Synergistic effects of beetroot juice combined with blood flow restriction training on early neuromuscular performance in elite basketball players: a crossover study
Time: January 22, 2026
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This study found that acute beetroot juice (BJ) supplementation, combined with blood flow restriction (BFR)-induced postactivation potentiation (PAP), significantly improved the take-off height of elite basketball players within 8 minutes of the intervention.[H(v)]peak power (PP) and peak force development rate (PRFD), showing a time-dependent synergistic effect. This study provides a precise time window basis for optimizing pre-match warm-up strategies (such as utilizing the NO3−–NO2−–NO pathway).
1 Introduction
Vertical jump performance is a key indicator for evaluating the explosive power of an athlete’s lower limbs. Elite basketball players, for example, need to complete 40 to 60 jumps per game, highlighting their importance to athletic performance. Therefore, a pre-competition warm-up regimen is essential to optimize neuromuscular function and improve key athletic abilities such as jumping and agility, while reducing the risk of injury. A scientifically designed warm-up program is necessary to maximize an athlete’s competitive readiness.
Postactivation potentiation (PAP), the transient enhancement of neuromuscular performance following prior muscle activation, has become a key strategy for optimizing the effectiveness of the warm-up. Available evidence suggests that induction of PAP requires near-maximal contractions. However, practical limitations such as equipment dependence and risk of injury limit the application of pre-competition heavy-duty PAP protocols. To address this problem, blood flow restriction (BFR) training has emerged as a promising alternative. BFR simulates high-intensity stress by performing low-load exercise under restricted blood flow conditions, promoting the accumulation of metabolites and triggering neuromuscular adaptations. Notably, research shows that BFR, especially when combined with plyometrics or other exercises, can significantly improve jumping performance within 4 to 8 minutes of activation. These findings highlight the potential of BFR to optimize pre-competition warm-up.
Nitric oxide (NO) plays a key regulatory role in exercise physiology. Dietary nitrates (NO) from sources such as beetroot juice (BJ)3−) is reduced to nitrite (NO2−), and then converted into NO. This pathway is significantly enhanced under ischemic/hypoxic conditions (such as the environment created by BFR). NO improves skeletal muscle function by regulating calcium ion handling and blood flow. The International Olympic Committee recognizes dietary nitrate supplementation as an effective energy-boosting aid. As a rich source of nitrates, beetroot juice (BJ) has strong evidence to support its ability to improve athletic performance. However, its acute effects are still controversial, with some studies reporting improvements in some situations, but no consistent effects in team sports such as basketball.
Despite these mixed findings and the strong theoretical synergy between the NO-boosting effects of BJ and the ischemic environment of BFR, a critical gap remains. Specifically, whether acute BJ supplementation can synergize with BFR-induced PAP to amplify and potentially accelerate performance gains in basketball-specific explosive movements remains to be explored. Elucidating this interaction is critical to developing time-optimized, evidence-based warm-up strategies. Since BFR will cause local tissue ischemia/hypoxia, this is precisely the NO3−–NO2−–The optimal environment for the NO pathway to function. Therefore, this study aimed to investigate the acute effects of BJ supplementation combined with BFR-induced PAP on vertical jump performance in male basketball players. By clarifying this potential synergy, this study aimed to provide evidence-based strategies for optimizing pre-competition warm-up regimens.
2 Materials and methods
2.1 Participants
A total of 20 healthy male basketball players whose competitive level was classified as Level II or higher were recruited for this study. Exclusion criteria included: history of lower limb musculoskeletal injury or surgery within the past 6 months; chronic pain or neuromuscular dysfunction; use of drugs/supplements that affect exercise performance (such as creatine, caffeine) within the past 3 months; smokers or habitual mouthwash users; and currently participating in other exercise intervention studies. The study followed the guiding principles of the Declaration of Helsinki and was approved by the Sports Science Experimental Ethics Committee of Beijing Sport University. All participants provided written informed consent.
2.2 Experimental design
This study used a randomized, double-blind, placebo-controlled, balanced crossover design with two supplementation conditions. Under experimental conditions, participants drank nitrate-rich beetroot juice (BJ), providing a total nitrate dose of 8.4 mmol. In the placebo condition, participants drank matching-looking nitrate-depleted juice made from nitrate-free natural carotenoids and brown sugar water. A 7-day washout period separated the two experiments to avoid carryover effects. The order of supplementary conditions was determined by a computer-generated random sequence, and a strict double-blind procedure was implemented.
2.3 Equipment and instrumentation
The study used the SIEMENS Cypress PLUS color Doppler ultrasound diagnostic instrument to measure the arterial occlusion pressure (AOP) of the lower limbs at rest. The blood flow restriction band was from the Chinese company Theratools and was pressurized to 50% AOP levels to induce PAP. Data were collected using a Kunwei force measuring platform (Kunwei Sports Technology Corporation, China), which has been evaluated for reliability and validity.
2.4 Protocol and control
2.4.1 Measurement of AOP
After the participants rested supine for 10 minutes, the BFR band was placed on the proximal thigh, and Doppler ultrasound was used to detect the blood flow signal of the dorsalis pedis artery. The BFR band was gradually pressurized until the arterial blood flow signal was completely occluded, then slowly deflated, and the pressure when the arterial signal reappeared was recorded as the AOP.
2.4.2 Supplement intake
After randomization, participants had a 2.5-hour rest period after drinking juice. During this period, they were supervised and were not allowed to eat, drink beverages other than water, or use oral care products such as mouthwash and chewing gum.
2.4.3 Warm-up and baseline measurement
All subjects were familiar with the essentials of CMJ movements. After completion of the supplementation program, subjects performed a warm-up consisting of 5 minutes of jogging and a standardized dynamic stretching routine. Subsequently, the subjects performed two full-force CMJs on the force platform, and the resulting data served as the baseline.
2.4.4 Induction of PAP
The subject wore a BFR band and was pressurized to 50% AOP. The PAP induction protocol was then implemented: two sets of straight-leg jumps (10 times per set, 30 seconds apart, 90 seconds to complete), followed by three sets of continuous obstacle jumps (5 times per set, 50 cm height, 30 seconds apart, 120 seconds to finish), and finally five deep jumps (50 cm in height, 10 seconds apart, 90 seconds to finish). The entire sequence is completed in 5 minutes.
2.4.5 Measurement of PAP effects
Time was started after the subject completed the plyometric training and the BFR band was removed. Two CMJ tests were performed at 0, 4, 8, 12 and 16 minutes respectively and the data were recorded.
2.5 Data collection and processing
The collected indicators include: take-off height calculated based on ground speed[H(v), m]maximum resultant force (MCF, N), maximum relative force (MRF, BW), peak power (PP, w), relative peak power (RPP, W/kg), peak force development rate (PRFD, N/s) and modified reaction force index (RSImod). The RSImod calculation formula is the take-off height (meters) divided by the take-off time (seconds). These indicators are automatically calculated and saved by Kunwei Sports Function Performance Testing System software. The data were then manually imported into Excel for sorting and analysis, and the percentage change of each indicator relative to the baseline value at different time points under each supplementation condition was calculated.
2.6 Statistical analysis
3 Result
3.1 Effects of plyometric exercise with blood flow restriction on PAP following supplementation with placebo or beetroot juice
In the placebo (PL) condition, H(v) increased significantly 8 min after exercise compared with baseline (p = 0.001, d = 0.90). PP also increased at 8 minutes (p = 0.007, d = 0.67). In contrast, RSImod decreased at 16 minutes (p = 0.006, d = 0.69). There were no significant changes in other indicators after correction.
BJ triggered a broader PAP effect. H(v) increased immediately, 4 minutes and 8 minutes after intervention (p ≤ 0.01, d ≥ 0.64). MCF and MRF improved at 4 minutes (MCF: p = 0.008, d = 0.67; MRF: p = 0.003, d = 0.75). PP increased at 0 and 8 min (p ≤ 0.004, d ≥ 0.74). RPP improved between 0 and 8 minutes (p ≤ 0.007, d ≥ 0.67), and PRFD improved between 0 and 4 minutes (p ≤ 0.006, d ≥ 0.68).
ANOVA showed a significant main effect of group (all p = 0.01, η² ≥ 0.30) for H(v), RPP and RSImod, but not for MCF, MRF, PP or PRFD. There was a main effect of time for all variables (p ≤ 0.02, η² ≥ 0.17). Significant group × time interactions were found for H(v) (p = 0.01, η² = 0.17), PP (p = 0.02, η² = 0.15) and RPP (p = 0.03, η² = 0.14).
3.2 Comparative analysis of PAP effects between placebo and beetroot juice intake
Immediately post-intervention, the percentage change in PRFD was significantly greater in the BJ condition than placebo (p 0.05), but some comparisons showed small to moderate effect sizes. For example, RPP showed a small effect in favor of BJ at 4 minutes (d = 0.42), and H(v) showed a small effect in favor of BJ immediately after the intervention (d = 0.39). These nonsignificant but not insignificant effect sizes reflect the observed between-condition trends.
4 Discussion
This study investigated the acute effects of BJ supplementation combined with BFR-induced PAP on vertical jump kinetics in elite male basketball players. The results revealed a synergistic but short-lived effect between the two interventions, highlighting a critical time window for optimizing athletic performance.
The results revealed a significant PAP effect in the placebo condition, suggesting that BFR itself may contribute to the observed performance enhancement. Notably, the placebo condition showed effects at both 4 and 8 minutes after activation, followed by a gradual decline. These findings are consistent with previous studies showing that low-load BFR training enhances PAP by promoting metabolite accumulation and increasing motor unit recruitment.
The key finding of this study is that acute beetroot juice ingestion synergizes with a blood flow-restricted plyometric protocol to transiently enhance key measures of neuromuscular performance in elite basketball players during the critical early 0 to 8-minute post-activation window.[H(v), PP, PRFD]. Although the energizing effect of BJ and the ability of BFR to induce PAP have been independently reported, this study is the first to demonstrate a time-sensitive synergistic interaction between the two. This finding advances our understanding of nutritional and physiological strategies, which are critical in pre-competition preparation, by highlighting that their combined effects are not merely additive, but may accelerate the timing of the onset of performance enhancements.
Combined intervention of BJ intake and BFR significantly enhanced PAP-induced improvements in H(v), PP, and PRFD compared with placebo within 0–8 min of intervention. This enhancement was supported by moderate to large effect sizes, indicating clinically meaningful improvements beyond statistical significance. This suggests that BJ may accelerate the onset of PAP through enhanced nitric oxide bioavailability, which improves muscle oxygenation and calcium handling during the early stages of recovery. The ischemic/hypoxic environment created by BFR is the most effective condition for the non-classical nitrate-nitrite-NO pathway, enhancing NO production from the BJ nitrate pool. Elevated NO bioavailability may enhance early PAP through two main mechanisms: Improved calcium ion handling: NO may modulate sarcoplasmic reticulum function and increase calcium ion (Ca2+), leading to faster, more forceful contractions; enhanced perfusion and metabolic clearance: The vasodilatory effects of NO, coupled with the potential homogenization of microvascular blood flow after cuff release (reperfusion), may accelerate the accumulation of metabolic byproducts (e.g., inorganic phosphates, H+ions) to improve the metabolic environment for strength production. This can be attributed to NO precursors in the BJ, as increased nitrate and nitrite levels have been shown to rapidly increase blood flow.
Although no previous studies have examined the effects of acute combination of BJ and BFR on vertical jump performance, our results are consistent with and extend the mechanistic findings of Esen et al. They reported that nitrate supplementation improved motor unit firing rate and contractile function during isometric BFR exercise. Our study shows that this synergy translates to dynamic, basketball-related tasks and, critically, identifies a narrow post-activation time window for its practical application.
A noteworthy and unexpected observation was that H(v) was significantly higher in the placebo condition 12 minutes after the intervention. This between-group difference exhibited a medium effect size, indicating that it is of practical significance despite the limited sample size. This delayed peak in the placebo group may reflect interindividual variability in PAP response times. This result may be explained by several possible mechanisms. First, BJ supplementation may have induced an earlier performance peak due to accelerated NO-mediated vasodilation and muscle oxygenation. However, this effect may also dissipate more quickly due to a mismatch between BJ pharmacokinetics and the timing of optimal PAP expression or due to metabolic fatigue. Second, the placebo group may have experienced a delayed PAP response that peaked at 12 minutes. Third, the presence of nonresponders to dietary nitrates (a well-established phenomenon in BJ studies) may have diluted the group-level advantage under BJ, resulting in seemingly inferior performance relative to placebo despite similar variances.
The return of PP and RSImod to levels below baseline at 16 min post-intervention suggests that their effects are time-dependent, revealing a narrow window for performance optimization. The decrease in performance after 12 minutes suggests that the combined effects of BJ and BFR are transient and may be attributed to the short half-life of nitric oxide or the onset of metabolic fatigue. Notably, no significant enhancement was observed in MCF, MRF, or RSImod during the PAP window. For MCF and MRF, the observed effect sizes were consistently small, confirming that either intervention had minimal actual impact on these indicators. This differential effect suggests that BJ-BFR synergy preferentially benefits metrics related to rate and explosiveness of force production[H(v), PP, PRFD]rather than maximum absolute force (MCF, MRF). This is consistent with proposed mechanisms targeting calcium dynamics and metabolic recovery that are more critical for power output than maximal strength.
Detailed analysis of significance levels and effect sizes for all outcome variables provides a more comprehensive understanding of the observed effects. Under the BJ condition, H(v), PP, and RPP showed statistically significant improvements accompanied by moderate to large partial η² values, indicating robust performance enhancement effects. PRFD did not reach significance but showed a moderate effect size, suggesting a possible trend toward improvement. Although RSImod was statistically significant over time, the effect size was only small to moderate, indicating limited magnitude of change. In contrast, MCF and MRF had neither statistical significance nor meaningful effect sizes in either condition. This can be attributed to two factors: a timing mismatch between BFR-induced metabolite accumulation (most effective at 4–8 min) and peak NO bioavailability (usually occurring around 2.5 h after ingestion), potentially attenuating the synergistic effect; and NO-mediated microcirculatory and mitochondrial enhancement preferentially benefiting differential physiological adaptations for endurance activities, in contrast to PAP’s reliance on rapid neuromuscular synchronization for explosive output. Collectively, these mechanisms suggest that, despite its circulatory advantages, NO may be of limited effectiveness in supporting high-intensity, strength-oriented exercise. Additionally, while the energizing effects of BJ appear to be limited in young trained athletes, it is important to recognize that dietary nitrate supplementation may provide greater benefits in populations with lower baseline nitrite availability, such as the elderly or clinical populations. The observed improvements in H(v) and PP by BJ are consistent with previous findings that nitrate supplementation enhances power output and jumping performance in athletes, especially when combined with ischemic stimulation. However, the lack of sustained benefit over 8 minutes underscores the need for precise timing in practical applications.
From a practical perspective, our findings provide coaches and athletes with a targeted, evidence-based strategy to optimize explosive performance at the start of a game or after halftime. To exploit the synergistic window identified here, we propose the following protocol: athletes should ingest a single dose of BJ (≈8.4 mmol nitrate) approximately 2.5 hours before competition. Subsequently, a BFR-enhanced plyometric protocol (as described in this study) should be scheduled as the final component of the active warm-up, concluding 4 to 8 minutes before the start of an explosive activity such as a jump ball, first down set, or key defensive sequence. This approach provides an efficient, minimal equipment requirement alternative to traditional high-load PAP methods, which are often impractical in competitive environments.
Several methodological limitations should be acknowledged. First, sample characteristics limit the generalizability of the findings. The relatively small sample size may have resulted in insufficient power to detect effects on some variables, as shown by medium effect sizes with low statistical power. Therefore, nonsignificant results should be interpreted with caution, and future studies with larger sample sizes are warranted. Furthermore, our cohort consisted entirely of elite male athletes and does not provide insight into the female population or amateur athletes. Future studies should include female participants and consider the potential impact of the menstrual cycle. Additionally, participants were primarily of similar body size (e.g., guards), which may limit the applicability of our findings to all basketball player positions (e.g., centers and forwards); therefore, studies among athletes of different body types are encouraged.
Second, intervention parameters are standardized rather than individualized. Using a fixed BFR pressure (50% AOP) and a single nitrate dose (8.4 mmol) may not represent optimal stimulation for all athletes. Future dose-response studies are needed to determine individual-specific thresholds for maximizing performance.
Finally, the mechanistic basis of our observations remains to be explored. The physiological basis of time-dependent effects, such as the reason for the delayed decrease in RSImod and PP, is not fully understood. Furthermore, the lack of biochemical measurements (such as plasma nitrate/nitrite levels) meant that we were unable to confirm individual compliance or the precise pharmacokinetic profile of the supplements in our cohort. Integrating simultaneous assessment of plasma nitrate/nitrite dynamics, blood lactate, and myoelectric activity in future work could elucidate the metabolic and neuromuscular interactions underlying these patterns. Likewise, longitudinal studies are needed to determine whether chronic BJ supplementation maintains PAP effects or reduces fatigue during repeated explosive efforts.
From a practical perspective, our findings provide a targeted strategy for optimizing explosive performance at the start of a game. To take advantage of the established performance window of 0 to 8 minutes, we propose the following protocol: Athletes should ingest a single dose of BJ (≈8.4 mmol nitrate) approximately 2.5 hours before competition. A BFR-enhanced plyometric regimen (as described in this study) should then be scheduled as the final component of the active warm-up, ending 4 to 8 minutes before the jump ball or initial sprint. This approach provides an effective, minimal equipment requirement alternative to traditional high-load PAP methods, which are often impractical before competition.
5 Conclusion
This study demonstrates that acute BJ supplementation, when combined with a BFR-based plyometric protocol, enhances CMJ performance in elite basketball players, but only within a limited time window. Significant improvements in H(v), PP, and PRFD were observed within the first 8 minutes after activation, after which performance returned to baseline or declined. Of note, BJ was not superior to placebo at later time points, and variability in response highlights the need for individualized strategies. These findings highlight the need for precise timing when applying nitrate supplementation in explosive performance situations and suggest limited benefit after early activation late in the process.
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