Effects of Dietary Nitrate Supplementation on Physiological Responses, Cognitive Function, and Exercise Performance at Moderate and Very-High Simulated Altitude

Nitric oxide (NO) bioavailability is reduced during acute altitude exposure, contributing toward the decline in physiological and cognitive function in this environment. This study evaluated the effects of nitrate ([Formula: see text]) supplementation on NO bioavailability, physiological and cognitive function, and exercise performance at moderate and very-high simulated altitude. Ten males (mean (SD): [Formula: see text]: 60.9 (10.1) ml·kg·min) rested and performed exercise twice at moderate (~14.0% O; ~3,000 m) and twice at very-high (~11.7% O; ~4,300 m) simulated altitude. Participants ingested either 140 ml concentrated [Formula: see text]-rich (BRJ; ~12.5 mmol [Formula: see text]) or [Formula: see text]-deplete (PLA; 0.01 mmol [Formula: see text]) beetroot juice 2 h before each trial. Participants rested for 45 min in normobaric hypoxia prior to completing an exercise task. Exercise comprised a 45 min walk at 30% [Formula: see text] and a 3 km time-trial (TT), both conducted on a treadmill at a 10% gradient whilst carrying a 10 kg backpack to simulate altitude hiking. Plasma nitrite concentration ([[Formula: see text]]), peripheral oxygen saturation (SpO), pulmonary oxygen uptake ([Formula: see text]), muscle and cerebral oxygenation, and cognitive function were measured throughout. Pre-exercise plasma [[Formula: see text]] was significantly elevated in BRJ compared with PLA ( = 0.001). Pulmonary [Formula: see text] was reduced ( = 0.020), and SpO was elevated ( = 0.005) during steady-state exercise in BRJ compared with PLA, with similar effects at both altitudes. BRJ supplementation enhanced 3 km TT performance relative to PLA by 3.8% [1,653.9 (261.3) vs. 1718.7 (213.0) s] and 4.2% [1,809.8 (262.0) vs. 1,889.1 (203.9) s] at 3,000 and 4,300 m, respectively ( = 0.019). Oxygenation of the gastrocnemius was elevated during the TT consequent to BRJ ( = 0.011). The number of false alarms during the Rapid Visual Information Processing Task tended to be lower with BRJ compared with PLA prior to altitude exposure ( = 0.056). Performance in all other cognitive tasks did not differ significantly between BRJ and PLA at any measurement point ( ≥ 0.141). This study suggests that BRJ improves physiological function and exercise performance, but not cognitive function, at simulated moderate and very-high altitude.