Post-exercise hypotension and skeletal muscle oxygenation is regulated by nitrate-reducing activity of oral bacteria
Open accessAbstract
Post-exercise hypotension (PEH) is a common physiological phenomenon leading to lower blood pressure after acute exercise, but it is not fully understood how this intriguing response occurs. This study investigated whether the nitrate-reducing activity of oral bacteria is a key mechanism to trigger PEH. Following a randomized, double blind and crossover design, twenty-three healthy individuals (15 males/8 females) completed two treadmill trials at moderate intensity. After exercise, participants rinsed their mouth with antibacterial mouthwash to inhibit the activity of oral bacteria or a placebo mouthwash. Blood pressure was measured before, 1h and 2 h after exercise. The microvascular response to a reactive hyperaemia test, as well as blood and salivary samples were taken before and 2 h after exercise to analyse nitrate and nitrite concentrations and the oral microbiome. As expected, systolic blood pressure (SBP) was lower (1 h: -5.2 ± 1.0 mmHg; P < 0.001); 2 h: -3.8 ± 1.1 mmHg, P = 0.005) after exercise compared to baseline in the placebo condition. This was accompanied by an increase of circulatory nitrite 2 h after exercise (2h: 100 ± 13 nM) compared to baseline (59 ± 9 nM; P = 0.013). Additionally, an increase in the peak of the tissue oxygenation index (TOI) during the reactive hyperaemia response was observed after exercise (86.1 ± 0.6%) compared to baseline levels (84.8 ± 0.5%; P = 0.010) in the placebo condition. On the other hand, the SBP-lowering effect of exercise was attenuated by 61% at 1 h in the recovery period, and it was fully attenuated 2 h after exercise with antibacterial mouthwash. This was associated with a lack of changes in circulatory nitrite (P > 0.05), and impaired microvascular response (peak TOI baseline: 85.1 ± 3.1%; peak TOI post-exercise: 84.6 ± 3.2%; P > 0.05). Diversity of oral bacteria did not change after exercise in any treatment. These findings show that nitrite synthesis by oral commensal bacteria is a key mechanism to induce the vascular response to exercise over the first period of recovery thereby promoting lower blood pressure and greater muscle oxygenation.
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Melo-Dias, S., Cabral, M., Furtado, A., Souto‐Miranda, S., Mendes, M. A., Cravo, J., Almeida, C. R., Marques, A., & Sousa, A. (2024) · Figshare · doi:10.6084/m9.figshare.26564076
Melo-Dias, S., Cabral, M., Furtado, A., Souto‐Miranda, S., Mendes, M. A., Cravo, J., Almeida, C. R., Marques, A. S. P. D. D., & Sousa, A. (2024) · Figshare · doi:10.6084/m9.figshare.26564079
Overview of head & neck microbiota
Jayasinghe, R., Gunawardhana, K. S. N. D., & Senevirathna, K. (2026) · Advances in immunology · doi:10.1016/bs.ai.2026.04.003
Bescós, R., Joyce, C., Mutahar, M., Sharma, S., Era, T., Brookes, Z. L. S., & Casas‐Agustench, P. (2026) · Research Square · doi:10.21203/rs.3.rs-11115345/v1
Self-citationZhao, Z., Lai, Z., Zhao, S., Li, W., Wang, M., Guan, F., Liang, X., Zhang, J., & Wang, L. (2026) · Nutrients · doi:10.3390/nu18203315
“A separate exercise study used mouthwash perturbation and found that lower oral nitrate-reducing activity was accompanied by an attenuated post-exercise blood pressure response and reduced skeletal muscle oxygenation [26].”
InfluentialLess bacteria, less benefit: Correlation of dietary nitrate and the oral microbiome
Bhardwaj, K., & Srivastava, D. (2026) · Adesh University Journal of Medical Sciences & Research · doi:10.25259/aujmsr_90_2026
- Authors
- Clarke, C., Kiernan, M., Willis, J. R., Gallardo-Alfaro, L., Casas-Agustench, P., White, D., Hickson, M., Gabaldon, T., & Bescos, R.
- Affiliations
- University of Plymouth (GB)
- Barcelona Institute of Science and Technology (ES)
- Universitat de les Illes Balears (ES)
- Venue
- Free Radical Biology and Medicine
- Publisher
- Elsevier BV
- Published
- 2019-11
- Volume
- 143
- Pages
- 252-259
- ISSN
- 0891-5849 (ISSN-L)
- OpenAlex
- W2964637210
- Cited by
- 49
- References
- 38
- Citations by year
- 2026: 7 · 2025: 9 · 2024: 10 · 2023: 4 · 2022: 5 · 2021: 7 · 2020: 7
- FWCI
- 6.12
- Type
- journal article
- Language
- en
- Open access
- green
- pearl.plymouth.ac.uk
- Licence
- Locations
- Free Radical Biology and Medicine (publishedVersion)
- PubMed (publishedVersion)
- PEARL (University of Plymouth) (submittedVersion, cc-by-nc-nd)
- PEARL (University of Plymouth) (submittedVersion)
- Funders
- Instituto de Salud Carlos III (CIBEROBN CB12/03/30038)
- Plymouth University
- Ministerio de Educación, Cultura y Deporte (FPU 15/06147)
- Topics
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Health Sciences › Medicine › Rehabilitation › Exercise and Physiological Responses
- Health Sciences › Medicine › Physiology › Nitric Oxide and Endothelin Effects
- Keywords
- post-exercise hypotension, nitrate-reducing bacteria, oral microbiota, nitrite, blood pressure, post-exercise recovery, reactive hyperemia, microvascular response, tissue oxygenation, antibacterial mouthwash, skeletal muscle oxygenation, nitric oxide signaling, vascular function, exercise-induced vasodilation, nitric oxide synthase inhibition, nitric oxide reductase inhibition
- MeSH terms
- Adult, Bacteria, Double-Blind Method, Female, Humans, Hyperemia, Male, Mouth, Mouthwashes, Nitrates, Saliva, Exercise, Muscle, Skeletal, Cross-Over Studies, Post-Exercise Hypotension
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