The effects of dietary nitrate supplementation on endurance exercise performance and cardiorespiratory measures in healthy adults: A systematic review and meta-analysis
Open accessAbstract
Nitrate supplementation is thought to improve performance in endurance sports. To meta-analyze studies evaluating the effect of nitrate supplementation on endurance sports performance among adults. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, Web of Science and CINAHL without language restrictions. We included studies that: 1) compared nitrate supplementation with placebo; 2) enrolled adults engaging in an endurance-based activity; and 3) reported a performance measure or surrogate physiologic outcome. We evaluated risk of bias using the Cochrane Collaboration tool and pooled data with a random-effects model. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to evaluate confidence in estimates. We included 73 studies ( n = 1061). Nitrate supplementation improved power output (MD 4.6 watts, P < 0.0001), time to exhaustion (MD 25.3 s, P < 0.00001), and distance travelled (MD 163.7 m, P = 0.03). We found no significant difference on perceived exertion, time trial performance and work done. Nitrate supplementation decreased VO 2 (MD − 0.04 L/min, P < 0.00001) but had no significant effect on VO 2max or blood lactate levels. The available evidence suggests that dietary nitrate supplementation benefits performance-related outcomes for endurance sports.
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Greater benefits from dietary nitrate are typically observed in less-trained individuals, whereas highly trained athletes often show limited responses due to their already optimised endogenous NO pathways.
“Greater benefits are typically observed in less-trained individuals, whereas highly trained athletes often show limited responses due to their already optimised endogenous NO pathways [47,48,49].”
From Dietary Nitrate-Rich Vegetables as Natural Modulators of Health: Mechanisms and Benefits in Ageing Populations (2026) · cites this paper as [47]
The Results (Subgroup analyses; page unavailable) report a significant VO2 effect in recreational athletes but not in elite or sedentary participants. The Discussion cautions that this subgroup finding may be spurious and says no conclusive inference can be drawn. It speculates about already-optimized muscle-fibre efficiency in elite athletes, not already-optimized endogenous NO pathways; the claim overstates both the consistency and the proposed mechanism. (LLM, conf=0.88)
Experimental — accuracy not yet measuredIn conditions of low oxygen availability, nitrite can be converted into nitric oxide, which plays important roles in vascular and metabolic control.
“In conditions of low oxygen availability, nitrite can be converted into nitric oxide, which is known to play a number of important roles in vascular and metabolic control [299].”
From International society of sports nutrition position stand: nutritional concerns of the female athlete (2023) · cites this paper as [299]
Recommended nitrate dosages generally range between 300-600 mg ingested 1-2 h prior to exercise.
“Recommended dosages generally range between 300–600 mg ingested 1–2 h prior to exercise [204,205,206].”
From Bioavailability, Efficacy, Safety, and Regulatory Status of Creatine and Related Compounds: A Critical Review (2022) · cites this paper as [205]
The Results (Subgroup analyses; page unavailable) say there were insufficient data to analyze effects by daily nitrate dose. The Discussion’s athlete perspective describes a personal protocol of 500 ml of beetroot juice 2–3 hours before exercise, not a recommendation of 300–600 mg 1–2 hours beforehand. Searches for those dose and timing ranges found no supporting passage in our copy. (LLM, conf=0.76)
Experimental — accuracy not yet measuredSystematic reviews and meta-analyses have shown that dietary nitrate is a useful nutritional strategy to optimize muscular performance during resistance and endurance exercises in different training modalities.
“Systematic reviews and meta-analyses have shown that dietary nitrate is a useful nutritional strategy to optimize muscular performance during resistance and endurance exercises in different training modalities [54,55,56].”
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- Authors
- Gao, C., Gupta, S., Adli, T., Hou, W., Coolsaet, R., Hayes, A., Kim, K., Pandey, A., Gordon, J., Chahil, G., Belley-Cote, E. P., & Whitlock, R. P.
- Affiliations
- University of British Columbia (CA)
- McMaster University (CA)
- Western University (CA)
- University of Guelph (CA)
- Queen's University (CA)
- Population Health Research Institute (CA)
- Population Health Research Institute Hamilton Ontario Canada
- Corresponding author
- Whitlock, Richard P.
- Venue
- Journal of the International Society of Sports Nutrition
- Publisher
- Informa UK Limited
- Published
- 2021-01-02
- Volume
- 18
- Issue
- 1
- Pages
- 55-55
- ISSN
- 1550-2783 (ISSN-L)
- PMC
- PMC8268374
- OpenAlex
- W3181601537
- Cited by
- 53
- References
- 24
- Citations by year
- 2026: 11 · 2025: 11 · 2024: 7 · 2023: 10 · 2022: 7 · 2021: 7
- FWCI
- 1.78
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Journal of the International Society of Sports Nutrition (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- cIRcle (University of British Columbia) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- Heart and Stroke Foundation of Canada
- Topics
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Cell Biology › Muscle metabolism and nutrition
- Health Sciences › Medicine › Rehabilitation › Exercise and Physiological Responses
- Keywords
- nitrate supplementation, endurance exercise performance, output power, time to exhaustion, VO2, blood lactate, perceived exertion, time trial performance, healthy adults
- MeSH terms
- Cardiorespiratory Fitness, Adult, Humans, Nitrates, Oxygen Consumption, Physical Endurance, Time Factors, Bias, Exercise Tolerance, Publication Bias, Lactic Acid, Dietary Supplements, Athletic Performance, Athletes, Sedentary Behavior
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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