The Role of Creatine Supplementation in Post-stroke Rehabilitation: Promising but Still Unresolved
Minahil Iqbal1, Mariam Akmal2, Esam Abobaker3, Shayan Marsia3, Jiangyong Min4
1Allama Iqbal Medical College, 2Lahore Medical and Dental College, 3Neurology, Corewell Health/Michigan State University, 4Corewell Health West
Objective:
This systematic review evaluates the safety, efficacy, and potential mechanisms of creatine supplementation in stroke recovery.
Background:
Stroke is a major cause of long-term disability, often leading to functional impairment. Beyond neurological damage, stroke-related sarcopenia from immobility and inflammation worsens recovery outcomes. Creatine, which enhances energy metabolism and shows neuroprotective properties, has been proposed as an adjunct therapy to improve functional rehabilitation after stroke.
Design/Methods:
MEDLINE, Embase, and CENTRAL databases were systematically searched till October 1, 2025 assessing creatine use in stroke survivors. Eligible designs were randomized or interventional studies assessing muscle mass, strength, mobility, and inflammatory outcomes of creatine supplement for post stroke recovery. Data was extracted and appraised using standardized quality assessment tools, and findings were narratively synthesized due to heterogeneity among studies.
Results:
Three studies (n=71) were included from 1,167 studies screened, with a mean follow-up duration of 58 days. Across three studies, creatine supplementation in stroke showed mixed results. The ICaRUS Trial (10 g/day for 7 days) found no improvement in muscle or functional recovery but noted reduced serum progranulin, suggesting anti-inflammatory effects. Butchart et al. reported better walking performance with creatine plus resistance training, while Meulengracht et al. found no functional or endurance benefits with creatine and maltodextrin. Overall, creatine was safe, well tolerated, and showed no adverse effects.
Conclusions:
Creatine appears safe and may improve functional recovery, particularly with exercise in post-stroke patients. Limited evidence, by small sample sizes and methodological variability, suggests potential anti-inflammatory and neuroplastic effects. Larger, high-quality randomized controlled trials are needed to define optimal dosing, timing, and therapeutic efficacy in mitigating stroke-related sarcopenia and enhancing recovery outcomes.
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