Skip to main content Accessibility help
×
Home

Nitrate supplementation improves physical performance specifically in non-athletes during prolonged open-ended tests: a systematic review and meta-analysis

  • Helton O. Campos (a1), Lucas R. Drummond (a1), Quezia T. Rodrigues (a1), Frederico S. M. Machado (a1), Washington Pires (a2), Samuel P. Wanner (a3) and Cândido C. Coimbra (a1)...

Abstract

Nitrate (NO3 ) is an ergogenic nutritional supplement that is widely used to improve physical performance. However, the effectiveness of NO3 supplementation has not been systematically investigated in individuals with different physical fitness levels. The present study analysed whether different fitness levels (non-athletes v. athletes or classification of performance levels), duration of the test used to measure performance (short v. long duration) and the test protocol (time trials v. open-ended tests v. graded-exercise tests) influence the effects of NO3 supplementation on performance. This systematic review and meta-analysis was conducted and reported according to the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. A systematic search of electronic databases, including PubMed, Web of Science, SPORTDiscus and ProQuest, was performed in August 2017. On the basis of the search and inclusion criteria, fifty-four and fifty-three placebo-controlled studies evaluating the effects of NO3 supplementation on performance in humans were included in the systematic review and meta-analysis, respectively. NO3 supplementation was ergogenic in non-athletes (mean effect size (ES) 0·25; 95 % CI 0·11, 0·38), particularly in evaluations of performance using long-duration open-ended tests (ES 0·47; 95 % CI 0·23, 0·71). In contrast, NO3 supplementation did not enhance the performance of athletes (ES 0·04; 95 % CI −0·05, 0·15). After objectively classifying the participants into different performance levels, the frequency of trials showing ergogenic effects in individuals classified at lower levels was higher than that in individuals classified at higher levels. Thus, the present study indicates that dietary NO3 supplementation improves physical performance in non-athletes, particularly during long-duration open-ended tests.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Nitrate supplementation improves physical performance specifically in non-athletes during prolonged open-ended tests: a systematic review and meta-analysis
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Nitrate supplementation improves physical performance specifically in non-athletes during prolonged open-ended tests: a systematic review and meta-analysis
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Nitrate supplementation improves physical performance specifically in non-athletes during prolonged open-ended tests: a systematic review and meta-analysis
      Available formats
      ×

Copyright

Corresponding author

* Corresponding author: C. C. Coimbra, fax +55 31 3409 2924, email coimbrac@icb.ufmg.br

Footnotes

Hide All

These authors contributed equally to this work.

Footnotes

References

Hide All
1. Jones, AM, Haramizu, S, Ranchordas, M, et al. (2011) A–Z of nutritional supplements: dietary supplements, sports nutrition foods and ergogenic aids for health and performance – part 27. Br J Sports Med 45, 12461248.
2. Jones, AM, Vanhatalo, A & Bailey, SJ (2013) Influence of dietary nitrate supplementation on exercise tolerance and performance. Nestle Nutr Inst Workshop Ser 75, 2740.
3. Jones, AM (2014) Dietary nitrate supplementation and exercise performance. Sports Med 44, Suppl. 1, S35S45.
4. Thompson, C, Wylie, LJ, Blackwell, JR, et al. (2017) Influence of dietary nitrate supplementation on physiological and muscle metabolic adaptations to sprint interval training. J Appl Physiol (1985) 122, 642652.
5. Hoon, MW, Johnson, NA, Chapman, PG, et al. (2013) The effect of nitrate supplementation on exercise performance in healthy individuals: a systematic review and meta-analysis. Int J Sport Nutr Exerc Metab 23, 522532.
6. McMahon, NF, Leveritt, MD & Pavey, TG (2017) The effect of dietary nitrate supplementation on endurance exercise performance in healthy adults: a systematic review and meta-analysis. Sports Med 47, 735 –756.
7. Jonvik, KL, Nyakayiru, J, van Loon, LJ, et al. (2015) Last word on viewpoint: can elite athletes benefit from dietary nitrate supplementation? J Appl Physiol (1985) 119, 770.
8. Jonvik, KL, Nyakayiru, J, van Loon, LJ, et al. (2015) Can elite athletes benefit from dietary nitrate supplementation? J Appl Physiol (1985) 119, 759761.
9. Hultstrom, M, Amorim de Paula, C, Antonio Peliky Fontes, M, et al. (2015) Commentaries on viewpoint: can elite athletes benefit from dietary nitrate supplementation? J Appl Physiol (1985) 119, 762769.
10. Lacerda, AC, Marubayashi, U, Balthazar, CH, et al. (2006) Evidence that brain nitric oxide inhibition increases metabolic cost of exercise, reducing running performance in rats. Neurosci Lett 393, 260263.
11. Lacerda, AC, Marubayashi, U & Coimbra, CC (2005) Nitric oxide pathway is an important modulator of heat loss in rats during exercise. Brain Res Bull 67, 110116.
12. Lima, PM, Santiago, HP, Szawka, RE, et al. (2014) Central blockade of nitric oxide transmission impairs exercise-induced neuronal activation in the PVN and reduces physical performance. Brain Res Bull 108, 8087.
13. Wanner, SP, Leite, LH, Guimaraes, JB, et al. (2015) Increased brain L-arginine availability facilitates cutaneous heat loss induced by running exercise. Clin Exp Pharmacol Physiol 42, 609616.
14. Larsen, FJ, Weitzberg, E, Lundberg, JO, et al. (2007) Effects of dietary nitrate on oxygen cost during exercise. Acta Physiol 191, 5966.
15. Larsen, FJ, Weitzberg, E, Lundberg, JO, et al. (2010) Dietary nitrate reduces maximal oxygen consumption while maintaining work performance in maximal exercise. Free Radic Biol Med 48, 342347.
16. Vanhatalo, A, Bailey, SJ, Blackwell, JR, et al. (2010) Acute and chronic effects of dietary nitrate supplementation on blood pressure and the physiological responses to moderate-intensity and incremental exercise. Am J Physiol Regul Integr Comp Physiol 299, R1121R1131.
17. Wylie, LJ, Kelly, J, Bailey, SJ, et al. (2013) Beetroot juice and exercise: pharmacodynamic and dose–response relationships. J Appl Physiol (1985) 115, 325336.
18. Bailey, SJ, Winyard, P, Vanhatalo, A, et al. (2009) Dietary nitrate supplementation reduces the O2 cost of low-intensity exercise and enhances tolerance to high-intensity exercise in humans. J Appl Physiol 107, 11441155.
19. Bailey, SJ, Fulford, J, Vanhatalo, A, et al. (2010) Dietary nitrate supplementation enhances muscle contractile efficiency during knee-extensor exercise in humans. J Appl Physiol 109, 135148.
20. Bond, H, Morton, L & Braakhuis, AJ (2012) Dietary nitrate supplementation improves rowing performance in well-trained rowers. Int J Sport Nutr Exerc Metab 22, 251256.
21. Cermak, NM, Gibala, MJ & van Loon, LJC (2012) Nitrate supplementation’s improvement of 10-km time-trial performance in trained cyclists. Int J Sport Nutr Exerc Metab 22, 6471.
22. Lansley, KE, Winyard, PG, Bailey, SJ, et al. (2011) Acute dietary nitrate supplementation improves cycling time trial performance. Med Sci Sports Exerc 43, 11251131.
23. Lansley, KE, Winyard, PG, Fulford, J, et al. (2011) Dietary nitrate supplementation reduces the O2 cost of walking and running: a placebo-controlled study. J Appl Physiol 110, 591600.
24. Masschelein, E, Van Thienen, R, Wang, X, et al. (2012) Dietary nitrate improves muscle but not cerebral oxygenation status during exercise in hypoxia. J Appl Physiol (1985) 113, 736745.
25. Bescόs, R, Ferrer-Roca, V, Galilea, PA, et al. (2012) Sodium nitrate supplementation does not enhance performance of endurance athletes. Med Sci Sports Exerc 44, 24002409.
26. Bescόs, R, Rodriguez, FA, Iglesias, X, et al. (2011) Acute administration of inorganic nitrate reduces VO(2peak) in endurance athletes. Med Sci Sports Exerc 43, 19791986.
27. Cermak, NM, Res, P, Stinkens, R, et al. (2012) No improvement in endurance performance after a single dose of beetroot juice. Int J Sport Nutr Exerc Metab 22, 470478.
28. Peacock, O, Tjonna, AE, James, P, et al. (2012) Dietary nitrate does not enhance running performance in elite cross-country skiers. Med Sci Sports Exerc 44, 22132219.
29. Wilkerson, DP, Hayward, G, Stephen, BJ, et al. (2012) Acute dietary nitrate supplementation does not improve 50-mile time trial performance in highly trained cyclists. Med Sci Sport Exerc 44, 442442.
30. Liberati, A, Altman, DG, Tetzlaff, J, et al. (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Ann Intern Med 151, W65W94.
31. Moher, D, Liberati, A, Tetzlaff, J, et al. (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 151, 264269, W264.
32. Christensen, PM, Nyberg, M & Bangsbo, J (2013) Influence of nitrate supplementation on VO2 kinetics and endurance of elite cyclists. Scand J Med Sci Sports 23, e21e31.
33. Duffield, R, Dawson, B & Goodman, C (2005) Energy system contribution to 400-metre and 800-metre track running. J Sports Sci 23, 299307.
34. De Pauw, K, Roelands, B, Cheung, SS, et al. (2013) Guidelines to classify subject groups in sport-science research. Int J Sports Physiol Perform 8, 111122.
35. JPT, Higgins & Green, S (editors) (2011) Cochrane Handbook for Systematic Reviews of Interventions, version 5.1.0 (updated March 2011). The Cochrane Collaboration. http://handbook.cochrane.org
36. Cohen, J (1988) Statistical Power Analysis for the Behavioral Sciences, 2nd ed. Hillsdale, NJ: Lawrence Earlbaum Associates.
37. Sterne, JA, Sutton, AJ, Ioannidis, JP, et al. (2011) Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials. BMJ 343, d4002.
38. Aucouturier, J, Boissiere, J, Pawlak-Chaouch, M, et al. (2015) Effect of dietary nitrate supplementation on tolerance to supramaximal intensity intermittent exercise. Nitric Oxide 49, 1625.
39. Bailey, SJ, Varnham, RL, DiMenna, FJ, et al. (2015) Inorganic nitrate supplementation improves muscle oxygenation, O2 uptake kinetics, and exercise tolerance at high but not low pedal rates. J Appl Physiol 118, 13961405.
40. Breese, BC, McNarry, MA, Marwood, S, et al. (2013) Beetroot juice supplementation speeds O2 uptake kinetics and improves exercise tolerance during severe-intensity exercise initiated from an elevated metabolic rate. Am J Physiol Regul Integr Comp Physiol 305, R1441R1450.
41. Buck, CL, Henry, T, Guelfi, K, et al. (2015) Effects of sodium phosphate and beetroot juice supplementation on repeated-sprint ability in females. Eur J Appl Physiol 115, 22052213.
42. Christensen, PM, Petersen, NK, Friis, SN, et al. (2017) Effects of nitrate supplementation in trained and untrained muscle are modest with initial high plasma nitrite levels. Scand J Med Sci Sports 27, 16161626.
43. Coggan, AR, Leibowitz, JL, Kadkhodayan, A, et al. (2015) Effect of acute dietary nitrate intake on maximal knee extensor speed and power in healthy men and women. Nitric Oxide 48, 1621.
44. Corry, LR & Gee, TI (2015) Dietary nitrate enhances power output during the early phases of maximal intensity sprint cycling. Int J Coaching Sci 9, 8797.
45. Fulford, J, Winyard, PG, Vanhatalo, A, et al. (2013) Influence of dietary nitrate supplementation on human skeletal muscle metabolism and force production during maximum voluntary contractions. Pflugers Arch 465, 517528.
46. Kelly, J, Vanhatalo, A, Wilkerson, DP, et al. (2013) Effects of nitrate on the power-duration relationship for severe-intensity exercise. Med Sci Sports Exerc 45, 17981806.
47. Kokkinoplitis, K & Chester, N (2014) The effect of beetroot juice on repeated sprint performance and muscle force production. J Phys Educ Sport 14, 242247.
48. Mosher, SL, Sparks, SA, Williams, EL, et al. (2016) Ingestion of a nitric oxide enhancing supplement improves resistance exercise performance. J Strength Cond Res 30, 35203524.
49. Murphy, M, Eliot, K, Heuertz, RM, et al. (2012) Whole beetroot consumption acutely improves running performance. J Acad Nutr Diet 112, 548552.
50. Nyakayiru, J, Jonvik, KL, Trommelen, J, et al. (2017) Beetroot juice supplementation improves high-intensity intermittent type exercise performance in trained soccer players. Nutrients 9, E314.
51. Porcelli, S, Ramaglia, M, Bellistri, G, et al. (2015) Aerobic fitness affects the exercise performance responses to nitrate supplementation. Med Sci Sports Exerc 47, 16431651.
52. Rienks, JN, Vanderwoude, AA, Maas, E, et al. (2015) Effect of beetroot juice on moderate-intensity exercise at a constant rating of perceived exertion. Int J Exerc Sci 8, 277286.
53. Thompson, KG, Turner, L, Prichard, J, et al. (2014) Influence of dietary nitrate supplementation on physiological and cognitive responses to incremental cycle exercise. Respir Physiol Neurobiol 193, 1120.
54. Thompson, C, Wylie, LJ, Fulford, J, et al. (2015) Dietary nitrate improves sprint performance and cognitive function during prolonged intermittent exercise. Eur J Appl Physiol 115, 18251834.
55. Vasconcellos, J, Henrique Silvestre, D, Dos Santos Baiao, D, et al. (2017) A single dose of beetroot gel rich in nitrate does not improve performance but lowers blood glucose in physically active individuals. J Nutr Metabol 2017, 7853034.
56. Wylie, LJ, Mohr, M, Krustrup, P, et al. (2013) Dietary nitrate supplementation improves team sport-specific intense intermittent exercise performance. Eur J Appl Physiol 113, 16731684.
57. Wylie, LJ, Bailey, SJ, Kelly, J, et al. (2016) Influence of beetroot juice supplementation on intermittent exercise performance. Eur J Appl Physiol 116, 415425.
58. Boorsma, RK, Whitfield, J & Spriet, LL (2014) Beetroot juice supplementation does not improve performance of elite 1500-m runners. Med Sci Sports Exerc 46, 23262334.
59. Callahan, MJ, Parr, EB, Hawley, JA, et al. (2017) Single and combined effects of beetroot crystals and sodium bicarbonate on 4-km cycling time trial performance. Int J Sport Nutr Exerc Metab 27, 271278.
60. Glaister, M, Pattison, JR, Muniz-Pumares, D, et al. (2015) Effects of dietary nitrate, caffeine, and their combination on 20-km cycling time trial performance. J Strength Cond Res 29, 165174.
61. Hoon, MW, Hopkins, WG, Jones, AM, et al. (2014) Nitrate supplementation and high-intensity performance in competitive cyclists. Appl Physiol Nutr Metab 39, 10431049.
62. Hoon, MW, Jones, AM, Johnson, NA, et al. (2014) The effect of variable doses of inorganic nitrate-rich beetroot juice on simulated 2000-m rowing performance in trained athletes. Int J Sport Physiol 9, 615620.
63. Kramer, SJ, Baur, DA, Spicer, MT, et al. (2016) The effect of six days of dietary nitrate supplementation on performance in trained CrossFit athletes. J Int Soc Sports Nutr 13, 39.
64. Lane, SC, Hawley, JA, Desbrow, B, et al. (2014) Single and combined effects of beetroot juice and caffeine supplementation on cycling time trial performance. Appl Physiol Nutr Metab 39, 10501057.
65. Lowings, S, Shannon, OM, Deighton, K, et al. (2017) Effect of dietary nitrate supplementation on swimming performance in trained swimmers. Int J Sport Nutr Exerc Metab 27, 377384.
66. Martin, K, Smee, D, Thompson, KG, et al. (2014) No improvement of repeated-sprint performance with dietary nitrate. Int J Sports Physiol Perform 9, 845850.
67. McQuillan, JA, Dulson, DK, Laursen, PB, et al. (2017) Dietary nitrate fails to improve 1 and 4 km cycling performance in highly trained cyclists. Int J Sport Nutr Exerc Metab 27, 255263.
68. McQuillan, JA, Dulson, DK, Laursen, PB, et al. (2017) The effect of dietary nitrate supplementation on physiology and performance in trained cyclists. Int J Sports Physiol Perform 12, 684689.
69. Muggeridge, DJ, Howe, CC, Spendiff, O, et al. (2013) The effects of a single dose of concentrated beetroot juice on performance in trained flatwater kayakers. Int J Sport Nutr Exerc Metab 23, 498506.
70. Nyakayiru, JM, Jonvik, KL, Pinckaers, PJ, et al. (2017) No effect of acute and 6-day nitrate supplementation on VO2 and time-trial performance in highly trained cyclists. Int J Sport Nutr Exerc Metab 27, 1117.
71. Peeling, P, Cox, GR, Bullock, N, et al. (2015) Beetroot juice improves on-water 500 M time-trial performance, and laboratory-based paddling economy in national and international-level Kayak athletes. Int J Sport Nutr Exerc Metab 25, 278284.
72. Rimer, EG, Peterson, LR, Coggan, AR, et al. (2016) Acute dietary nitrate supplementation increases maximal cycling power in athletes. Int J Sports Physiol Perform 11, 715720.
73. Rimer, EG, Peterson, LR, Coggan, AR, et al. (2016) Increase in maximal cycling power with acute dietary nitrate supplementation. Int J Sports Physiol Perform 11, 715720.
74. Shannon, OM, Barlow, MJ, Duckworth, L, et al. (2017) Dietary nitrate supplementation enhances short but not longer duration running time-trial performance. Eur J Appl Physiol 117, 775785.
75. Thompson, C, Vanhatalo, A, Jell, H, et al. (2016) Dietary nitrate supplementation improves sprint and high-intensity intermittent running performance. Nitric Oxide 61, 5561.
76. Wilkerson, DP, Hayward, GM, Bailey, SJ, et al. (2012) Influence of acute dietary nitrate supplementation on 50 mile time trial performance in well-trained cyclists. Eur J Appl Physiol 112, 41274134.
77. Goulet, ED (2011) Effect of exercise-induced dehydration on time-trial exercise performance: a meta-analysis. Br J Sports Med 45, 11491156.
78. Larsen, FJ, Schiffer, TA, Borniquel, S, et al. (2011) Dietary inorganic nitrate improves mitochondrial efficiency in humans. Cell Metab 13, 149159.
79. Hernández, A, Schiffer, TA, Ivarsson, N, et al. (2012) Dietary nitrate increases tetanic [Ca2+]i and contractile force in mouse fast-twitch muscle. J Physiol 590, 35753583.
80. Ferguson, SK, Hirai, DM, Copp, SW, et al. (2013) Impact of dietary nitrate supplementation via beetroot juice on exercising muscle vascular control in rats. J Physiol 591, 547557.
81. McNamara, TC, Keen, JT, Simmons, GH, et al. (2014) Endothelial nitric oxide synthase mediates the nitric oxide component of reflex cutaneous vasodilatation during dynamic exercise in humans. J Physiol 592, 53175326.
82. Larsen, FJ, Ekblom, B, Sahlin, K, et al. (2006) Effects of dietary nitrate on blood pressure in healthy volunteers. New Eng J Med 355, 27922793.
83. McConell, GK, Bradley, SJ, Stephens, TJ, et al. (2007) Skeletal muscle nNOS mu protein content is increased by exercise training in humans. Am J Physiol Regul Integr Comp Physiol 293, R821R828.
84. Tesch, PA & Karlsson, J (1985) Muscle fiber types and size in trained and untrained muscles of elite athletes. J Appl Physiol (1985) 59, 17161720.
85. Currell, K & Jeukendrup, AE (2008) Validity, reliability and sensitivity of measures of sporting performance. Sports Med 38, 297316.
86. Amann, M, Hopkins, WG & Marcora, SM (2008) Similar sensitivity of time to exhaustion and time-trial time to changes in endurance. Med Sci Sports Exerc 40, 574578.
87. Jeukendrup, A, Saris, WH, Brouns, F, et al. (1996) A new validated endurance performance test. Med Sci Sports Exerc 28, 266270.
88. Jeukendrup, AE & Currell, K (2005) Should time trial performance be predicted from three serial time-to-exhaustion tests? Med Sci Sports Exerc 37, 1820 author reply 1821.
89. Alexander, J, Diane, B, Cockburn, A, et al. (2008) Nitrate in vegetables scientific opinion of the Panel on Contaminants in the Food chain. EFSA J 689, 179.

Keywords

Type Description Title
UNKNOWN
Supplementary materials

Campos et al. supplementary material
Figure S1

 Unknown (1.1 MB)
1.1 MB
UNKNOWN
Supplementary materials

Campos et al. supplementary material
Figure S2

 Unknown (1.1 MB)
1.1 MB
UNKNOWN
Supplementary materials

Campos et al. supplementary material
Figure S3

 Unknown (1.0 MB)
1.0 MB
WORD
Supplementary materials

Campos et al. supplementary material
Tables 3-4

 Word (32 KB)
32 KB
UNKNOWN
Supplementary materials

Campos et al. supplementary material
Figure

 Unknown (494 KB)
494 KB

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed