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Key Points
- Combination improved heart and lung fitness
- NR alone increased NAD+ levels
- Exercise improved performance
- Benefits appear to be driven by improved energy utilization
Methods
Sixty-six adults and children (ages 10-40) with Friedreichโs ataxia were randomized into four groups:
- Placebo: Placebo with no exercise for 12 weeks
- NR only: NR with no exercise for 12 weeks
- Exercise only: Exercise with placebo for 12 weeks
- NR + Exercise: NR combined with exercise for 12 weeks
NR dosing ranged from 300โ900 mg/day depending on body weight.
The exercise intervention included three aerobic sessions and two resistance training sessions per week.
"The primary outcome was change in peak VO2 (L/min) during cardiopulmonary exercise testing at 12 weeks versus baseline."
NR + Exercise Produced the Largest Gains
The most meaningful improvement in fitness occurred when NR was combined with exercise.
- Combination therapy: ~13% increase in VOโ
- Exercise alone: ~9.5% increase
- NR alone: ~5% increase
- Control: ~2.5% decrease
VO2 increased 12.7% with combination therapy and decreased 2.4% in the control group.โ
Exercise alone had clear improvements in fitness however, the combination showed:
- Greater overall improvement
- Increased engagement in physical activity
Participants in the combination group reported increased time spent in physical activity.
This raises the possibility that NAD+ support may improve energy production or exercise capacity.
NR Increased Whole-Blood NAD+
NR supplementation successfully increased NAD+ levels in the blood,
Measurements demonstrated increased whole blood NAD+ concentrations in those taking nicotinamide riboside.
The largest effects were observed when NR was paired with exercise, suggesting that improvements were driven by how the body actively uses that increase in energy.
Conclusion
This study demonstrates that exercise, when paired with NR meaningfully improves functional capacity in individuals with Friedreichโs ataxia.
Combination therapy resulted in a statistically significant improvement in peak VOโ compared to control.
Importantly, these benefits come from improving how the body produces and utilizes energy at the cellular level and highlight a more accessible pathway to functional improvement through metabolic support.
