Recipient organisationNIHR Wellcome Trust Southampton Clinical Research Facility
NIHR supportRecorded as supported by this research centre
PeriodFeb 2025 — Jun 2026
In plain English
AI plain-English summary
A single dose of concentrated beetroot juice may help people with idiopathic pulmonary fibrosis (IPF) breathe more easily during exercise. IPF is a progressive lung-scarring disease that leaves patients severely breathless, and no current treatment fully restores their ability to exercise. The researchers previously noticed that IPF patients show an unusual drop in blood nitrite after exercise—the opposite of what happens in healthy people—suggesting their bodies handle nitric oxide differently. This pilot study will give eight IPF patients either nitrate-rich beetroot juice or a placebo for three days, then measure their exercise capacity, blood markers, and forearm blood flow. After a washout period, patients will switch treatments. Eight matched healthy controls will provide comparison data. If the beetroot juice boosts exercise capacity, it could offer a cheap, safe, and readily available supplement to improve daily function for IPF patients—a group with very few treatment options. This is a small, early-stage trial designed to test feasibility and gather initial signals; larger studies would be needed before any clinical recommendation.
View original technical description
Idiopathic pulmonary fibrosis (IPF) is a type of scarring (fibrotic) luroung disease. Reduced exercise capacity is a key symptom experienced by patients. In previous research we identified that an interval-based exercise programme led to significant improvements in exercise capacity (Wallis et al Antioxidants. 2023). An unexpected finding was that in patients with IPF, exercise led to a reduction in blood nitrite concentrations an observation we did not see in non-affected individuals. Research has identified that nitrite concentrations are expected to increase after exercise and the size of this increase is related to an individual’s exercise capacity. There is also evidence from healthy individuals and patients with COPD that nitrate supplementation (a source of nitrite) improves response to exercise training. However, in both these groups an exercise-induced fall in blood nitrite concentrations has not been observed. Hence our finding of an exercise-induced fall in blood nitrite levels in IPF patients suggest that they may be especially sensitive to supplementation with nitrate, commercially available as nitrate-rich beetroot juice (NRBJ). This current study investigates this in a pilot placebo-controlled, double-blind, randomised, cross-over study of NRBJ on exercise capacity in IPF patients. Aims In patients with IPF • Quantify the effect of nitrate supplementation on exercise capacity • Determine the effect of nitrate supplementation on blood markers of nitric oxide production/metabolism. • Determine the effect of nitrate supplementation on forearm blood flow. Sample size: n=8 IPF patients, aged 18-85years and medical research breathlessness scale 1-3 Intervention: 3-days (two-times daily) NRBJ or nitrate-depleted placebo juice (both commercially available) with subsequent constant-load exercise test (Primary outcome). Following at least 1 week wash-out period participants will cross-over and repeat. A cohort (n=8) of age, sex-matched controls without IPF will be enrolled for comparison of forearm blood flow and pre-exercise venous blood samples for biomarkers comparison only
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