The nitrate-nitrite-nitric oxide pathway: Its role in human exercise physiology

Effects of chronic nitric oxide synthase inhibition on V'O2max and exercise capacity in mice

Acute inhibition of NOS by L-NAME (N^ω-nitro-L-arginine methyl ester) is known to decrease maximal oxygen consumption (V'O_2max) and impair maximal exercise capacity, whereas the effects of chronic L-NAME treatment on V'O_2max and exercise performance have not been studied so far. In this study, we analysed the effect of L-NAME treatment, (LN2 and LN12, respectively) on V'O_2max and exercise capacity (in maximal incremental running and prolonged sub-maximal incremental running tests), systemic NO bioavailability (plasma nitrite (NO₂^-) and nitrate (NO₃^-)) and prostacyclin (PGI₂) production in C57BL6/J mice. Mice treated with L-NAME for 2 weeks (LN2) displayed higher V'O_2max and better running capacity than age-matched control mice. In LN2 mice, NO bioavailability was preserved, as evidenced by maintained NO₂^- plasma concentration. PGI₂ production was activated (increased 6-keto-PGF_1α plasma concentration) and the number of circulating erythrocytes (RBC) and haemoglobin concentration were increased. In mice treated with L-NAME for 12 weeks (LN12), NO bioavailability was decreased (lower NO₂^- plasma concentration), and 6-keto-PGF_1α plasma concentration and RBC number were not elevated compared to age-matched control mice. However, LN12 mice still performed better during the maximal incremental running test despite having lower V'O_2max. Interestingly, the LN12 mice showed poorer running capacity during the prolonged sub-maximal incremental running test. To conclude, short-term (2 weeks) but not long-term (12 weeks) treatment with L-NAME activated robust compensatory mechanisms involving preservation of NO2- plasma concentration, overproduction of PGI₂ and increased number of RBCs, which might explain the fully preserved exercise capacity despite the inhibition of NOS.

Nitrate-Containing Beetroot Juice Reduces Oxygen Consumption During Submaximal Exercise in Low but Not High Aerobically Fit Male Runners

Purpose

to examine the effect of a 4-day NO3- loading protocol on the submaximal oxygen cost of both low fit and high fit participants at five different exercise intensities.

Methods

participants were initially assigned to a placebo (PL; negligible NO3-) or inorganic nitrate-rich (NR; 6.2 mmol nitrate/day) group; double-blind, placebo-controlled, crossover. Participants completed three trials (T1, T2 and T3). T1 included a maximal aerobic capacity (VO2max) treadmill test. A 6-day washout, minimizing nitrate consumption, preceded T2. Each of the four days prior to T2 and T3, participants consumed either PL or NR; final dose 2.5 hours prior to exercise. A 14-day washout followed T2. T2 and T3 consisted of 5-minute submaximal treadmill bouts (45, 60, 70, 80 and 85% VO2max) determined during T1.

Results

Low fit nitrate-supplemented participants consumed less oxygen (p<0.05) at lower workloads (45% and 60% VO2max) compared to placebo trials; changes not observed in high fit participants. The two lowest intensity workloads of 45 and 60% VO2max revealed the greatest correlation (r=0.54, p=0.09 and r=0.79, p<0.05; respectively). No differences were found between conditions for heart rate, respiratory exchange ratio or rating of perceived exertion for either fitness group.

Conclusion

Nitrate consumption promotes reduced oxygen consumption at lower exercise intensities in low fit, but not high fit males. Lesser fit individuals may receive greater benefit than higher fit participants exercising at intensities <60% VO2max.

Effects of pomegranate extract on blood flow and vessel diameter after high-intensity exercise in young, healthy adults

The effects of pomegranate extract (PE) supplementation were evaluated on high-intensity exercise performance, blood flow, vessel diameter, oxygen saturation (SPO₂), heart rate (HR), and blood pressure (BP). In a randomized, crossover design, nineteen recreationally resistance-trained participants were randomly assigned to PE (1000 mg) or placebo (PL), which were consumed 30 min prior to a repeated sprint ability (RSA) test and repetitions to fatigue (RTF) on bench and leg press. The RSA consisted of ten six-second sprints on a friction-loaded cycle ergometer with 30 s recovery. Brachial artery blood flow and vessel diameter were assessed by ultrasound. Blood flow, vessel diameter, SPO₂, HR, and BP were assessed at baseline, 30 min post ingestion, immediately post exercise (IPost), and 30 min post exercise (30minPost). With PE, blood flow significantly increased IPost RSA (mean difference = 18.49 mL min^-1; P < .05), and IPost and 30minPost RTF (P < .05) according to confidence intervals (CI). Vessel diameter increased significantly 30minPost RSA according to CI and resulted in a significant interaction IPost and 30minPost RTF (P < .05). With PE, according to CI, average and peak power output increased significantly in sprint 5 of the RSA (P < .05). There was no significant difference between PE and PL for bench (P = .25) or leg press (P = .15) repetitions. Acute PE supplementation enhanced vessel diameter and blood flow, suggesting possible exercise performance enhancement from increased delivery of substrates and oxygen. The acute timing and capsule form of PE may be advantageous to athletic populations due to ergogenic effects, taste, and convenience.

Beetroot juice supplementation does not improve performance of elite 1500-m runners

PURPOSE

Dietary nitrate supplementation with beetroot juice (BR) has received widespread attention as an ergogenic aid. However, recent evidence in well-trained cyclists has not consistently reported improved cycling economy or performance. The present study examined the effects of acute and chronic BR supplementation on V˙O2 during submaximal running and 1500-m time trial (TT) performance of elite distance runners.

METHODS

Eight male 1500-m runners (V˙O2peak, 80 ± 5 mL·kg·min; 1500-m personal best, 3:56 ± 9 s) participated in this study. In a randomized, double-blind, crossover design, subjects supplemented with BR or a nitrate-free BR placebo (PL) for 8 d separated by at least 1 wk. On days 1 (acute) and 8 (chronic), subjects ingested 210 mL of BR (19.5-mmol nitrate) or PL and completed a submaximal treadmill run and 1500-m TT on an indoor 200-m track.

RESULTS

Plasma nitrate increased from 37 ± 15 to 615 ± 151 μM (acute) and 870 ± 259 μM (chronic) after BR supplementation. There were no V˙O2 differences between conditions at 50%, 65%, and 80% V˙O2peak (acute PL, 4194 ± 90 mL·min; chronic PL, 4216 ± 95 mL·min; acute BR, 4192 ± 113 mL·min; chronic BR, 4299 ± 92 mL·min). The 1500-m TT was unaffected by acute or chronic BR supplementation (acute PL, 4:10.4 min:s ± 2.5 s; chronic PL, 4:11.4 min:s ± 2.7 s; acute BR, 4:10.7 min:s ± 1.5 s; chronic BR, 4:10.5 min:s ± 2.2 s). However, two subjects improved their TT performance after acute (5.8 and 5.0 s) and chronic BR supplementation (7.0 and 0.5 s).

CONCLUSIONS

Acute and chronic BR supplementation did not reduce running V˙O2 or improve 1500-m TT performance of a group of elite distance runners, but two responders to BR were identified.

Effects of dietary nitrate supplementation on the oxygen cost of exercise and walking performance in individuals with type 2 diabetes: a randomized, double-blind, placebo-controlled crossover trial

Dietary nitrate supplementation has been shown to reduce the oxygen (O2) cost of exercise and enhance exercise tolerance in healthy individuals. This study assessed whether similar effects could be observed in individuals with type 2 diabetes (T2DM). In a randomized, double-blind, placebo-controlled crossover study, 48 participants with T2DM supplemented their diet for 4 days with either nitrate-rich beetroot juice (70ml/day, 6.43mmol nitrate/day) or nitrate-depleted beetroot juice as placebo (70ml/day, 0.07mmol nitrate/day). After each intervention period, resting plasma nitrate and nitrite concentrations were measured subsequent to participants completing moderate-paced walking. Pulmonary gas exchange was measured to assess the O2 cost of walking. After a rest period, participants performed the 6-min walk test (6MWT). Relative to placebo, beetroot juice resulted in a significant increase in plasma nitrate (placebo, 57±66 vs beetroot, 319±110µM; P < 0.001) and plasma nitrite concentration (placebo, 680±256 vs beetroot, 1065±607nM; P < 0.001). There were no differences between placebo juice and beetroot juice for the O2 cost of walking (946±221 vs 939±223ml/min, respectively; P = 0.59) and distance covered in the 6MWT (550±83 vs 554±90m, respectively; P = 0.17). Nitrate supplementation did not affect the O2 cost of moderate-paced walking or improve performance in the 6MWT. These findings indicate that dietary nitrate supplementation does not modulate the response to exercise in individuals with T2DM.

l-Citrulline supplementation improves O2 uptake kinetics and high-intensity exercise performance in humans

The purpose of this study was to compare the effects of l-citrulline (Cit) and l-arginine (Arg) supplementation on nitric oxide (NO) biomarkers, pulmonary O2 uptake (V̇o2) kinetics, and exercise performance. In a randomized, placebo (Pla)-controlled, crossover study, 10 healthy adult men completed moderate- and severe-intensity cycling exercise on days 6 and 7 of a 7-day supplementation period with Pla, Arg (6 g/day), and Cit (6 g/day). Compared with Pla, plasma Arg concentration was increased by a similar magnitude with Arg and Cit supplementation, but plasma Cit concentration was only increased ( P < 0.001) with Cit supplementation. Plasma nitrite (NO2−) concentration was increased with Arg supplementation ( P < 0.05) and tended to increase with Cit supplementation ( P = 0.08) compared with Pla (83 ± 25, 106 ± 41, and 100 ± 38 nM with Pla, Arg, and Cit, respectively); however, mean arterial blood pressure was only lower ( P < 0.05) after Cit supplementation. The steady-state V̇o2 amplitude during moderate-intensity cycle exercise was not significantly different between supplements, but Cit lowered the V̇o2 mean response time (59 ± 8 and 53 ± 5 s with Pla and Cit, respectively, P < 0.05) during severe-intensity exercise, improved tolerance to severe-intensity exercise (589 ± 101 and 661 ± 107 s with Pla and Cit, respectively), and increased the total amount of work completed in the exercise performance test (123 ± 18 and 125 ± 19 kJ with Pla and Cit, respectively, P < 0.05). These variables were not altered by Arg supplementation ( P > 0.05). In conclusion, these results suggest that short-term Cit, but not Arg, supplementation can improve blood pressure, V̇o2 kinetics, and exercise performance in healthy adults.

The effect of nitrate supplementation on muscle contraction in healthy adults

This study examined the effect of dietary supplementation with inorganic nitrate ([Formula: see text] ) on markers of contractile function in human knee extensors. In a double-blinded, randomized cross-over design, 18 (12 M) healthy participants undertook four days of supplementation with either nitrate-rich beetroot juice (NITRATE; days 1-3: 525 mg [Formula: see text], day 4: 1050 mg [Formula: see text]) or nitrate-depleted beetroot juice (PLACEBO). On the fourth day, isometric knee extension force was assessed during a series of voluntary and electrically evoked (stimulation) tests. In addition, muscular fatigue was examined in two separate continuous-stimulation (0.8 s tetanus with a 1:1 work:rest ratio for 102.4 s) fatigue tests, one with and one without blood flow restriction. There were no differences for maximum voluntary contraction, peak twitch force, half-relaxation time and the force-frequency relationship for stimulations up to 100 Hz between the NITRATE and PLACEBO trials. No differences between trials were observed in the non-restricted fatigue test, however NITRATE was found to attenuate the decline in force during the restricted test, such that the force at the 80 s mark (PLACEBO: 66 ± 11 vs. NITRATE 74 ± 9% of initial force; P = .01) and 102 s mark (PLACEBO: 47 ± 8% vs. NITRATE 55 ± 8%; P < .01) were significantly higher. These results suggest that four days of [Formula: see text] supplementation elicits peripheral responses in muscle that attenuate muscular fatigue during exhaustive exercise under hypovolemic conditions. This ergogenic action is likely attributable to improved Ca(2+) handling in the muscle, or enhanced perfusion during ischemia.

Site-directed delivery of nitric oxide to cancers

Nitric oxide (NO) is a reactive gaseous free radical which mediates numerous biological processes. At elevated levels, NO is found to be toxic to cancers and hence, a number of strategies for site-directed delivery of NO to cancers are in development during the past two decades. More recently, the focus of research has been to, in conjunction with other cancer drugs deliver NO to cancers for its secondary effects including inhibition of cellular drug efflux pumps. Among the various approaches toward site-selective delivery of exogenous NO sources, enzyme activated nitric oxide donors belonging to the diazeniumdiolate category afford unique advantages including exquisite control of rates of NO generation and selectivity of NO production. For this prodrug approach, enzymes including esterase, glutathione/glutathione S-transferase, DT-diaphorase, and nitroreductase are utilized. Here, we review the design and development of various approaches to enzymatic site-directed delivery of NO to cancers and their potential.

Effects of pomegranate extract on blood flow and running time to exhaustion

Recent research has shown that dietary nitrate has favorable effects on blood flow and exercise performance. The purpose of this randomized, double-blind, placebo-controlled crossover study was to investigate the acute effects of pomegranate extract on blood flow, vessel diameter, and exercise performance in active individuals. Nineteen men and women (mean ± SD: age, 22.2 ± 2.2 years; height, 174.8 ± 10.7 cm; body mass, 71.9 ± 13.5 kg) were randomly assigned to a placebo (PL) or pomegranate extract (PE) group. Participants performed a maximal oxygen consumption treadmill test to determine peak velocity (PV). Participants returned after 24-48 h and ingested either PL or PE. Brachial artery blood flow was assessed using ultrasound at baseline and 30 min post-ingestion (30minPI). Three treadmill runs to exhaustion were performed at 90%, 100%, and 110% PV. Blood flow was assessed immediately after each exercise bout and 30 min postexercise (30minPEx). After a 7-10 day washout, participants repeated the same procedures, ingesting the opposite supplement. Separate repeated measures ANOVAs were performed for blood flow, vessel diameter, and time to exhaustion (TTE). Blood flow was significantly augmented (p = 0.033) 30minPI with PE in comparison with PL. Vessel diameter was significantly larger (p = 0.036) 30minPEx with PE. Ingestion of PE was found to significantly augment TTE at 90% (p = 0.009) and 100% PV (p = 0.027). Acute ingestion of PE 30 min before exercise may enhance vessel diameter and blood flow and delay fatigue during exercise. Results of the current study indicate that PE is ergogenic for intermittent running, eliciting beneficial effects on blood flow.

Nitrate supplementation and high-intensity performance in competitive cyclists

Consumption of inorganic nitrate (NO3(-)) is known to enhance endurance exercise performance in recreationally trained subjects. Here we report the effect on a high-intensity performance task in national-level cyclists. The performance test consisted of 2 cycle ergometer time trials of 4 min duration with 75 min between trials. In a randomized crossover design, 26 cyclists performed the test under the following 4 conditions (each separated by a 6-day washout): consumption of 70 mL of nitrate-rich beetroot juice at 150 min or 75 min before the first time trial, addition of a 35 mL "top-up dose" following the first time trial in the 150 min condition, and consumption of a placebo. A linear mixed model with adjustments for learning effects and athlete fitness (peak incremental power) was used to estimate effects on mean power, with probabilistic inferences based on a smallest important effect of 1.0%. Peak plasma nitrite (NO2(-)) concentration was greatest when nitrate was taken 75 min before the first time trial. Relative to placebo, the mean effect of all 3 nitrate treatments was unclear in the first time trial (1.3%, 90% confidence limits: ±1.7%), but possibly harmful in the second time trial (-0.3%, ±1.6%). Differences between nitrate treatments were unclear, as was the estimate of any consistent individual response to the treatments. Allowing for sampling uncertainty, the effect of nitrate on performance was less than previous studies. Under the conditions of our experiment, nitrate supplementation may be ineffective in facilitating high-intensity exercise in competitive athletes.

Dietary nitrate does not enhance running performance in elite cross-country skiers

PURPOSE

The objective of this study is to examine the effects of acute ingestion of dietary nitrate on endurance running performance in highly trained cross-country skiers. Dietary nitrate has been shown to reduce the oxygen cost of submaximal exercise and improve tolerance of high-intensity exercise, but it is not known if this holds true for highly trained endurance athletes.

METHODS

Ten male junior cross-country skiers (V˙O(2max)) ≈ 70 mL·kg·min) each completed two trials in a randomized, double-blind design. Participants ingested potassium nitrate (614-mg nitrate) or a nitrate-free placebo 2.5 h before two 5-min submaximal tests on a treadmill at 10 km·h (≈55% of V˙O(2max)) and 14 km·h (≈75% of V˙O(2max)), followed by a 5-km running time trial on an indoor track.

RESULTS

Plasma nitrite concentrations were higher after nitrate supplementation (325 ± 95 nmol·L) compared with placebo (143 ± 59 nmol·L, P < 0.001). There was no significant difference in 5-km time-trial performance between nitrate (1005 ± 53 s) and placebo treatments (996 ± 49 s, P = 0.12). The oxygen cost of submaximal running was not significantly different between placebo and nitrate trials at 10 km·h (both 2.84 ± 0.34 L·min) and 14 km·h (3.89 ± 0.39 vs. 3.77 ± 0.62 L·min).

CONCLUSIONS

Acute ingestion of dietary nitrate may not represent an effective strategy for reducing the oxygen cost of submaximal exercise or for enhancing endurance exercise performance in highly trained cross-country skiers.

Dietary nitrate supplementation improves team sport-specific intense intermittent exercise performance

Recent studies have suggested that dietary inorganic nitrate (NO₃(-)) supplementation may improve muscle efficiency and endurance exercise tolerance but possible effects during team sport-specific intense intermittent exercise have not been examined. We hypothesized that NO₃(-) supplementation would enhance high-intensity intermittent exercise performance. Fourteen male recreational team-sport players were assigned in a double-blind, randomized, crossover design to consume 490 mL of concentrated, nitrate-rich beetroot juice (BR) and nitrate-depleted placebo juice (PL) over ~30 h preceding the completion of a Yo-Yo intermittent recovery level 1 test (Yo-Yo IR1). Resting plasma nitrite concentration ([NO₂(-)]) was ~400% greater in BR compared to PL. Plasma [NO₂(-)] declined by 20% in PL (P < 0.05) and by 54 % in BR (P < 0.05) from pre-exercise to end-exercise. Performance in the Yo-Yo IR1 was 4.2% greater (P < 0.05) with BR (1,704 ± 304 m) compared to PL (1,636 ± 288 m). Blood [lactate] was not different between BR and PL, but the mean blood [glucose] was lower (3.8 ± 0.8 vs. 4.2 ± 1.1 mM, P < 0.05) and the rise in plasma [K(+)] tended to be reduced in BR compared to PL (P = 0.08). These findings suggest that NO₃(-) supplementation may promote NO production via the nitrate-nitrite-NO pathway and enhance Yo-Yo IR1 test performance, perhaps by facilitating greater muscle glucose uptake or by better maintaining muscle excitability. Dietary NO₃(-) supplementation improves performance during intense intermittent exercise and may be a useful ergogenic aid for team sports players.