Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2025 May;55(5):1213-1231.
doi: 10.1007/s40279-025-02194-6. Epub 2025 Mar 14.

Dietary Nitrate Supplementation and Exercise Performance: An Umbrella Review of 20 Published Systematic Reviews with Meta-analyses

Eric Tsz-Chun Poon  1 , Jason Chun-Kit Iu  2   3 , Wesley Man-Kuk Sum  2 , Po-San Wong  2 , Kenneth Ka-Hei Lo  4 , Ajmol Ali  5 , Stephen F Burns  6 , Eric T Trexler  7
Affiliations
Meta-Analysis

Dietary Nitrate Supplementation and Exercise Performance: An Umbrella Review of 20 Published Systematic Reviews with Meta-analyses

Eric Tsz-Chun Poon et al. Sports Med. 2025 May.

Abstract

Background: Dietary nitrate (NO3-) supplementation is purported to benefit exercise performance. However, previous studies have evaluated this nutritional strategy with various performance outcomes, exercise tasks, and dosing regimens, often yielding inconsistent results that limit the generalizability of the findings.

Objective: We aimed to synthesize the available evidence regarding the effect of NO3- supplementation on 11 domains of exercise performance.

Methods: An umbrella review was reported in accordance with the Preferred Reporting Items for Overviews of Reviews guideline. Seven databases (MEDLINE, EMBASE, Cochrane Database, CINAHL, Scopus, SPORTDiscus, and Web of Science) were searched from inception until July 2024. Systematic reviews with meta-analyses comparing NO3- supplementation and placebo-controlled conditions were included. Literature search, data extraction, and methodological quality assessment (A Measurement Tool to Assess Systematic Reviews Assessing the Methodological quality of SysTemAtic Review [AMSTAR-2]) were conducted independently by two reviewers.

Results: Twenty systematic reviews with meta-analyses, representing 180 primary studies and 2672 unique participants, met the inclusion criteria. Our meta-analyses revealed mixed effects of NO3- supplementation. It improved time-to-exhaustion tasks [standardized mean difference (SMD): 0.33; 95% confidence interval (CI) 0.19-0.47] with subgroup analyses indicating more pronounced improvements when a minimum dose of 6 mmoL/day (372 mg/day) and chronic (> 3 days) supplementation protocol was implemented. Additionally, ergogenic effects of NO3- supplementation were observed for total distance covered (SMD: 0.42; 95% CI 0.09-0.76), muscular endurance (SMD: 0.48; 95% CI 0.23-0.74), peak power output (PPO; SMD: 0.25; 95% CI 0.10 to 0.39), and time to PPO (SMD: - 0.76; 95% CI - 1.18, - 0.33). However, no significant improvements were found for other performance outcomes (all p > 0.05). The AMSTAR-2 ratings of most included reviews ranged from low to critically low.

Conclusions: This novel umbrella review with a large-scale meta-analysis provides an updated synthesis of evidence on the effects of NO3- supplementation across various aspects of exercise performance. Our review also highlights significant methodological quality issues that future systematic reviews in this field should address to enhance the reliability of evidence.

Clinical trial registration: This study was registered in the International Prospective Register of Systematic Review (PROSPERO) database (registration number: CRD42024577461).

PubMed Disclaimer

Conflict of interest statement

Declarations. Funding: This study did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Conflict of Interest: Eric Tsz-Chun Poon, Jason Chun-Kit Iu, Wesley Man-Kuk Sum, Po-San Wong, Kenneth Ka-Hei Lo, Ajmol Ali, Stephen F. Burns, and Eric T. Trexler have no conflicts of interest that are directly relevant to the content of this article. Ethics Approval: Not applicable. Consent to Participate: Not applicable. Consent for Publication: Not applicable. Availability of Data and Material: The datasets analyzed in this review are available from the corresponding author on reasonable request. Code Availability: Not applicable. Authors’ Contributions: EP and JI conceived the idea for the review. EP, JI, and WS conducted search, study selection, data extraction, and quality assessment. EP drafted the initial manuscript. EP, JI, WS, KL, AA, SB, and ET contributed to writing the manuscript. All authors reviewed and approved the final manuscript.

Figures

Fig. 1
Fig. 1
Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 2020 flowchart of literature selection on systematic reviews
Fig. 2
Fig. 2
Results of meta-analyses that compared nitrate supplementation with placebo-controlled conditions for common measures of aerobic endurance performance using standardized mean differences. # a positive value indicates an improvement
Fig. 3
Fig. 3
Results of meta-analyses that compared nitrate supplementation with placebo-controlled conditions for common measures of muscular fitness and power output performance using standardized mean differences
Fig. 4
Fig. 4
Graphical representation of the efficacy of nitrate supplementation in improving exercise performance. AMSTAR-2 A Measurement Tool to Assess Systematic Reviews Assessing the Methodological quality of SysTemAtic Review-2, CI confidence interval, SMD standardized mean difference
See this image and copyright information in PMC

References

    1. Jones AM. Dietary nitrate supplementation and exercise performance. Sports Med. 2014;44(Suppl. 1):S35-45. - PMC - PubMed
    1. Jones AM, Vanhatalo A, Seals DR, Rossman MJ, Piknova B, Jonvik KL. Dietary nitrate and nitric oxide metabolism: mouth, circulation, skeletal muscle, and exercise performance. Med Sci Sports Exerc. 2021;53(2):280–94. - PubMed
    1. Bredt DS. Endogenous nitric oxide synthesis: biological functions and pathophysiology. Free Radic Res. 1999;31(6):577–96. - PubMed
    1. Hord NG, Tang Y, Bryan NS. Food sources of nitrates and nitrites: the physiologic context for potential health benefits. Am J Clin Nutr. 2009;90(1):1–10. - PubMed
    1. Tamme T, Reinik M, Roasto M, Juhkam K, Tenno T, Kiis A. Nitrates and nitrites in vegetables and vegetable-based products and their intakes by the Estonian population. Food Addit Contam A. 2006;23(4):355–61. - PubMed