Dietary nitrate supplementation to enhance exercise capacity in hypoxic COPD: EDEN-OX, a double-blind, placebo-controlled, randomised cross-over study
Pavitt MJ, Lewis A, Buttery SC, Fernandez BO, Mikus-Lelinska M, Banya WAS, Feelisch M, Polkey MI, Hopkinson NS
Thorax · 22 citations
How it was studied
- Design
- Randomized controlled trial (indexed by PubMed)
- Studied in
- People
- Main outcome
- Health markers and function
- Intake measured by
- Not stated
Who paid for it
- Funding
- Independent funding
- Nonprofit
- Moulton Charitable Foundation
Based on 1 listed funder(s).
Publication
- Published
- 2021-12-01 · Thorax · vol. 77 · issue 10 · pp. 968–975
- Publisher
- BMJ
- Cited
- 32 citations · more than 95% of similar papers · 5.1× the field average
- Impact
- Top 10% most cited in its field
- References
- 41 works
- Access
- Free to read
- Research areas
- Cardiovascular and exercise physiology · Chronic Obstructive Pulmonary Disease (COPD) Research · High Altitude and Hypoxia
- Keywords
- Medicine, Placebo, COPD, Hypoxia (environmental), Dietary Nitrate, Nitrate, Heart rate, Nitrite, Internal medicine, Blood pressure, Surgery, Physical therapy, Oxygen, Pathology
- MeSH
- humans, pulmonary disease, chronic obstructive, nitrates, oxygen, antioxidants, cross-over studies, double-blind method, exercise tolerance, dietary supplements, adult, hypoxia
9 authors
From US, GB, CZ, AU
- Matthew J. PavittLung Institute; Imperial College London
- Adam P LewisLung Institute; Imperial College London
- Sara Catherine ButteryLung Institute; Imperial College London
- Bernadette O. FernandezSouthampton Hospital
- Monika Mikus-LelinskaSouthampton Hospital
- WINSTON A. S. BANYALung Institute; Imperial College London
Abstract
Rationale
Dietary nitrate supplementation improves skeletal muscle oxygen utilisation and vascular endothelial function. We hypothesised that these effects might be sufficient to improve exercise performance in patients with COPD and hypoxia severe enough to require supplemental oxygen.
Methods
We conducted a single-centre, double-blind, placebo-controlled, cross-over study, enrolling adults with COPD who were established users of long-term oxygen therapy. Participants performed an endurance shuttle walk test, using their prescribed oxygen, 3 hours after consuming either 140 mL of nitrate-rich beetroot juice (BRJ) (12.9 mmol nitrate) or placebo (nitrate-depleted BRJ). Treatment order was allocated (1:1) by computer-generated block randomisation.
Measurements
The primary outcome was endurance shuttle walk test time. The secondary outcomes included area under the curve to isotime for fingertip oxygen saturation and heart rate parameters during the test, blood pressure, and endothelial function assessed using flow-mediated dilatation. Plasma nitrate and nitrite levels as well as FENO were also measured.
Main results
20 participants were recruited and all completed the study. Nitrate-rich BRJ supplementation prolonged exercise endurance time in all participants as compared with placebo: median (IQR) 194.6 (147.5-411.7) s vs 159.1 (121.9-298.5) s, estimated treatment effect 62 (33-106) s (p<0.0001). Supplementation also improved endothelial function: NR-BRJ group +4.1% (-1.1% to 14.8%) vs placebo BRJ group -5.0% (-10.6% to -0.6%) (p=0.0003).
Conclusion
Acute dietary nitrate supplementation increases exercise endurance in patients with COPD who require supplemental oxygen. Trial registration number ISRCTN14888729.
Abstract via Europe PMC. Copyright remains with the authors or publisher.
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