- A new meta-study finds that exercise is almost as effective in treating erectile dysfunction (ED) as medications for the condition, and is also safer and less expensive.
- The largest sexual performance gains observed in the study occurred for men with the most severe erectile dysfunction.
- Erectile dysfunction is linked to cardiovascular health and can be improved using the same forms of exercise that promote heart health.
- The study is a meta-analysis of randomized controlled studies, making its conclusions highly credible.
For men with erectile dysfunction (ED), regular exercise can be almost as effective as ED medications, such as Viagra (sildenafil), at improving performance, according to a new study. The authors say the benefits of exercise include other sexual performance benefits as well.
The study found that men with severe ED improved more with exercise.
Erectile dysfunction is measured according to the 30-point International Index of Erectile Function (IIEF-EF). Scores of 26 to 30 indicate no erectile dysfunction, 22 to 25 indicate mild erectile dysfunction, while scores of 17 to 21 indicate mild to moderate erectile dysfunction. Moderate ED corresponds to a score of 11 to 16, and a score of 6 to 10 indicates severe ED.
In the descriptive study, the average improvement was 2.8 points on the IIIEF-EF scale. Exercise led to improvements of 2.3, 3.3, and 4.9 points in mild, moderate, and severe erectile dysfunction, respectively.
What distinguishes this meta-study is that its analysis is based on 11 randomized, controlled studies. Such studies are considered the gold standard in research.
The study was published in Oxford Journal of Sexual Medicine.
Urologist Dr. Mehran Movassaghi, who was not involved in the study, explained that cardiovascular health is closely linked to ED:
“[ED is] Basically like a 10-year introduction to possible cardiovascular deterioration. If you have erection problems at the age of 30 or 40, the most important thing is not to take Viagra or Cialis, but to check your lipid panel.
He explained that the same atherosclerosis that causes strokes and myocardial infarctions is the same condition that occurs in the blood vessels of the penis. However, because these blood vessels are relatively small, its effect becomes evident and its symptoms appear very early.
“I kind of joke with my patients when I say, ‘You can open a window into a man’s heart by looking at his penis,’” Dr. Movasaghi noted.
“And you know, that’s true in the sense that if they have healthy erections, they’re likely to have good cardiovascular health,” he added.
He added that cardiovascular disease risk factors such as high blood pressure, metabolic syndrome, dyslipidemia, and diabetes are also risk factors for ED.
Some men experience ED as a result of radical prostatectomy, which may cause muscle damage, causing ED. The single radical prostatectomy study included in the meta-study analysis “was not sufficient for us to adequately explore the effect of exercise in this subgroup of patients specifically,” according to Dr. Larry E. Miller, the study’s corresponding author.
Most ED medications — including Viagra and Cialis — are PDE5, or phosphodiesterase 5, inhibitors. PDE5 inhibitors work by stopping the action of the enzyme phosphodiesterase 5, which enhances nitric oxide activity and allows smooth muscle in the penis to relax. When smooth muscles relax longer, this allows the penis to become engorged.
“Some patients cannot use PDE5 inhibitors due to medical contraindications or intolerance to side effects,” Dr. Miller noted.
Dr. Movasaghi explained that such drugs “do not act selectively in the smooth muscles of the penis. It also works on smooth muscles in different areas of the body. The result can be a severe drop in blood pressure, as well as “esophageal reflux disease, or gastroesophageal reflux disease, because the lower esophageal sphincter in the esophagus is also under smooth muscle control.”
Sinusitis may also occur with PDE5 inhibitors, along with headache.
Meanwhile, PDE5 drugs are also prescribed to treat pulmonary hypertension and blood pressure in the lung blood vessels.
“For many years, exercise has been underused to treat ED due to a lack of research on its effectiveness,” Dr. Miller said. But now we can confidently say that exercise provides clinically meaningful improvements in erectile function.
Across the trials analyzed in the meta-study, there were differences in the amount of exercise evaluated. However, most aerobic exercise involves 30 to 60 minutes, three to five days a week, Dr. Miller said.
These levels of physical activity are consistent with recommendations from the American College of Sports Medicine (ACSM) and the Centers for Disease Control and Prevention.
“Individuals who cannot achieve these goals should be as physically active as their abilities and circumstances allow,” Dr. Miller said.
Since erectile dysfunction is linked to cardiovascular health,
Dr. Miller noted that exercise benefits more than ED in terms of sexual performance, including improved libido, improved stamina, and improved self-confidence.
The study authors also found that in addition to exercise, “exercises that target the pelvic floor, such as Kegel exercises, can also improve sexual endurance by improving muscle control, which may lead to prolonged sexual activity and increased orgasmic responses.”
“This study provides the first level I evidence from a meta-analysis of randomized trials supporting the effectiveness of exercise for improving erectile function,” said Dr. Miller.
“Now doctors can confidently tell their patients that regular aerobic activity is a proven approach supported by high-quality data from randomized studies.”
He added that exercise should be the first line of intervention for treating ED because it is low-risk, affordable, and available to people who would not or cannot take PED5 medications.
“This meta-analysis provides clinicians with the evidence needed to vigorously encourage exercise as part of a comprehensive approach to managing erectile dysfunction.”
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