Skip to content
Deals

NAD+ precursors (nicotinamide riboside and nicotinamide mononucleotide) and endurance performance: grade C

Limited evidence. Direction: Benefit.

C LimitedShort-term onlyIndustry-funded

Educational guidance, not medical advice

Why this grade

Rubric condition met: Two small positive RCTs on secondary or submaximal measures plus one null RCT; a network meta-analysis mixing clinical cohorts is positive for NMN. Not B under the rubric: VO2max was unchanged in the positive runner trial, the 6-minute-walk trial was industry-funded, and the network estimate mixes populations

NMN only: the supporting trials tested NMN, not NR. In 48 amateur runners, with NMN supplied by GeneHarbor, 600 and 1200 mg/day of NMN for 6 weeks raised power at the ventilatory thresholds more than placebo, but VO2max and peak power did not differ. In 80 healthy middle-aged adults, NMN raised six-minute walking distance more than placebo in a trial fully funded by two NMN manufacturers. A 28-day trial of MIB-626 in overweight or obese adults, funded in part by its developer, found no significant difference in aerobic capacity. A 2026 network meta-analysis found dose-dependent gains in endurance with NMN across mixed adult and clinical cohorts. All three trials ran 60 days or less, so C.

How we grade evidence

Studies this grade rests on

EffectMixedNo effectSize shows participants (n)202020252030Meta-analysisRCTGao 2026, 2026: meta-analysis, n = 1,599, result not recordedYi 2023, 2023: RCT, n = 80, result not recordedLiao 2021, 2021: RCT, n = 48, result not recordedPencina 2023, 2023: RCT, n = 30, result not recordedProkopidis 2025, 2025: meta-analysis, n not recorded, result not recorded
each study this grade rests on, by publication year and design. Solid: effect versus the comparator; half-filled: mixed; hollow: no effect; dashed: result not recorded yet. Larger marks had more participants.
Show the numbers
StudyYearDesignParticipantsResult
Liao 20212021RCT48result not recorded
Pencina 20232023RCT30result not recorded
Yi 20232023RCT80result not recorded
Prokopidis 20252025meta-analysisnot recordedresult not recorded
Gao 20262026meta-analysis1599result not recorded

The Effect of Nicotinamide Mononucleotide and Riboside on Skeletal Muscle Mass and Function: A Systematic Review and Meta-Analysis.

Prokopidis K, Moriarty F, Bahat G. The Effect of Nicotinamide Mononucleotide and Riboside on Skeletal Muscle Mass and Function: A Systematic Review and Meta-Analysis J Cachexia Sarcopenia Muscle, 2025. PMID 40275690

Result not recorded
Design
Systematic review and meta-analysis of RCTs
Population
Adults with mean age 60.9 to 83 years, including clinical groups
Funding
not stated in the PubMed or Crossref record

Nicotinamide Adenine Dinucleotide Augmentation in Overweight or Obese Middle-Aged and Older Adults: A Physiologic Study.

Pencina KM, Valderrabano R, Wipper B. Nicotinamide Adenine Dinucleotide Augmentation in Overweight or Obese Middle-Aged and Older Adults: A Physiologic Study J Clin Endocrinol Metab, 2023. PMID 36740954

Result not recorded
Design
Randomized, placebo-controlled trial (2:1), 28 days
Sample
n = 30
Population
Overweight or obese adults aged 45 and older
Funding
Metro International Biotech (developer of MIB-626) and NIH

The efficacy and safety of β-nicotinamide mononucleotide (NMN) supplementation in healthy middle-aged adults: a randomized, multicenter, double-blind, placebo-controlled, parallel-group, dose-dependent clinical trial.

Yi L, Maier AB, Tao R. The efficacy and safety of β-nicotinamide mononucleotide (NMN) supplementation in healthy middle-aged adults: a randomized, multicenter, double-blind, placebo-controlled, parallel-group, dose-dependent clinical trial Geroscience, 2023. PMID 36482258

Result not recorded
Design
Randomized, multicenter, double-blind, placebo-controlled, dose-ranging trial, 60 days
Sample
n = 80
Population
Healthy middle-aged adults
Funding
Aba Chemicals Co. and Abinopharm, Inc. (NMN manufacturers)

Nicotinamide mononucleotide supplementation enhances aerobic capacity in amateur runners: a randomized, double-blind study.

Liao B, Zhao Y, Wang D. Nicotinamide mononucleotide supplementation enhances aerobic capacity in amateur runners: a randomized, double-blind study J Int Soc Sports Nutr, 2021. PMID 34238308

Result not recorded
Design
Randomized, double-blind, placebo-controlled, four-arm trial, 6 weeks
Sample
n = 48
Population
Healthy recreationally trained amateur runners (young and middle-aged)
Funding
National Key Research and Development Program of China; NMN and placebo provided by GeneHarbor (Hong Kong) Biotechnologies Ltd.

Domain-specific effects of NAD(+) precursors on fatigue and functional performance: a systematic review and network meta-analysis.

Gao Y, Li S, Guan J. Domain-specific effects of NAD(+) precursors on fatigue and functional performance: a systematic review and network meta-analysis Front Nutr, 2026. PMID 42774067

Result not recorded
Design
Systematic review and network meta-analysis of 25 RCTs and 2 quasi-experimental studies
Sample
n = 1,599
Population
Adults, including clinical cohorts (NR, NMN, NADH and nicotinamide)
Funding
not stated in the PubMed or Crossref record (authors declare no commercial or financial relationships)

Search and history

Search (): (nicotinamide mononucleotide[tiab] OR nicotinamide riboside[tiab]) AND (exercise[tiab] OR "physical performance"[tiab] OR endurance[tiab] OR aerobic[tiab]) AND randomized controlled trial[pt]

  • Graded C (proposed): Proposed in the monograph draft
  • C to C (approved): Editor sign-off November 13, 2026: grade matches the editor-approved final page