Creatine added little to lifting in cancer survivors

People who have been through chemotherapy for colorectal cancer often finish treatment with reduced strength and physical function, and resistance training is the most direct countermeasure available. Delivering that training is the hard part: clinic-only programmes are burdensome, so hybrid models combining supervised and virtual sessions are attractive if patients will actually stick with them. Creatine monohydrate is separately proposed as a low-cost adjunct that might amplify muscle and function gains. This pilot trial asked the practical questions first — can such a programme be recruited, delivered and tolerated — before asking how well it works.

Twenty-seven participants previously treated for colorectal cancer were randomised to a 10-week hybrid resistance training programme with either 5 grams per day of creatine monohydrate (n=13) or a matched corn-starch maltodextrin placebo (n=14). Training was performed three times per week. Feasibility was judged on recruitment, retention and fidelity, measured as the percentage of prescribed sessions and supplement doses completed. Acceptability used a 5-point Likert scale and focus group interviews, and safety was tracked through adverse event reporting. Body composition, muscular strength and physical function were secondary outcomes analysed with baseline-adjusted ANCOVA.

Registry-based recruitment identified 1378 potentially eligible individuals, and just 27 of the 410 assessed enrolled — 6.6% — which the authors flag as a real recruitment challenge. Once enrolled, however, participants stayed: retention was 24 of 27, or 88.9%, adherence to both training and supplementation exceeded 85%, and no serious adverse events were reported. Participants rated both the in-person and virtual components highly acceptable. For the secondary outcomes there were no significant between-group differences, though both groups showed modest improvements in muscular strength and short physical performance battery scores.

The feasibility message is the solid one: hybrid supervised resistance training is deliverable and well tolerated in this population, and low recruitment rates rather than dropout are the bottleneck. On creatine, this pilot does not support a clear additive effect, but it was never designed to detect one — with 27 participants split across two arms, a genuine modest benefit could easily be missed. The similar improvements in both groups are consistent with training doing the work. Adequately powered trials are the acknowledged next step, and readers should note the creatine-industry disclosures among the authors.

If you or someone you know is rebuilding after cancer treatment, the encouraging finding is that a mixed clinic-and-home lifting programme was safe, acceptable and associated with modest gains in strength and physical function. What this trial does not show is that adding creatine changes that trajectory — and it also does not show it fails to, given the small sample. The broader lesson is that the training itself carries the signal here. It is a reason to treat creatine's role in this setting as genuinely unresolved rather than either established or dismissed.