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Addressing Methodological Gaps: A Systematic Review and Meta-Analysis of Beetroot Juice and Exercise Capacity in
Gaspar R Chiappa1,2, Alberto S Sá Filho2,3, Juliene Sá2
1Faculty of Health Sciences, Universidad Autónoma de Chile, Providencia, 7500912, Santiago, Chile.
Beetroot juice (BJ) supplementation significantly enhances exercise capacity and improves cardiovascular health in patients with chronic obstructive pulmonary disease (COPD). This meta-analysis stratified results by study design, offering reliable clinical application insights.
Area of Science:
- Pulmonary Medicine
- Cardiovascular Health
- Nutritional Science
Background:
- Chronic Obstructive Pulmonary Disease (COPD) patients often face limitations in exercise capacity.
- Previous meta-analyses on beetroot juice (BJ) supplementation in COPD have methodological limitations, particularly in stratifying study designs.
- Addressing these gaps is crucial for understanding BJ's potential benefits in COPD management.
Purpose of the Study:
- To assess the effects of BJ supplementation on exercise capacity and cardiovascular parameters in COPD patients.
- To identify methodological gaps by stratifying results from parallel and crossover randomized clinical trials (RCTs).
- To provide robust evidence for the clinical application of BJ in COPD.
Main Methods:
- Systematic search across multiple databases (Scopus, PubMed, Embase, etc.) until December 2024.
- Independent data extraction by two reviewers, assessing participant characteristics, supplementation protocols, and outcomes.
- Stratified random effects meta-analyses, subgroup and sensitivity analyses, meta-regression, risk of bias assessment (RoB2), and GRADE methodology for evidence certainty.
Main Results:
- Included 12 studies with 357 participants; BJ supplementation significantly improved exercise capacity (SMD, 0.31).
- Greater benefits observed in parallel RCTs (SMD, 0.52) compared to crossover trials (SMD, 0.06).
- BJ supplementation led to significant reductions in systolic (MD, -5.33 mmHg) and diastolic blood pressure (MD, -3.01 mmHg).
Conclusions:
- Beetroot juice (BJ) supplementation offers robust evidence for improving exercise capacity and cardiovascular parameters in COPD patients.
- Stratification by study design addresses critical methodological limitations, establishing a reliable foundation for clinical use.
- Further standardized, long-term studies are recommended to confirm findings and explore dose-response relationships.
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