Applied Physiology of Exercise Lab · University of Virginia
We study how exercise — paired with nutritional and pharmacological strategies — restores vascular function and functional capacity in people with limited therapeutic options: peripheral artery disease, heart failure, aging adults, and women after menopause. One of our major focus areas is the restoration of nitric oxide bioavailability.
What we do
The APEX Lab sits between the Department of Kinesiology and the Division of Cardiovascular Medicine at the University of Virginia. That dual footing is the point: we pair mechanistic vascular science with the practical craft of prescribing exercise for people who are sick, deconditioned, or aging.
Our through-line is the nitrate–nitrite–nitric oxide pathway — the body's own route to widening blood vessels and delivering oxygen to working muscle. When exercise alone isn't enough, raising nitric oxide availability can help the vessels keep up.
We run randomized clinical trials, measure vascular function and muscle perfusion directly, and translate what we learn into exercise prescriptions that patients can actually complete. The lab is co-directed within the Robert M. Berne Cardiovascular Research Center.
Increasingly, our attention is on populations that cardiovascular research has historically underserved — most of all women navigating the sharp rise in cardiovascular risk that follows menopause.
Four programs
Our landmark trials showed a beetroot-derived nitrate drink can lengthen pain-free walking in PAD — and that pairing it with exercise beats exercise alone. This work now anchors two multi-center trials.
PAD · claudication · ambulation 02We showed that bacteria on the tongue are required to convert dietary nitrate into its active form — reshaping how the whole field designs its trials.
microbiome · nitrite · methodology 03A low-mass, high-repetition approach that builds function in frail older adults and heart-failure patients without the central cardiovascular strain of standard training.
heart failure · aging · rehabilitation 04Nitrate works differently across the sexes and the menstrual cycle. We're following that signal into postmenopausal women, where estrogen's vascular protection fades.
sex differences · menopause · vascular healthSignature finding
In 2011, our randomized trial showed that a single dose of dietary inorganic nitrate raised plasma nitrite and extended claudication-free walking time in patients with peripheral artery disease — the first clinical evidence that a non-pharmacological nitric-oxide precursor could move a meaningful functional endpoint in any clinical population.
The paper has been cited more than 440 times and continues to accumulate roughly 30 citations a year, seeding funded programs in our lab and many others.
Kenjale et al. 2011
"Dietary Nitrate Supplementation Enhances Exercise Performance in Peripheral Arterial Disease."
Journal of Applied Physiology · 440+ citations · PMID 21454745