phosphocreatine (PCr; 7).
In the course of anaerobic-alactic energy delivery (Figure 1), the creatine
kinase in the cytosol (CK) catalyses the phosphorylation of adenosin diphosphate
(ADP) to yield adenosine triphosphate (ATP) by means of phosphocreatine (PCr).
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About the Authors
Prof. Dr. Alexander Ferrauti is the head of the Department of Training Science in the Faculty
of Sports Science at Ruhr-University Bochum. He is a professor of applied training science,
and his special working fields are training and testing, energy metabolism, and nutrition in
ballgames. He has experience both as a coach and a tournament tennis player.
Dr. Hubert Remmert is a lecturer of the Department of Training Science in the Faculty
of Sports Science at Ruhr-University Bochum. Since 2000, he has also been responsible for
teaching basketball at the same faculty. The author has been an active basketball player and
coach for several years in Germany’s top divisions.
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4(22, 108). Around 70% of the
phosphocreatine storage in the type-II fibers are used up after 10 s of maximal
contraction (54). For the rephosphorylation of creatine, ATP has to be generated by
oxidative phosphorylation in the mitochondria (96). The mitochondrial creatine
kinase (Mi-CK) catalyses the transphosphorylation of ATP to creatine to yield PCr,
which crosses the outer membrane of the mitochondrion and remains in the cytosol
until the next muscle contraction. After a maximal effort, it takes approximately 30
to 60 s before half, and around 5 min before all, PCr is resynthesized (7, 107, 114).
This cycle is termed the creatine/phosphocreatine-shuttle (61, 79; Figure 1).
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Creatine Supplementation and Ballgames / 3
Creatine Supplementation
Dosage
Creatine supplementation (CS) should start with a loading phase of 5 days, during
which daily doses of 20 to 25 g are taken (54). This loading course may increase the
total storage of creatine by about 20% (8, 19, 21, 25, 38, 41, 44, 51, 55, 89). Subse-
quently, a maintenance dose of 2 g creatine · day–1 is sufficient to sustain the effect
(19). HULTMAN et al. (55) propose a weight dependent dosage of 0.3 g · kg–1 during
the 5-day loading phase, followed by 0.03 g · kg–1 throughout the maintenance
phase. The authors expect to find the same effect with a daily dose of 3 g creatine
during 28 days without a loading phase.
It is recommended to ingest the creatine powder together with glucose or
fructose in order to use the sugar-induced rise in insulin and increase the creatine
uptake of the muscle cells (55). An alternative solution is to ingest the creatine right
after a meal rich in carbohydrates. Apparently insulin facilitates not only the uptake
of glucoses and amino acids, but also the uptake of creatine into muscle cells. It has
further been suggested that creatine uptake is enhanced when the supplementation
period is accompanied by submaximal exercise, due to the exercise induced in-
creased insulin sensitivity (51). On the other hand, after creatine loading is com-
pleted, additional acute creatine intake during exercise may counteract the ergo-
genic effects (118).
The saturation of skeletal muscle is reached at creatine levels of 150 to 160
mmol · kg–1 of dry muscle. An additional increase in creatine uptake is not possible
(7, 43, 51). The surplus of creatine is excreted by the kidneys. After cessation of
creatine intake, the creatine concentrations in urine and muscle return to a basal
level during a wash-out phase of approximately 28 days (38, 120).
Figure 1 — Shuttle hypothesis for the creatine kinase (CK) system (according to Mesa et
al., 79).
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Physiological Effects
CS enhances PCr stores. The increased presence of creatine in the cytosol of the
muscle cells activates the Mi-CK and the mitochondrial oxidative phosphorylation.
As a result, the PCr concentration in the cytosol rises (61). Approximately 20–30%
of the creatine uptake in the muscles is measurable as PCr (21, 51). Theoretically,
this allows an increased duration of maximal performance capacity and an im-
proved resynthesis of PCr in the creatine/phosphocreatine shuttle (Figure 1). Anaero-
bic-lactic or aerobic ATP-production dominates during exercise of longer duration,
which renders the relevance of an efficient creatine/phosphocreatine shuttle less
important (7, 16, 43, 77, 100).
CS may result in lower (2, 5, 8, 93), similar (6, 15, 18, 20, 21, 31, 45, 59, 87, 89,
105, 111, 113) or higher (44, 112, 123) blood-lactate levels after high-intensive
exercise when compared to the control group. Lower concentrations may be the
result of an increased anaerobic-alactic potential and a delayed start of the anaerobic
glycolysis (5, 8). This would result in a smaller decrease in intramuscular pH and an
enhanced resistance to fatigue. Similar or elevated lactate values can be explained
by an indirect activation of the glycolysis through the increase in phosphate produc-
tion from PCr hydrolysis, which contributes to the H+ buffering in the cytosol
necessary after lactic acid production (81).
Several studies have demonstrated a decrease in ammonia and hypoxanthine
concentration during creatine intake compared to placebo (2, 5, 8, 15, 45, 87). This is
considered to be a result of the decreased flux through adenylate kinase and
myoadenylate deaminase in the purinnucleotidcycle. On the other hand, Snow et al.
(105) were not able to demonstrate differences in plasma concentrations of ammo-
nia and hypoxanthine in a study with a double-blind crossover design.
Effects on Body Composition
With few exceptions (48, 94), most authors measured a gain in body weight after CS
(5, 6, 8, 12, 25, 31, 34, 44, 87, 105, 123). The measured increase after only 5 to 7 days
of CS varied between 0.5 to 1.6 kg. Studies in which creatine was supplied over
longer periods (65, 120), demonstrated even greater increases of 1.8 to 2.4 kg. This
is mainly based on a gain in the lean body mass (34, 65, 120) and can be traced back
to two causes: (a) water retention and (b) synthesis of contractile proteins.
Water Retention. The initial body mass increase is attributed to water retention
(55). On the first day of creatine loading (20 g daily), Hultmann et al. (55) already
measured a significant reduction of the urine excretion (0.6 L). It is possible that the
enhanced creatine concentration in the muscles increases the osmotic pressure on
the myofibers, which may result in cell swelling and increased muscle size (30).
Synthesis of Contractile Proteins. Longer periods of CS increase the synthesis
of contractile proteins in skeletal and cardiac muscle (30, 56, 57, 100). Ingwall et al.
(56, 57) demonstrated a rise in actin and myosin synthesis of skeletal muscle cul-
tures in a creatine medium in vitro, while the synthesis of other proteins was not
altered (56, 57). The therapeutic use of CS in gyrate atrophy patients increased only
the fast type II myofiber diameters (100). It is concluded that creatine selectively
stimulates the rate of synthesis of contractile proteins and may play a role in muscle
hypertrophy with a special influence on fast myofibers.
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The underlying mechanisms for the creatine action on muscle are largely
unknown. Dangott et al. (30) showed that CS increases the satellite cell mitotic
activity in rats, when CS is combined with an increased training load. The satellite
cell mitotic activity seems to be a major determining factor for compensatory hyper-
trophy, since the myonuclei do not split. The cell swelling may indirectly signal
satellite cells to proliferate and fuse with enlarging myofibers (30, 52).
On the other hand, CS and cell swelling alone do not appear to affect satellite
cell mitotic activity. The necessity of functional activity for a creatine related hyper-
trophic response remains unclear. CS may allow an increase of the total training
stimulus (duration and intensity of the work load), resulting in a greater stimulus on
muscle hypertrophy (23, 92, 120).
This suggestion corresponds to the results of several studies, which demon-
strated an ergogenic effect of CS on maximum strength during bench pressing or leg
pressing or other weight lifting exercises (34, 65, 112, 120, 123). These studies
allow the conclusion that CS improves strength as a result of muscle hypertrophy.
Effects on Cycle Performance
Numerous studies focused on the influence of CS on the performance during cycle
ergometer work. In general, no clear ergogenic effect was found during single sprint
performance. In detail, the results seem to depend on the length of the exercise.
When the exercise duration is too short (5–10 s), no performance enhancement canbe found, because the physiological creatine phosphate concentration may be suffi-
cient (5, 25, 31). In case of longer cycle-ergometer sprints (15–30 s), an advantage
was shown after CS (15, 31, 34, 65), although not in most cases (5, 12, 25, 26, 31, 90,
105). When the duration of the exercise is even longer, the contribution of PCr to the
total anaerobic ATP production decreases, thereby reducing the probability of a
creatine effect.
Studies focused on intermittent cycle sprint performance are more convinc-
ing with respect to an ergogenic effect of CS. Most of these studies (5, 15, 31, 34, 65,
93), which are based on different exercise protocols (5–30 s workload duration, 20–
300 s recovery) showed an increase of exercise performance (mean and peak power
output, working time until exhaustion). Only a few studies do not share these find-
ings (12, 25, 38). Research studies examining the effects of creatine on weight-
dependent activities, such as running or swimming, are less convincing (18, 20, 47, 59).
Creatine Supplementation in Ballgames
Prevalence
The self-reported prevalence of creatine use in game players was investigated in
several studies (46, 67, 72, 73, 75, 104), which are mainly related to American high
school students and to football players. The reported prevalence ranged from 2% in
female volleyball players (72) to 71% in male American football players (67). In a
recent study by McGuine et al. (75), which was conducted with a total of 1,349 high
school football players (Grades 9–12), 30% of the athletes reported the use of
creatine at an increasing rate from the 9th grade (10.4%) to the 12th grade (50.5%;
75). Metzl and colleagues (80) reported about creatine use already in 10-year-old
middle school athletes. When compared with other game sport players, American
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football had the highest percentage of players who used creatine, followed by soccer
21%, hockey 14%, tennis 9%, baseball 9%, basketball 7%, and golf 3% (75). These
figures support other reports indicating that athletes involved in football, hockey,
and wrestling are more likely to use supplements than athletes in other sports (73).
Today, no serious representative data on European athletes and professional players
in traditional European ballgames, such as soccer, tennis, and handball, are avail-
able. Nevertheless, several case reports about famous creatine-consuming game
players in the yellow press (e.g., the French tennis player Mary Pierce or the French
soccer player Zinedine Zidane), as well as anecdotal reports by coaches and players,
suggest that CS has become popular worldwide among game players in different
sports.
Workload Profiles
Game players require aerobic and anaerobic endurance, speed, power, power endur-
ance, agility, and strength (35). Depending on the specific rules of the games, the
size and type of the sporting field, the relation between the number of players and the
size of the ground, and the tactical position (e.g., forward vs. midfielder in soccer) or
game strategy (e.g., baseline player vs. serve-and-volley player in tennis), respec-
tively, the player is exposed to a specific mixture of demands (Table 1). Sport games
are usually classified as multiple sprint sports (49) because they involve periods of
short intensive running loads interspersed with recovery periods of variable length.
The number of sprints within a competitive game varies between 5 (in American
football, depending on the player’s position) and 150 (e.g., in soccer and tennis).
Depending on the type of game, the length of sprints differs considerably, ranging
from 1–2 m in squash up to 60 m in American football (running backs and wide
receivers) and soccer. The rest periods breaking up the high-intensity exercise
phases also vary between 7 s (squash) and 240 s (ice hockey). Furthermore, the
intermittent types of moving change in their intensity and duration (stationary,
walking, jogging, running), and they have to be combined with powerful actions of
the upper (hit and throw) and lower extremities (shots, jumps) as well as the trunk
and the head (Table 1).
Mainly depending on the length/duration and frequency of the high-intensity
sprints, a different metabolic profile can be defined for each ballgame, resulting in a
specific pattern of aerobic, anaerobic-alactic, and anaerobic-lactic demands. Low
concentrations of blood lactate during competitive matches of volleyball and tennis
(2–3 mmol/L) indicate that energy during the short exercise periods (2–8 s) is
mainly supplied by a breakdown of PCr, while aerobic pathways restore the energy
sources during the rest periods (15–20 s; 14, 24, 27, 37, 66, 103, 115). The anaero-
bic-lactic energy production usually becomes more important in soccer (9–11, 36,
82, 124), basketball (32, 76, 117), ice hockey (4, 42, 84), and squash (78, 85, 97, 116)
because of the longer duration of high-intensity periods and/or the higher percent-
age of net playing time (Table 1). In blood samples taken after top-flight soccer
matches, the lactate concentration averages 4–6 mmol/L, and individual values
frequently exceed 10 mmol/L (10; Table 1). In this study from Bangsbo (10), the
adenosin diphosphate degradation products—ammonia, hypoxanthine, and uric
acid—are also elevated, pointing to an overall skeletal muscle adenine nucleotide
loss.
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T
ab
le
 1
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T
ab
le
 1
(c
on
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)
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Studies in different racket sports show that the training load of typical on-
court training regimes frequently exceeds the anaerobic demands during competi-
tion (39, 69), leading to much higher lactate formation (8–11 mmol/L). Obviously,
coaches in these sports tend to deliberately increase the average workload intensity
in training sessions—for example, by extending the duration of the high intensity
exercise bouts without modifying the recovery duration (39). These data underline
the fact that the overall characterization of the workload profile in ballgames has to
cover both the competition and the training load.
Theoretical Effects
Theoretically, CS may be an ergogenic aid in ballgames for several reasons (126):
• CS increases the PCr availability: A higher initial muscle PCr concentration
may help to sustain muscle contractions (e.g., during a long, intensive sprint
or rally).
• CS increases PCr resynthesis: A higher initial level of creatine may help to
synthesize more PCr during recovery (e.g., in between the rallies in racket
sports or between two attacks of a forward; Figure 1).
• CS reduces muscle acidity: PCr acts as a metabolic buffer consuming H+ in the
process of resynthesizing ATP from ADP (Figure 2). This may allow the
muscle to accumulate more lactic acid (e.g., during high-intensive training
routines).
• CS increases body mass: An increased fat-free body weight and muscle mass
are necessary in all ballgames involving close and intensive body contacts
(e.g., football and handball). Furthermore, it might be advantageous for all
powerful actions of the upper (e.g., stroke velocity) and lower extremities
(e.g., shots and jumps).
A CS-induced increase in body mass, especially when not accompanied by a
rise in muscle mass, could be detrimental to those ballgames in which the body mass
needs to be accelerated and stopped repeatedly, as is the case in the racket sports,
resulting in an overall increased energetic demand. However, in the case of single,
linear accelerations (e.g., fast counterattack in handball), theoretical increases in
power production may counterbalance the potentially adverse effects of increased
body mass (126).
A profound analysis considering possible effects of CS in different ballgames
will have to take into account the specific exercise profiles of the respective games
(Table 1 & 2):
• A rise in PCr availability will have a positive effect primarily on those sports
that constantly require a high energetic flow rate over a relatively long period
of time (15–30 s, e.g., in soccer and ice hockey). In tennis match play, the
exercise duration is possibly too short and the physiological creatine phos-
phate concentration seems to be sufficient (5, 25, 31).
• The acceleration and optimization of the PCr resynthesis becomes theoreti-
cally more important in racket sports, with their typical work/rest pattern
including short and complete aerobic recovery periods (Figure 2).
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• The increased H+ buffer capacity is advantageous in ballgames with higher
anaerobic-lactic demands such as soccer, basketball, and ice hockey and/or in
case of high metabolic training demands in all games.
• An increase in body mass will be highly important in those sports in which
tackles have a major impact on the outcome of a match. In particular, this
applies to contact sport games with close body contact (e.g., American foot-
ball and ice hockey). In contrast, this effect can be counterproductive in those
sports in which players have no physical contact with their opponents and
where players are required to quickly change directions in the game as the
constant acceleration of the increased body mass results in a substantial rise in
the players’ energetic demands (e.g., in squash and tennis).
• A final evaluation will also have to consider the present individual physique,
the respective tactical tasks of the players, as well as their skills in terms of
technique, endurance, speed, and power. As a matter of fact, extremely light-
weight tennis players are prone to not achieving the necessary stroke power
(e.g., the former Top Ten player Petr Korda from the Czech Republic and the
current world-class player Justine Henin from Belgium).
• An increase in strength and power seems to be more important in ballgames
with close body contact (football and ice hockey) but also in sports with high
demands for short sprint and acceleration capacity (e.g., soccer and basket-
ball) and finally in sport games demanding powerful actions such as the
strokes and shots in tennis and ice hockey. In squash, however, the lower
racket weight rather points against the primary importance of strength and
power.
Research Overview
The research into the specific effects of CS in ballgames was carried out on the
PubMed database (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi) using the key
Figure 2 — Theoretical effects of creatine supplementation on repeated bouts of high-
intensity exercise (according to Williams et al., 126).
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Creatine Supplementation and Ballgames / 11
Table 2 Theoretical Benefits of the Effects of Creatine Supplementation
in Ballgames
Creatine
effects Football Soccer Basketball Icehockey Tennis Squash
PCr availability ++ ++ + ++ ± +
PCr resynthesis ± + ++ + ++ ++
H+ buffer + ++ ++ ++ ± +
Body mass ++ ± ± ++ ± –
Strength/power ++ ++ ++ ++ ++ ±
words creatine and basketball, football, handball, hockey, soccer, squash, tennis,
volleyball. In total, the search resulted in 18 hits (soccer: 6, football: 5, tennis: 2,
handball: 2, ice hockey 1, squash: 1, softball: 1), most of which referred to articles
published in the last 5 years. No studies could be found for the sport games basket-
ball and volleyball. Two of the studies are abstracts; the rest were published as entire
original papers. The results of the research predominantly originates from the Euro-
pean (10 studies) and American continents (7 studies; Table 3).
All studies have in common that test persons were picked from the field of
sports games (Table 3). All studies were compared to placebo intake as well as
carried out with a double-blind or blind scheme. In two cases only, the study was set
up with a crossover design (91, 95). The number of test participants ranged from 6
(28) to 18 players (29), respectively. The longer the studies took to conduct, the
smaller was the size of the test groups, falling below 10 participants when the
duration of the study exceeded 50 days (13, 60, 69, 110, 125).
As supplements, the testers primarily applied various compounds mixed out
of creatinmonohydrate and carbohydrates. The duration of supplementation in the
studies mentioned turned out to be very heterogeneous and was confined to a load-
ing phase of 3 to 7 days in half the studies (28, 29, 58, 83, 87, 91, 94, 95, 101). During
this loading phase, the dosage varied between 15 and 25 g creatine monohydrate per
day. In two studies, the authors applied a weight-dependent dosage of roughly the
same amount (40, 109). In the other half of the studies, the loadingphase is followed
by a maintenance phase of 9 (1) to 84 days (69). In these cases, 2 to 5 g creatine
monohydrate per day were given to the test participants—in one study, even 10 to 15
g per day (65, 110). Most of the longitudinal studies combine CS with specific
training sessions, which the test groups undergo twice to five times a week, consist-
ing to a great extent of strength training and specific ballgame conditioning (sprint,
power, and agility). Only two studies monitor the combination of creatine and
exercise by comparing a creatine-plus-training test group with a creatine-only set
that does not undergo any additional exercise (40, 110).
In all studies, the period of CS is embedded in a more or less sophisticated test
battery (pre- and post-measurements). The odd study incorporates an intermediate
test at the end of the loading phase in addition to the pre- and post-measurements (1,
60, 125). With regards to the test substance and measurement details, the studies
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display a relatively heterogeneous picture. Some restrict themselves to only mea-
suring basic dimensions such as strength (squat and bench press), jumping force,
body composition (body mass, skinfold thickness, intracellular water), cycle power,
blood lactate, and other blood chemistry measurements (e.g., 65), whose relation to
the specific workload profile of the sport games can be described only as limited (13,
29, 83, 110). Others to some extent include semi-specific tests, such as intermittent
short sprint running over distances of 15 to 60 m, with 6 to 30 repetitions and 25–60-
s rest periods (1, 40, 58, 60, 65, 69, 88, 94, 101).
Few studies go beyond basic and semi-specific measurements and actually
make an effort to simulate the specific profile characteristic of a particular ballgame
in a suitable field-test situation. This is only understandable, as recording the game
players’ performance in a standardized and reliable way causes major methodical
difficulties. On the other hand, several experiments in this field have provided
valuable results in the past, for instance, when tests were carried out in order to
verify the impact of fluid and carbohydrate ingestion on the specific skill perfor-
mance (2, 9, 68, 74, 102, 121). In connection with CS, the following studies have
made an attempt at measuring performance in specific ballgame situations:
• Jones et al. (60): intermittent ice sprint test with ice hockey players
• Op’t Eijnde et al. (91): standardized Leuven Tennis Performance Test (LTPT)
• Romer et al. (95): squash on-court simulation shuttle with squash players
• Cox et al. (28): specific soccer running simulation test with soccer players
• Ferrauti et al. (40): stroke velocity measurements with tennis players.
Acute Effects of Creatine Loading
Generally speaking, findings on the effects of an acute creatine monohydrate load-
ing with game players are far from uniform (Table 3). The majority of the authors
recorded performance enhancements in various intermittent sprint tests (1, 28, 58,
60, 88, 95). Others, however, did not find any evidence for short-term effects on
sprint performance (94, 101), vertical jump performance (83), or stroke perfor-
mance and sprint power in tennis (121). The body mass increased significantly in all
studies during the 5–7-day loading phase (0.6–1.9 kg).
Cox et al. (28) registered a performance enhancement after creatine loading in
a 20-m sprint test and in an agility run during a specific soccer test; the precision of
ball kicking remained unaffected. Mujika et al. (88) found the same ergogenic
effects after creatine loading in an intermittent sprint test (6 � 15 m, 30 s rest) with
soccer players, while the intermittent endurance performance was not improved.
Izquierdo et al. (58) found an increase in the one repetition maximum power and the
repetitive power during bench press and half-squat exercises and also recorded an
improvement in the average 5-m sprint performance in an intermittent sprint test
(6 � 15 m, 60 s rest). The studies by Jones et al. (60) with ice-hockey players and
Aaserud et al. (1) with handball players all included a loading phase with a subse-
quent maintenance phase, each followed by a test battery. In both studies, an in-
crease of the intermittent ice sprint, cycle sprint, and running sprint performance
was significant after the loading phase already, but no additional improvement was
recorded during the maintenance phase. The authors mostly suggest an increased
availability of pre-exercise PCr, particularly in type II muscle fibers, and the accel-
eration of post-exercise PCr resynthesis to account for the performance enhancements
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Creatine Supplementation and Ballgames / 13
T
ab
le
 3
A
–D
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es
ea
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O
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 A
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 S
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as
ic
et
 a
l. 
(1
3)
20
 g
 +
 G
at
or
ad
e
58
 d
ay
s
C
r:
 n
 =
 9
St
re
ng
th
 te
st
s
4 
d/
w
ee
k 
re
si
st
an
ce
B
od
y 
co
m
po
si
tio
n 
(±
)
Pl
:
m
ai
nt
en
an
ce
Pl
:n
 =
 8
C
yc
le
 (
an
ae
ro
bi
c
tr
ai
ni
ng
,
St
re
ng
th
 (
+
)
So
/P
ho
 +
 G
at
or
ad
e
C
o:
 n
 =
 8
 
po
w
er
)
4 
d/
w
ee
k
A
na
er
ob
ic
 p
ow
er
 (
±)
C
o:
 —
co
nd
iti
on
in
g
C
r:
C
r:
B
od
y 
m
as
s/
le
an
 
5 
g 
+
 g
at
or
ad
e
bo
dy
 m
as
s 
(+
)
Pl
:
In
tr
ac
el
lu
la
r 
w
at
er
 (
+
)
So
/P
ho
 +
 G
at
or
ad
e
St
re
ng
th
/a
na
er
ob
ic
C
o:
 —
po
w
er
 (
+
)
C
ro
w
de
r
C
r po
w
de
r: 
15
 g
,
3 
da
ys
 lo
ad
in
g
31
 m
en
/f
oo
tb
al
l
T
ot
al
 s
tr
en
gt
h
A
ll 
su
bj
ec
ts
C
r po
w
de
r a
nd
 C
r gu
m
:
B
as
ic
et
 a
l. 
(2
9)
C
r gu
m
: 1
5 
g
C
r po
w
de
r: 
n 
=
 1
8
B
od
y 
m
as
s
ov
er
 2
8 
da
ys
:
T
ot
al
 s
tr
en
gt
h 
(+
)
C
r gu
m
: n
 =
 1
3
Sk
in
fo
ld
2 
d/
w
ee
k
B
od
y 
m
as
s 
(+
)
re
si
st
an
ce
Sk
in
fo
ld
s 
(–
)
tr
ai
ni
ng
K
re
id
er
C
r:
 1
5.
75
 g
 +
 p
ho
sp
h 
H
P
28
 d
ay
s
25
 m
en
/f
oo
tb
al
l
B
lo
od
 c
he
m
is
tr
y
A
ll 
su
bj
ec
ts
:
Pl
:
B
as
ic
/
et
 a
l. 
(6
5)
Pl
:p
ho
sp
ha
ge
n 
H
P
C
r:
 n
 =
 1
1,
B
od
y 
co
m
po
si
tio
n
5 
h/
w
ee
k 
re
si
s-
Fa
t f
re
e 
m
as
s 
(+
)
se
m
i-
Pl
: n
 =
 1
4
Sq
ua
t, 
be
nc
h 
pr
es
s
ta
nc
e 
tr
ai
ni
ng
,
T
ot
al
 li
ft
in
g 
vo
lu
m
e 
(+
)
sp
ec
if
ic
C
yc
le
 1
2 
�
 6
 s
,
3 
h/
w
ee
k 
ag
ili
ty
/
C
r:
30
 s
 r
es
t
sp
ri
nt
 tr
ai
ni
ng
L
D
H
, A
L
T
,
H
D
L
, C
K
 (
+
)
B
od
y 
m
as
s,
 f
at
 f
re
e
m
as
s 
(+
)
T
ot
al
 li
ft
in
g 
vo
lu
m
e 
(+
),
Sp
ri
nt
 p
ow
er
 (
sp
ri
nt
1–
5)
 (
+
)
D
ow
nl
oa
de
d 
by
 [
U
Q
 L
ib
ra
ry
] 
at
 1
1:
33
 1
1 
O
ct
ob
er
 2
01
4 
14 / Ferrauti and Remmert
St
on
e 
et
 a
l.
C
r 1:
 0
.2
2 
g/
kg
,
35
 d
ay
s
42
 m
en
/f
oo
tb
al
l
Sq
ua
t +
 b
en
ch
A
ll 
su
bj
ec
ts
:
C
a/
Py
 a
nd
 P
l: 
(±
);
B
as
ic
/
(1
09
)
C
r 2:
 0
.0
9 
g/
kg
 +
C
r 1:
 n
 =
 9
pr
es
s
3 
da
ys
/w
ee
k
C
r 1 a
nd
 C
r 2:
se
m
i-
C
a/
Py
C
r 2:
 n
 =
 1
1
V
er
tic
al
 ju
m
p
w
ei
gh
t t
ra
in
in
g
B
od
y 
m
as
s,
 L
B
M
 (
+
)
sp
ec
if
ic
C
a/
Py
 0
.2
2 
g/
kg
C
a/
Py
: n
 =
 1
1
C
yc
le
 1
5 
�
5 
s
2–
3 
da
ys
/w
ee
k
Sq
ua
t+
be
nc
h 
pr
es
s 
(+
)
Pl
: 0
.2
2g
/k
gsi
lic
a
Pl
: n
 =
 1
1
1-
m
in
 r
es
t
fo
ot
ba
ll
V
er
tic
al
 ju
m
p 
(+
)
C
yc
le
 p
ow
er
 (
±)
W
ild
er
 e
t a
l.
C
r 1:
 3
 g
 +
 9
 g
 d
ex
70
 d
ay
s 
(7
 d
ay
s
25
 m
en
/f
oo
tb
al
l
B
od
y 
co
m
po
si
tio
n
A
ll 
su
bj
ec
ts
:
C
r 1, 
C
r 2 a
nd
 P
l:
B
as
ic
/
(1
25
)
C
r 2:
 2
0 
g 
+
 2
8 
g 
de
x
lo
ad
in
g,
 6
3
C
r 1/
C
r 2:
 n
 =
 8
M
ax
. s
qu
at
 s
tr
en
gt
h
4 
h/
w
ee
k 
re
si
s-
Sk
in
fo
ld
 (
±)
se
m
i-
5 
g 
+
 7
 g
 d
ex
da
ys
 m
ai
n-
Pl
: n
 =
 9
Sq
ua
t s
tr
en
gt
h
ta
nc
e 
tr
ai
ni
ng
,
Fa
t f
re
e 
m
as
s 
(+
)
sp
ec
if
ic
Pl
: 4
8 
g 
de
x
te
na
nc
e)
en
du
ra
nc
e
4 
h/
w
ee
k 
co
nd
i-
M
ax
. s
qu
at
70
 d
ay
s
T
es
t 1
: p
re
tio
ni
ng
st
re
ng
th
 (
+
)
T
es
t 2
: m
id
Sq
ua
t s
tr
en
gt
h
T
es
t 3
: p
os
t
en
du
ra
nc
e 
(+
)
B
. S
oc
ce
r
C
ox
 e
t a
l.
C
r:
 2
0 
g
6 
da
ys
 lo
ad
in
g
12
 w
om
en
/s
oc
ce
r
Sp
ec
if
ic
 s
oc
ce
r
Pl
: (
±)
Sp
ec
if
ic
(2
8)
Pl
: 2
0 
g
C
r:
 n
 =
 6
te
st
 (
60
 m
in
)
C
r:
Pl
: n
 =
 6
5 
�
 1
1 
m
in
,
B
od
y 
m
as
s 
(+
)
60
-s
 r
es
t
20
 m
 s
pr
in
t t
im
e 
(+
)
A
gi
lit
y 
ru
n 
tim
e 
(+
)
Pr
ec
is
io
n 
ba
ll
ki
ck
in
g 
(±
)
H
ea
rt
 r
at
e 
an
d 
bl
oo
d
la
ct
at
e 
(–
)
Pe
rc
ei
ve
d 
ex
er
tio
n 
(±
)
L
ar
so
n
C
r:
 1
5 
g
7 
da
ys
 lo
ad
in
g
14
 w
om
en
/s
oc
ce
r
B
en
ch
 p
re
ss
Pl
: (
±)
B
as
ic
/
et
 a
l. 
(6
9)
Pl
: 1
5 
g 
gl
u
84
 d
ay
s
C
r:
 n
 =
 7
Sh
ut
tle
 r
un
C
r 
te
st
 2
 a
nd
 3
:
se
m
i-
C
r:
 5
 g
m
ai
nt
en
an
ce
Pl
: n
 =
 7
(2
74
 m
)
B
en
ch
 p
re
ss
 (
+
)
sp
ec
if
ic
Pl
: 5
 g
 g
lu
T
es
t 1
: p
re
Sh
ut
tle
 r
un
 ti
m
e 
(+
)
T
es
t 2
: 3
–5
 w
ee
ks
T
es
t 3
: p
os
t
D
ow
nl
oa
de
d 
by
 [
U
Q
 L
ib
ra
ry
] 
at
 1
1:
33
 1
1 
O
ct
ob
er
 2
01
4 
Creatine Supplementation and Ballgames / 15
M
uj
ik
a
C
r:
 2
0 
g
6 
da
ys
 lo
ad
in
g
17
 m
en
/s
oc
ce
r
St
an
da
rd
is
ed
A
ll 
su
bj
ec
ts
Pl
: (
±)
Se
m
i-
et
 a
l. 
(8
8)
Pl
:2
0 
g 
m
al
C
r:
 n
 =
 8
,
T
es
t b
at
te
ry
:
id
en
tic
al
ly
C
r:
sp
ec
if
ic
/
Pl
:n
 =
 9
C
ou
nt
er
 m
ov
em
en
t
C
ou
nt
er
 m
ov
em
en
t
sp
ec
if
ic
ju
m
p pr
e
ju
m
p pr
e (
±)
Sp
ri
nt
 6
 �
 1
5 
m
,
Sp
ri
nt
 6
 �
 1
5 
m
,
 
30
-s
 r
es
t
30
-s
 r
es
t (
+
)
Sp
ec
if
ic
 e
nd
ur
an
ce
Sp
ec
if
ic
 e
nd
ur
an
ce
 (
±)
C
ou
nt
er
 m
ov
em
en
t
C
ou
nt
er
 m
ov
em
en
t
ju
m
p po
st
ju
m
p po
st
 (
+
)
B
lo
od
 la
ct
at
e 
(±
)
R
ed
on
do
C
r:
 2
5 
g
7 
da
ys
 lo
ad
in
g
18
 m
en
/s
oc
ce
r
Sp
ri
nt
 3
 �
 6
0 
m
,
Pl
 a
nd
 C
r:
Se
m
i-
et
 a
l. 
(9
4)
Pl
:2
5 
g 
gl
u
an
d 
w
om
en
/f
ie
ld
12
0 
s 
re
st
20
–3
0 
m
 v
el
oc
ity
 (
±)
sp
ec
if
ic
ho
ck
ey
20
–3
0 
m
 v
el
oc
ity
40
–5
0 
m
 v
el
oc
ity
 (
±)
C
r:
 n
 =
 9
40
–5
0 
m
 v
el
oc
ity
50
–6
0 
m
 v
el
oc
ity
 (
±)
Pl
: n
 =
 9
50
–6
0 
m
 v
el
oc
ity
Sm
ar
t e
t a
l.
C
r:
 2
4 
g 
+
 3
0 
g 
gl
u
6 
da
ys
 lo
ad
in
g
11
 m
en
/s
oc
ce
r
Sp
ri
nt
 3
0 
�
 2
0 
m
,
C
r:
Se
m
i-
(1
01
)
Pl
: 3
0 
g 
gl
u
C
r:
 n
 =
 5
,
30
 s
 r
es
t
B
od
y 
m
as
s 
(+
)
sp
ec
if
ic
Pl
: n
 =
 6
Pl
 a
nd
 C
r:
Sp
ri
nt
 ti
m
e 
(±
)
B
lo
od
 la
ct
at
e/
hy
po
xa
nt
hi
ne
 (
±)
St
ou
t e
t a
l.
C
r 1:
 2
1 
g 
+
 4
 g
 g
lu
5 
da
ys
 lo
ad
in
g
24
 m
en
/s
oc
ce
r
B
en
ch
 p
re
ss
,
C
r 2:
C
r 1 a
nd
 P
l: 
(±
)
B
as
ic
(1
10
)
C
r 2:
 2
1 
g 
+
 1
32
 g
 g
lu
50
 d
ay
s 
m
ai
n-
C
r 1:
 n
 =
 8
V
er
tic
al
 ju
m
p
4 
da
ys
 3
0 
m
in
C
r 2:
Pl
: 
14
0 
g 
gl
u
te
na
nc
e
C
r 2:
 n
 =
 8
Sp
ri
nt
 1
00
 y
ar
d
sp
ri
nt
/w
ee
k
B
en
ch
 p
re
ss
 (
+
)
C
r 1:
 1
0.
5 
g 
+
 2
 g
 g
lu
Pl
: n
 =
 8
V
er
tic
al
 ju
m
p 
(+
)
C
r 2:
 1
0.
5 
g 
+
 6
6 
g 
gl
u
Sp
ri
nt
 1
00
 y
ar
d 
(+
)
Pl
: 
70
 g
 g
lu
D
ow
nl
oa
de
d 
by
 [
U
Q
 L
ib
ra
ry
] 
at
 1
1:
33
 1
1 
O
ct
ob
er
 2
01
4 
16 / Ferrauti and Remmert
C
. R
ac
ke
t 
Sp
or
ts
Fe
rr
au
ti
C
r:
 0
.3
 g
/k
g 
+
 g
lu
 +
 m
al
6 
da
ys
 lo
ad
in
g,
47
 m
en
/te
nn
is
B
od
y 
co
m
po
si
tio
n
O
nl
y 
in
 P
l+
A
ll 
gr
ou
ps
:
Se
m
i-
et
 a
l.(
40
)
Pl
: g
lu
 +
 m
a
28
 d
ay
s 
m
ai
n-
C
r 
+
 tr
ai
ni
ng
:
Is
om
et
ri
c 
st
re
ng
th
an
d 
C
r+
:
B
lo
od
 la
ct
at
e 
(±
)
sp
ec
if
ic
/
C
r:
 0
.0
5 
g/
kg
 +
 g
lu
 +
 m
al
te
na
nc
e
n 
=
 1
0
Sp
ri
nt
 1
5 
�
 2
0 
m
,
3 
d/
w
ee
k 
re
si
s-
Is
om
et
ri
c 
st
re
ng
th
 (
+
)
sp
ec
if
ic
Pl
: g
lu
 +
 m
al
C
r-
tr
ai
ni
ng
:
30
 s
 r
es
t
ta
nc
e 
tr
ai
ni
ng
O
nl
y 
C
r 
gr
ou
ps
:
n 
=
 1
5
T
en
ni
s 
ba
se
lin
e 
te
st
3 
d/
w
ee
k 
sp
ri
nt
B
od
y 
w
ei
gh
t (
+
)
Pl
 +
 tr
ai
ni
ng
:
St
ro
ke
 v
el
oc
ity
po
w
er
/a
gi
lit
y
In
tr
ac
el
lu
la
r 
w
at
er
 (
+
)
n 
=
 1
1
B
lo
od
 c
he
m
is
tr
y
O
nl
y 
C
r+
:
Pl
-t
ra
in
in
g:
20
 m
 ti
m
e 
(+
)
n 
=
 1
1
St
ro
ke
 v
el
oc
ity
 (
+
)
O
p’
t E
ijn
de
C
r:
 2
0 
g 
+
 m
al
,
C
ro
ss
-o
ve
r:
8 
m
al
e/
te
nn
is
L
eu
ve
n 
T
en
ni
s
St
ro
ke
 v
el
oc
ity
 (
±)
,
Sp
ec
if
ic
et
 a
l. 
(9
1)
Pl
: m
al
6 
da
ys
 lo
ad
in
g
Pe
rf
or
m
an
ce
 T
es
t
St
ro
ke
 p
re
ci
si
on
 (
±)
35
 d
ay
s 
w
as
h 
ou
t
(L
T
PT
):
Sh
ut
tle
 r
un
 ti
m
e 
(±
)
6 
da
ys
 lo
ad
in
g
Sh
ut
tle
 r
un
 (
70
 m
)
R
om
er
 e
t a
l.
C
r:
 2
0 
g
C
ro
ss
-o
ve
r:
9 
m
al
e/
sq
ua
sh
Sq
ua
sh
 s
im
ul
at
io
n
C
r:
Sp
ec
if
ic
(9
5)
Pl
: 2
0 
g 
m
al
5 
da
ys
 lo
ad
in
g
Sh
ut
tle
:
Sh
ut
tle
 r
un
 ti
m
e 
(+
)
28
 d
ay
s 
w
as
h 
ou
t
10
 �
 2
 �
 s
im
ul
at
io
n,
B
od
y 
m
as
s 
(+
)
5 
da
ys
 lo
ad
in
g
30
-s
 r
es
t
D
. I
ce
 H
oc
ke
y 
an
d 
H
an
db
al
l
A
as
er
ud
C
r:
 1
5 
g 
+
 1
5 
g 
gl
u
5 
da
ys
 lo
ad
in
g,
14
 m
en
/h
an
db
al
l,
Sp
ri
nt
 8
 �
 4
0 
m
,
A
ll 
su
bj
ec
ts
:
Pl
: (
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Creatine Supplementation and Ballgames / 17
Iz
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18 / Ferrauti and Remmert
recorded (95). A reduced metabolic acidosis does not seem to be a principal mecha-
nism for improvements, since blood lactate concentrations were usually unaffected
after creatine loading (1, 88, 95).
On the other hand, there are several original papers and abstracts that fail to
report any beneficial effect of creatine loading. Redondo et al. (94) found no im-
provements in an intermittent sprint test over a 60-m distance with only three repeti-
tions. The low number of repititions can hardly be considered the only reason for
these different findings. Smart et al. (101) also failed to record any improvement in
a sprint test, although the number of repititions over a distance of 20 m was relatively
high (30 sprints). They conclude that increases in muscular power are perhaps offset
by the increase in body mass. In a tennis-specific crossover study, which so far has
managed to simulate the workload demands in competition best (Leuven Tennis
Performance Test), the authors did not find any positive short-term effects of CS
(121). They suppose that the PCr capacity is not an important limiting factor in
tennis, since the short maximal sprints will only partly deplete the PCr stores during
the rallies.
The discrepancy between the results of the studies cited can be related to the
specific profile of sprint and performance test demands (e.g., length of intensive
bouts, number of repetitions, duration of recovery), the existence of responders and
non-responders, and the different and partly insufficient statistical power of the
subject samples. Furthermore, it cannot be ruled out that an intensive intermittent
sprint test with up to 30 repetitions (101) may cause considerable damage to the
muscle cells of even well-trained game players so that even a 1-week recovery
period does not suffice the working muscles to get back to their full functional
strength, which has a negative effect on the test results after creatine loading.
To sum it up, the results at hand do not provide sufficient evidence to support
the view that short-term creatine loading results in thoroughly convincing effects in
ballgames. The possibly highly specific quality of workload demands in which
positive effects are produced can only be found fractionally in the varying workload
profile of sports games (Table 1). Intermittent maximal sprint loads at a density
implemented in the studies cited rarely occur in match play situations. In the future,
more valid field studies with a higher affinity for the genuine conditions found both
in competition and training of ballgames should be carried out.
Training Effects of Creatine
In eight studies, the investigators tried to find out how far the training effect within a
training meso-cycle with game players could be increased by CS (Table 3). The
duration of studies ranged between 1 (40, 65) and 3 months (60, 69). This specific
time span was chosen, as testers were looking to simulate a typical preseason inter-
val that teams use to prepare for the season to come. Only one study was deliberately
carried out under normal in-season training conditions (109). The frequency of
training sessions varied between 3 (40) and 5 days per week (65). The training
programs mostly consisted of a combination of resistance training and game-spe-
cific conditioning (e.g., agility/sprint training). The majority of studies were carried
out with American football players as test groups (13, 65, 109, 125). This implies
that, in American football, the enhancement of power and body mass is considered a
major factor in terms of performance.
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Creatine Supplementation and Ballgames / 19
In a 9-week study by Bemben et al. (13), CS plus training resulted in changes
in total body weight (+3.5%), intracellular water (+9.0%), lean body mass (+3.8%),
one-repetition maximum for bench press (+5.2 kg), and anaerobic power and capac-
ity (+18–19 W). No comparable results were found either in a placebo (sodium
phosphate monohydrate) or control group (no supplementation). Kreider et al. (65)
came to similar results (in terms of changes in body composition and strength)
during a 4-week training and supplementation period with 25 NCAA division IA
football players. Additionally, the authors found increased performance in intermit-
ting cycle ergometer sprints (12 � 6 s, 30-s rest). They provide the only study in
which clinical blood chemistry parameters are analyzed distinctly. The authors
come to the conclusion that all blood variables remained within the normal limits
despite a mild elevation of some important enzymes of the energy metabolism
(creatine kinase, lactate dehydrogenase, asparatate aminotransferase, and alanine
aminotransferase).
Two studies presented differing views with regard to the importance of com-
bining exercise with CS. Wilder et al. (125) found that well-periodized resistance
training alone is a sufficient training stimulus to produce significant changes. The
authors did not record any differences in performance enhancements between a
low- and high-dose CS group when compared with a placebo group. A recent study
carried out by our own working group came to different results (40). When compar-
ing the effects of a 4-week placebo-controlled CS period with or without training
intervention, significant increases in the 20-m sprint performance and the tennis
service velocity only occurred in the combined creatine-plus-training group.
The higher longitudinal increase in strength and the clearer changes in body
composition prompted by CS in combination with training intervention compared
to CS without training or compared to training intervention without supplementa-
tion can be attributed to three factors (52, 56, 57, 126, 127):
• The increase in muscle cell hydration as a result of a higher osmotic draw of
water stimulates the protein synthesis (myosin heavy chain mRNA and pro-
tein expression) and leads to muscle hypertrophy.
• Creatine predominantly affects cells already synthesizing muscle proteins.
The primary and/or boosting effect for starting gene transcription seems to be
the training stimulus.
• The increase in PCr availability and recovery allows a higher training inten-
sity and training volume and thus an overall higher training stimulus.
To sum up, the findings of the studies at hand suggest that combining CS with
training intervention (resistancetraining and game-specific conditioning) within a
meso-cycle of 1 to 2 months (for instance, serving as a pre-season preparation
period) can result in a significant increase in strength, power, and power endurance,
as well as a rise in lean body mass. However, the studies cited do not provide a viable
answer to the question of how far these effects can be transferred to the specific
workload profile of various ballgames in an attempt to enhance the players’ perfor-
mance. Supplementing creatine alone without specifically adjusting the training
process is not recommended. A perfectly designed training program still seems to be
the key to enhancing any dimension of performance (125).
None of the studies cited explicitly address the issue of possible side effects
(muscle injuries or cramps) occurring during the experimental period. One
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retrospective study, which was published recently, found no adverse health effects
on liver and kidney functions after a long-term CS in American football players
(71). According to the authors of this article, health problems, which may occur
acutely, should be taken seriously. In our own research, 60% of the subjects (15 out
of 25 tennis players) stated that they experienced unwanted side effects such as
muscle stiffness and cramps during the 4-week supplementation period (40).
Recommendations for Coaches and Athletes
Practical recommendations are based upon the initial theoretical considerations and
subsequent experimental findings about the effects of CS in ballgames as well as the
authors’ personal experiences and views. As a result, coaches and athletes in ballgames
are advised to take the following aspects into account:
• CS should only be applied on mature players to whom the entire range of its
effects (including its significance for the specific demands of the respective
sport), as well as the probability of potential side effects, have been brought to
attention. In addition, an indication is necessary for every single athlete before
supplementing creatine (e.g., specific deficits in body mass, power, or power
endurance). Therefore, the universal application of CS to an entire team must
be avoided by all means.
• Before opting for CS, all means of training intervention (resistance and sprint
power training) should have been exhausted. While applying CS, the players
involved should also go through systematic conditioning. Only when these
preconditions have been fulfilled can performance enhancement be expected.
In many ballgames, specific conditioning is difficult to put into practice, as the
specific on-court tactical and technical training dominates daily training rou-
tine.
• Unwanted side-effects of CS, with dehydration and muscle cramps at the top
of the list (40, 75), were reported by many players. In the first phase of CS, in
particular, game players should stay in close contact with coaches and medi-
cal staff and give detailed feedback on a regular basis. A muscular injury (e.g.,
of a key player) may result in a crucial disadvantage for the whole team, which
cannot be offset by the small positive ergogenic effects in other players.
• The individual responses of CS vary to a great extent. Possibly those athletes
whose muscles contain relatively minor quantities of creatine, such as veg-
etarians or rather untrained athletes, benefit the most. If players fail to record
positive effects, either subjectively or objectively, CS should be terminated.
As a rule, the authors recommend periodic intervals, with two peak phases per
season (in combination with specific meso-cycle conditioning) and an inter-
mediate washout phase in which CS is to be applied.
• The quality of creatine products varies greatly, as these food supplements are
not subject to strict quality control guidelines. Undesired byproducts (hor-
mones and prohormones such as nandrolone) may be found in many cheap
products (data from the Institute of Biochemistry at the German Sports Uni-
versity Cologne, Germany). Quality control of the products supplied is there-
fore inevitable prior to their use.
• As for the dosage and intake of creatine, all the usual standards given in
relevant literature (e.g., sufficient intake of liquids) are to be followed.
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Creatine Supplementation and Ballgames / 21
Furthermore, it has been shown that caffeine counteracts the positive effect of
creatine. Therefore, athletes should abstain from a simultaneous intake of
coffee and creatine, and total coffee consumption should be limited to 1–2
cups per day (119).
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