Creatine monohydrate loading (20 g/day for 7 days) enhanced breath-hold exercise performance in trained breath-hold divers, as reflected by increases in total work and time to exhaustion, with lower lactate accumulation compared to placebo, without elevating perceived breath-hold difficulty.
Key Findings
Results
Creatine monohydrate loading produced a significant Time × Group interaction for total work, with greater improvements in the creatine group compared to placebo.
The Time × Group interaction for total work (TW) was statistically significant (p = 0.011).
Testing involved a maximal cycling trial performed on a single breath-hold on a bicycle ergometer, with participants aiming to cover the greatest possible distance.
The study used a double-blind, randomized, placebo-controlled design with 20 trained breath-hold divers (18 males, 2 females; mean age 41.6 ± 8.6 years).
The loading protocol was 20 g/day of creatine monohydrate for 7 days.
Results
Creatine supplementation produced a significant Time × Group interaction for time to exhaustion, with greater improvements in the creatine group compared to placebo.
The Time × Group interaction for time to exhaustion (TTE) was statistically significant (p = 0.028).
TTE was measured during a maximal single breath-hold cycling trial.
Participants were trained breath-hold divers, tested pre- and post-supplementation.
Results
Peripheral blood lactate accumulation showed a significant Time × Group interaction, with greater changes observed in the placebo group compared to the creatine group despite the creatine group achieving greater performance improvements.
The Time × Group interaction for lactate accumulation (LA) was statistically significant (p = 0.003).
The creatine group showed lower lactate accumulation despite achieving greater improvements in total work and time to exhaustion.
Lactate was measured as peripheral blood lactate accumulation following breath-hold exercise.
Results
Creatine supplementation produced a significant Time × Group interaction for fat-free mass, with greater increases observed in the creatine group compared to placebo.
The Time × Group interaction for fat-free mass was statistically significant (p = 0.017).
Body composition was assessed using dual-energy X-ray absorptiometry (DXA).
No significant between-group differences were observed for fat mass or total body mass.
Results
Creatine supplementation did not significantly affect ratings of perceived exertion for breath-hold difficulty, mean partial pressure of carbon dioxide in exhaled air, fat mass, or total body mass.
No significant between-group differences were observed for pCO₂, RPE-BH, RPE-MF, fat mass, or total body mass.
Mean partial pressure of carbon dioxide (pCO₂) in exhaled air following breath-hold exercise was measured as a marker of hypercapnic drive.
RPE-BH (ratings of perceived exertion for breath-hold) did not differ significantly between groups despite performance improvements in the creatine group.
A slight increase in RPE-MF (muscle fatigue) was observed in the creatine group, though this did not reach statistical significance between groups.
Background
The study rationale was based on the premise that breath-hold exercise increases reliance on anaerobic ATP production, creating a metabolic environment in which phosphocreatine-derived ATP may be particularly valuable.
Creatine supplementation is known to enhance anaerobic energy availability and buffering capacity.
Prior to this study, the impact of creatine supplementation on muscle work under voluntary breath-hold had not been explored.
Participants were trained breath-hold divers, representing a population with specific relevance to breath-hold-related sports.
What This Means
This research suggests that taking a high dose of creatine monohydrate (20 grams per day for one week) can meaningfully improve how much work trained breath-hold divers can perform during a single maximal breath-hold cycling effort. In this randomized controlled trial, participants who took creatine were able to cycle longer and produce more total work on a single breath compared to those who took a placebo, and they did so while accumulating less lactic acid in the blood — even though they performed better overall. This combination of improved performance and lower lactate suggests that creatine may help muscles generate energy more efficiently under the oxygen-restricted conditions of a breath-hold.
Interestingly, despite performing better, creatine users did not report a greater sense of difficulty breathing or breath-hold discomfort (though they did notice slightly more muscle fatigue). The creatine group also gained more fat-free mass (lean body mass) over the 7-day period, consistent with what is typically seen with creatine loading due to increased water retention in muscle tissue. No changes were seen in carbon dioxide levels in exhaled air, which suggests that the improved performance was not driven by changes in the participants' tolerance to carbon dioxide buildup.
This research matters because breath-hold sports — such as competitive freediving, underwater hockey, and spearfishing — rely heavily on anaerobic energy systems during the breath-hold itself, yet very little research has examined nutritional strategies specifically for these athletes. This study suggests creatine loading could be a practical and effective ergogenic (performance-enhancing) strategy for breath-hold athletes looking to improve their performance in competition or training, though further research with larger and more diverse samples would help confirm these findings.
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Kurmazovic N, Nomikos T, Adamakis M, Forbes S, Arnaoutis G, Djordjevic B, et al.. (2026). Load and breath-hold: impact of 7-day creatine monohydrate loading on breath-hold exercise performance - a double-blind randomized controlled trial.. Journal of the International Society of Sports Nutrition. https://doi.org/10.1080/15502783.2026.2732743