Nitrate supplementation enhances the contractile properties of human skeletal muscle

Relationships between nitric oxide biomarkers and physiological outcomes following dietary nitrate supplementation

Dietary nitrate (NO3-) supplementation can increase nitric oxide (NO) bioavailability, reduce blood pressure (BP) and improve muscle contractile function in humans. Plasma nitrite concentration (plasma [NO2-]) is the most oft-used biomarker of NO bioavailability. However, it is unclear which of several NO biomarkers (NO3-, NO2-, S-nitrosothiols (RSNOs)) in plasma, whole blood (WB), red blood cells (RBC) and skeletal muscle correlate with the physiological effects of acute and chronic dietary NO3- supplementation. Using a randomized, double-blind, crossover design, 12 participants (9 males) consumed NO3--rich beetroot juice (BR) (∼12.8 mmol NO3-) and NO3--depleted placebo beetroot juice (PL) acutely and then chronically (for two weeks). Biological samples were collected, resting BP was assessed, and 10 maximal voluntary isometric contractions of the knee extensors were performed at 2.5-3.5 h following supplement ingestion on day 1 and day 14. Diastolic BP was significantly lower in BR (-2 ± 3 mmHg, P = 0.03) compared to PL following acute supplementation, while the absolute rate of torque development (RTD) was significantly greater in BR at 0-30 ms (39 ± 57 N m s-1, P = 0.03) and 0-50 ms (79 ± 99 N m s-1, P = 0.02) compared to PL following two weeks supplementation. Greater WB [RSNOs] rather than plasma [NO2-] was correlated with lower diastolic BP (r = -0.68, P = 0.02) in BR compared to PL following acute supplementation, while greater skeletal muscle [NO3-] was correlated with greater RTD at 0-30 ms (r = 0.64, P=0.03) in BR compared to PL following chronic supplementation. We conclude that [RSNOs] in blood, and [NO3-] in skeletal muscle, are relevant biomarkers of NO bioavailability which are related to the reduction of BP and the enhanced muscle contractile function following dietary NO3- ingestion in humans.

Acute effects of caffeine or quercetin ingestion on motor unit firing pattern before and after resistance exercise

The aim of the present study was to investigate the acute effect of caffeine or quercetin ingestion on motor unit firing patterns and muscle contractile properties before and after resistance exercise. High-density surface electromyography (HDs-EMG) during submaximal contractions and electrically elicited torque in knee extensor muscles were measured before (PRE) and 60 min after (POST1) ingestion of caffeine, quercetin glycosides, or placebo, and after resistance exercise (POST2) in ten young males. The Convolution Kernel Compensation technique was used to identify individual motor units of the vastus lateralis muscle for the recorded HDs-EMG. Ingestion of caffeine or quercetin induced significantly greater decreases in recruitment thresholds (RTs) from PRE to POST1 compared with placebo (placebo: 94.8 ± 9.7%, caffeine: 84.5 ± 16.2%, quercetin: 91.9 ± 36.7%), and there were significant negative correlations between the change in RTs (POST1-PRE) and RT at PRE for caffeine (rs = - 0.448, p < 0.001) and quercetin (rs =  - 0.415, p = 0.003), but not placebo (rs =  - 0.109, p = 0.440). Significant positive correlations between the change in firing rates (POST2-POST1) and RT at PRE were noted with placebo (rs = 0.380, p = 0.005) and quercetin (rs = 0.382, p = 0.007), but not caffeine (rs = 0.069, p = 0.606). No significant differences were observed in electrically elicited torque among the three conditions. These results suggest that caffeine or quercetin ingestion alters motor unit firing patterns after resistance exercise in different threshold-dependent manners in males.

Impact of a short-term nitrate and citrulline co-supplementation on sport performance in elite rowers: a randomized, double-blind, placebo-controlled crossover trial

PURPOSE

Citrulline (CIT) and beetroot extract (BR) have separately shown benefits in rowing performance-related outcomes. However, effects of combined supplementation remain to be elucidated. The main purpose of this research was to study the effects of 1 week of daily co-supplementation of 3.5 g BR (500 mg NO3-) plus 6 g CIT on aerobic performance, maximal strength, and high-intensity power and peak stroke in elite male rowers compared to a placebo and to a BR supplementation.

METHODS

20 elite rowers participated in this randomized, double-blind, placebo-controlled crossover trial completing 1 week of supplementation in each group of study: Placebo group (PLAG); BR group (BRG); and BR + CIT group (BR-CITG). 3 main physical tests were performed: aerobic performance, Wingate test and CMJ jump, and metabolic biomarkers and physiological outcomes were collected.

RESULTS

The Wingate all-out test showed no between-condition differences in peak power, mean power, relative power, or fatigue index (P > 0.05), but clearance of lactate was better in BR-CITG (P < 0.05). In the performance test, peak power differed only between PLAG and BR-CITG (P = 0.036), while VO2peak and maximum heart rate remained similar. CMJ jumping test results showed no between-condition differences, and blood samples were consistent (P > 0.200).

CONCLUSION

Supplementation with 3.5 g of BR extract plus 6 g of CIT for 7 days improved lactate clearance after Wingate test and peak power in a performance test. No further improvements were found, suggesting longer period of supplementation might be needed to show greater benefits.

Influence of nitrate supplementation on motor unit activity during recovery following a sustained ischemic contraction in recreationally active young males

PURPOSE

Dietary nitrate (NO3-) supplementation enhances muscle blood flow and metabolic efficiency in hypoxia, however, its efficacy on neuromuscular function and specifically, the effect on motor unit (MU) activity is less clear. We investigated whether NO3- supplementation affected MU activity following a 3 min sustained ischemic contraction and whether this is influenced by blood flow restriction (BFR) during the recovery period.

METHOD

In a randomized, double-blinded, cross-over design, 14 males (mean ± SD, 25 ± 6 years) completed two trials following 5 days of supplementation with NO3--rich (NIT) or NO3--depleted (PLA) beetroot juice to modify plasma nitrite (NO2-) concentration (482 ± 92 vs. 198 ± 48 nmol·L-1, p < 0.001). Intramuscular electromyography was used to assess MU potential (MUP) size (duration and area) and mean firing rates (MUFR) during a 3 min submaximal (25% MVC) isometric contraction with BFR. These variables were also assessed during a 90 s recovery period with the first half completed with, and the second half completed without, BFR.

RESULTS

The change in MUP area and MUFR, did not differ between conditions (all p > 0.05), but NIT elicited a reduction in MUP recovery time during brief isometric contractions (p < 0.001), and during recoveries with (p = 0.002) and without (p = 0.012) BFR.

CONCLUSION

These novel observations improve understanding of the effects of NO3- on the recovery of neuromuscular function post-exercise and might have implications for recovery of muscle contractile function.

TRIAL REGISTRATION

The study was registered on clinicaltrials.gov with ID of NCT05993715 on August 08, 2023.

Higher plant-derived nitrate intake is associated with lower odds of frailty in a cross-sectional study of community-dwelling older women

PURPOSE

Dietary nitrate intake is inversely related to numerous contributors towards frailty, including cardiovascular disease and poor physical function. Whether these findings extend to frailty remain unknown. We investigated if habitual nitrate intake, derived from plants or animal-based foods, was cross-sectionally associated with frailty in women.

METHODS

Community-dwelling older Australian women (n = 1390, mean age 75.1 ± 2.7 years) completed a validated semi-quantitative food frequency questionnaire (FFQ). Nitrate concentrations in food were obtained from international nitrate databases. We adopted the Rockwood frailty index (FI) of cumulative deficits comprising 33 variables across multiple health domains (scored 0 to 1), which predicts increased hospitalisation and mortality risk. A FI ≥ 0.25 indicated frailty. Cross-sectional associations between nitrate intake (total plant and animal nitrate, separately) and frailty were analysed using multivariable-adjusted logistic regression models (including lifestyle factors), as part of restricted cubic splines.

RESULTS

A non-linear inverse relationship was observed between total plant nitrate intake and frailty. Compared to women with the lowest plant nitrate intake (Quartile [Q]1), women with greater intakes in Q2 (OR 0.69 95%CI 0.56-0.84), Q3 (OR 0.67 95%CI 0.50-0.90) and Q4 (OR 0.66 95%CI 0.45-0.98) had lower odds for frailty. A nadir in the inverse association was observed once intakes reached ~ 64 mg/d (median Q2). No relationship was observed between total animal nitrate and frailty.

CONCLUSION

Community-dwelling older women consuming low amounts of plant-derived nitrate were more likely to present with frailty. Consuming at least one daily serving (~ 75 g) of nitrate-rich green leafy vegetables may be beneficial in preventing frailty.

A comparative study of 8-week complex training and resistance training on athletic performance of amateur futsal players

Background: Despite the acknowledged importance of resistance training (RT) in enhancing physical performance in futsal players., the comparative effectiveness of RT and complex training (CT) on both physical and technical performance in futsal players remains underexplored. This study aimed to compare the effects of RT vs. CT on physical and technical performance in amateur futsal players. Method: Players from two amateur futsal teams were assigned to RT (one team of 16 players; 18 years) and CT (one team of 16 players; 18 years) to perform an 8-week intervention with two weekly sessions. The RT performed the squat and deadlift (6 sets of 6-10 repetitions at 75%-85% one-repetition maximum (1RM), while the CT performed the squat + squat jump and deadlift + high pull (3 sets of 4-6 + 10-12 repetitions at 75%-85% 1RM). Pre- and post-intervention assessments included the Futsal Special Performance Test (FSPT), repeated sprint ability (RSA), sprint decrement (Sdec), sprint times at 10-m (T10), 10-20-m (T10-20), and 20-m (T20), 1RM back squat (1RM BS), isometric mid-thigh pull (IMTP), and countermovement jump (CMJ). Results: At baseline, no significant differences between groups were observed for any variable analyzed (p > 0.05). After 8 weeks, there were significant differences between CT vs. RT on FSPT (-10.8% vs. -3.4%; p < 0.05), T10 (-5.2% vs. -0.1%; p < 0.05), IMTP (7.8% vs. 5.1%; p < 0.05), and CMJ (10.2% vs. 4.5%; p < 0.05). On the other hand, no significant differences between CT vs. RT were observed for RSA (-2.0% vs. -1.2%; p > 0.05), Sdec (-7.6% vs. -3.5%; p > 0.05), T10-20 (-0.9% vs. -0.9%; p > 0.05), T20 (-1.8% vs. -1.7%; p > 0.05), and 1RM BS (5.7% vs. 4.5%; p > 0.05) after the training program. Both groups significantly improved FSPT, T20, 1RM BS, and IMTP, while only CT significantly improved RSA, Sdec, T10, and CMJ. Conclusion: The results suggest that CT may be valuable for improving specific performance parameters in amateur futsal players, with some advantages over RT in enhancing strength and power. These findings support tailored training protocols for futsal players to optimize performance.

Effects of 7-day quercetin intervention on motor unit activity and muscle contractile properties before and after resistance exercise in young adults randomized controlled trials

We investigated whether the alteration of the motor unit recruitment threshold (MURT) caused by quercetin ingestion intervention for 7 days modifies motor unit activation patterns before and after a single session of resistance exercise. Twenty young male and female adults were divided into two groups: ingestion of placebo (PLA) or quercetin glycosides at 200 mg/day (QUE). High-density surface electromyography during submaximal contractions was measured to assess the motor unit firing rate (MUFR) and MURT of the vastus lateralis muscle before (PRE) and after (POST) resistance exercise (DAY1). The same measurements were repeated after 7 days of placebo or quercetin glycoside ingestion (DAY8). In QUE, MURT decreased more from DAY1-PRE to DAY8-PRE (29.1 ± 9.1 to 27.1 ± 9.5% MVC, p < 0.001) but not in PLA (29.8 ± 10.4 to 28.9 ± 9.7% MVC, p < 0.167). For percentage change in MUFR following resistance exercise, there was a significant interaction (day × group, p < 0.001). The degree of changes in MURT from DAY1-PRE to DAY8-PRE was significantly correlated with the percentage change of MUFR from DAY8-PRE to DAY8-POST in QUE (p = 0.014, r = -0.363) but not in PLA (p = 0.518). The study suggests that 7-day quercetin ingestion alters the motor unit recruitment pattern, and this may induce changes in motor unit firing patterns during a single session of resistance training (Trial registration: UMIN000052255, R000059650).

Effects of Beetroot-Based Supplements on Muscular Endurance and Strength in Healthy Male Individuals: A Systematic Review and Meta-Analysis

The aim of this study was to systematically review the current literature and analyze the effects of beetroot-based supplements (BRS) on muscular performance. Randomized controlled trials that assessed the acute or short-term effects of BRS administration on muscular endurance and/or strength in healthy male individuals were retrieved from PubMed, EMBASE, CENTRAL, and Web of Science databases from inception to February 20th, 2023. In addition, we also searched preprint papers in medRxiv.org, bibRxiv.org; thesis and dissertations included in oatd.org; and clinical trials published in ClinicalTrials.gov. Data extraction, risk of bias, and study quality were assessed by 2 authors. Meta-analyses and subgroup analyses of standardized mean differences (SMD) were performed using a random-effects model. A total of 1486 records were identified in the databases and 2 were obtained by manual search in the reference list. Of those, 27 studies attended eligibility criteria and composed this systematic review. BRS administration resulted in a positive effect on muscular endurance (SMD: 0.31; 95% confidence interval (CI): 0.10 to 0.51; p < 0.01; n = 16 studies). There was an overall significative effect for muscular strength (SMD: 0.26; 95% CI: 0.03 to 0.48; p < 0.05; n = 18 studies), but a subgroup analysis showed that significant effects were found when strength was measured in a fatigued (SMD: 0.64; 95% CI: 0.25 to 1.03; p < 0.01), but not resting state. BRS administration have a small ergogenic effect on muscular endurance and attenuate the decline in muscular strength in a fatigued state in healthy male individuals.

The effect of eight weeks beetroot juice supplement on aerobic, anaerobic power, and field performance of soccer players

The purpose of the study investigated the effect of eight weeks of soccer training with beetroot juice supplement on aerobic power, anaerobic power, and field performance of soccer players. This is experimental research, by the control group in pre and post-test. The statistical population was male soccer players. Forty subjects were randomly divided into four groups including the exercise group (EX) the exercise group with beetroot juice supplement (EX&BRJS) the beetroot juice supplement group (BRJS), and the control group (C). Aerobic power, anaerobic threshold, and respiratory exchange ratio, measured by the gas analyser (Cosmed), anaerobic power (peak, mean power), and fatigue index, by Wingate cycle test (Monark, 839), and field performance by (Bangsbo, field test performance). The statistical methods include the Kolmogorov-Smirnov, Levin, covariance (ANCOVA), and pair comparison with Bonferroni test. The results showed eight weeks' of soccer training with beetroot juice supplement, significantly changed aerobic power, respiratory exchange ratio, anaerobic threshold, anaerobic power, field performance, and fatigue index (P ≤ 0.05). Additionally, in all variables, the paired comparison showed that the EX&BRJS group progressed more than all other condition groups. The soccer athletes may use beetroot juice supplements along with soccer exercises to improve aerobic and anaerobic power and field performance.

Chronic beetroot juice supplementation attenuates neuromuscular fatigue etiology during simulated soccer match play

The aim of the present study was to assess the effect of beetroot juice supplementation (BEET) on neuromuscular fatigue etiology during simulated soccer match play. In a randomized, double-blind, crossover design, 13 soccer players completed the Loughborough Intermittent Shuttle Test (LIST). Players received either BEET (2×150 mL; ∼8 mmol/L nitrate) or placebo (PLA) for 7 days (6 days prior to the experimental session and on the day of trial, 2 h before LIST). Neuromuscular assessments were performed at baseline, 45 min (half time: HT), and 90 min (full time: FT) following LIST. Maximal voluntary contraction (MVC) and twitch responses, delivered through electrical femoral nerve stimulation, were used to assess peripheral (quadriceps resting twitch force Qtw,pot) and central fatigue (voluntary activation, VA). Compared with baseline, MVC Qtw,pot and VA values decreased in PLA and BEET conditions at HT and FT (P < 0.05). Compared with PLA, the decrease in MVC and Qtw,pot was significantly attenuated with BEET at HT and FT (P < 0.001). Likewise, BEET attenuated the decrease in VA at HT (P < 0.001, d = 1.3) and FT (P < 0.001, d = 1.5) compared with the PLA condition. Chronic beetroot juice supplementation attenuates neuromuscular fatigue development during simulated soccer matches, and this is due to both central and peripheral factors. Consequently, chronic beetroot may optimize physical performance.

Nutritional strategies to optimise musculoskeletal health for fall and fracture prevention: Looking beyond calcium, vitamin D and protein

Falls and osteoporotic fractures are a major public health problem, particularly among older adults. A third of individuals aged 65 years and over fall at least once each year, with up to 20 % of these resulting in serious injury, including fracture. In conjunction with regular exercise, the importance of diet for musculoskeletal health has largely focused upon calcium, vitamin D, and protein, particularly in the context of preventing falls and fractures. Whilst there is evidence for the benefits of these nutrients for musculoskeletal health, other aspects of the diet remain largely underexplored. For example, vegetables are rich sources of macro- and micronutrients that are essential for muscle function and bone health, which are key factors in the prevention of falls and fractures. Recent work has highlighted the importance of nutrients such as vegetable-derived nitrate and vitamin K1 in optimising muscle strength, physical function, and bone quality. In the context of dietary patterns, vegan/plant-based diets have recently gained popularity due to perceived health benefits, animal welfare, or to tackle climate change. The elimination and/or substitution of animal-based products for plant foods (without careful planning and/or expert dietary guidance) could, however, have long-term negative musculoskeletal consequences; a trend uncovered by recent evidence. Within the overarching theme of nutrition for fall and fracture prevention in older populations, the aim of this review is to (i) summarise the current evidence for calcium, vitamin D and protein; (ii) describe the importance of vegetables and selected nutrients, such as nitrate and vitamin K1, for muscle function and bone structural integrity; and (iii) highlight current evidence around different dietary patterns (e.g., plant-based, diet quality, data driven approaches) and their impact on musculoskeletal health.

Effects of dietary nitrate supplementation on peak power output: Influence of supplementation strategy and population

Increasing evidence indicates that dietary nitrate supplementation has the potential to increase muscular power output during skeletal muscle contractions. However, there is still a paucity of data characterizing the impact of different nitrate dosing regimens on nitric oxide bioavailability and its potential ergogenic effects across various population groups. This review discusses the potential influence of different dietary nitrate supplementation strategies on nitric oxide bioavailability and muscular peak power output in healthy adults, athletes, older adults and some clinical populations. Effect sizes were calculated for peak power output and absolute and/or relative nitrate doses were considered where applicable. There was no relationship between the effect sizes of peak power output change following nitrate supplementation and when nitrate dosage when considered in absolute or relative terms. Areas for further research are also recommended including a focus on nitrate dosing regimens that optimize nitric oxide bioavailability for enhancing peak power at times of increased muscular work in a variety of healthy and disease populations.

"Diet for the prevention and management of sarcopenia"

Sarcopenia is a geriatric condition characterized by a progressive loss of skeletal muscle mass and strength, with an increased risk of adverse health outcomes (e.g., falls, disability, institutionalization, reduced quality of life, mortality). Pharmacological remedies are currently unavailable for preventing the development of sarcopenia, halting its progression, or impeding its negative health outcomes. The most effective strategies to contrast sarcopenia rely on the adoption of healthier lifestyle behaviors, including adherence to high-quality diets and regular physical activity. In this review, the role of nutrition in the prevention and management of sarcopenia is summarized. Special attention is given to current "blockbuster" dietary regimes and agents used to counteract age-related muscle wasting, together with their putative mechanisms of action. Issues related to the design and implementation of effective nutritional strategies are discussed, with a focus on unanswered questions on the most appropriate timing of nutritional interventions to preserve muscle health and function into old age. A brief description is also provided on new technologies that can facilitate the development and implementation of personalized nutrition plans to contrast sarcopenia.

The Effect of Dietary Nitrate on the Contractile Properties of Human Skeletal Muscle: A Systematic Review and Meta-Analysis

The propose of this study was to systematically review the current literature and meta-analyse the effects of dietary nitrate (NO₃^-) supplementation on the contractile properties of skeletal muscle. A literature search of three databases was conducted in June 2021, with 19 studies meeting the inclusion criteria. Studies were included if a placebo versus dietary NO₃^--only supplementation protocol was used in healthy human, assessed muscle contraction or activities that was < 3 minutes in duration and focused on the lower-body. For the meta-analysis, a pooled standardised mean difference (SMD) was determined for maximum voluntary contraction (MVC) (n = 11), cycling, running and inertial load squad peak power output (PPO) (n = 8), mean power output (MPO) (n = 6) and time to PPO (n = 4). NO₃^- supplementation demonstrated a small improvement in PPO (SMD = 0.25, P = 0.030) and MPO (SMD = 0.28, P = 0.030) when compared to the placebo. NO₃^- also resulted in an enhanced time to PPO (SMD = -0.78, P < 0.001). There was no clear effect of NO₃^- on isometric MVC (SMD = 0.03, P = 0.758). This review reports that NO₃^- supplementation may have potential to enhance PPO, MPO and time to PPO during dynamic exercise, which may transfer to brief explosive actions commonly observed in sporting activities. Due to the variability in studies, we encourage researchers to use this work to explore areas where evidence in lacking and standardize the study design and procedures.Key teaching pointsFindings from this meta-analysis highlight the potential positive ergogenic effect of dietary NO3-supplementation on PPO, MPO and time to PPO during short duration (<10 s) dynamic exercise.NO3- supplementation might be considered as an ergogenic aid when executing power-based actions (e.g., 100 m sprinter or weightlifter).This review highlights that further research is required to address some of the contrasting findings presented here using a standardised procedure to allow for improved synthesis.

15 N-labeled dietary nitrate supplementation increases human skeletal muscle nitrate concentration and improves muscle torque production

AIM

Dietary nitrate (NO₃ ^- ) supplementation increases nitric oxide bioavailability and can enhance exercise performance. We investigated the distribution and metabolic fate of ingested NO₃ ^- at rest and during exercise with a focus on skeletal muscle.

METHODS

In a randomized, crossover study, 10 healthy volunteers consumed 12.8 mmol ¹⁵ N-labeled potassium nitrate (K¹⁵ NO₃ ; NIT) or potassium chloride placebo (PLA). Muscle biopsies were taken at baseline, at 1- and 3-h post-supplement ingestion, and immediately following the completion of 60 maximal intermittent contractions of the knee extensors. Muscle, plasma, saliva, and urine samples were analyzed using chemiluminescence to determine absolute [NO₃ ^- ] and [NO₂ ^- ], and by mass spectrometry to determine the proportion of NO₃ ^- and NO₂ ^- that was ¹⁵ N-labeled.

RESULTS

Neither muscle [NO₃ ^- ] nor [NO₂ ^- ] were altered by PLA. Following NIT, muscle [NO₃ ^- ] (but not [NO₂ ^- ]) was elevated at 1-h (from ~35 to 147 nmol/g, p < 0.001) and 3-h, with almost all of the increase being ¹⁵ N-labeled. There was a significant reduction in ¹⁵ N-labeled muscle [NO₃ ^- ] from pre- to post-exercise. Relative to PLA, mean muscle torque production was ~7% greater during the first 18 contractions following NIT. This improvement in torque was correlated with the pre-exercise ¹⁵ N-labeled muscle [NO₃ ^- ] and the magnitude of decline in ¹⁵ N-labeled muscle [NO₃ ^- ] during exercise (r = 0.66 and r = 0.62, respectively; p < 0.01).

CONCLUSION

This study shows, for the first time, that skeletal muscle rapidly takes up dietary NO₃ ^- , the elevated muscle [NO₃ ^- ] following NO₃ ^- ingestion declines during exercise, and muscle NO₃ ^- dynamics are associated with enhanced torque production during maximal intermittent muscle contractions.

Estimating nitrate intake in the Australian diet: Design and validation of a food frequency questionnaire

BACKGROUND

Dietary nitrates may play a role in mediating several key physiological processes impacting health and/or exercise performance. However, current methods for assessing dietary nitrate (NO3 - ) consumption are inadequate. The present study aimed to examine the dietary nitrate intake in a sample of 50 healthy adults, as well as test the validity of a purposefully developed food frequency questionnaire (FFQ).

METHODS

Dietary nitrate intake was estimated over a week using (i) three 24-h dietary recalls; (ii) a short-term (7-day) FFQ; and (iii) a biomarker (urinary nitrate), in conjunction with a nitrate reference database.

RESULTS

Daily dietary nitrate intake estimates were 130.94 mg (average of three 24-h recalls) and 180.62 mg (FFQ). The mean urinary NO3 - excretion was 1974.79 µmol day-1 (or 917.9 µmol L-1 ). Despite the difference between the two dietary assessment methods, there was a moderate positive correlation (r = 0.736, ρ < 0.001) between the two tools. There was also a positive correlation between urinary NO3 - and 24-h recall data (r = 0.632, ρ < 0.001), as well as between urinary NO3 - and FFQ (r = 0.579, ρ < 0.001).

CONCLUSIONS

The ability to accurately estimate nitrate intakes depends on having suitable reference methods to estimate the concentrations of nitrate in the food supply, coupled with valid and reliable dietary assessment tools. Based on the findings from the present study, at an individual level, dietary recalls or records may be more accurate in estimating intakes of NO3 - . However, given the lower cost and time needed for administration relative to recalls, the FFQ has merit for estimating NO3 - intakes in health interventions, dietary surveys and surveillance programs.

Supplementation with Nitric Oxide Precursors for Strength Performance: A Review of the Current Literature

Nitric-oxide-stimulating dietary supplements are widely available and marketed to strength athletes and weightlifters seeking to increase muscle performance and augment training adaptations. These supplements contain ingredients classified as nitric oxide (NO) precursors (i.e., "NO boosters"). Endogenous NO is generated via a nitric oxide synthase (NOS)-dependent pathway and a NOS-independent pathway that rely on precursors including L-arginine and nitrates, with L-citrulline serving as an effective precursor of L-arginine. Nitric oxide plays a critical role in endothelial function, promoting relaxation of vascular smooth muscle and subsequent dilation which may favorably impact blood flow and augment mechanisms contributing to skeletal muscle performance, hypertrophy, and strength adaptations. The aim of this review is to describe the NO production pathways and summarize the current literature on the effects of supplementation with NO precursors for strength and power performance. The information will allow for an informed decision when considering the use of L-arginine, L-citrulline, and nitrates to improve muscular function by increasing NO bioavailability.

Dietary Nitrate Supplementation Enhances Performance and Speeds Muscle Deoxyhaemoglobin Kinetics during an End-Sprint after Prolonged Moderate-Intensity Exercise

Short-term dietary nitrate (NO3−) supplementation has the potential to enhance performance during submaximal endurance, and short-duration, maximal-intensity exercise. However, it has yet to be determined whether NO3− supplementation before and during submaximal endurance exercise can improve performance during a short-duration, maximal-intensity end-sprint. In a randomised, double-blind, crossover study, 9 recreationally active men ingested NO3−-rich (BR: 8 mmol NO3−/day) and NO3−-depleted (PL: 0.75 mmol NO3−/day) beetroot powder for 7 days. On day 7, participants completed 2 h of moderate-intensity cycling, which immediately transitioned into a 60 s maximal-intensity end-sprint, with supplements ingested 2 h before and 1 h into the moderate-intensity exercise bout. Plasma [NO3−] and [NO2−] were higher in BR compared to PL pre- and post-exercise (p < 0.05). Post-exercise plasma [NO3−] was higher than pre-exercise (562 ± 89 µM vs. 300 ± 73 µM; p < 0.05) and plasma [NO2−] was not significantly different pre- (280 ± 58 nM) and post-exercise (228 ± 63 nM) in the BR condition (p > 0.05). Mean power output during the final 30 s of the end-sprint was greater after BR (390 ± 38 W) compared to PL (365 ± 41 W; p < 0.05). There were no differences between BR and PL in any muscle oxygenation variables during moderate-intensity cycling (p > 0.05), but muscle [deoxyhaemoglobin] kinetics was faster during the end-sprint in BR (6.5 ± 1.4 s) compared to PL (7.3 ± 1.4 s; p < 0.05). These findings suggest that NO3− supplementation has the potential to improve end-sprint performance in endurance events when ingested prior to and during exercise.

The Generation of Nitric Oxide from Aldehyde Dehydrogenase-2: The Role of Dietary Nitrates and Their Implication in Cardiovascular Disease Management

Reduced bioavailability of the nitric oxide (NO) signaling molecule has been associated with the onset of cardiovascular disease. One of the better-known and effective therapies for cardiovascular disorders is the use of organic nitrates, such as glyceryl trinitrate (GTN), which increases the concentration of NO. Unfortunately, chronic use of this therapy can induce a phenomenon known as "nitrate tolerance", which is defined as the loss of hemodynamic effects and a reduction in therapeutic effects. As such, a higher dosage of GTN is required in order to achieve the same vasodilatory and antiplatelet effects. Mitochondrial aldehyde dehydrogenase 2 (ALDH2) is a cardioprotective enzyme that catalyzes the bio-activation of GTN to NO. Nitrate tolerance is accompanied by an increase in oxidative stress, endothelial dysfunction, and sympathetic activation, as well as a loss of the catalytic activity of ALDH2 itself. On the basis of current knowledge, nitrate intake in the diet would guarantee a concentration of NO such as to avoid (or at least reduce) treatment with GTN and the consequent onset of nitrate tolerance in the course of cardiovascular diseases, so as not to make necessary the increase in GTN concentrations and the possible inhibition/alteration of ALDH2, which aggravates the problem of a positive feedback mechanism. Therefore, the purpose of this review is to summarize data relating to the introduction into the diet of some natural products that could assist pharmacological therapy in order to provide the NO necessary to reduce the intake of GTN and the phenomenon of nitrate tolerance and to ensure the correct catalytic activity of ALDH2.

Influence of Beetroot Juice Ingestion on Neuromuscular Performance on Semi-Professional Female Rugby Players: A Randomized, Double-Blind, Placebo-Controlled Study

PURPOSE

Beetroot juice (BRJ) is considered an ergogenic aid with good to strong evidence for improving human performance in sport modalities with similar demands to rugby. However, most of the studies were realized in male athletes with limited evidence in female athletes. Thus, the aim of this study was to explore the acute ingestion of BRJ in female rugby players.

METHODS

Fourteen semi-professional female rugby players (25.0 ± 3.7 years) belonging to a team from the First Spanish Female Rugby Division participated in this study. Participants were randomly divided into two groups that realized a neuromuscular battery after BRJ (140mL, 12.8 mmol NO₃^-) or placebo (PLAC, 140 mL, 0.08 mmol NO₃^-) ingestion on two different days separated by one week between protocols. The neuromuscular test battery consisted of a countermovement jump (CMJ), isometric handgrip strength (i.e., dominant), 10-m and 30-m sprint, agility t-test and Bronco test. Afterwards, participants reported a rate of perception scale (6-20 points) and side effects questionnaire associated with BRJ or PLAC ingestion.

RESULTS

Statistically significant improvements were observed in CMJ (7.7%; p = 0.029; ES = 0.62), while no differences were reported in dominant isometric handgrip strength (-1.7%; p = 0.274; ES = -0.20); 10-m and 30-m sprint (0.5-0.8%; p = 0.441-0.588; ES = 0.03-0.18); modified agility t-test (-0.6%; p = 0.503; ES = -0.12) and Bronco test (1.94%; p = 0.459; ES = 0.16).

CONCLUSIONS

BRJ ingestion could improve neuromuscular performance in the CMJ test, while no differences in sprint (10-m and 30-m sprint test), agility, isometric handgrip strength and endurance performance (i.e., Bronco test) were reported.

Acute Effects of Beetroot Juice Supplementation on Isometric Muscle Strength, Rate of Torque Development and Isometric Endurance in Young Adult Men and Women: A Randomized, Double-Blind, Controlled Cross-Over Pilot Study

This study was conducted to investigate the effect of concentrated beetroot juice on isometric strength and knee extensor muscle endurance in healthy adults. We conducted a randomized cross-over, double-blind experiment in which participants (18 healthy, physically active adults, 9 men, 9 women) consumed either concentrated beetroot juice (140 mL) or low-nitrate control supplement 2.5 h before the measurement. Isometric maximum strength (peak torque), explosive strength (isometric rate of torque development), and strength endurance at 50% of peak torque were measured on an isometric dynamometer. The results showed that concentrated beetroot juice had no effect on the maximum voluntary isometric strength and rate of torque development of the knee extensors. The only exception was the maximum rate of torque development, for which a positive influence was demonstrated only in men. As for the endurance of the knee extensors, the supplement had a positive effect in men (endurance time increased from 86.4 ± 46.1 s to 103.4 ± 53.7 s; p = 0.022), but not in women. The absence of effect on maximal voluntary strength is consistent with previous research. One the other hand, improvements in endurance and rate of torque development in men only point to an important aspect of a previously under-researched area of sex-specific responses to nitrate supplementation.

Deconstructing the Ergogenic Effects of Photobiomodulation: A Systematic Review and Meta-analysis of its Efficacy in Improving Mode-Specific Exercise Performance in Humans

BACKGROUND

Photobiomodulation therapy (PBMT) is defined as non-thermal electromagnetic irradiation through laser or light-emitting diode sources. In recent decades, PBMT has attracted attention as a potential preconditioning method. The current meta-analysis was conducted to assess the effectiveness of PBMT in improving mode-specific exercise performance in healthy young adults.

METHODS

A computerized literature search was conducted, ending on 15 May 2022. The databases searched were PubMed, Cochrane Central Register of Controlled Trials, Embase, SPORTDiscus, and the Physiotherapy Evidence Database. Inclusion/exclusion criteria limited articles to crossover, double-blind, placebo-controlled studies investigating the PBMT effects as a preconditioning method. The included trials were synthesized according to exercise mode (single-joint, cycling, running, and swimming). All results were combined using the standardized mean differences (SMDs) method and the 95% confidence intervals (CIs) were described.

RESULTS

A total of 37 individual studies, employing 78 exercise performance measurements in 586 participants, were included in the analyses. In single-joint exercises, PBMT improved muscle endurance performance (SMD 0.27, 95% CI 0.12-0.41; p < 0.01) but not muscle strength performance (p = 0.92). In cycling, PBMT improved time to exhaustion performance (SMD 0.35, 95% CI 0.10-0.59; p < 0.01) but had no effect on all-out sprint performance (p = 0.96). Similarly, PBMT had no effect on time to exhaustion (p = 0.10), time-trial (p = 0.61), or repeated-sprint (p = 0.37) performance in running and no effect on time-trial performance in swimming (p = 0.81).

CONCLUSION

PBMT improves muscle endurance performance in single-joint exercises and time to exhaustion performance in cycling but is not effective for muscle strength performance in single-joint exercises, running, or swimming performance metrics.

Nitrate, nitrite and nitrosamines in the global food supply

Inorganic nitrate provided by either nitrate salts or food supplements may improve cardiometabolic health. However, current methods to assess dietary nitrate, nitrite and nitrosamine consumption are inadequate. The purpose of this study was to develop a reference database to estimate the levels of nitrate, nitrite and nitrosamines in the global food supply. A systematic literature search was undertaken; of the 5,747 articles screened, 448 met the inclusion criteria. The final database included data for 1,980 food and beverages from 65 different countries. There were 5,105 unique records for nitrate, 2,707 for nitrite, and 954 for nitrosamine. For ease of use, data were sorted into 12 categories; regarding nitrate and nitrite concentrations in food and beverages, 'vegetables and herbs' were most reported in the literature (n = 3,268 and n = 1,200, respectively). For nitrosamines, 'protein foods of animal origin' were most reported (n = 398 records). This database will allow researchers and practitioners to confidently estimate dietary intake of nitrate, nitrite and nitrosamines. When paired with health data, our database can be used to investigate associations between nitrate intake and health outcomes, and/or exercise performance and could support the development of key dietary nitrate intake guidelines.

Dietary nitrate increases submaximal SERCA activity and ADP transfer to mitochondria in slow-twitch muscle of female mice

Rapid oscillations in cytosolic calcium (Ca²⁺) coordinate muscle contraction, relaxation, and physical movement. Intriguingly, dietary nitrate decreases ATP cost of contraction, increases force production, and increases cytosolic Ca²⁺, which would seemingly necessitate a greater demand for sarcoplasmic reticulum Ca²⁺ ATPase (SERCA) to sequester Ca²⁺ within the sarcoplasmic reticulum (SR) during relaxation. As SERCA is highly regulated, we aimed to determine the effect of 7-day nitrate supplementation (1 mM via drinking water) on SERCA enzymatic properties and the functional interaction between SERCA and mitochondrial oxidative phosphorylation. In soleus, we report that dietary nitrate increased force production across all stimulation frequencies tested, and throughout a 25 min fatigue protocol. Mice supplemented with nitrate also displayed an ∼25% increase in submaximal SERCA activity and SERCA efficiency (P = 0.053) in the soleus. To examine a possible link between ATP consumption and production, we established a methodology coupling SERCA and mitochondria in permeabilized muscle fibers. The premise of this experiment is that the addition of Ca²⁺ in the presence of ATP generates ADP from SERCA to support mitochondrial respiration. Similar to submaximal SERCA activity, mitochondrial respiration supported by SERCA-derived ADP was increased by ∼20% following nitrate in red gastrocnemius. This effect was fully attenuated by the SERCA inhibitor cyclopiazonic acid and was not attributed to differences in mitochondrial oxidative capacity, ADP sensitivity, protein content, or reactive oxygen species emission. Overall, these findings suggest that improvements in submaximal SERCA kinetics may contribute to the effects of nitrate on force production during fatigue.NEW & NOTEWORTHY We show that nitrate supplementation increased force production during fatigue and increased submaximal SERCA activity. This was also evident regarding the high-energy phosphate transfer from SERCA to mitochondria, as nitrate increased mitochondrial respiration supported by SERCA-derived ADP. Surprisingly, these observations were only apparent in muscle primarily expressing type I (soleus) but not type II fibers (EDL). These findings suggest that alterations in SERCA properties are a possible mechanism in which nitrate increases force during fatiguing contractions.

Dietary Nitrate Supplementation and Small Muscle Mass Exercise Hemodynamics in Patients with Essential Hypertension

Exaggerated blood pressure and diminished limb hemodynamics during exercise in patients with hypertension often are not resolved by antihypertensive medications. We hypothesized that, independent of antihypertensive medication status, dietary nitrate supplementation would increase limb blood flow, decrease mean arterial pressure (MAP), and increase limb vascular conductance during exercise in patients with hypertension. Patients with hypertension either abstained from (n=14, Off-Meds) or continued (n=12, On-Meds) antihypertensive medications. Within each group, patients consumed (cross-over design) nitrate-rich or nitrate-depleted (placebo) beetroot juice for 3-days before performing handgrip (HG) and knee-extensor exercise (KE). Blood flow and MAP were measured using Doppler ultrasound and an automated monitor, respectively. Dietary nitrate increased plasma-[nitrite] Off-Meds and On-Meds. There were no significant effects of dietary nitrate on blood flow, MAP, or vascular conductance during HG in Off-Meds or On-Meds. For KE, dietary nitrate decreased MAP (mean±SD across all three exercise intensities, 118±14 vs. 122±14 mmHg, p=0.024) and increased vascular conductance (26.2±6.1 vs. 24.7±7.0 ml/min/mmHg, p=0.024), but did not affect blood flow for Off-Meds, with no effects On-Meds. Dietary nitrate-induced changes in blood flow (r=-0.67, p<0.001), MAP (r=-0.43, p=0.009), and vascular conductance (r=-0.64, p<0.001) during KE, but only vascular conductance (r=-0.35, p=0.039) during HG, were significantly related to the magnitude of placebo values, with no differentiation between groups. Thus, the effects of dietary nitrate on limb hemodynamics and MAP during exercise in patients with hypertension are dependent on the values at baseline, independent of antihypertensive medication status, and dependent on whether exercise was performed by the forearm or quadriceps.

Acute Effects of Beetroot Juice Supplements on Lower-Body Strength in Female Athletes: Double-Blind Crossover Randomized Trial

BACKGROUND

Beetroot juice (BRJ) is used as an ergogenic aid, but no previous study has analyzed the effect this supplement has on the production of explosive force and muscular endurance in physically active women.

HYPOTHESIS

BRJ improves explosive force and muscular endurance in the lower limbs of physically active women.

STUDY DESIGN

Randomized double-blind crossover study.

LEVEL OF EVIDENCE

Level 3.

METHODS

Fourteen physically active women performed a countermovement jump (CMJ) test, a back squat test for assessing velocity and power at 50% and 75% of one-repetition maximum (1RM), and the number of repetitions on a muscular endurance test consisting of 3 sets at 75% of 1RM in a resistance training protocol comprising 3 exercises (back squat, leg press, and leg extension). The participants performed the test in 2 sessions, 150 minutes after ingesting 70 mL of either BRJ (400 mg of nitrate) or a placebo (PLA).

RESULTS

A greater maximum height was achieved in the CMJ after consuming BRJ compared with a PLA (P = 0.04; effect size (ES) = 0.34). After a BRJ supplement at 50% 1RM, a higher mean velocity [+6.7%; P = 0.03; (ES) = 0.39 (-0.40 to 1.17)], peak velocity (+6%; P = 0.04; ES = 0.39 [-0.40 to 1.17]), mean power (+7.3%; P = 0.02; ES = 0.30 [-0.48 to 1.08]) and peak power (+6%; P = 0.04; ES = 0.20 [-0.59 to 0.98]) were attained in the back squat test. In the muscular endurance test, BRJ increased performance compared with the PLA (P < 0.00; η_p² = 0.651).

CONCLUSION

BRJ supplements exert an ergogenic effect on the ability to produce explosive force and muscular endurance in the lower limbs in physically active women.

CLINICAL RELEVANCE

If physically active women took a BRJ supplement 120 minutes before resistance training their performance could be enhanced.

Inorganic nitrate supplementation and blood flow restricted exercise tolerance in post-menopausal women

Exercise tolerance appears to benefit most from dietary nitrate (NO3-) supplementation when muscle oxygen (O2) availability is low. Using a double-blind, randomized cross-over design, we tested the hypothesis that acute NO3- supplementation would improve blood flow restricted exercise duration in post-menopausal women, a population with reduced endogenous nitric oxide bioavailability. Thirteen women (57-76 yr) performed rhythmic isometric handgrip contractions (10% MVC, 30 per min) during progressive forearm blood flow restriction (upper arm cuff gradually inflated 20 mmHg each min) on three study visits, with 7-10 days between visits. Approximately one week following the first (familiarization) visit, participants consumed 140 ml of NO3- concentrated (9.7 mmol, 0.6 gm NO3-) or NO3-depleted beetroot juice (placebo) on separate days (≥7 days apart), with handgrip exercise beginning 100 min post-consumption. Handgrip force recordings were analyzed to determine if NO3- supplementation enhanced force development as blood flow restriction progressed. Nitrate supplementation increased plasma NO3- (16.2-fold) and NO2- (4.2-fold) and time to volitional fatigue (61.8 ± 56.5 s longer duration vs. placebo visit; p = 0.03). Nitrate supplementation increased the rate of force development as forearm muscle ischemia progressed (p = 0.023 between 50 and 75% of time to fatigue) with non-significant effects thereafter (p = 0.052). No effects of nitrate supplementation were observed for mean duration of contraction or relaxation rates (all p > 0.150). These results suggest that acute NO3- supplementation prolongs time-to-fatigue and speeds grip force development during progressive forearm muscle ischemia in postmenopausal women.

Effect of nitrate supplementation on skeletal muscle motor unit activity during isometric blood flow restriction exercise

Background

Nitrate (NO₃⁻) supplementation has been reported to lower motor unit (MU) firing rate (MUFR) during dynamic resistance exercise; however, its impact on MU activity during isometric and ischemic exercise is unknown.

Purpose

To assess the effect of NO₃⁻ supplementation on knee extensor MU activities during brief isometric contractions and a 3 min sustained contraction with blood flow restriction (BFR).

Methods

Sixteen healthy active young adults (six females) completed two trials in a randomized, double-blind, crossover design. Trials were preceded by 5 days of either NO₃⁻ (NIT) or placebo (PLA) supplementation. Intramuscular electromyography was used to determine the M. vastus lateralis MU potential (MUP) size, MUFR and near fibre (NF) jiggle (a measure of neuromuscular stability) during brief (20 s) isometric contractions at 25% maximal strength and throughout a 3 min sustained BFR isometric contraction.

Results

Plasma nitrite (NO₂⁻) concentration was elevated after NIT compared to PLA (475 ± 93 vs. 198 ± 46 nmol L⁻¹, p < 0.001). While changes in MUP area, NF jiggle and MUFR were similar between NIT and PLA trials (all p > 0.05), MUP duration was shorter with NIT compared to PLA during brief isometric contractions and the sustained ischemic contraction (p < 0.01). In addition, mean MUP duration, MUP area and NF jiggle increased, and MUFR decreased over the 3 min sustained BFR isometric contraction for both conditions (all p < 0.05).

Conclusions

These findings provide insight into the effect of NO₃⁻ supplementation on MUP properties and reveal faster MUP duration after short-term NO₃⁻ supplementation which may have positive implications for skeletal muscle contractile performance.

Nitric oxide and skeletal muscle contractile function

Nitric oxide (NO) is complex modulator of skeletal muscle contractile function, capable of increasing or decreasing force and power output depending on multiple factors. This review explores the effects and potential mechanisms for modulation of skeletal muscle contractile function by NO, from pharmacological agents in isolated muscle preparations to dietary nitrate supplementation in humans and animals. Pharmacological manipulation in vitro suggests that NO signaling diminishes submaximal isometric force, whereas dietary manipulation in vivo suggest that NO enhances submaximal force. The bases for these different responses are unknown but could reflect dose-dependent effects. Maximal isometric force is unaffected by physiologically relevant levels of NO, which do not induce overt protein oxidation. Pharmacological and dietary manipulation of NO signaling enhances the maximal rate of isometric force development, unloaded shortening velocity, and peak power. We hypothesize that these effects are mediated by post-translational modifications of myofibrillar proteins that modulate thick filament regulation of contraction (e.g., mechanosensing and strain-dependence of cross-bridge kinetics). NO effects on contractile function appear to have some level of fiber type and sex-specificity. The mechanisms behind NO-mediated changes in skeletal muscle function need to be explored through proteomics analysis and advanced biophysical assays to advance the development of small molecules and open intriguing therapeutic and ergogenic possibilities for aging, disease, and athletic performance.

The Effects of Dietary Nitrate Supplementation on Explosive Exercise Performance: A Systematic Review

Dietary nitrate supplementation is evidenced to induce physiological effects on skeletal muscle function in fast-twitch muscle fibers and may enhance high-intensity exercise performance. An important component of sport-specific skills is the ability to perform explosive movements; however, it is unclear if nitrate supplementation can impact explosive efforts. We examined the existing evidence to determine whether nitrate supplementation improves explosive efforts lasting ≤ 6 s. PubMed, Scopus and Directory of Open Access Journals (DOAJ) were searched for articles using the following search strategy: (nitrate OR nitrite OR beetroot) AND (supplement OR supplementation) AND (explosive OR power OR high intensity OR high-intensity OR sprint* OR “athletic performance”). Out of 810 studies, 18 were eligible according to inclusion criteria. Results showed that 4 of the 10 sprint-type studies observed improved sprint time, power output, and total work in cycling or running, whereas 4 of the 10 resistance-based exercise studies observed improvements to power and velocity of free-weight bench press as well as isokinetic knee extension and flexion at certain angular velocities. These results suggest that nitrate potentially improves explosive exercise performance, but further work is required to clarify the factors influencing the efficacy of nitrate in different exercise modalities.

Long-Term Combined Effects of Citrulline and Nitrate-Rich Beetroot Extract Supplementation on Recovery Status in Trained Male Triathletes: A Randomized, Double-Blind, Placebo-Controlled Trial

Citrulline (CIT) and nitrate-rich beetroot extract (BR) are widely studied ergogenic aids. Nevertheless, both supplements have been studied in short-term trials and separately. To the best of the authors' knowledge, the effects of combining CIT and BR supplementation on recovery status observed by distance covered in the Cooper test, exercise-induced muscle damage (EIMD) and anabolic/catabolic hormone status have not been investigated to date. Therefore, the main purpose of this research was to assess the effect of the long-term (9 weeks) mixture of 3 g/day of CIT plus 2.1 g/day of BR (300 mg/day of nitrates (NO3-)) supplementation on recovery by distance covered in the Cooper test, EIMD markers (urea, creatinine, AST, ALT, GGT, LDH and CK) and anabolic/catabolic hormones (testosterone, cortisol and testosterone/cortisol ratio (T/C)) in male trained triathletes. Thirty-two triathletes were randomized into four different groups of eight triathletes in this double-blind, placebo-controlled trial: placebo group (PLG), CIT group (CITG; 3 g/day of CIT), BR group (BRG; 2.1 g/day of BR (300 mg/day of NO3-)) and CIT-BR group (CIT-BRG; 3 g/day of CIT plus 2.1 g/day of BR (300 mg/day of NO3-)). Distance covered in the Cooper test and blood samples were collected from all participants at baseline (T1) and after 9 weeks of supplementation (T2). There were no significant differences in the interaction between group and time in EIMD markers (urea, creatinine, AST, ALT, GGT, LDH and CK) (p > 0.05). However, significant differences were observed in the group-by-time interaction in distance covered in the Cooper test (p = 0.002; η2p = 0.418), cortisol (p = 0.044; η2p = 0.247) and T/C (p = 0.005; η2p = 0.359). Concretely, significant differences were observed in distance covered in the Cooper test percentage of change (p = 0.002; η2p = 0.418) between CIT-BRG and PLG and CITG, in cortisol percentage change (p = 0.049; η2p = 0.257) and in T/C percentage change (p = 0.018; η2p = 0.297) between CIT-BRG and PLG. In conclusion, the combination of 3 g/day of CIT plus 2.1 g/day of BR (300 mg/day of NO3-) supplementation for 9 weeks did not present any benefit for EIMD. However, CIT + BR improved recovery status by preventing an increase in cortisol and showing an increase in distance covered in the Cooper test and T/C.

Significance of Inorganic Nitrate Supplement in Cardiovascular Health

BACKGROUND & OBJECTIVES

Nitric Oxide (NO) is frequently produced by the enzyme nitric oxide synthase (NOS) and is crucial for the control and effectiveness of the cardiovascular system. However, there is a substantial reduction in NOS activity with aging that can lead to the development of hypertension and other cardiovascular obstacles. Fortunately, NO can also be produced by sequential reduction of inorganic nitrates supplementation. This proves that NO from inorganic nitrate supplements can compensate for inadequate NOS activity, thus providing cardio protective benefits.

DISCUSSION

This review focuses on the general information about nitrous oxide, its types and mechanism of action and the fact that overview of inadequate NOS activity for cardio protective benefits was often studied for cardiovascular treatments.

CONCLUSION

We concluded that the natural plant NO is essential for cardiovascular activity to target site with desired concentration. Moreover, the researchers focused on evidence that suggested that nitrate supplementation could help regulate blood pressure, limit progression of atherosclerosis, and improve myocardial contractility in both healthy individuals and those with cardiovascular diseases.

Combined Effects of Citrulline Plus Nitrate-Rich Beetroot Extract Co-Supplementation on Maximal and Endurance-Strength and Aerobic Power in Trained Male Triathletes: A Randomized Double-Blind, Placebo-Controlled Trial

Citrulline (CIT) and nitrate-rich beetroot extract (BR) are ergogenic aids and nitric oxide (NO) precursors. In addition, both supplements seem to have other actions at the level of muscle metabolism that can benefit strength and aerobic power performance. Both supplements have been studied in numerous investigations in isolation. However, scientific evidence combining both supplements is scarce, and to the best of the authors' knowledge, there is no current study of endurance athletes. Therefore, the main purpose of this study was to determine the effect of 9 weeks of CIT plus BR supplementation on maximal and endurance-strength performance and aerobic power in male triathletes. This study was a randomized double-blind, placebo-controlled trial where participants (n = 32) were randomized into four different groups: placebo group (PLG; n = 8), CIT plus BR group (CIT- BRG; 3 g/kg/day of CIT plus 3 mg/kg/day of nitrates (NO3-); n = 8), CIT group (CITG; 3 g/kg/day; n = 8) and BR group (BRG; 3 mg/kg/day of NO3-; n = 8). Before (T1) and after 9 weeks (T2), four physical condition tests were carried out in order to assess sport performance: the horizontal jump test (HJUMP), handgrip dynamometer test, 1-min abdominal tests (1-MAT) and finally, the Cooper test. Although, no significant interactions (time × supplementation groups) were found for the strength tests (p > 0.05), the CIT- BRG supplementation presented a trend on HJUMP and 1-MAT tests confirmed by significant increase between two study moments in CIT-BRG. Likewise, CIT-BRG presented significant interactions in the aerobic power test confirmed by this group's improve estimated VO2max during the study with respect to the other study groups (p = 0.002; η2p = 0.418). In summary, supplementing with 3 g/day of CIT and 2.1 g/day of BR (300 mg/day of NO3-) for 9 weeks could increase maximal and endurance strength. Furthermore, when compared to CIT or BR supplementation alone, this combination improved performance in tests related to aerobic power.

Nutritional optimization for female elite football players-topical review

Women's football is an intermittent sport characterized by frequent intense actions throughout the match. The high number of matches with limited recovery time played across a long competitive season underlines the importance of nutritional strategies to meet these large physical demands. In order to maximize sport performance and maintain good health, energy intake must be optimal. However, a considerable proportion of female elite football players does not have sufficient energy intake to match the energy expenditure, resulting in low energy availability that might have detrimental physiologic consequences and impair performance. Carbohydrates appear to be the primary fuel covering the total energy supply during match-play, and female elite football players should aim to consume sufficient carbohydrates to meet the requirements of their training program and to optimize the replenishment of muscle glycogen stores between training bouts and matches. However, several macro- and micronutrients are important for ensuring sufficient energy and nutrients for performance optimization and for overall health status in female elite football players. The inadequacy of macro-and micronutrients in the diet of these athletes may impair performance and training adaptations, and increase the risk of health disorders, compromising the player's professional career. In this topical review, we present knowledge and relevant nutritional recommendations for elite female football players for the benefit of sports nutritionists, dietitians, sports scientists, healthcare specialists, and applied researchers. We focus on dietary intake and cover the most pertinent topics in sports nutrition for the relevant physical demands in female elite football players as follows: energy intake, macronutrient and micronutrient requirements and optimal composition of the everyday diet, nutritional and hydration strategies to optimize performance and recovery, potential ergogenic effects of authorized relevant supplements, and future research considerations.

On the implication of dietary nitrate supplementation for the hemodynamic and fatigue response to cycling exercise

This study investigated the impact of dietary nitrate supplementation on peripheral hemodynamics, the development of neuromuscular fatigue, and time to task failure during cycling exercise. Eleven recreationally active male participants (27 ± 5 yr, V̇o2max: 42 ± 2 mL/kg/min) performed two experimental trials following 3 days of either dietary nitrate-rich beetroot juice (4.1 mmol NO3-/day; DNS) or placebo (PLA) supplementation in a blinded, counterbalanced order. Exercise consisted of constant-load cycling at 50, 75, and 100 W (4 min each) and, at ∼80% of peak power output (218 ± 12 W), to task-failure. All participants returned to repeat the shorter of the two trials performed to task failure, but with the opposite supplementation regime (iso-time comparison; ISO). Mean arterial pressure (MAP), leg blood flow (QL; Doppler ultrasound), leg vascular conductance (LVC), and pulmonary gas exchange were continuously assessed during exercise. Locomotor muscle fatigue was determined by the change in pre to postexercise quadriceps twitch-torque (ΔQtw) and voluntary activation (ΔVA; electrical femoral nerve stimulation). Following DNS, plasma [nitrite] (∼670 vs. ∼180 nmol) and [nitrate] (∼775 vs. ∼11 μmol) were significantly elevated compared with PLA. Unlike PLA, DNS lowered both QL and MAP by ∼8% (P < 0.05), but did not alter LVC (P = 0.31). V̇O2 across work rates, as well as cycling time to task-failure (∼7 min) and locomotor muscle fatigue following the ISO-time comparison were not different between the two conditions (ΔQtw ∼42%, ΔVA ∼4%). Thus, despite significant hemodynamic changes, DNS did not alter the development of locomotor muscle fatigue and, ultimately, cycling time to task failure.NEW & NOTEWORTHY This study sought to characterize the impact of dietary nitrate supplementation on the hemodynamic response, locomotor muscle fatigue, and time to task failure during cycling exercise. Although nitrate supplementation lowered mean arterial pressure and exercising leg blood flow, leg vascular conductance and oxygen utilization were unaffected. Despite significant hemodynamic changes, there was no effect of dietary nitrate on neuromuscular fatigue development and, ultimately, cycling time to task failure.

The Nitrate-Nitrite-Nitric Oxide Pathway on Healthy Ageing: A Review of Pre-clinical and Clinical Data on the Impact of Dietary Nitrate in the Elderly

We are living longer. Are we living healthier? As we age, cellular and molecular damage reshape our physiological responses towards environmental and endogenous stimuli. The free radical theory of ageing has been proposed long before ageing has been considered a “scientific discipline” and, since then, has been discussed and upgraded as a major contributor to aberrant ageing. Assuming that ageing results merely from the accumulation of oxidative modifications of biomolecules is not only a simplistic and reductive view of such a complex and dynamic process, but also free radicals and related oxidants are now considered pivotal signalling molecules. The fine modulation of critical signalling pathways by redox compounds demands a novel approach to tackle the role of free radicals in ageing. Nitric oxide (^⋅NO) is a paradigmatic example given its biological functions in cardiovascular, neurologic and immune systems. In addition to the canonical ^⋅NO synthesis by a family of enzymes, nitrate from green leafy vegetables, is reduced to nitrite in the oral cavity which is further reduced to ^⋅NO in the stomach. Boosting this nitrate-nitrite-NO pathway has been shown to improve gastrointestinal, cardiovascular, metabolic and cognitive performance both in humans and in animal models of disease. In the elderly, nitrate-derived ^⋅NO has been shown improve several physiological functions that typically decline during ageing. In this paper, the role of nitrate and derived nitrogen oxides will be discussed while reviewing pre-clinical and clinical data on the cardiovascular, neuronal, musculoskeletal and metabolic effects of nitrate during healthy ageing.

Moving beyond inclusion: Methodological considerations for the menstrual cycle and menopause in research evaluating effects of dietary nitrate on vascular function

Recent reports have acknowledged the underrepresentation of women in the field of dietary nitrate (NO₃^-) research. Undoubtedly, greater participation from women is warranted to clarify potential sex differences in the responses to dietary NO₃^- interventions. However, careful consideration for the effects of sex hormones - principally 17β-estradiol - on endogenous nitric oxide (NO) synthesis and dietary NO₃^- reductase capacity is necessary for improved interpretation and reproducibility of such investigations. From available literature, we present a narrative review describing how hormonal variations across the menstrual cycle, as well as with menopause, may impact NO biosynthesis catalyzed by NO synthase enzymes and NO₃^- reduction via the enterosalivary pathway. In doing so, we address methodological considerations related to the menstrual cycle and hormonal contraceptive use relevant for the inclusion of premenopausal women along with factors to consider when testing postmenopausal women. Adherence to such methodological practices may explicate the utility of dietary NO₃^- supplementation as a means to improve vascular function among women across the lifespan.

Skeletal Muscle Nitrate as a Regulator of Systemic Nitric Oxide Homeostasis

ABSTRACT

Non-enzymatic nitric oxide (NO) generation via the reduction of nitrate and nitrite ions, along with remarkably high levels of nitrate ions in skeletal muscle, have been recently described. Skeletal muscle nitrate storage may be critical for maintenance of NO homeostasis in healthy ageing and nitrate supplementation may be useful for treatment of specific pathophysiologies as well as enhancing normal functions.

Assessment of ankle plantar flexor neuromuscular properties: A reliability study

This study aimed to determine test-retest reliability of ankle plantar flexor neuromuscular properties in healthy people to improve understanding of additional measurement and analysis procedures that may be used in outcome assessment. Ten healthy participants (age 29.60 ± 5.36 years) volunteered. Isometric torque_max, rate of torque development (RTD), rate of electromyography rise (RER), impulse, electromechanical delay (EMD), torque steadiness, and torque sensing were obtained during two testing sessions 60 min apart. ICC values ranged from 0.81 to 0.99, indicating good to excellent test-retest reliability. Lower bands of the 95% CIs were all above 0.75 apart from the early phase measures (≤50 ms) derived from explosive torque-time and EMG-time curves, which were between 0.32 and 0.73, indicating poor to moderate reliability. Heteroscedasticity was observed for RTD, impulse, and EMD. LOA as a function of the mean (X̅) for these measures ranged from mean_difference ± 0.25X̅ to ± 0.68X̅. EMD showed excellent reliability (ICC = 0.90; 95% CI [0.63, 0.98]). Torque sensing and torque steadiness showed good reliability (0.81 ≤ ICC ≤ 0.89). Thus, ankle plantar flexor neuromuscular properties showed good to excellent test-retest reliability. However, reliability of measures in the early phase of muscle contraction were consistently lower than the late phase.

Neuromuscular Adaptations after an Altitude Training Camp in Elite Judo Athletes

The aim of this study was to investigate neuromuscular adaptations in elite judo athletes after three weeks of power-oriented strength training at terrestrial altitude (2320 m). Nineteen men were assigned to altitude training (AL) (22.1 ± 2.3 years) and sea level training (SL) (22.6 ± 4.1 years). Neuromuscular assessment consisted of: (1) maximal isometric knee extensor (KE) torque, (2) KE rate of torque development (RTD), (3) quadriceps activity and voluntary activation, (4) soleus H-reflex, (5) quadriceps single (T_TW) and double twitch torque (T_DB100) and contraction time (CT_TW). There were no significant differences between groups at baseline for any of the observed parameters. Significant differences were found between groups in terms of change in RTD (p = 0.04). Cohen’s d showed a positive significant effect (0.43) in the SL group and a negative significant effect (−0.58) in the AL group. The difference between groups in changes in CT_TW as a function of altitude was on the edge of significance (p = 0.077). CT_TW increased by 8.1 ± 9.0% in the AL group (p = 0.036) and remained statistically unchanged in the SL group. Only the AL group showed a relationship between changes in T_TW and T_DB100 and changes in RTD at posttest (p = 0.022 and p = 0.016, respectively). Altitude induced differences in muscular adaptations likely due to greater peripheral fatigue.

Repeated administration of inorganic nitrate on blood pressure and arterial stiffness: a systematic review and meta-analysis of randomized controlled trials

OBJECTIVE

We aim to synthesize effects of repeated administration (≥3 days) of inorganic nitrate on blood pressure and arterial stiffness measures.

METHODS

We conducted a systematic review and meta-analysis of randomized controlled trials with at least 3 days treatment of inorganic nitrate on blood pressure and arterial stiffness in individuals with or without elevated cardiovascular disease risk. MEDLINE, EMBASE and the Cochrane Library were searched through 2 July 2019. Two independent reviewers extracted relevant study data. Data were pooled using the generic inverse variance method with random-effects model, and expressed as mean differences with 95% confidence intervals. Certainty in the evidence was assessed using GRADE.

RESULTS

Forty-seven trials were included (n = 1101). Administration of inorganic nitrate significantly lowered SBP [mean difference: -2.91 mmHg, 95% confidence interval (95% CI): -3.92 to -1.89, I = 76%], DBP (mean difference: -1.45 mmHg, 95% CI: -2.22 to -0.68, I = 78%], central SBP (mean difference: -1.56 mmHg, 95% CI: -2.62 to -0.50, I = 30%) and central DBP (mean difference: -1.99 mmHg, 95% CI: -2.37 to -1.60, I = 0%). There was no effect on 24-h blood pressure, augmentation index or pulse wave velocity. Certainty in the evidence was graded moderate for central blood pressure, pulse wave velocity and low for peripheral blood pressure, 24-h blood pressure and augmentation index.

CONCLUSION

Repeated administration (≥3 days) of inorganic nitrate lower peripheral and central blood pressure. Results appear to be driven by beneficial effects in healthy and hypertensive individuals. More studies are required to increase certainty in the evidence.

Dietary nitrate and population health: a narrative review of the translational potential of existing laboratory studies

BACKGROUND

Dietary inorganic nitrate (NO3-) is a polyatomic ion, which is present in large quantities in green leafy vegetables and beetroot, and has attracted considerable attention in recent years as a potential health-promoting dietary compound. Numerous small, well-controlled laboratory studies have reported beneficial health effects of inorganic NO3- consumption on blood pressure, endothelial function, cerebrovascular blood flow, cognitive function, and exercise performance. Translating the findings from small laboratory studies into 'real-world' applications requires careful consideration.

MAIN BODY

This article provides a brief overview of the existing empirical evidence basis for the purported health-promoting effects of dietary NO3- consumption. Key areas for future research are then proposed to evaluate whether promising findings observed in small animal and human laboratory studies can effectively translate into clinically relevant improvements in population health. These proposals include: 1) conducting large-scale, longer duration trials with hard clinical endpoints (e.g. cardiovascular disease incidence); 2) exploring the feasibility and acceptability of different strategies to facilitate a prolonged increase in dietary NO3- intake; 3) exploitation of existing cohort studies to explore associations between NO3- intake and health outcomes, a research approach allowing larger samples sizes and longer duration follow up than is feasible in randomised controlled trials; 4) identifying factors which might account for individual differences in the response to inorganic NO3- (e.g. sex, genetics, habitual diet) and could assist with targeted/personalised nutritional interventions; 5) exploring the influence of oral health and medication on the therapeutic potential of NO3- supplementation; and 6) examining potential risk of adverse events with long term high- NO3- diets.

CONCLUSION

The salutary effects of dietary NO3- are well established in small, well-controlled laboratory studies. Much less is known about the feasibility and efficacy of long-term dietary NO3- enrichment for promoting health, and the factors which might explain the variable responsiveness to dietary NO3- supplementation between individuals. Future research focussing on the translation of laboratory data will provide valuable insight into the potential applications of dietary NO3- supplementation to improve population health.

Effect of acute nitrite infusion on contractile economy and metabolism in isolated skeletal muscle in situ during hypoxia

KEY POINTS

Increased plasma nitrite concentrations may have beneficial effects on skeletal muscle function. The physiological basis explaining these observations has not been clearly defined and it may involve positive effects on muscle contraction force, microvascular O₂ delivery and skeletal muscle oxidative metabolism. In the isolated canine gastrocnemius model, we evaluated the effects of acute nitrite infusion on muscle force and skeletal muscle oxidative metabolism. Under hypoxic conditions, but in the presence of normal convective O₂ delivery, an elevated plasma nitrite concentration affects neither muscle force, nor muscle contractile economy. In accordance with previous results suggesting limited or no effects of nitrate/nitrite administrations in highly oxidative and highly perfused muscle, our data suggest that neither mitochondrial respiration, nor muscle force generation are affected by acute increased concentrations of NO precursors in hypoxia.

ABSTRACT

Contrasting findings have been reported concerning the effects of augmented nitric oxide (NO) on skeletal muscle force production and oxygen consumption ( V ̇ O 2 ). The present study examined skeletal muscle mitochondrial respiration and contractile economy in an isolated muscle preparation during hypoxia (but normal convective O₂ delivery) with nitrite infusion. Isolated canine gastrocnemius muscles in situ (n = 8) were studied during 3 min of electrically stimulated isometric tetanic contractions corresponding to ∼35% of V ̇ O 2 peak . During contractions, sodium nitrite (NITRITE) or sodium chloride (SALINE) was infused into the popliteal artery. V ̇ O 2 was calculated from the Fick principle. Experiments were carried out in hypoxia ( F I O 2  = 0.12), whereas convective O₂ delivery was maintained at normal levels under both conditions by pump-driven blood flow ( Q ̇ ). Muscle biopsies were taken and mitochondrial respiration was evaluated by respirometry. Nitrite infusion significantly increased both nitrite and nitrate concentrations in plasma. No differences in force were observed between conditions. V ̇ O 2 was not significantly different between NITRITE (6.1 ± 1.8 mL 100 g^-1  min^-1 ) and SALINE (6.2 ± 1.8 mL 100 g^-1  min^-1 ), even after being 'normalized' per unit of developed force (muscle contractile economy). No differences between conditions were found for maximal ADP-stimulated mitochondrial respiration (both for complex I and complex II), leak respiration and oxidative phosphorylation coupling. In conclusion, in the absence of changes in convective O₂ delivery, muscle force, muscle contractile economy and mitochondrial respiration were not affected by acute infusion of nitrite. The previously reported positive effects of elevated plasma nitrite concentrations are presumably mediated by the increased microvascular O₂ availability.

Effect of dietary nitrate ingestion on muscular performance: a systematic review and meta-analysis of randomized controlled trials

Dietary nitrate consumption from foods such as beetroot has been associated with many physiological benefits including improvements in vascular health and exercise performance. More recently, attention has been given to the use of dietary nitrate as a nutritional strategy to optimize muscular performance during resistance exercise. Our purpose was to perform a systematic review and meta-analysis of the research literature assessing the effect of dietary nitrate ingestion on muscular strength and muscular endurance. A structured search was carried out in accordance with PRISMA guidelines and from the total included studies (n = 34 studies), 12 studies had data for both measurement of strength and muscular endurance outcomes, 14 studies had data only for muscular strength outcome, and 8 studies had data only for muscular endurance outcome. Standardized mean difference (SMD) was calculated and meta-analyses were performed by using a random-effects model. Dietary nitrate ingestion was found to result in a trivial but significant effect on muscular strength (overall SMD = 0.08, P = 0.0240). Regarding muscular endurance dietary nitrate was found to promote a small but significant effect (overall SMD = 0.31, P < 0.0001). Dosage, frequency of ingestion, training level, muscle group, or type of contraction did not affect the findings, except for a greater improvement in muscle endurance during isometric and isotonic when compared to isokinetic contractions. Dietary nitrate seems to have a positive effect on muscular strength and muscular endurance, which is mostly unaffected by dosage, frequency of ingestion, training level, muscle group, or type of contraction. However, given the trivial to small effect, further experimental research on this topic is warranted.

Dietary Nitrate and Nitric Oxide Metabolism: Mouth, Circulation, Skeletal Muscle, and Exercise Performance

Nitric oxide (NO) is a gaseous signaling molecule that plays an important role in myriad physiological processes, including the regulation of vascular tone, neurotransmission, mitochondrial respiration, and skeletal muscle contractile function. NO may be produced via the canonical NO synthase-catalyzed oxidation of l-arginine and also by the sequential reduction of nitrate to nitrite and then NO. The body's nitrate stores can be augmented by the ingestion of nitrate-rich foods (primarily green leafy vegetables). NO bioavailability is greatly enhanced by the activity of bacteria residing in the mouth, which reduce nitrate to nitrite, thereby increasing the concentration of circulating nitrite, which can be reduced further to NO in regions of low oxygen availability. Recent investigations have focused on promoting this nitrate-nitrite-NO pathway to positively affect indices of cardiovascular health and exercise tolerance. It has been reported that dietary nitrate supplementation with beetroot juice lowers blood pressure in hypertensive patients, and sodium nitrite supplementation improves vascular endothelial function and reduces the stiffening of large elastic arteries in older humans. Nitrate supplementation has also been shown to enhance skeletal muscle function and to improve exercise performance in some circumstances. Recently, it has been established that nitrate concentration in skeletal muscle is much higher than that in blood and that muscle nitrate stores are exquisitely sensitive to dietary nitrate supplementation and deprivation. In this review, we consider the possibility that nitrate represents an essential storage form of NO and discuss the integrated function of the oral microbiome, circulation, and skeletal muscle in nitrate-nitrite-NO metabolism, as well as the practical relevance for health and performance.

Dietary nitrate supplementation increases diaphragm peak power in old mice

KEY POINTS

Respiratory muscle function declines with ageing, contributing to breathing complications in the elderly. Here we report greater in vitro respiratory muscle contractile function in old mice receiving supplemental NaNO₃ for 14 days compared with age-matched controls. Myofibrillar protein phosphorylation, which enhances contractile function, did not change in our study - a finding inconsistent with the hypothesis that this post-translational modification is a mechanism for dietary nitrate to improve muscle contractile function. Nitrate supplementation did not change the abundance of calcium-handling proteins in the diaphragm of old mice, in contrast with findings from the limb muscles of young mice in previous studies. Our findings suggest that nitrate supplementation enhances myofibrillar protein function without affecting the phosphorylation status of key myofibrillar proteins.

ABSTRACT

Inspiratory muscle (diaphragm) function declines with age, contributing to ventilatory dysfunction, impaired airway clearance, and overall decreased quality of life. Diaphragm isotonic and isometric contractile properties are reduced with ageing, including maximal specific force, shortening velocity and peak power. Contractile properties of limb muscle in both humans and rodents can be improved by dietary nitrate supplementation, but effects on the diaphragm and mechanisms behind these improvements remain poorly understood. One potential explanation underlying the nitrate effects on contractile properties is increased phosphorylation of myofibrillar proteins, a downstream outcome of nitrate reduction to nitrite and nitric oxide. We hypothesized that dietary nitrate supplementation would improve diaphragm contractile properties in aged mice. To test our hypothesis, we measured the diaphragm function of old (24 months) mice allocated to 1 mm NaNO₃ in drinking water for 14 days (n = 8) or untreated water (n = 6). The maximal rate of isometric force development (∼30%) and peak power (40%) increased with nitrate supplementation (P < 0.05). There were no differences in the phosphorylation status of key myofibrillar proteins and abundance of Ca²⁺-release proteins in nitrate vs. control animals. In general, our study demonstrates improved diaphragm contractile function with dietary nitrate supplementation and supports the use of this strategy to improve inspiratory function in ageing populations. Additionally, our findings suggest that dietary nitrate improves diaphragm contractile properties independent of changes in abundance of Ca²⁺-release proteins or phosphorylation of myofibrillar proteins.

Synergetic Effect of NO Precursor Supplementation and Exercise Training

INTRODUCTION

Nitric oxide (NO) precursor supplementation has been shown to increase NO bioavailability and can potentially improve vascular function and exercise performance. It remains unclear whether the combination of NO precursor supplementation and exercise training has synergic effects on exercise performance. This study aims to assess the effect of chronic nitrate and citrulline intake on exercise training adaptations in healthy young individuals.

METHODS

In this randomized, double-bind trial, 24 healthy young (12 females) subjects performed vascular function assessment (blood pressure, pulse wave velocity, postischemia vasodilation, and cerebrovascular reactivity) and both local (submaximal isometric unilateral knee extension) and whole-body (incremental cycling) exercise tests to exhaustion before and after a 2-month exercise training program and daily intake of a placebo or a nitrate-rich salad and citrulline (N + C, 520 mg nitrate and 6 g citrulline) drink. Prefrontal cortex and quadriceps oxygenation was monitored continuously during exercise by near-infrared spectroscopy.

RESULTS

N + C supplementation had no effect on vascular function and muscle and cerebral oxygenation during both local and whole-body exercise. N + C supplementation induced a significantly larger increase in maximal knee extensor strength (+5.1 ± 3.5 vs +0.2 ± 5.5 kg, P = 0.008) as well as a trend toward a larger increase in knee extensor endurance (+35.2 ± 26.1 vs +24.0 ± 10.4 contractions, P = 0.092) than placebo, but no effect on exercise training-induced maximal aerobic performance improvement.

CONCLUSION

These results suggest that chronic nitrate and citrulline supplementation enhances the effect of exercise training on quadriceps muscle function in healthy active young individuals, but this does not translate into improved maximal aerobic performances.

Effect of New Zealand Blackcurrant Extract on Isometric Contraction-Induced Fatigue and Recovery: Potential Muscle-Fiber Specific Effects

New Zealand blackcurrant (NZBC) extract has shown performance-enhancing effects during cycling, running and sport climbing. We examined effects of NZBC extract on (1) voluntary and twitch force of the quadriceps femoris muscles during repeated isometric contraction-induced fatigue, (2) twitch force during recovery and (3) muscle fiber-specific effects. Familiarized recreationally active males (n = 12, age: 24 ± 5 yrs; height: 180 ± 5 cm; body mass: 89 ± 11 kg) performed sixteen, 5-s voluntary maximal isometric contractions (iMVC) separated by 3-s rest. Twitch force was recorded before, during the 3-s rests and 5-min recovery. Supplementation consisted of 7-days intake of NZBC extract (600 mg∙day⁻¹ containing 210 mg anthocyanin) in a double-blind, randomized, placebo-controlled crossover design with a 14-days washout. NZBC extract allowed for greater force in the first quartile of the iMVCs. Twitch force at baseline was 12% higher with NZBC extract (p = 0.05). However, there was no effect of NZBC for twitch force during the 16-iMVCs and recovery. Based on the maximum post-activation potentiation during the placebo 16-iMVCs, four subjects were classified of having a predominant type I or II muscle fiber typology. In type II, NZBC extract provided a trend for increased MVC force (~14%) in the first quartile and for type I in the fourth quartile (~10%). In type I, NZBC extract seemed to have higher twitch forces during the fatiguing exercise protocol and recovery, indicating increased fatigue resistance. New Zealand blackcurrant extract affects force during repeated maximal isometric contractions. Future work on mechanisms by NZBC extract for muscle fiber-specific fatigue-induced force responses is warranted.