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Dietary nitrate supplementation to enhance exercise capacity in hypoxic COPD: EDEN-OX a double-blind, placebo-controlled, randomised crossover study

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Title: Dietary nitrate supplementation to enhance exercise capacity in hypoxic COPD: EDEN-OX a double-blind, placebo-controlled, randomised crossover study
Authors: Pavitt, M
Lewis, A
Buttery, S
Fernandez, BO
Mikus-Lelinska, M
Banya, W
Feelisch, M
Polkey, M
Hopkinson, N
Item Type: Journal Article
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.
Issue Date: 16-Sep-2022
Date of Acceptance: 5-Nov-2021
URI: http://hdl.handle.net/10044/1/92867
DOI: 10.1136/thoraxjnl-2021-217147
ISSN: 0040-6376
Publisher: BMJ Publishing Group
Start Page: 968
End Page: 975
Journal / Book Title: Thorax
Volume: 77
Issue: 10
Copyright Statement: © Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ. This article has been accepted for publication in Thorax following peer review. The definitive copyedited, typeset version Pavitt MJ, Lewis A, Buttery SC, et alDietary nitrate supplementation to enhance exercise capacity in hypoxic COPD: EDEN-OX, a double-blind, placebo-controlled, randomised cross-over studyThorax 2022;77:968-975 is available online at: http://dx.doi.org/10.1136/thoraxjnl-2021-217147. Reuse of this manuscript version (excluding any databases, tables, diagrams, photographs and other images or illustrative material included where a another copyright owner is identified) is permitted strictly pursuant to the terms of the Creative Commons Attribution-Non Commercial 4.0 International (CC-BY-NC 4.0) https://creativecommons.org/licenses/by-nc/4.0/
Sponsor/Funder: J P Moulton Charitable Foundation
Funder's Grant Number: n/a
Keywords: Science & Technology
Life Sciences & Biomedicine
Respiratory System
exercise
COPD pharmacology
long term oxygen therapy (LTOT)
NITRIC-OXIDE
PLASMA NITRITE
MUSCLE
OXYGEN
PHYSIOLOGY
VASODILATION
PERFORMANCE
EFFICIENCY
WALKING
COST
COPD pharmacology
exercise
long term oxygen therapy (LTOT)
Respiratory System
1103 Clinical Sciences
Publication Status: Published
Online Publication Date: 2021-12-01
Appears in Collections:National Heart and Lung Institute
Faculty of Medicine



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