The purpose of this review was to examine the effect of nitrate supplementation on exercise performance by systematic review and meta-analysis of controlled human studies. A search of four electronic databases and cross-referencing found 17 studies investigating the effect of inorganic nitrate supplementation on exercise performance that met the inclusion criteria. Beetroot juice and sodium nitrate were the most common supplements, with doses ranging from 300 to 600 mg nitrate and prescribed in a manner ranging from a single bolus to 15 days of regular ingestion. Pooled analysis showed a significant moderate benefit (ES = 0.79, 95% CI: 0.23-1.35) of nitrate supplementation on performance for time to exhaustion tests (p = .006). There was a small but insignificant beneficial effect on performance for time trials (ES = 0.11, 95% CI: -0.16-0.37) and graded exercise tests (ES = 0.26, 95% CI: -0.10-0.62). Qualitative analysis suggested that performance benefits are more often observed in inactive to recreationally active individuals and when a chronic loading of nitrate over several days is undertaken. Overall, these results suggest that nitrate supplementation is associated with a moderate improvement in constant load time to exhaustion tasks. Despite not reaching statistical significance, the small positive effect on time trial or graded exercise performance may be meaningful in an elite sport context. More data are required to clarify the effect of nitrate supplementation on exercise performance and to elucidate the optimal way to implement supplementation.
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