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Exercise as good as Viagra for impotence – US study

A recent US analysis suggests that just half an hour of exercise thrice weekly is as effective as Viagra and other medications aimed at improving erectile function, according to the experts.

Their study of the best research to date on aerobic exercise and erectile function, which was published in The Journal of Sexual Medicine, found that aerobic activities like walking or cycling improved erectile function in all men with erectile dysfunction, regardless of body weight, overall health, or medication use.

Those with the most severe erectile dysfunction saw the greatest benefit, reports Medscape.

“This study provides physicians and patients the proof needed to definitively recommend aerobic activity as part of ED management,” said study author Larry Miller, PhD, Department of Biostatistics, Miller Scientific.

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 randomised, controlled trials – a gold-standard 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 standardised scale of six to 30, men with severe ED who exercised reported a five-point improvement in erectile function.

Those with mild and moderate ED saw improvements of two and three points, respectively.

By comparison, phosphodiesterase-5 inhibitors – like sildenafil (Viagra) or tadalafil (Cialis) – can lead to improvements of four to eight points, the study authors note.

And testosterone replacement therapy can lead to an improvement of two 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,” 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 recognise that erectile dysfunction can often serve as an indicator or barometer of underlying cardiovascular health,” said Dr Amy Pearlman, a urologist specialising in male sexual health at Prime Institute in Miami.

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 Dr Rahul Mehan, founder of East Valley Urology Centre, in Arizona. (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 Mehan. He added: “Everyone can exercise.”

Some doctors, including 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 randomised studies”, 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.”

Study details

Effect of aerobic exercise on erectile function: systematic review and meta-analysis of randomised controlled trials 

Mohit Khera, Samir Bhattacharyya, Larry Miller.

Published in The Journal of Sexual Medicine on 9 October 2023

Abstract

Background
The health benefits of regular aerobic exercise are well established, although there is limited high-quality evidence regarding its impact on erectile function.

Aim
To determine the effect of aerobic exercise on erectile function in men and to identify factors that may influence this effect.

Methods
This systematic review and meta-analysis included randomised controlled trials that evaluated the effects of aerobic exercise on erectile function via the Erectile Function domain of the International Index of Erectile Function (IIEF-EF). The mean difference in IIEF-EF scores between the aerobic exercise and non-exercising control groups was estimated by a random-effects meta-analysis. Meta-regression was used to evaluate the association of moderator variables on meta-analysis results.

Outcomes
The IIEF-EF score is reported on a 6-30 scale, with higher values indicating better erectile function.

Results
Among 11 randomised controlled trials included in the analysis, aerobic exercise resulted in statistically significant improvements in IIEF-EF scores as compared with controls, with a mean difference of 2.8 points (95% CI, 1.7-3.9; P < .001) and moderate heterogeneity among studies (I2 = 53%). The effect of aerobic exercise on erectile function was greater in men with lower baseline IIEF-EF scores, with improvements of 2.3, 3.3, and 4.9 points for mild, moderate, and severe erectile dysfunction, respectively (P = .02). The meta-analysis results were not influenced by publication bias or individual study effects.

Clinical Implications
Health care providers should consider recommending regular aerobic exercise as a low-risk non-pharmacologic therapy for men experiencing erectile difficulties.

Strengths and Limitations
The primary strength of this review was the generation of level 1 evidence on a topic of general interest regarding sexual health in men. However, the included studies evaluated diverse groups, which may complicate data interpretation for specific segments of the population.

Conclusion
Regular aerobic exercise can improve the erectile function of men, particularly those with lower baseline IIEF-EF scores.

 

Journal of Sexual Medicine article – Effect of aerobic exercise on erectile function: systematic review and meta-analysis of randomised controlled trials (Open access)

 

Medscape article – Exercise as Good as Viagra for ED: Study (Open access)

 

See more from MedicalBrief archives:

 

Up to half of men under 50 suffer from erectile dysfunction

 

Pfizer to launch generic and chewable Viagra

 

Impotence related to an unhealthy lifestyle

 

 

 

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