What does this research mean for the field?

Inorganic nitrate supplementation attenuates the post-exercise decline in the Buckberg ratio following high-intensity, but not moderate-intensity, exercise in postmenopausal females. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To determine how acute exercise intensity affects the Buckberg ratio in postmenopausal females and whether inorganic nitrate supplementation attenuates post-exercise reductions in this index of myocardial perfusion.

July 9, 2026Experimental PhysiologyOpen Access

The acute effects of exercise intensity and inorganic nitrate supplementation on the Buckberg ratio in postmenopausal females

Q: What are the key findings of this study?

Inorganic nitrate supplementation significantly attenuated the decline in the Buckberg ratio following high-intensity exercise in postmenopausal females (P < 0.001).

Q: What is the clinical evidence from this study?

Study design: RCT. Population: Postmenopausal females (n=24). Intervention: Inorganic nitrate (beetroot juice) vs. Nitrate-depleted placebo. Primary outcome: Buckberg ratio following high-intensity exercise (p=<0.001).

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Key result

Inorganic nitrate attenuates post-exercise decline in myocardial oxygen supply-demand balance in postmenopausal females.

P<0.001
n=24

Why the study?

The Buckberg ratio is lower in postmenopausal females than in age-matched males, and the effect of inorganic nitrate supplementation on this index of myocardial oxygen supply-demand balance was unknown.

Does inorganic nitrate supplementation attenuate the exercise-induced decline in the Buckberg ratio in postmenopausal females?

Key Points

To determine how acute exercise intensity affects the Buckberg ratio in postmenopausal females and whether inorganic nitrate supplementation attenuates post-exercise reductions in this index of myocardial perfusion.
In a double-blind, randomized design, 24 postmenopausal females (60 ± 5 years) received nitrate-rich beetroot juice (BRJ; n = 12) or nitrate-depleted placebo (PL; n = 12) for ~2 days, with the final dose consumed 2 h before testing.
Participants completed calorically matched high-intensity exercise (HIE), moderate-intensity exercise (MIE), and non-exercise control (CON) sessions.
The Buckberg ratio was calculated via pulse wave analysis from central aortic pressure waveforms at rest and every 30 min for 3 h post-exercise, alongside venous plasma nitrate and nitrite assays.
BRJ supplementation markedly increased plasma nitrate (Pre: 45 ± 28 µM vs. Post: 1094 ± 153 µM, P < 0.001) and nitrite (Pre: 130 ± 33 nM vs. Post: 366 ± 133 nM, P < 0.001), whereas placebo produced no significant changes.
The Buckberg ratio remained unchanged during CON but declined significantly following MIE (P < 0.001) and HIE (P < 0.001) in both groups, reaching nadir values at 60 min post-exercise.
BRJ supplementation significantly attenuated the post-exercise decline in the Buckberg ratio compared with placebo following HIE (P < 0.001), but did not significantly alter the response following MIE.

Study Design

Type

RCT (n=24)

Blinding

Double-blind

Randomization

Randomized

Multicenter

Structured PICO

Does inorganic nitrate supplementation attenuate the exercise-induced decline in the Buckberg ratio in postmenopausal females?

Population

24 healthy, sedentary postmenopausal females (mean age 60 years) were randomized to beetroot juice or placebo to assess myocardial perfusion during acute exercise.

Intervention

Inorganic nitrate supplementation via 140 mL nitrate-rich beetroot juice (13 mmol nitrate) for ~2 days, with a final dose 2 hours before testing, followed by calorically matched high-intensity exercise (HIE), moderate-intensity exercise (MIE), or non-exercise control (CON).

Comparator

Identical nitrate-depleted placebo (<0.1 mmol nitrate) for ~2 days, with a final dose 2 hours before testing, followed by the same exercise and control conditions.

Outcome

Buckberg ratio (an index of myocardial oxygen supply-demand balance) measured at rest and every 30 min for 3 hours following exercise and control conditions using pulse wave analysis.surrogate

Main Result

p-value: p=<0.001

Inorganic nitrate supplementation attenuates the acute decline in the Buckberg ratio following high-intensity exercise in postmenopausal females, suggesting a potential strategy to preserve coronary perfusion during physical stress.

Limitations

Modest sample size
Lack of direct imaging techniques to elucidate clinical implications
Need for long-term studies to determine sustained improvements
Lack of a directly comparable, prospectively collected premenopausal group
Blood samples not collected at each postexercise pulse wave analysis time point

Discussion

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Implication

May support nitrate use to preserve coronary perfusion during high-intensity exercise; extends nitric oxide benefits to exercise stress in postmenopausal females.

Cite This Study

Derella et al. (2026) conducted an RCT in Postmenopausal females (n=24). Inorganic nitrate (beetroot juice) vs. Nitrate-depleted placebo was evaluated on Buckberg ratio following high-intensity exercise (p=<0.001). Inorganic nitrate supplementation significantly attenuated the decline in the Buckberg ratio following high-intensity exercise in postmenopausal females (P < 0.001).

synapsesocial.com/papers/6a4f3a702b81a944af574bd7 https://doi.org/10.1113/ep093920

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Implication

May support nitrate use to preserve coronary perfusion during high-intensity exercise; extends nitric oxide benefits to exercise stress in postmenopausal females.

The acute effects of exercise intensity and inorganic nitrate supplementation on the Buckberg ratio in postmenopausal females

Key Points

Study Design

Structured PICO

Main Result

Limitations

Discussion

Implication

Cite This Study

The acute effects of exercise intensity and inorganic nitrate supplementation on the Buckberg ratio in postmenopausal females

Key Points

Study Design

Structured PICO

Main Result

Limitations

Discussion

Implication

Cite This Study

Also Consider

Also Consider