Nicotinamide Riboside In Combination with Exercise Improves Cardiopulmonary Fitness in Friedreich's Ataxia: Clinical Findings

Objectives

To evaluate the effects of aerobic and resistance exercise training, alone and in combination with NR supplementation, on cardiopulmonary (heart-lung) fitness and blood sugar control in children and adults with Friedreich's ataxia.

Journal

The Lancet Neurology

Key Outcomes

• NR supplementation was well-tolerated and increased whole blood NAD+ levels.
• NR combined with exercise produced the greatest improvement in cardiopulmonary fitness, increasing peak VO₂ by about 12.7% compared with baseline. However, this improvement was not significantly better than exercise alone.
• NR + exercise also resulted in a small but significant decrease in HbA1c levels, suggesting a mild improvement in blood sugar control. 
• Additional analyses showed improvements in maximal workload (the highest level of effort achieved during the exercise test) and physical activity levels. 
• NR alone did not meaningfully improve fitness outcomes, but it was associated with reductions in body fat. 
• Exploratory subgroup analyses suggested potential age-related differences in response: children appeared to respond more to NR alone, while adults showed clearer improvements in peak VO₂ with exercise (with or without NR).

Duration

12 weeks

Dose

300, 600, or 900 mg*

*Dosage depended on individual bodyweight.

Study Design

Randomized, placebo-controlled, single-center, phase II trial in 66 children and adults with Friechreich's ataxia. The study used a 2x2 factorial design to test exercise and a supplement, both alone and in combination.