Sports Medicine

, Volume 47, Issue 4, pp 735–756 | Cite as

The Effect of Dietary Nitrate Supplementation on Endurance Exercise Performance in Healthy Adults: A Systematic Review and Meta-Analysis

  • Nicholas F. McMahonEmail author
  • Michael D. Leveritt
  • Toby G. Pavey
Systematic Review



Recent research into the use of dietary nitrates and their role in vascular function has led to it becoming progressively more popular amongst athletes attempting to enhance performance.


The objective of this review was to perform a systematic review and meta-analysis of the literature to evaluate the effect of dietary nitrate (NO3 ) supplementation on endurance exercise performance. An additional aim was to determine whether the performance outcomes are affected by potential moderator variables.

Data sources

Relevant databases such as Cochrane Library, Embase, PubMed, Ovid, Scopus and Web of Science were searched for the following search terms ‘nitrates OR nitrate OR beetroot OR table beet OR garden beet OR red beet AND exercise AND performance’ from inception to October 2015.

Study selection

Studies were included if a placebo versus dietary nitrate-only supplementation protocol was able to be compared, and if a quantifiable measure of exercise performance was ≥30 s (for a single bout of exercise or the combined total for multiple bouts).

Study appraisal and synthesis

The literature search identified 1038 studies, with 47 (76 trials) meeting the inclusion criteria. Data from the 76 trials were extracted for inclusion in the meta-analysis. A fixed-effects meta-analysis was conducted for time trial (TT) (n = 28), time to exhaustion (TTE) (n = 22) and graded-exercise test (GXT) (n = 8) protocols. Univariate meta-regression was used to assess potential moderator variables (exercise type, dose duration, NO3 type, study quality, fitness level and percentage nitrite change).


Pooled analysis identified a trivial but non-significant effect in favour of dietary NO3 supplementation [effect size (ES) = −0.10, 95 % Cl = −0.27 to 0.06, p > 0.05]. TTE trials had a small to moderate statistically significant effect in favour of dietary NO3 supplementation (ES = 0.33, 95 % Cl = 0.15–0.50, p < 0.01). GXT trials had a small but non-significant effect in favour of dietary NO3 supplementation in GXT performance measures (ES = 0.25, 95 % Cl = −0.06 to 0.56, p > 0.05). No significant heterogeneity was detected in the meta-analysis. No statistically significant effects were observed from the meta-regression analysis.


Dietary NO3 supplementation is likely to elicit a positive outcome when testing endurance exercise capacity, whereas dietary NO3 supplementation is less likely to be effective for time-trial performance. Further work is needed to understand the optimal dosing strategies, which population is most likely to benefit, and under which conditions dietary nitrates are likely to be most effective for performance.


Exercise Performance Time Trial Time Trial Performance Ergogenic Effect Beetroot Juice 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors would like to express their gratitude to Julie Hansen and Scott Macintyre for their assistance in developing a search strategy, and to several authors cited herein for providing access to data.

Compliance with Ethical Standards


No sources of funding were used to assist in the preparation of this article.

Conflict of interest

Nicholas McMahon, Michael Leveritt and Toby Pavey declare they have no conflicts of interest relevant to the content of this review.

Supplementary material

40279_2016_617_MOESM1_ESM.docx (23 kb)
Supplementary material 1 (DOCX 23 kb)


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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.School of Human Movement and Nutrition SciencesUniversity of QueenslandSt. LuciaAustralia
  2. 2.School of Exercise and Nutrition SciencesQueensland University of TechnologyKelvin GroveAustralia

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