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Silva KVC, Costa BD, Gomes AC, Saunders B, Mota JF. Factors that Moderate the Effect of Nitrate Ingestion on Exercise Performance in Adults: A Systematic Review with Meta-Analyses and Meta-Regressions. Adv Nutr 2022; 13:1866-1881. [PMID: 35580578 PMCID: PMC9526841 DOI: 10.1093/advances/nmac054] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 11/16/2021] [Accepted: 05/09/2022] [Indexed: 01/28/2023] Open
Abstract
To identify how variables such as exercise condition, supplementation strategy, participant characteristics and demographics, and practices that control oral microbiota diversity could modify the effect of inorganic nitrate ingestion (as nitrate salt supplements, beetroot juice, and nitrate-rich vegetables) on exercise performance, we conducted a systematic review with meta-analysis. Studies were identified in PubMed, Embase, and Cochrane databases. Eligibility criteria included randomized controlled trials assessing the effect of inorganic nitrate on exercise performance in healthy adults. To assess the variation in effect size, we used meta-regression models for continuous variables and subgroup analysis for categorical variables. A total of 123 studies were included in this meta-analysis, comprising 1705 participants. Nitrate was effective for improving exercise performance (standardized mean difference [SMD]: 0.101; 95% CI: 0.051, 0.151, P <0.001, I2 = 0%), although nitrate salts supplementation was not as effective (P = 0.629) as ingestion via beetroot juice (P <0.001) or a high-nitrate diet (P = 0.005). Practices that control oral microbiota diversity influenced the nitrate effect, with practices harmful to oral bacteria decreasing the ergogenic effect of nitrate. The ingestion of nitrate was most effective for exercise lasting between 2 and 10 min (P <0.001). An inverse dose-response relation between the fraction of inspired oxygen and the effect size (coefficient: -0.045, 95% CI: -0.085, -0.005, P = 0.028) suggests that nitrate was more effective in increasingly hypoxic conditions. There was a dose-response relation for acute administration (P = 0.049). The most effective acute dose was between 5 and 14.9 mmol provided ≥150 min prior to exercise (P <0.001). An inverse dose-response for protocols ≥2 d was observed (P = 0.025), with the optimal dose between 5 and 9.9 mmol·d-1 (P <0.001). Nitrate, via beetroot juice or a high-nitrate diet, improved exercise performance, in particular, in sessions lasting between 2 and 10 min. Ingestion of 5-14.9 mmol⋅d-1 taken ≥150 min prior to exercise appears optimal for performance gains and athletes should be aware that practices controlling oral microbiota diversity may decrease the effect of nitrate.
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Affiliation(s)
| | - Breno Duarte Costa
- Applied Physiology and Nutrition Research Group, Rheumatology Division, Faculty of Medicine, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Aline Corado Gomes
- Faculty of Nutrition, Federal University of Goiás (UFG), Goiania, Goiás, Brazil
| | - Bryan Saunders
- Applied Physiology and Nutrition Research Group, Rheumatology Division, Faculty of Medicine, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
- Institute of Orthopaedics and Traumatology, Faculty of Medicine FMUSP, University of São Paulo, São Paulo, Brazil
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d'Unienville NMA, Blake HT, Coates AM, Hill AM, Nelson MJ, Buckley JD. Effect of food sources of nitrate, polyphenols, L-arginine and L-citrulline on endurance exercise performance: a systematic review and meta-analysis of randomised controlled trials. J Int Soc Sports Nutr 2021; 18:76. [PMID: 34965876 PMCID: PMC8715640 DOI: 10.1186/s12970-021-00472-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 11/23/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Increasing nitric oxide bioavailability may induce physiological effects that enhance endurance exercise performance. This review sought to evaluate the performance effects of consuming foods containing compounds that may promote nitric oxide bioavailability. METHODS Scopus, Web of Science, Ovid Medline, EMBASE and SportDiscus were searched, with included studies assessing endurance performance following consumption of foods containing nitrate, L-arginine, L-citrulline or polyphenols. Random effects meta-analysis was conducted, with subgroup analyses performed based on food sources, sex, fitness, performance test type and supplementation protocol (e.g. duration). RESULTS One hundred and eighteen studies were included in the meta-analysis, which encompassed 59 polyphenol studies, 56 nitrate studies and three L-citrulline studies. No effect on exercise performance following consumption of foods rich in L-citrulline was identified (SMD=-0.03, p=0.24). Trivial but significant benefits were demonstrated for consumption of nitrate and polyphenol-rich foods (SMD=0.15 and 0.17, respectively, p<0.001), including performance in time-trial, time-to-exhaustion and intermittent-type tests, and following both acute and multiple-day supplementation, but no effect of nitrate or polyphenol consumption was found in females. Among nitrate-rich foods, beneficial effects were seen for beetroot, but not red spinach or Swiss chard and rhubarb. For polyphenol-rich foods, benefits were found for grape, (nitrate-depleted) beetroot, French maritime pine, Montmorency cherry and pomegranate, while no significant effects were evident for New Zealand blackcurrant, cocoa, ginseng, green tea or raisins. Considerable heterogeneity between polyphenol studies may reflect food-specific effects or differences in study designs and subject characteristics. Well-trained males (V̇O2max ≥65 ml.kg.min-1) exhibited small, significant benefits following polyphenol, but not nitrate consumption. CONCLUSION Foods rich in polyphenols and nitrate provide trivial benefits for endurance exercise performance, although these effects may be food dependent. Highly trained endurance athletes do not appear to benefit from consuming nitrate-rich foods but may benefit from polyphenol consumption. Further research into food sources, dosage and supplementation duration to optimise the ergogenic response to polyphenol consumption is warranted. Further studies should evaluate whether differential sex-based responses to nitrate and polyphenol consumption are attributable to physiological differences or sample size limitations. OTHER The review protocol was registered on the Open Science Framework ( https://osf.io/u7nsj ) and no funding was provided.
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Affiliation(s)
- Noah M A d'Unienville
- Allied Health and Human Performance, University of South Australia, Adelaide, Australia. Noah.D'
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, Australia. Noah.D'
| | - Henry T Blake
- Allied Health and Human Performance, University of South Australia, Adelaide, Australia
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, Australia
| | - Alison M Coates
- Allied Health and Human Performance, University of South Australia, Adelaide, Australia
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, Australia
| | - Alison M Hill
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, Australia
- Clinical and Health Sciences, University of South Australia, Adelaide, Australia
| | - Maximillian J Nelson
- Allied Health and Human Performance, University of South Australia, Adelaide, Australia
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, Australia
| | - Jonathan D Buckley
- Allied Health and Human Performance, University of South Australia, Adelaide, Australia
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, Australia
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Miraftabi H, Avazpoor Z, Berjisian E, Sarshin A, Rezaei S, Domínguez R, Reale R, Franchini E, Samanipour MH, Koozehchian MS, Willems MET, Rafiei R, Naderi A. Effects of Beetroot Juice Supplementation on Cognitive Function, Aerobic and Anaerobic Performances of Trained Male Taekwondo Athletes: A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910202. [PMID: 34639501 PMCID: PMC8507686 DOI: 10.3390/ijerph181910202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/22/2021] [Accepted: 09/24/2021] [Indexed: 12/21/2022]
Abstract
Studies have shown that nitrate (NO3−)-rich beetroot juice (BJ) supplementation improves endurance and high-intensity intermittent exercise. The dose–response effects on taekwondo following BJ supplementation are yet to be determined. This study aimed to investigate two acute doses of 400 mg of NO3− (BJ-400) and 800 mg of NO3− (BJ-800) on taekwondo-specific performance and cognitive function tests compared with a placebo (PL) and control (CON) conditions. Eight trained male taekwondo athletes (age: 20 ± 4 years, height: 180 ± 2 cm, body mass: 64.8 ± 4.0 kg) completed four experimental trials using a randomized, double-blind placebo-controlled design: BJ-400, BJ-800, PL, and CON. Participants consumed two doses of BJ-400 and BJ-800 or nitrate-depleted PL at 2.5 h prior to performing the Multiple Frequency Speed of Kick Test (FSKT). Countermovement jump (CMJ) was performed before the (FSKT) and PSTT, whereas cognitive function was assessed (via the Stroop test) before and after supplementation and 10 min following PSTT. Blood lactate was collected before the CMJ tests immediately and 3 min after the FSKT and PSST; rating of perceived exertion (RPE) was recorded during and after both specific taekwondo tests. No significant differences (p > 0.05), with moderate and large effect sizes, between conditions were observed for PSTT and FSKT performances. In addition, blood lactate, RPE, heart rate, and CMJ height were not significantly different among conditions (p > 0.05). However, after the PSTT test, cognitive function was higher in BJ-400 compared to other treatments (p < 0.05). It was concluded that acute intake of 400 and 800 mg of NO3− rich BJ reported a moderate to large effect size in anaerobic and aerobic; however, no statistical differences were found in taekwondo-specific performance.
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Affiliation(s)
- Hossein Miraftabi
- Department of Exercise Physiology, Faculty of Physical Education and Sport Sciences, Tehran University, Tehran 1417935840, Iran; (H.M.); (Z.A.); (E.B.); (R.R.)
| | - Zahra Avazpoor
- Department of Exercise Physiology, Faculty of Physical Education and Sport Sciences, Tehran University, Tehran 1417935840, Iran; (H.M.); (Z.A.); (E.B.); (R.R.)
| | - Erfan Berjisian
- Department of Exercise Physiology, Faculty of Physical Education and Sport Sciences, Tehran University, Tehran 1417935840, Iran; (H.M.); (Z.A.); (E.B.); (R.R.)
| | - Amir Sarshin
- Clinical Care and Health Promotion Research Center, Karaj Branch, Islamic Azad University, Karaj 3149968111, Iran;
| | - Sajjad Rezaei
- Department of Physical Education & Sport Sciences, Faculty of Humanities, Tarbiat Modares University, Tehran 1411713116, Iran;
| | - Raúl Domínguez
- Departamento de Motricidad Humana y Rendimiento Deportivo, Faculty of Education Sciences, Universidad de Sevilla, 41018 Sevilla, Spain;
- Studies Research Group in Neuromuscular Responses (GEPREN), University of Lavras, Lavras 37200-000, Brazil
| | - Reid Reale
- USA.UFC Performance Institute, Shanghai 200072, China;
| | - Emerson Franchini
- School of Physical Education and Sport, University of São Paulo, São Paulo 05508-030, Brazil;
| | | | - Majid S. Koozehchian
- Department of Kinesiology, Jacksonville State University, Jacksonville, AL 36265, USA;
| | - Mark E. T. Willems
- Institute of Sport, Nursing and Allied Health, College Lane, University of Chichester, Chichester PO19 6PE, UK;
| | - Ramin Rafiei
- Department of Exercise Physiology, Faculty of Physical Education and Sport Sciences, Tehran University, Tehran 1417935840, Iran; (H.M.); (Z.A.); (E.B.); (R.R.)
| | - Alireza Naderi
- Department of Sport Physiology, Boroujerd Branch, Islamic Azad University, Boroujerd 6915136111, Iran
- Correspondence: ; Tel.: +98-91-0448-6440
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Macuh M, Knap B. Effects of Nitrate Supplementation on Exercise Performance in Humans: A Narrative Review. Nutrients 2021; 13:3183. [PMID: 34579061 PMCID: PMC8465461 DOI: 10.3390/nu13093183] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 09/04/2021] [Accepted: 09/10/2021] [Indexed: 12/20/2022] Open
Abstract
Nitrates have become increasingly popular for their potential role as an ergogenic aid. The purpose of this article was to review the current scientific evidence of nitrate supplementation on human performance. The current recommendation of nitrate supplementation is discussed, as well as possible health complications associated with nitrate intake for athletes, and dietary strategies of covering nitrate needs through sufficient intake of nitrate-rich foods alone are presented. Pubmed, Scopus, and Web of Science were searched for articles on the effects of nitrate supplementation in humans. Nitrates are an effective ergogenic aid when taken acutely or chronically in the range of ~5-16.8 mmol (~300-1041 mg) 2-3 h before exercise and primarily in the case of exercise duration of ~10-17 min in less trained individuals (VO2max < 65 mL/kg/min). Nitrate needs are most likely meet by ingesting approximately 250-500 g of leafy and root vegetables per day; however, dietary supplements might represent a more convenient and accurate way of covering an athlete's nitrate needs. Athletes should refrain from mouthwash usage when nitrate supplementation benefits are desired. Future research should focus on the potential beneficial effects of nitrate supplementation on brain function, possible negative impacts of chronic nitrate supplementation through different nitrate sources, and the effectiveness of nitrate supplementation on strength and high-intensity intermittent exercise.
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Affiliation(s)
- Matjaž Macuh
- Department of Food Science and Technology, Biotechnical Faculty, University of Ljubljana; Jamnikarjeva 10, 1000 Ljubljana, Slovenia
| | - Bojan Knap
- Department of Nephrology, University Medical Centre Ljubljana, Zaloška 7, 1000 Ljubljana, Slovenia;
- Faculty of Medicine, University of Ljubljana, Korytkova ulica 2, 1000 Ljubljana, Slovenia
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Effects of Dietary Nitrates on Time Trial Performance in Athletes with Different Training Status: Systematic Review. Nutrients 2020; 12:nu12092734. [PMID: 32911636 PMCID: PMC7551808 DOI: 10.3390/nu12092734] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 09/04/2020] [Indexed: 12/14/2022] Open
Abstract
Much research has been done in sports nutrition in recent years as the demand for performance-enhancing substances increases. Higher intake of nitrates from the diet can increase the bioavailability of nitric oxide (NO) via the nitrate-nitrite-NO pathway. Nevertheless, the increased availability of NO does not always lead to improved performance in some individuals. This review aims to evaluate the relationship between the athlete's training status and the change in time trial performance after increased dietary nitrate intake. Articles indexed by Scopus and PubMed published from 2015 to 2019 were reviewed. Thirteen articles met the eligibility criteria: clinical trial studies on healthy participants with different training status (according to VO2max), conducting time trial tests after dietary nitrate supplementation. The PRISMA guidelines were followed to process the review. We found a statistically significant relationship between VO2max and ergogenicity in time trial performance using one-way ANOVA (p = 0.001) in less-trained athletes (VO2 < 55 mL/kg/min). A strong positive correlation was observed in experimental situations using a chronic supplementation protocol but not in acute protocol situations. In the context of our results and recent histological observations of muscle fibres, there might be a fibre-type specific role in nitric oxide production and, therefore, supplement of ergogenicity.
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Abstract
Over the last decade, there has been a growing interest in the utility of nitrate (NO3-) supplementation to improve exercise-related performance. After consumption, dietary NO3- can be reduced to nitric oxide, a free radical gas involved in numerous physiological actions including blood vessel vasodilation, mitochondrial respiration, and skeletal muscle contractile function. Emerging evidence indicates that dietary NO3- supplementation has a small but nevertheless significant beneficial effect on endurance performance through the combined effects of enhanced tissue oxygenation and metabolic efficiency in active skeletal muscle. There is further evidence to suggest that dietary NO3- exerts a direct influence on contractile mechanisms within the skeletal muscle through alterations in calcium availability and sensitivity. Response heterogeneity and sizeable variability in the nitrate content of beetroot juice products influence the effectiveness of dietary NO3- for exercise performance, and so dosing and product quality, as well as training history, sex, and individual-specific characteristics, should be considered.
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San Juan AF, Dominguez R, Lago-Rodríguez Á, Montoya JJ, Tan R, Bailey SJ. Effects of Dietary Nitrate Supplementation on Weightlifting Exercise Performance in Healthy Adults: A Systematic Review. Nutrients 2020; 12:nu12082227. [PMID: 32722588 PMCID: PMC7469052 DOI: 10.3390/nu12082227] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/21/2020] [Accepted: 07/23/2020] [Indexed: 02/07/2023] Open
Abstract
Dietary nitrate (NO3−) supplementation has been evidenced to induce an ergogenic effect in endurance and sprint-type exercise, which may be underpinned by enhanced muscle contractility and perfusion, particularly in type II muscle fibers. However, limited data are available to evaluate the ergogenic potential of NO3− supplementation during other exercise modalities that mandate type II fiber recruitment, such as weightlifting exercise (i.e., resistance exercise). In this systematic review, we examine the existing evidence basis for NO3− supplementation to improve muscular power, velocity of contraction, and muscular endurance during weightlifting exercise in healthy adults. We also discuss the potential mechanistic bases for any positive effects of NO3− supplementation on resistance exercise performance. Dialnet, Directory of Open Access Journals, Medline, Pubmed, Scielo, Scopus and SPORT Discus databases were searched for articles using the keywords: nitrate or beetroot and supplement or nut*r or diet and strength or “resistance exercise” or “resistance training” or “muscular power”. Four articles fulfilling the inclusion criteria were identified. Two of the four studies indicated that NO3− supplementation could increase aspects of upper body weightlifting exercise (i.e., bench press) performance (increases in mean power/velocity of contraction/number of repetitions to failure), whereas another study observed an increase in the number of repetitions to failure during lower limb weightlifting exercise (i.e., back squat). Although these preliminary observations are encouraging, further research is required for the ergogenic potential of NO3− supplementation on weightlifting exercise performance to be determined.
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Affiliation(s)
- Alejandro F. San Juan
- Department of Health and Human Performance, Sport Biomechanics Laboratory, Facultad de Ciencias de la Actividad Física y del Deporte—INEF, Universidad Politécnica de Madrid, 28040 Madrid, Spain;
| | - Raul Dominguez
- Faculty of Health Science, Universidad Isabel I, 09003 Burgos, Spain;
- Correspondence: ; Tel.: +34-695182853
| | | | - Juan José Montoya
- Faculty of Medicine, School of Medicine of Physical Education and Sport, Complutense University, 28040 Madrid, Spain;
| | - Rachel Tan
- Faculty of Sports Medicine, Natural Sciences Division, Pepperdine University, Malibu, CA 90263, USA;
| | - Stephen J. Bailey
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK;
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Zamani H, de Joode MEJR, Hossein IJ, Henckens NFT, Guggeis MA, Berends JE, de Kok TMCM, van Breda SGJ. The benefits and risks of beetroot juice consumption: a systematic review. Crit Rev Food Sci Nutr 2020; 61:788-804. [PMID: 32292042 DOI: 10.1080/10408398.2020.1746629] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Beetroot juice (BRJ) has become increasingly popular amongst athletes aiming to improve sport performances. BRJ contains high concentrations of nitrate, which can be converted into nitric oxide (NO) after consumption. NO has various functions in the human body, including a vasodilatory effect, which reduces blood pressure and increases oxygen- and nutrient delivery to various organs. These effects indicate that BRJ may have relevant applications in prevention and treatment of cardiovascular disease. Furthermore, the consumption of BRJ also has an impact on oxygen delivery to skeletal muscles, muscle efficiency, tolerance and endurance and may thus have a positive impact on sports performances. Aside from the beneficial aspects of BRJ consumption, there may also be potential health risks. Drinking BRJ may easily increase nitrate intake above the acceptable daily intake, which is known to stimulate the endogenous formation of N-nitroso compounds (NOC's), a class of compounds that is known to be carcinogenic and that may also induce several other adverse effects. Compared to studies on the beneficial effects, the amount of data and literature on the negative effects of BRJ is rather limited, and should be increased in order to perform a balanced risk assessment.
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Affiliation(s)
- H Zamani
- Department of Toxicogenomics, GROW-school for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - M E J R de Joode
- Department of Toxicogenomics, GROW-school for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - I J Hossein
- Department of Toxicogenomics, GROW-school for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - N F T Henckens
- Department of Toxicogenomics, GROW-school for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - M A Guggeis
- Department of Toxicogenomics, GROW-school for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - J E Berends
- Department of Toxicogenomics, GROW-school for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - T M C M de Kok
- Department of Toxicogenomics, GROW-school for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - S G J van Breda
- Department of Toxicogenomics, GROW-school for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands
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