are you still talking about covid relief?

The short version: yes, the question is still about the same topic — whether exercise explains the improvements, not creatine.

The evidence you already have makes the same point. Every trial that compared creatine-plus-exercise to exercise-plus-placebo found that the exercise alone produced the gains. The 1998 trial in older adults, the 2009 trial in young men, and the 2026 pilot study all show this pattern . The 2025 trial added a second supplement (HMB) and found a small extra benefit, but that is a combination product, not creatine alone .

The 2026 pilot is the most relevant to your question. Both creatine groups and the placebo group did the same structured exercise program three times a week. The 6 g/day group showed a fatigue reduction of about 2 points on the Piper scale and a handgrip gain of about 4.4 kg compared to the sugar-plus-exercise placebo . But the 18 g/day group, which got three times the dose, showed zero benefit on either measure. That U-shaped result is not what a real drug effect looks like. It is random variation in a small, single-blind, 4-week study.

The systematic review from 2020 confirms the pattern: creatine combined with resistance training increases strength and muscle mass, but the gains are measured against a placebo that does not exercise . The question is whether creatine adds anything to exercise alone. The trials that test that directly say no .

My call: exercise is the true cause of the improvements. The creatine adds no consistent benefit beyond what the exercise program alone produces. Confidence: moderate.