Nitric oxide precursor interventions for post-exercise delayed onset muscle soreness: a systematic review and network meta-analysis of randomized placebo-controlled trials
Study Details
This systematic review and network meta-analysis included 19 randomized placebo-controlled trials and 356 participants, comparing nitric oxide precursor strategies for delayed onset muscle soreness (DOMS) 🔍
Interventions included beetroot-derived nitrate, watermelon-derived citrulline, watermelon + added citrulline, and isolated amino acid precursors such as L-arginine and citrulline malate 🍉
Here are the key findings ⬇️
Key Findings
⏱️ Effects differed according to the stage of recovery, with benefits most apparent at 24–48 h
🍉 At 24 h, watermelon + added citrulline produced the largest significant reduction in soreness versus placebo (SMD = −0.97)
Beetroot-derived nitrate also significantly reduced DOMS at 24 h (SMD = −0.67)
📉 At 48 h, beetroot-derived nitrate was the only intervention with a significant benefit versus placebo (SMD = −1.18)
↔️ By 72 h, none of the interventions significantly reduced soreness compared with placebo
🏆 Exploratory rankings placed watermelon + citrulline highest at 24 h and beetroot-derived nitrate highest at 48 h
🏃 In trained athletes, beetroot-derived nitrate significantly reduced 48-h soreness, whereas this was not demonstrated in untrained participants
💊 Isolated L-arginine/citrulline interventions did not show a consistent significant benefit across recovery time points
🧬 Whole-food products may offer effects beyond nitric oxide production through compounds such as polyphenols, betalains, lycopene and vitamin C, although this was not directly established
⚠️ Evidence certainty was generally low, with substantial heterogeneity and few direct head-to-head comparisons between supplements
Conclusion
For athletes, beetroot-derived nitrate currently has the most consistent evidence for reducing soreness across the first 48 h of recovery, while citrulline-enriched watermelon may provide a more specific early benefit around 24 h ✅
Reference
https://www.frontiersin.org/journals/nutrition/articles/10.3389/fnut.2026.1868555/full
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