Evidence map›Paper›PMID 29976553›Full record

Trial reportCirculation research2018

Beet the Best?

Mary Woessner, Mitch D VanBruggen, Carl F Pieper, Richard Sloane, William E Kraus, Andrew J Gow, Jason D Allen

2 registry-linked trialsAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Circulation research, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 23 papers, 5 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
23citing papers in PubMed, 5 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT01684930 phase2completednot on this map

Increased Plasma Nitrite, Tissue Oxygenation and Functional Changes in PAD

TypeinterventionalSponsorDuke UniversityRan2012 to 2014Enrolled32ConditionsPeripheral Arterial DiseaseArmsBeetroot Juice (Beet-It Stamina Shot) & Supervised Exercise Training, Placebo Comparator Beverage (Beet-It Stamina Shot) & Exercise Training
NCT01785524 phase2completednot on this map

Dietary Nitrate to Augment Exercise Training Benefits in Subjects With Type II Diabetes (DM) and Peripheral Arterial Disease (PAD)

TypeinterventionalSponsorDuke UniversityRan2013 to 2014Enrolled18ConditionsPeripheral Arterial Disease, Type II Diabetes MellitusArmsBeetroot Juice (Beet-It Stamina Shot) and Exercise Training, Placebo Comparator Beverage (Beet-It Stamina Shot) & Exercise Training
3 · Its place in the literature

Who cites it

23 citing papers in PubMed, 5 syntheses or guidelines pooled it.

  1. Pooled it
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  6. Trial
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  8. Article
  9. Review
  10. Peripheral artery disease.Nature reviews. Disease primers · 2025
    Review
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

7 authors.

Mary WoessnerFrom the Institute of Health and Sport, Victoria University, Melbourne, Australia (M.W.).
Mitch D VanBruggenDuke Molecular Physiology Institute, Duke University Medical Center, Durham, NC (M.W., M.D.V., W.E.K., J.D.A.).
Carl F PieperDepartment of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC (C.F.P., R.S.).
Richard SloaneDepartment of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC (C.F.P., R.S.).
William E KrausDuke Molecular Physiology Institute, Duke University Medical Center, Durham, NC (M.W., M.D.V., W.E.K., J.D.A.).
Andrew J GowDepartment of Pharmacology and Toxicology, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ (A.J.G.).
Jason D AllenDuke Molecular Physiology Institute, Duke University Medical Center, Durham, NC (M.W., M.D.V., W.E.K., J.D.A.).

Funding

Resource Core 3 - Metabolomics CoreP30AG028716 · NIA · DUKE UNIVERSITY · PI Virginia B Kraus · 2006 to 2026
$24.6M
NO-Modified Biomolecules and Pulmonary SignalingR01HL086621 · NHLBI · RUTGERS, THE STATE UNIV OF N.J. · PI GOW, ANDREW J · 2008 to 2016
$2.8M
Dietary Nitrate to Augment Exercise Training Benefits in DM+PADR21HL113717 · NHLBI · DUKE UNIVERSITY · PI ALLEN, JASON DAVID · 2013 to 2014
$445k
Increased Plasma Nitrite, Tissue Oxygenation and Functional Changes in PADR21HL111972 · NHLBI · DUKE UNIVERSITY · PI ALLEN, JASON DAVID · 2012 to 2013
$436k
NHLBI NIH HHS R01 HL086621NHLBI NIH HHS R21 HL111972NHLBI NIH HHS R21 HL113717NIA NIH HHS P30 AG028716
6 · The paper itself

Abstract

rationaleA primary goal of therapy for patients with peripheral artery disease (PAD) and intermittent claudication is increased ambulatory function. Supervised exercise rehabilitation was recently shown to confer superior walking benefits to pharmacological or surgical interventions. Increases in plasma inorganic nitrite, via oral nitrate, have been shown to increase exercise performance in both human and animal models, especially in hypoxic conditions.

objectiveTo determine whether a 36-session exercise rehabilitation program while consuming oral inorganic nitrate (4.2 mmol concentrated beetroot juice) would produce superior benefits over exercise plus placebo in pain-free walking and markers of increased skeletal muscle perfusion in patients with PAD and intermittent claudication. METHODS AND

resultsThis was a randomized, double-blind, per-protocol study design. After the 12-week protocol, claudication onset time on a maximal treadmill test increased by 59.2±57.3 s for the exercise plus placebo group (n=13) and by 180.3±46.6 s for the exercise plus beetroot juice group (n=11; P≤0.05). This produced a between treatment medium to large standardized effect size (Cohen d) of 0.62 (95% CI, -0.23 to +1.44). The data for 6-minute walk distance showed a similar pattern with increases of 24.6±12.1 and 53.3±19.6 m ( P≤0.05) in the exercise plus placebo and exercise plus beetroot juice groups, respectively. Measures of gastrocnemius perfusion, including ankle-brachial index, peak reactive hyperemic blood flow, and tissue deoxygenation characteristics, during exercise (assessed my near-infrared spectroscopy) all changed significantly for the exercise plus beetroot juice group with moderate-to-large effect sizes over exercise plus placebo changes.

conclusionsAlthough it is premature to speculate on overall clinical utility of a nitrate-based therapy for PAD, this early pilot study evidence is encouraging. Specifically, our data suggests that increasing plasma nitrite before exercise may allow PAD subjects to train with less pain, at higher workloads for longer durations at each training session, thereby maximizing the beneficial peripheral vascular and skeletal muscle adaptations. CLINICAL

trial registrationURL: http://www.clinicaltrials.gov . Unique identifier: NCT01684930 and NCT01785524.

Indexed as

Beta vulgarisExercise ToleranceFruit and Vegetable JuicesPlant RootsAgedBiomarkersDouble-Blind MethodExercise TherapyFemaleHemodynamicsHumansIntermittent ClaudicationLower ExtremityMaleMiddle AgedNitritesBiomarkersNitritesexercisehumansinorganic nitratenitric oxideperipheral artery disease

Identifiers

PMID29976553
PMCPMC6202165

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.