Physical activity as an adjunct treatment for erectile dysfunction

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Increasing data are available to suggest that physical activity and lifestyle modification in general can benefit erectile function, with effect sizes comparable with established treatment options such as testosterone therapy and phosphodiesterase type 5 inhibitors. Despite this evidence, primary-care physicians are rarely afforded critical information on the underlying mechanisms through which physical activity works as a treatment, severely hampering treatment credibility for both physician and patient. Physical activity is associated with psychological and metabolic adaptations that are compatible with the adaptations required for the treatment of erectile dysfunction (ED). These adaptations include increased expression and activity of nitric oxide synthase, strengthened endothelial function, acute rises in testosterone, decreased stress and anxiety, and improved body image. Use of physical activity as a first-line treatment option for ED is limited, and explicit physical activity guidelines for the treatment of ED are required. Such guidelines should include not only a suggested exercise programme but also guidelines for physician–patient communication that might enhance patient receptivity and therapy continuation. An understanding of how physical activity affects erectile function, as well as its effectiveness in treating ED compared with other established treatments, can benefit urologists and primary-care physicians searching for noninvasive treatment options for men presenting with poor erectile function.

Key points

  • Erectile function is a haemodynamic process governed by multiple regulatory systems; notably endothelial nitric oxide (NO), testosterone and psychological factors.

  • Physical activity is the most effective way to increase NO and strengthen endothelial function, and can also increase testosterone and positive body image, and decrease stress and anxiety.

  • Pharmacotherapy is the most common method of treating erectile dysfunction (ED), with testosterone therapy and phosphodiesterase type 5 inhibitors identified as effective treatments.

  • Physical activity interventions show the largest effect sizes in terms of efficacy for the treatment of ED.

  • Different exercise modalities — aerobic, resistance, combat training and group sports — have effects on different inputs into erectile function and can, therefore, be used together to maximize the therapeutic benefit.

  • Regular physical activity should be considered the first-line treatment option for men presenting with poor erectile function.

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Fig. 1: Mechanisms of penile erection.
Fig. 2: Physical activity and NO homeostasis.
Fig. 3: Differential effects of different exercise modalities.


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Nature Reviews Urology thanks A. Seftel, P. Jern and K. A. Josefsson for their contribution to the peer review of this work.

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Correspondence to Mark S. Allen.

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Allen, M.S. Physical activity as an adjunct treatment for erectile dysfunction. Nat Rev Urol 16, 553–562 (2019) doi:10.1038/s41585-019-0210-6

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