Athletic performance / endurance

MOTS-c is an exercise-induced mitochondrial peptide; intermittent injection enhanced running/physical performance in young, middle-aged and old mice and improved myocardial efficiency during training in rats.

Human NAD+-precursor (nicotinamide riboside) trials are mixed: acute NR improved isometric strength and fatigue index in older men but not young; 7-day NR did not alter muscle NAD+ or exercise metabolic/mitochondrial responses in young men.

In sedentary mice, 4 weeks of the AMPK agonist AICAR alone increased treadmill running endurance by ~44% and induced oxidative-metabolic genes, demonstrating drug-induced endurance without exercise (rodent only).

BPC-157 accelerated healing of tendon, ligament and skeletal-muscle injuries in rodent models (e.g., improved functional and biomechanical medial collateral ligament healing), but efficacy remains unconfirmed in humans.

In aged mice, 8 weeks of elamipretide (SS-31) reversed age-related decline in mitochondrial ATP production, restored muscle redox homeostasis, increased fatigue resistance and significantly improved treadmill endurance.

In a randomized controlled trial in older adults, adding metformin to progressive resistance training blunted muscle hypertrophy and attenuated training-induced transcriptomic (ECM remodeling) adaptations versus placebo.