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These studies were rated as fair to excellent following the PEDro scale. The outcome measures were compared between the CrM and placebo groups at 24\u201336\u00a0h and 48\u201390\u00a0h following muscle-damaging exercises, using standardised mean differences (SMDs) and associated <jats:italic>p<\/jats:italic>-values via forest plots. Furthermore, sub-group analyses were conducted by separating studies into those that examined the effects of CrM as an acute training response (i.e., after one muscle-damaging exercise bout) and those that examined the chronic training response (i.e., examining the acute response after the last training session following several weeks of training).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>According to the meta-analysis, the CrM group exhibited significantly lower indirect muscle damage markers (i.e., creatine kinase, lactate dehydrogenase, and\/or myoglobin) at 48\u201390\u00a0h post-exercise for the acute training response (SMD\u2009\u2212\u20091.09; <jats:italic>p<\/jats:italic>\u2009=\u20090.03). However, indirect muscle damage markers were significantly greater in the CrM group at 24\u00a0h post-exercise (SMD 0.95; <jats:italic>p<\/jats:italic>\u2009=\u20090.04) for the chronic training response. Although not significant, a large difference in indirect muscle damage markers was also found at 48\u00a0h post-exercise (SMD 1.24) for the chronic training response. The CrM group also showed lower inflammation for the acute training response at 24\u201336\u00a0h post-exercise and 48\u201390\u00a0h post-exercise with a large effect size (SMD\u2009\u2212\u20091.38\u2009\u2264\u2009<jats:italic>d<\/jats:italic>\u2009\u2264\u2009\u2009\u2212\u20091.79). Similarly, the oxidative stress markers were lower for the acute training response in the CrM group at 24\u201336\u00a0h post-exercise and 90\u00a0h post-exercise, with a large effect size (SMD\u2009\u2212\u20091.37 and\u2009\u2212\u20091.36, respectively). For delayed-onset muscle soreness (DOMS), the measures were lower for the CrM group at 24\u00a0h post-exercise with a moderate effect size (SMD\u2009\u2212\u20090.66) as an acute training response. However, the inter-group differences for inflammation, oxidative stress, and DOMS were not statistically significant (<jats:italic>p<\/jats:italic>\u2009&gt;\u20090.05).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Overall, our meta-analysis demonstrated a paradoxical effect of CrM supplementation post-exercise, where CrM appears to minimise exercise-induced muscle damage as an acute training response, although this trend is reversed as a chronic training response. Thus, CrM may be effective in reducing the level of exercise-induced muscle damage following a single bout of strenuous exercises, although training-induced stress could be exacerbated following long-term supplementation of CrM. Although long-term usage of CrM is known to enhance training adaptations, whether the increased level of exercise-induced muscle damage as a chronic training response may provide potential mechanisms to enhance chronic training adaptations with CrM supplementation remains to be confirmed.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s40279-022-01640-z","type":"journal-article","created":{"date-parts":[[2022,2,26]],"date-time":"2022-02-26T09:02:53Z","timestamp":1645866173000},"page":"1623-1645","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":23,"title":["The Paradoxical Effect of Creatine Monohydrate on Muscle Damage Markers: A Systematic Review and Meta-Analysis"],"prefix":"10.1007","volume":"52","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8903-0067","authenticated-orcid":false,"given":"Kenji","family":"Doma","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akhilesh Kumar","family":"Ramachandran","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Boullosa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Connor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,2,26]]},"reference":[{"issue":"2","key":"1640_CR1","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1002\/mus.24077","volume":"49","author":"RD Hyldahl","year":"2014","unstructured":"Hyldahl RD, Hubal MJ. 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No sources of funding were used to assist in the preparation of this article.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Funding"}},{"value":"Kenji Doma, Akhilesh Kumar Ramachandran, Daniel Boullosa, and Jonathan Connor have no conflicts of interest that are directly relevant to the content of this article.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflicts of Interest"}},{"value":"Data will be provided upon request.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Availability of data and material"}},{"value":"Not applicable.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Code availability"}},{"value":"Not applicable.","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"Not applicable.","order":7,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"Not applicable.","order":8,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"KD wrote the first draft. 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