The purpose of this paper was to carry out a systematic review with a meta-analysis of randomized controlled trials that examined the combined effects of resistance training (RT) and creatine supplementation on regional changes in muscle mass, with direct imaging measures of hypertrophy. Moreover, we performed regression analyses to determine the potential influence of covariates. We included trials that had a duration of at least 6 weeks and examined the combined effects of creatine supplementation and RT on site-specific direct measures of hypertrophy (magnetic resonance imaging (MRI), computed tomography (CT), or ultrasound) in healthy adults. A total of 44 outcomes were analyzed across 10 studies that met the inclusion criteria. A univariate analysis of all the standardized outcomes showed a pooled mean estimate of 0.11 (95% Credible Interval (CrI): −0.02 to 0.25), providing evidence for a very small effect favoring creatine supplementation when combined with RT compared to RT and a placebo. Multivariate analyses found similar small benefits for the combination of creatine supplementation and RT on changes in the upper and lower body muscle thickness (0.10–0.16 cm). Analyses of the moderating effects indicated a small superior benefit for creatine supplementation in younger compared to older adults (0.17 (95%CrI: −0.09 to 0.45)). In conclusion, the results suggest that creatine supplementation combined with RT promotes a small increase in the direct measures of skeletal muscle hypertrophy in both the upper and lower body.

The present paper aimed to systematically review case studies on physique athletes to evaluate longitudinal changes in measures of body composition, neuromuscular performance, chronic hormonal levels, physiological adaptations, and psychometric outcomes during pre-contest preparation. We included studies that (1) were classified as case studies involving physique athletes during the pre-contest phase of their competitive cycle; (2) involved adults (18+ years of age) as participants; (3) were published in an English-language peer-reviewed journal; (4) had a pre-contest duration of at least 3 months; (5) reported changes across contest preparation relating to measures of body composition (fat mass, lean mass, and bone mineral density), neuromuscular performance (strength and power), chronic hormonal levels (testosterone, estrogen, cortisol, leptin, and ghrelin), physiological adaptations (maximal aerobic capacity, resting energy expenditure, heart rate, blood pressure, menstrual function, and sleep quality), and/or psychometric outcomes (mood states and food desire). Our review ultimately included 11 case studies comprising 15 ostensibly drug-free athletes (male = 8, female = 7) who competed in various physique-oriented divisions including bodybuilding, figure, and bikini. The results indicated marked alterations across the array of analyzed outcomes, sometimes with high inter-individual variability and divergent sex-specific responses. The complexities and implications of these findings are discussed herein.

This study assessed a male competitive powerlifter over a 6-month period that encompassed his pre-contest preparation and post-contest recovery. We conducted the following monthly assessments: multi-frequency bioelectrical impedance analysis (MF-BIA), B-mode ultrasound evaluation of muscle thickness (MT), body circumferences, handgrip strength, vertical jump height, isometric lower body strength, and questionnaires for perceived mood and sleep. The athlete undertook a 3-month pre-contest preparatory period that included an extreme energy-restricted diet intended to sufficiently reduce body mass. This period also included an 8-week pre-contest training regimen with a 10-day taper intended to promote peak strength increases in the target lifts for competition. During the pre-competition period, the athlete experienced rapid and substantial losses of body mass (10.3%), body fat (6.5%) and lean mass (3.3%), the majority of which was regained in the 2-month post-competition recovery phase. The athlete's isometric knee extension strength rose sharply during the initial month of the pre-competition phase (336.4 Nm), followed by consistent declines (299 to 262.2 to 283 Nm) over the next 3 months, eventually returning close to baseline values 2 months post- competition Jump height remained steady in the 3 months in the pre-contest phase but increased (+1.4 cm) in the 2 months post-competition while handgrip strength increased during the months preceding the competition (47.5 kg to 49 kg) but decreased to 42.3 cm post-competition. Overall, the athlete did not seem to have any marked sleep disturbances. The most notable changes in mood parameters were increased tension, anger, and depression immediately preceding the competition.

Piñero, A, Mohan, AE, Burke, R, Babault, N, Swinton, PA, and Schoenfeld, BJ. On equal footing? Sex-moderated post-activation performance enhancement in trained individuals. J Strength Cond Res XX(X): 000–000, 2026—This study explored whether resistance-trained men ( n = 16) and women ( n = 15) experienced different degrees of post-activation performance enhancement (PAPE) at varying proximities to failure. In a randomized, within-subject crossover design, subjects completed 4 experimental sessions in a randomized order. During each session, subjects completed countermovement jump assessments at baseline and at 3, 6, and 9 minutes following 2 barbell back squat sets of 1 repetition (1R), 3 repetitions (3R), 5 repetitions (5R), or passive rest (CON). Bayesian multilevel models were used, and inferences were based on posterior distributions of changes and sex contrasts, including region of practical equivalence (ROPE)-based probabilities of practically meaningful effects. Across protocols and time points, posterior distributions of sex differences were generally within the ROPE, indicating little evidence that sex meaningfully moderated PAPE outcomes. However, at 1R minute 9 and 3R minute 3, posterior probabilities of an improvement from baseline in jump height (JH) were higher in women than in men ( M = 0.09 [0.00, 0.19]; F = 0.34 [0.12, 0.54]) and ( M = 0.11 [0.00, 0.30]; F = 0.47 [0.20, 0.67]), respectively, suggesting possible protocol- and time-specific sex differences. By contrast, sex moderation was unlikely at other time points, including all 5R assessments. Overall, heavier back squats performed closer to failure were more likely to elicit PAPE than sets performed farther from failure, with broadly similar responses between sexes. Any sex-specific differences appeared limited and protocol- and time-dependent, with only tentative evidence of greater PAPE in women under some further-from-failure conditions.