A scoping review on the effects of beetroot juice combined with blood flow restriction training on neuromuscular performance and the calibration of arterial occlusion pressure
DOI:
https://doi.org/10.34119/bjhrv9n3-088Keywords:
beetroot juice, inorganic nitrate, blood flow restriction, neuromuscular function, arterial occlusion pressure, scoping reviewAbstract
Objective: To conduct a scoping review on the effectiveness and methodological characteristics of beetroot juice (inorganic nitrate) supplementation combined with blood flow restriction (BFR) training interventions on neuromuscular function and sports performance. Methods: Original studies concerning beetroot juice supplementation combined with BFR interventions were systematically searched in PubMed, Web of Science, Cochrane Library, CNKI, and Wanfang Data, from database inception to April 2026. Data were extracted for the scoping review, and the methodological quality of the literature was assessed using the Physiotherapy Evidence Database - PEDro - scale. Results: A total of 7 high-quality randomized controlled and crossover trials involving 118 participants were included. The study populations encompassed healthy young adults, collegiate athletes, and postmenopausal women. Behavioral and electrophysiological results indicated that beetroot juice combined with BFR training significantly shortened motor unit potential (MUP) duration, enhanced isokinetic muscle strength and countermovement jump (CMJ) explosive performance, and effectively prolonged the time to task failure under ischemic conditions. Methodological characteristic data revealed that none of the included studies dynamically recalibrated individual arterial occlusion pressure (AOP) or limb occlusion pressure (LOP) after beetroot juice ingestion induced a significant decrease in resting blood pressure, presenting a confounding variable of an implicitly elevated relative blood flow occlusion rate. Conclusion: Beetroot juice combined with BFR training can effectively enhance individual neuromuscular efficiency and fatigue resistance. However, the internal validity of the current evidence is severely compromised by the methodological blind spot wherein dynamic AOP is uncalibrated. Future crossover intervention studies urgently need to establish dynamic calibration protocols based on the pharmacokinetic characteristics of dietary nitrate to isolate confounding biases and ensure participants' cardiovascular safety.
References
BENJAMIM, Cicero Jonas R. et al. Nitrate derived from beetroot juice lowers blood pressure in patients with arterial hypertension: a systematic review and meta-analysis. Frontiers in Nutrition, v. 9, p. 823039, 2022.
CASHIN, Aidan G.; MCAULEY, James H. Clinimetrics: physiotherapy evidence database (PEDro) scale. Journal of Physiotherapy, v. 66, n. 1, p. 59, jan. 2020.
CENTNER, Christoph et al. Effects of blood flow restriction training on muscular strength and hypertrophy in older individuals: a systematic review and meta-analysis. Sports Medicine, v. 49, n. 1, p. 95–108, jan. 2019.
COGGAN, Andrew R.; PETERSON, Linda R. Dietary nitrate enhances the contractile properties of human skeletal muscle. Exercise and Sport Sciences Reviews, v. 46, n. 4, p. 254–261, out. 2018.
DA SILVA, Davi Vieira Teixeira et al. A critical review on vasoactive nutrients for the management of endothelial dysfunction and arterial stiffness in individuals under cardiovascular risk. Nutrients, v. 15, n. 11, p. 2618, 2 jun. 2023.
DE QUEIROS, Victor S. et al. Body position and cuff size influence lower limb arterial occlusion pressure and its predictors: implications for standardizing the pressure applied in training with blood flow restriction. Frontiers in Physiology, v. 15, p. 1446963, 2024.
ESEN, Ozcan et al. Effect of nitrate supplementation on skeletal muscle motor unit activity during isometric blood flow restriction exercise. European Journal of Applied Physiology, v. 122, n. 7, p. 1683–1693, jul. 2022a.
ESEN, Ozcan et al. High-dose nitrate supplementation attenuates the increased blood pressure responses to isometric blood flow restriction exercise in healthy males. Nutrients, v. 14, n. 17, p. 3645, 3 set. 2022b.
ESEN, Ozcan et al. Influence of nitrate supplementation on motor unit activity during recovery following a sustained ischemic contraction in recreationally active young males. European Journal of Nutrition, v. 63, n. 6, p. 2379–2387, set. 2024.
FATELA, Pedro et al. Acute effects of exercise under different levels of blood-flow restriction on muscle activation and fatigue. European Journal of Applied Physiology, v. 116, n. 5, p. 985–995, maio 2016.
HERNÁNDEZ, Andrés et al. Dietary nitrate increases tetanic [Ca2+]i and contractile force in mouse fast-twitch muscle. The Journal of Physiology, v. 590, n. 15, p. 3575–3583, 1 ago. 2012.
HUGHES, Luke et al. Blood flow restriction training in clinical musculoskeletal rehabilitation: a systematic review and meta-analysis. British Journal of Sports Medicine, v. 51, n. 13, p. 1003–1011, jul. 2017.
JING, Jiapeng et al. Effects of upper extremity blood flow restriction training on muscle strength and hypertrophy: a systematic review and meta-analysis. Frontiers in Physiology, v. 15, p. 1488305, 2024.
JOHNSON, Samuel R. et al. The impact of blood flow restriction therapy on orthopaedic conditions of the upper extremity: a systematic review of randomized controlled trials. Annals of Joint, v. 11, p. 11, 2026.
JONES, Andrew M. et al. Dietary nitrate and physical performance. Annual Review of Nutrition, v. 38, p. 303–328, 21 ago. 2018.
JONES, Andrew M. et al. Dietary nitrate and nitric oxide metabolism: mouth, circulation, skeletal muscle, and exercise performance. Medicine and Science in Sports and Exercise, v. 53, n. 2, p. 280–294, 1 fev. 2021.
JONVIK, Kristin L. et al. The impact of beetroot juice supplementation on muscular endurance, maximal strength and countermovement jump performance. European Journal of Sport Science, v. 21, n. 6, p. 871–878, jun. 2021.
KAPIL, Vikas et al. Inorganic nitrate supplementation lowers blood pressure in humans: role for nitrite-derived NO. Hypertension, v. 56, n. 2, p. 274–281, ago. 2010.
LIANG, Jing et al. The chemistry of the nitrate-nitrite-nitric oxide pathway: regulating muscle oxygenation and exercise performance. RSC advances, v. 16, n. 17, p. 15723–15735, 17 mar. 2026.
LOENNEKE, Jeremy P. et al. Blood flow restriction in the upper and lower limbs is predicted by limb circumference and systolic blood pressure. European Journal of Applied Physiology, v. 115, n. 2, p. 397–405, fev. 2015.
LUNDBERG, Jon O.; WEITZBERG, Eddie; GLADWIN, Mark T. The nitrate-nitrite-nitric oxide pathway in physiology and therapeutics. Nature Reviews. Drug Discovery, v. 7, n. 2, p. 156–167, fev. 2008.
MINNITI, Melissa C. et al. The safety of blood flow restriction training as a therapeutic intervention for patients with musculoskeletal disorders: a systematic review. The American Journal of Sports Medicine, v. 48, n. 7, p. 1773–1785, jun. 2020.
NIE, Runsheng et al. Acute beetroot juice supplementation augments early neuromuscular performance after blood flow restriction: a crossover study in elite basketball players. Frontiers in Nutrition, v. 12, p. 1699766, 2025.
PATTERSON, Stephen D. et al. Blood flow restriction exercise: considerations of methodology, application, and safety. Frontiers in Physiology, v. 10, p. 533, 2019.
PEARSON, Stephen John; HUSSAIN, Syed Robiul. A review on the mechanisms of blood-flow restriction resistance training-induced muscle hypertrophy. Sports Medicine, v. 45, n. 2, p. 187–200, fev. 2015.
PROCTOR, David N. et al. Inorganic nitrate supplementation and blood flow restricted exercise tolerance in post-menopausal women. Nitric Oxide: Biology and Chemistry, v. 122–123, p. 26–34, 1 maio 2022.
SAN JUAN, Alejandro F. et al. Effects of dietary nitrate supplementation on weightlifting exercise performance in healthy adults: a systematic review. Nutrients, v. 12, n. 8, p. 2227, 26 jul. 2020.
SCOTT, Brendan R. et al. Blood flow restricted exercise for athletes: a review of available evidence. Journal of Science and Medicine in Sport, v. 19, n. 5, p. 360–367, maio 2016.
SENEFELD, Jonathon W. et al. Ergogenic effect of nitrate supplementation: a systematic review and meta-analysis. Medicine and Science in Sports and Exercise, v. 52, n. 10, p. 2250–2261, out. 2020.
SHANNON, Oliver M. et al. Dietary inorganic nitrate as an ergogenic aid: an expert consensus derived via the modified delphi technique. Sports Medicine, v. 52, n. 10, p. 2537–2558, out. 2022.
TRICCO, Andrea C. et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Annals of Internal Medicine, v. 169, n. 7, p. 467–473, 2 out. 2018.
WORTMAN, Ryan J. et al. Blood flow restriction training for athletes: a systematic review. The American Journal of Sports Medicine, v. 49, n. 7, p. 1938–1944, jun. 2021.
WYLIE, Lee J. et al. Beetroot juice and exercise: pharmacodynamic and dose-response relationships. Journal of Applied Physiology, v. 115, n. 3, p. 325–336, 1 ago. 2013.
WYLIE, Lee J. et al. Human skeletal muscle nitrate store: influence of dietary nitrate supplementation and exercise. The Journal of Physiology, v. 597, n. 23, p. 5565–5576, dez. 2019.
YANG, Xudong et al. Synergistic effects of blood flow restriction training and beetroot juice supplementation on knee extensor strength and fatigue resistance in college athletes. Biology of Sport, v. 42, n. 4, p. 211–222, out. 2025.
YANG, Xudong et al. Beetroot juice supplementation enhances the effects of blood flow restriction training on lower limb strength and vertical jump performance under fatigue in Male university students: a randomized, double-blind, placebo-controlled study. Journal of the International Society of Sports Nutrition, v. 23, n. 1, p. 2636613, 31 dez. 2026.
