The DOI matches its Crossref record; 19 of the 19 references it cites were found in a registry or an index.
Limited Effects of Inorganic Nitrate Supplementation on Exercise Training Responses: A Systematic Review and Meta-analysis
Abstract
Background: Inorganic nitrate (NO 3−) supplementation is purported to benefit short-term exercise performance, but it is unclear whether NO 3− improves longer-term exercise training responses (such as improvements in VO 2peak or time to exhaustion (TTE)) versus exercise training alone. The purpose of this systematic review and meta-analysis was to determine the effects of NO 3− supplementation combined with exercise training on VO 2peak and TTE, and to identify potential factors that may impact outcomes. Methods: Electronic databases (PubMed, Medscape, and Web of Science) were searched for articles published through June 2022 with article inclusion determined a priori as: (1) randomized placebo-controlled trials, (2) exercise training lasted at least three weeks, (3) treatment groups received identical exercise training, (4) treatment groups had matched VO 2peak at baseline. Study quality was assessed using the Cochrane Risk-of-Bias 2 tool. Standardized mean difference (SMD) with 95% confidence intervals (CI) were calculated using restricted maximum likelihood estimation between pre- and post-training differences in outcomes. Moderator subgroup and meta-regression analyses were completed to determine whether the overall effect was influenced by age, sex, NO 3− dosage, baseline VO 2peak, health status, NO 3− administration route, and training conditions. Results: Nine studies consisting of eleven trials were included: n = 228 (72 females); age = 37.7 ± 21 years; VO 2peak: 40 ± 18 ml/kg/min. NO 3− supplementation did not enhance exercise training with respect to VO 2peak (SMD: 0.18; 95% CI: -0.09, 0.44; p = 0.19) or TTE (SMD: 0.08; 95% CI: − 0.21, 0.37; p = 0.58). No significant moderators were revealed on either outcome. Subset analysis on healthy participants who consumed beetroot juice (BRJ) revealed stronger trends for NO 3− improving VO 2peak (p = 0.08) compared with TTE (p = 0.19), with no significant moderators. Sunset funnel plot revealed low statistical power in all trials. Conclusions: NO 3− supplementation combined with exercise training may not enhance exercise outcomes such as VO 2peak or TTE. A trend for greater improvement in VO 2peak in healthy participants supplemented with BRJ may exist (p = 0.08). Overall, future studies in this area need increased sample sizes, more unified methodologies, longer training interventions, and examination of sex as a biological variable to strengthen conclusions.
Overview
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the citing paper
“However, systematic reviews highlight the limited number of studies and their heterogeneity in participant level, exercise protocols, dosages, and supplementation strategies [58,99].”
From Use of Nutritional Strategies, Bioactive Compounds, and Dietary Supplements in Young Athletes: From Evidence to Potential Risks—A Narrative Review (2025) · cites this paper as [99]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Citations
Cites
The PRISMA 2020 statement: An updated guideline for reporting systematic reviews
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., et al. (2021) · BMJ · doi:10.1136/bmj.n71 · Cited by 108,283
Bunney, P. E., Zink, A. N., Holm, A. A., Billington, C. J., & Kotz, C. M. (2017) · Physiology & Behavior · doi:10.1016/j.physbeh.2017.03.040 · Cited by 2,104
Dietary Inorganic Nitrate Improves Mitochondrial Efficiency in Humans
Larsen, F. J., Schiffer, T. A., Borniquel, S., Sahlin, K., Ekblom, B., Lundberg, J. O., & Weitzberg, E. (2011) · Cell Metabolism · doi:10.1016/j.cmet.2011.01.004 · Cited by 689 · cited 1×
“…beneficial role in several physiological processes linked to exercise performance, including increased blood flow and O 2 delivery [4, 5], increased microvascular PO 2 [6], improved muscular contractility [7, 8], and reduced O 2 cost of exercise [9–11] by enhancing mitochondrial function [12].”
BackgroundInorganic Nitrate Supplementation Lowers Blood Pressure in Humans: Role for Nitrite-Derived NO
Kapil, V., Milsom, A. B., Okorie, M., Maleki-Toyserkani, S., Akram, F., Rehman, F., Arghandawi, S., Pearl, V., Benjamin, N., Loukogeorgakis, S., et al. (2010) · Hypertension · doi:10.1161/hypertensionaha.110.153536 · Cited by 621 · cited 1×
“Whether NO 3– dose should be normalized to bodyweight has key implications in females due to the typically lower body mass compared to males and higher basal NO 2 − levels [55].”
BackgroundVanhatalo, A., Bailey, S. J., Blackwell, J. R., DiMenna, F. J., Pavey, T. G., Wilkerson, D. P., Benjamin, N., Winyard, P. G., & Jones, A. M. (2010) · American Journal of Physiology-Regulatory, Integrative and Comparative Physiology · doi:10.1152/ajpregu.00206.2010 · Cited by 529
THE PHYSIOLOGICAL MEANING OF THE MAXIMAL OXYGEN INTAKE TEST1
Mitchell, J. H., Sproule, B. J., & Chapman, C. B. (1958) · Journal of Clinical Investigation · doi:10.1172/jci103636 · Cited by 516
Mandsager, K., Harb, S., Cremer, P., Phelan, D., Nissen, S. E., & Jaber, W. (2018) · JAMA Network Open · doi:10.1001/jamanetworkopen.2018.3605 · Cited by 501 · cited 1×
“VO 2peak improves with exercise training via multifaceted improvements in oxygen delivery (e.g., stroke volume, blood volume) and oxygen utilization (e.g., a-vO 2 difference), and is a predictor of both endurance capacity and mortality/morbidity [18].”
BackgroundLansley, K. E., Winyard, P. G., Fulford, J., Vanhatalo, A., Bailey, S. J., Blackwell, J. R., DiMenna, F. J., Gilchrist, M., Benjamin, N., & Jones, A. M. (2011) · Journal of Applied Physiology · doi:10.1152/japplphysiol.01070.2010 · Cited by 404
McMahon, N. F., Leveritt, M. D., & Pavey, T. G. (2017) · Sports Medicine · doi:10.1007/s40279-016-0617-7 · Cited by 221
Carlsson, S., Wiklund, N. P., Engstrand, L., Weitzberg, E., & Lundberg, J. O. N. (2001) · Nitric Oxide · doi:10.1006/niox.2001.0371 · Cited by 189
Research works printed but not linked: 44
- OrtizdeZevallos J, Woessner MN, Kelley EE. Skeletal muscle as a reservoir for nitrate and nitrite: the role of xanthine oxidase reductase (XOR). Nitric Oxide. 2022. https://doi.org/10.1016/j.niox.2022.10.004. · DOI
- Richards JC, Racine ML, Hearon CM, et al. Acute ingestion of dietary nitrate increases muscle blood flow via local vasodilation during handgrip exercise in young adults. Physiol Rep. 2018;6:1–12. https://doi.org/10.14814/phy2.13572. · DOI
- Kruse NT, Ueda K, Hughes WE, et al. Eight weeks of nitrate supplementation improves blood flow and reduces the exaggerated pressor response during forearm exercise in peripheral artery disease. Am J Physiol Heart Circu Physiol. 2018;315:H101–8. https://doi.org/10.1152/ajpheart.00015.2018. · DOI
- Ferguson SK, Hirai DM, Copp SW, et al. Impact of dietary nitrate supplementation via beetroot juice on exercising muscle vascular control in rats. J Physiol. 2013;591:547–57. https://doi.org/10.1113/jphysiol.2012.243121. · DOI · Paper page
- Coggan AR, Leibowitz JL, Kadkhodayan A, et al. Effect of acute dietary nitrate intake on maximal knee extensor speed and power in healthy men and women. Nitric Oxide. 2015;48:16–21. https://doi.org/10.1016/j.gde.2016.03.011. · DOI
- Coggan AR, Leibowitz JL, Spearie CA, et al. Acute dietary nitrate intake improves muscle contractile function in patients with heart failure: a double-blind, placebo-controlled, randomized trial. Circ Heart Fail. 2015;8:914–20. https://doi.org/10.1161/CIRCHEARTFAILURE.115.002141. · DOI · Paper page
- Larsen FJ, Weitzberg E, Lundberg JO, et al. Effects of dietary nitrate on oxygen cost during exercise. Acta Physiol. 2007;191:59–66. https://doi.org/10.1111/j.1748-1716.2007.01713.x. · DOI · Paper page
- Jones L, Bailey SJ, Rowland SN, et al. The effect of nitrate-rich beetroot juice on markers of exercise-induced muscle damage: a systematic review and meta-analysis of human intervention trials. J Diet Suppl. 2021. https://doi.org/10.1080/19390211.2021.1939472. · DOI
- Shannon OM, Grisotto G, Babateen A, et al. Knowledge and beliefs about dietary inorganic nitrate among UK-based nutrition professionals: development and application of the KINDS online questionnaire. BMJ Open. 2019;9:e030719. https://doi.org/10.1136/bmjopen-2019-030719. · DOI
- Shannon OM, Allen JD, Bescos R, et al. Dietary inorganic nitrate as an ergogenic aid: an expert consensus derived via the modified delphi technique. Sports Med. 2022. https://doi.org/10.1007/s40279-022-01701-3. · DOI
- Snell PG, Stray-Gundersen J, Levine BD, et al. Maximal oxygen uptake as a parametric measure of cardiorespiratory capacity. Med Sci Sports Exerc. 2007;39:103–7.
- Coyle EF, Coggan AR, Hopper MK, et al. Determinants of endurance in well-trained cyclists. J Appl Physiol. 1988;64:2622–30. https://doi.org/10.1152/jappl.1988.64.6.2622. · DOI · Paper page
- Higgins JPT, Altman DG, Gotzsche PC, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928–d5928. https://doi.org/10.1136/bmj.d5928. · DOI · Paper page
- Viechtbauer W. Conducting meta-analyses in R with the metafor package. J Stat Soft. 2010. https://doi.org/10.18637/jss.v036.i03. · DOI · Paper page
- Cohen J. Statistical power analysis for the behavioural sciences. London: Routledge; 1988.
- Viechtbauer W, Cheung MWL. Outlier and influence diagnostics for meta-analysis. Res Synth Method. 2010;1:112–25. https://doi.org/10.1002/jrsm.11. · DOI · Paper page
- Higgins JPT. Measuring inconsistency in meta-analyses. BMJ. 2003;327:557–60. https://doi.org/10.1136/bmj.327.7414.557. · DOI · Paper page
- Kossmeier M, Tran US, Voracek M. Power-enhanced funnel plots for meta-analysis: the sunset funnel plot. Zeitschrift für Psychologie. 2020;228:43–9. https://doi.org/10.1027/2151-2604/a000392. · DOI
- De Smet S, Van Thienen R, Deldicque L, et al. Nitrate intake promotes shift in muscle fiber type composition during sprint interval training in hypoxia. Front Physiol. 2016. https://doi.org/10.3389/fphys.2016.00233. · DOI · Paper page
- Finkel A, Röhrich MA, Maassen N, et al. Long-term effects of NO3– on the relationship between oxygen uptake and power after three weeks of supplemented HIHVT. J Appl Physiol. 2018;125:1997–2007. https://doi.org/10.1152/japplphysiol.00176.2018. · DOI
- Puype J, Ramaekers M, Van Thienen R, et al. No effect of dietary nitrate supplementation on endurance training in hypoxia: nitrate intake and hypoxic training. Scand J Med Sci Sports. 2015;25:234–41. https://doi.org/10.1111/sms.12199. · DOI · Paper page
- Shaltout HA, Eggebeen J, Marsh AP, et al. Effects of supervised exercise and dietary nitrate in older adults with controlled hypertension and/or heart failure with preserved ejection fraction. Nitric Oxide. 2017;69:78–90. · DOI
- Sousa A, Viana JL, Milheiro J, et al. Dietary nitrate supplementation is not helpful for endurance performance at simulated altitude even when combined with intermittent normobaric hypoxic training. Front Physiol. 2022;13:839996. https://doi.org/10.3389/fphys.2022.839996. · DOI
- Thompson C, Vanhatalo A, Kadach S, et al. Discrete physiological effects of beetroot juice and potassium nitrate supplementation following 4-wk sprint interval training. J Appl Physiol. 2018;124:1519–28. https://doi.org/10.1152/japplphysiol.00047.2018. · DOI · Paper page
- Senefeld JW, Wiggins CC, Regimbal RJ, et al. Ergogenic effect of nitrate supplementation: a systematic review and meta-analysis. Med Sci Sports Exerc. 2020;52:2250–61. https://doi.org/10.1249/MSS.0000000000002363. · DOI
- Bahrami LS, Arabi SM, Feizy Z, et al. The effect of beetroot inorganic nitrate supplementation on cardiovascular risk factors: a systematic review and meta-regression of randomized controlled trials. Nitric Oxide. 2021;115:8–22. https://doi.org/10.1016/j.niox.2021.06.002. · DOI
- Shannon OM, McGawley K, Nybäck L, et al. “Beet-ing” the mountain: a review of the physiological and performance effects of dietary nitrate supplementation at simulated and terrestrial altitude. Sports Med. 2017;47:2155–69. https://doi.org/10.1007/s40279-017-0744-9. · DOI
- Pekas EJ, Wooden TK, Yadav SK, et al. Body mass-normalized moderate dose of dietary nitrate intake improves endothelial function and walking capacity in patients with peripheral artery disease. Am J Physiol Regul Integr Comp Physiol. 2021. https://doi.org/10.1152/ajpregu.00121.2021. · DOI
- Wylie LJ, Kelly J, Bailey SJ, et al. Beetroot juice and exercise: pharmacodynamic and dose–response relationships. J Appl Physiol. 2013;115:325–36. https://doi.org/10.1152/japplphysiol.00372.2013. · DOI · Paper page
- Gallardo EJ, Gray DA, Hoffman RL, et al. Dose-response effect of dietary nitrate on muscle contractility and blood pressure in older subjects: a pilot study. J Gerontol Ser A. 2021;76:591–8. https://doi.org/10.1093/gerona/glaa311. · DOI
- Behrens CE, Khandaker J, Karina A, et al. Acute beetroot juice supplementation improves exercise tolerance and cycling efficiency in adults with obesity. Physiol Rep. 2020;8:1–12. https://doi.org/10.14814/phy2.14574. · DOI
- Flueck JL, Bogdanova A, Mettler S, et al. Is beetroot juice more effective than sodium nitrate? The effects of equimolar nitrate dosages of nitrate-rich beetroot juice and sodium nitrate on oxygen consumption during exercise. Appl Physiol Nutr Metab. 2016;41:421–9. https://doi.org/10.1139/apnm-2015-0458. · DOI · Paper page
- Tsukiyama Y, Ito T, Nagaoka K, et al. Effects of exercise training on nitric oxide, blood pressure and antioxidant enzymes. J Clin Biochem Nutr. 2017;60:180–6. https://doi.org/10.3164/jcbn.16-108. · DOI
- Angadi SS, Mookadam F, Lee CD, et al. High-intensity interval training vs. moderate-intensity continuous exercise training in heart failure with preserved ejection fraction: a pilot study. J Appl Physiol. 2015;119:753–8. https://doi.org/10.1152/japplphysiol.00518.2014. · DOI · Paper page
- Larsen FJ, Schiffer TA, Ekblom B, et al. Dietary nitrate reduces resting metabolic rate: a randomized, crossover study in humans. Am J Clin Nutr. 2014;99:843–50. https://doi.org/10.3945/ajcn.113.079491. · DOI · Paper page
- Wickham KA, McCarthy DG, Pereira JM, et al. No effect of beetroot juice supplementation on exercise economy and performance in recreationally active females despite increased torque production. Physiol Rep. 2019;7:1–14. https://doi.org/10.14814/phy2.13982. · DOI · Paper page
- Kapil V, Rathod KS, Khambata RS, et al. Sex differences in the nitrate-nitrite-NO • pathway: role of oral nitrate-reducing bacteria. Free Radic Biol Med. 2018;126:113–21. https://doi.org/10.1016/j.freeradbiomed.2018.07.010. · DOI
- Wootton-Beard PC, Ryan L. A beetroot juice shot is a significant and convenient source of bioaccessible antioxidants. J Funct Foods. 2011;3:329–34. https://doi.org/10.1016/j.jff.2011.05.007. · DOI
- Peri L, Pietraforte D, Scorza G, et al. Apples increase nitric oxide production by human saliva at the acidic pH of the stomach: a new biological function for polyphenols with a catechol group? Free Radic Biol Med. 2005;39:668–81. https://doi.org/10.1016/j.freeradbiomed.2005.04.021. · DOI
- Tanaka K, Hayatsu T, Negishi T, et al. Inhibition of N-nitrosation of secondary amines in vitro by tea extracts and catechins. Mutat Res Genet Toxicol Environ Mutagen. 1998;412:91–8. https://doi.org/10.1016/S1383-5718(97)00178-2. · DOI
- Hellsten Y, Nyberg M. Cardiovascular adaptations to exercise training. Compr Physiol. 2016;6:1–32. https://doi.org/10.1002/cphy.c140080. · DOI · Paper page
- Hopper MK, Coggan AR, Coyle EF. Exercise stroke volume relative to plasma-volume expansion. J Appl Physiol. 1988;64:404–8. https://doi.org/10.1152/jappl.1988.64.1.404. · DOI
- Weltman A, Seip RL, Snead D, et al. Exercise training at and above the lactate threshold in previously untrained women. Int J Sports Med. 1992;13:257–63. https://doi.org/10.1055/s-2007-1021263. · DOI
- Hickson RC, Bomze HA, Holloszy JO. Linear increase in aerobic power induced by a strenuous program of endurance exercise. J Appl Physiol. 1977;42:372–6. https://doi.org/10.1152/jappl.1977.42.3.372. · DOI
Cited by
Poon, E. T.-C., Iu, J. C.-K., Sum, W. M.-K., Wong, P.-S., Lo, K. K.-H., Ali, A., Burns, S. F., & Trexler, E. T. (2025) · Sports Medicine · doi:10.1007/s40279-025-02194-6 · Cited by 28
Tian, C., Jiang, Q., Han, M., Guo, L., Huang, R., Zhao, L., & Mao, S. (2025) · Nutrients · doi:10.3390/nu17121958 · Cited by 16
De Zan, D., Eletti, F., Fiore, G., Di Girolamo, E., Bozzini, G. G. M., Perico, V., Tosi, M., Norsa, L., Zuccotti, G., & Verduci, E. (2025) · Nutrients · doi:10.3390/nu17132194 · Cited by 11
Nowak, A., Szymańska, A., Kwaśniewska, M., Kochan, E., & Lipert, A. (2025) · Nutrients · doi:10.3390/nu17243954 · Cited by 5
Metadata
- Authors
- Hogwood, A. C., Anderson, K. C., Ortiz de Zevallos, J., Paterson, C., Weltman, A., & Allen, J. D.
- ORCID
- Hogwood, Austin C.
- Venue
- Sports Medicine - Open
- Published
- 2023-09-11
- Volume
- 9
- Issue
- 1
- ISSN
- 2198-9761
- Cited by
- 14
- References
- 19
- Language
- en
- Licence
- creativecommons.org/licenses/by/4.0 (tdm)
- creativecommons.org/licenses/by/4.0 (vor)
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 ›
Are you an author, or do you see a problem with this page? Request a review
How to cite
Cite CoChat for the checks on this page, and the paper for its own findings.
- This page
- CoChat. (2026). Citation check: Limited Effects of Inorganic Nitrate Supplementation on Exercise Training Responses: A Systematic Review and Meta-analysis. https://app.cochat.ai/papers/10.1186/s40798-023-00632-1
- The paper
- Hogwood, A. C., Anderson, K. C., Ortiz de Zevallos, J., Paterson, C., Weltman, A., & Allen, J. D. (2023). Limited Effects of Inorganic Nitrate Supplementation on Exercise Training Responses: A Systematic Review and Meta-analysis. Sports Medicine - Open. https://doi.org/10.1186/s40798-023-00632-1
Data sources
Bibliographic data: Semantic Scholar, OpenAlex, Crossref.
Contains information from the Semantic Scholar Academic Graph Datasets, made available under the ODC Attribution License (ODC-BY 1.0).
Semantic Scholar’s data is described in: Kinney, R., et al. (2023). The Semantic Scholar Open Data Platform. arXiv:2301.10140.
