Nitrate supplementation improves physical performance specifically in non-athletes during prolonged open-ended tests: a systematic review and meta-analysis

Nitrate (NO3-) is an ergogenic nutritional supplement that is widely used to improve physical performance. However, the effectiveness of NO3- supplementation has not been systematically investigated in individuals with different physical fitness levels. The present study analysed whether different fitness levels (non-athletes v. athletes or classification of performance levels), duration of the test used to measure performance (short v. long duration) and the test protocol (time trials v. open-ended tests v. graded-exercise tests) influence the effects of NO3- supplementation on performance. This systematic review and meta-analysis was conducted and reported according to the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. A systematic search of electronic databases, including PubMed, Web of Science, SPORTDiscus and ProQuest, was performed in August 2017. On the basis of the search and inclusion criteria, fifty-four and fifty-three placebo-controlled studies evaluating the effects of NO3- supplementation on performance in humans were included in the systematic review and meta-analysis, respectively. NO3- supplementation was ergogenic in non-athletes (mean effect size (ES) 0 . 25; 95% CI 0.11, 0.38), particularly in evaluations of performance using long-duration open-ended tests (ES 0.47; 95% CI 0.23, 0.71). In contrast, NO3- supplementation did not enhance the performance of athletes (ES 0.04; 95% CI -0.05, 0.15). After objectively classifying the participants into different performance levels, the frequency of trials showing ergogenic effects in individuals classified at lower levels was higher than that in individuals classified at higher levels. Thus, the present study indicates that dietary NO3- supplementation improves physical performance in non-athletes, particularly during long-duration open-ended tests.