Physical Activity Improves Erectile Function

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A recent systematic review of intervention studies has found that in men with erectile dysfunction (ED), “supervised training consisting of aerobic exercise of moderate to vigorous intensity 4 times per week for 40 minutes,” or “an overall weekly exercise dose of 160 minutes for 6 months,” decreases ED.¹

What Is ED?

ED, which refers to “inability to attain or maintain a penile erection of sufficient quality to permit satisfactory sexual activity,” may be the most common male sexual dysfunction. On average, ED affects one third of all men, and its prevalence increases with age.

Some of the risk factors for erectile dysfunction include physical inactivity, hypertension (high blood pressure), obesity (excessive body fatness), and metabolic syndrome (refers to a cluster of risk factors such as obesity and hypertension, that increase the risk for cardiovascular disease).

The risk factors also include atherosclerosis (buildup of cholesterol in the blood vessel walls and formation of plaques, which narrows the blood vessels and slows the flow of blood) and cardiovascular disease (various conditions that affect the heart and blood vessels, including stroke and heart attack).

ED and mental health

Sexuality is a significant part of not only physical but also mental health. Not surprisingly, ED negatively affects mental health and is associated with depression and anxiety.

For instance, a 2014 survey of 40 publications concluded that prior to the treatment, men with ED reported “poor sexual relationships and sexual satisfaction, diminished confidence, low self-esteem, and symptoms of depression,” but that after treatment, “there were significant improvements from baseline in most of these measures.”²

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Can physical activity improve ED? How?

According to previous research, physical activity “has been identified as the lifestyle factor most strongly correlated with erectile function and the most important promoter of vascular health.”¹

Physical activity improves ED through improvement in endothelial functioning and the production of nitric oxide.

Nitric oxide is a gas and a signaling molecule and has numerous biological functions. In one such role, it directs the local smooth muscles to relax and the blood vessels to dilate; this results in increased blood flow, which improves erection.

The current review

Thought previous reviews have shown that physical activity protects against ED, the present review attempted to determine the specific type of (and duration of) physical activity needed to improve erectile functioning in men who are physically inactive, obese, and those with hypertension, metabolic syndrome, atherosclerosis, and cardiovascular disease.

Of the 2,000 potentially relevant studies identified, only ten met the inclusion criteria, including seven randomized controlled trials and three controlled trials.

The participants in these studies were aged 41 to 62. Most of the research had been conducted in Europe, with one study in Asia, one Africa, and one in the US.

Results of the review

The researchers concluded that “continuous and interval based aerobic training” improves ED. In addition, physical activity with “moderate intensity and intervals of vigorous intensity” appeared to be one of the main elements that determined the efficiency activity, a finding that was in accord with conclusions of previous reviews.

The authors also determined that “resistance training can complement aerobic exercises.” Specifically, the weekly duration and frequency of aerobic physical activity required to treat ED was “a volume of 4 sessions of moderate- to high-intensity training lasting 40 minutes per session, corresponding to a weekly dose of 160 minutes.”

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This recommendation is in accordance with one previous investigation, but not another—which had suggested 200-300 minutes of moderate-intensity training was more effective than 90 to 150 minutes of activity per week. That study, however, had included obese men and thus their findings may not apply to people who have ED but are of normal weight.

The recommendations of the present investigation are also slightly higher than World Health Organization’s recommendation of at least 75 minutes of vigorous-intensity or 150 minutes of moderate-intensity aerobic physical activity per week for healthy adults.

Aside from exercise, other non-pharmacologic interventions shown to be effective for decreasing ED include smoking cessation, pelvic floor muscle exercises, and weight loss.