Nicotinamide Mononucleotide Supplementation for Exercise Tolerance Improvement in Healthy Older Adults

Inclusion Criteria:

• Adults aged 60 to 80 years, of any sex

• Written clearance from primary care physician confirming medical fitness toparticipate in an exercise-based clinical study

• Normal or near-normal cardiovascular function to safely engage in moderate tovigorous exercise, demonstrated by either: stress echocardiogram or coronary CTangiogram within the past 12 months showing normal left ventricular function, nosignificant valvular heart disease, no ischemic changes, and no other clinicallysignificant abnormalities, plus confirmation that no new cardiovascular symptoms (e.g., chest pain, dyspnea, syncope) or changes in health status have occurred sincetesting

• Montreal Cognitive Assessment (MoCA) score of 26 or higher

• Free from acute or uncontrolled chronic medical conditions that would pose a risk orinterfere with study participation

• Physically capable of engaging in structured exercise involving moderate to vigorousintensity stationary cycling

• Successful completion of a graded exercise test (e.g., stationary bike) withoutsignificant adverse events or contraindications

• Ability to attend at least four in-person laboratory visits in Beverly Hills,California

• Non-smoker for at least 12 months

• Able to provide informed consent and comply with study procedures

• Willing to refrain from initiating new exercise, dietary supplement, or medicationregimens during the study

Exclusion Criteria:

• Severe cardiovascular disease (e.g., recent myocardial infarction <6 months,unstable angina, uncontrolled hypertension >160/100 mmHg)

• Severe respiratory conditions (e.g., advanced COPD or other conditions preventingexercise participation)

• Significant neurological impairments that hinder comprehension of instructions orparticipation in exercise

• Terminal illness or conditions limiting life expectancy or ability to complete thestudy

• Severe cognitive impairment preventing informed consent, protocol adherence, orcomprehension of interventions

• Significant orthopedic limitations or injuries that prevent safe exerciseparticipation

• Use of NMN, NR, or other NAD+-altering supplements within the past 14 weeks

• Anticipated or current alcohol consumption >2 drinks per week, or unwillingness toabstain from alcohol during the study

• Current substance abuse affecting study participation or adherence

• Other acute or chronic health conditions judged by the investigators to pose risk orinterfere with study objectives

• Non-compliance with study requirements, withdrawal of informed consent, orunforeseen circumstances compromising completion

• Any condition which, in the opinion of the investigator, would interfere with studyparticipation or interpretation of results