, according to a new analysis of the best research to date on aerobic exercise and erectile function.
The study, published in The Journal of Sexual Medicine, found that aerobic activities – such as walking or cycling – improved erectile function in all men with erectile dysfunction, regardless of body weight, overall health, or medication use. Men with the most severe erectile dysfunction saw the greatest benefit.
“This study provides physicians and patients the proof needed to definitively recommend aerobic activity as part of ED management,” said study author Larry E. Miller, PhD, president, Miller Scientific Consulting, Johnson City, Tenn.
Doctors have long known that erectile function is linked to cardiovascular health, but there is limited high-quality evidence on the impact of exercise on the disorder.
The researchers scoured the scientific literature and found 11 randomized, controlled trials – a preferred study design where participants are randomly assigned to receive an intervention or not. Of the 1,100 men involved in the studies, 600 were assigned to “experimental” groups that typically exercised for 30 to 60 minutes, three to five times a week, while 500 were assigned to “control” groups with no exercise plan.
The worse the ED was, the more exercise helped, the researchers found. On a standardized scale of 6 to 30, men with severe ED who exercised reported a 5-point improvement in erectile function. Those with mild and moderate ED saw improvements of 2 and 3 points, respectively.
By comparison, phosphodiesterase-5 inhibitors – like sildenafil (Viagra) or tadalafil (Cialis) – can lead to improvements of 4 to 8 points, the study authors note. And testosterone replacement therapy can lead to an improvement of 2 points.
“We were particularly impressed by the finding that men with more severe erectile dysfunction saw greater improvements with exercise, and these improvements were similar to those seen in men taking” drugs like Viagra, Dr. Miller said.
ED and heart health
Erectile dysfunction can often be traced to the same causes as cardiovascular disease, including inflammation, a narrowing of the arteries (endothelial dysfunction), or a hardening of the arteries (atherosclerosis).
“It’s important to recognize that erectile dysfunction can often serve as an indicator or barometer of underlying cardiovascular health,” said Amy Pearlman, MD, a urologist specializing in male sexual health at Prime Institute in Miami.
Dr. Pearlman was not involved in the study but thinks the results make sense. “It stands to reason that any intervention aimed at enhancing cardiovascular health may also have a positive impact on erectile health.”
But what was surprising was that aerobic exercise reduced symptoms on par with medications like Viagra, said urologist Rahul Mehan, MD, founder of East Valley Urology Center, in Mesa, Ariz. (Dr. Mehan was also not involved in the study.)
While erectile dysfunction medications are generally affordable and accessible, some patients don’t want to take them or can’t tolerate the side effects. These can include “headache, heartburn, nausea, flushing, and pain in muscles, back, arms, or legs,” said Dr. Mehan. He adds, “Everyone can exercise.”
Some doctors, including Dr. Mehan, already recommend exercise to their patients with ED.
Now they can tell patients that it’s “a proven approach backed by high-quality data from randomized studies,” Dr. Miller said. “Exercise is low risk and affordable, making it an ideal first-line treatment option for erectile difficulties, especially for patients unwilling or unable to use medications.”
A version of this article first appeared on Medscape.com.