Studies have shown that creatine supplementation increases intramuscular creatine concentrations, favoring the energy system of phosphagens, which may help explain the observed improvements in high-intensity exercise performance. However, research on physical performance in soccer has shown controversial results, in part because the energy system used is not taken into account. The main aim of this investigation was to perform a systematic review and meta-analysis to determine the efficacy of creatine supplementation for increasing performance in skills related to soccer depending upon the type of metabolism used (aerobic, phosphagen, and anaerobic metabolism). A structured search was carried out following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines in the Medline/PubMed and Web of Science, Cochrane Library, and Scopus databases until January 2019. The search included studies with a double-blind and randomized experimental design in which creatine supplementation was compared to an identical placebo situation (dose, duration, timing, and drug appearance). There were no filters applied to the soccer players' level, gender, or age. A final meta-analysis was performed using the random effects model and pooled standardized mean differences (SMD) (Hedges's g). Nine studies published were included in the meta-analysis. This revealed that creatine supplementation did not present beneficial effects on aerobic performance tests (SMD, -0.05; 95% confidence interval (CI), -0.37 to 0.28; p = 0.78) and phosphagen metabolism performance tests (strength, single jump, single sprint, and agility tests: SMD, 0.21; 95% CI, -0.03 to 0.45; p = 0.08). However, creatine supplementation showed beneficial effects on anaerobic performance tests (SMD, 1.23; 95% CI, 0.55⁻1.91; p <0.001). Concretely, creatine demonstrated a large and significant effect on Wingate test performance (SMD, 2.26; 95% CI, 1.40⁻3.11; p <0.001). In conclusion, creatine supplementation with a loading dose of 20⁻30 g/day, divided 3⁻4 times per day, ingested for 6 to 7 days, and followed by 5 g/day for 9 weeks or with a low dose of 3 mg/kg/day for 14 days presents positive effects on improving physical performance tests related to anaerobic metabolism, especially anaerobic power, in soccer players.

Although there are many studies showing the isolated effect of creatine monohydrate (CrM) and β-hydroxy β-methylbutyrate (HMB), it is not clear what effect they have when they are combined. The main purpose of this systematic review was to determine the efficacy of mixing CrM plus HMB in comparison with their isolated effects on sports performance, body composition, exercise induced markers of muscle damage, and anabolic-catabolic hormones. This systematic review was carried out in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement guidelines and the PICOS model, for the definition of the inclusion criteria. Studies were found by searching PubMed/MEDLINE, Web of Science (WOS), and Scopus electronic databases from inception to July 3rd 2019. Methodological quality and risk of bias were assessed by two authors independently, and disagreements were resolved by third-party evaluation, in accordance with the Cochrane Collaboration Guidelines samples. The literature was examined regarding the effects of the combination of CrM plus HMB on sport performance using several outcome variables (athletic performance, body composition, markers of muscle damage, and hormone status). This systematic review included six articles that investigated the effects of CrM plus HMB on sport performance (two on strength performance, showing improvements in one of them; three on anaerobic performance, presenting enhancements in two of them; and one on aerobic performance, not presenting improvements), body composition (three on body mass, showing improvements in one of them; two on fat free mass, presenting increases in one of them; and two on fat mass, showing decreases in one of them) and markers of muscle damage and hormone status (four on markers of muscle damage and one on anabolic-catabolic hormones, not showing benefits in any of them). In summary, the combination of 3-10 g/day of CrM plus 3 g/day of HMB for 1-6 weeks could produce potential positive effects on sport performance (strength and anaerobic performance) and for 4 weeks on body composition (increasing fat free mass and decreasing fat mass). However, this combination seems to not show positive effects relating to markers of exercise-induced muscle damage and anabolic-catabolic hormones.