The Role of Physical Activity in Erectile Functio
Erectile dysfunction is recognized as the most common sexual dysfunction in men. It has a negative impact on quality of life and well-being, and is further associated with anxiety and depression. In this article, Dr. Paul Henning investigates the role of physical activity on erectile dysfunction.More
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The value of physical activity in living a long quality life is deeply underappreciated. There are hundreds of studies demonstrating that regular exercise mitigates the risk of developing some deadly problems, including heart disease, stroke, and certain types of cancer (e.g., colorectal cancer). Exercise also alleviates the burden of chronic ailments like hypertension, diabetes, and arthritis.
A crucial area of concern for men is the fact that exercise seems to enhance prostate health.
Emerging scientific evidence indicates that engaging in exercise may reduce the risk of erectile dysfunction. Sexuality is an important part of physical and mental health.
Erectile dysfunction is recognized as the most common sexual dysfunction in men(1) and is described as the inability to attain or maintain an erection of sufficient quality to permit satisfactory sexual activity(2).
Evidence indicates that the sexual function of the male partner determines whether aging, heterosexual couples continue to be sexually active(3).
Erectile dysfunction has a negative impact on quality of life and well-being, and is further associated with anxiety and depression. Consequently, erectile dysfunction is increasingly recognized as a public health challenge(4), although it is frequently neglected in clinical practice(5). Erectile dysfunction affects approximately 33% of all men, and the prevalence increases with age(1).
It is extremely clear from the research that physical inactivity, obesity, hypertension, metabolic syndrome, atherosclerosis, and manifest cardiovascular diseases are risk factors for erectile dysfunction(6) because the prevalence of erectile dysfunction is increased in these general population groups.
It is also important to note that there is a positive correlation with erectile dysfunction and the number of risk factors present within an individual. Penile erection is a hemodynamic process involving increased arterial inflow and restricted venous outflow(7); hence erectile dysfunction can be an early warning sign of poor vascular function. Thus, erectile dysfunction has been coined “penile angina”(8) because it can be predictive of future cardiovascular disease and because cardiovascular risk factors and cardiovascular disease frequently lead to erectile dysfunction(9). A central determinant of vascular diseases including erectile dysfunction is endothelial inflammation and the disruption of nitric oxide production(9). The main therapeutic strategy in clinical health care is to compensate for erectile dysfunction by using phosphodiesterase type 5 inhibitor medications. However, phosphodiesterase type 5 inhibitors only provisionally restore erectile function, and they have been found to be ineffective in a significant proportion of men with erectile dysfunction.
Additionally, these medications do not provide a long-term curative effect on endothelia, arterial dysfunctions or erectile problems. Importantly, the role of non-pharmacologic lifestyle interventions in lessening the burden of erectile dysfunction have increasingly been recognized.
Physical activity can potentially decrease erectile dysfunction(10), and it has been deemed the lifestyle factor most strongly correlated with erectile function and the most important promoter of vascular health(11).
The protective effect of physical activity also applies to men with obesity, hypertension, and metabolic syndrome who can benefit from the protective effect of physical activity. This is due to the enhancement of endothelial function and nitric oxide production from physical activity. There is strong evidence that frequent physical activity significantly enhances erectile function. One of the things lacking in the literature is the quality and quantity of physical activity needed (i.e., modalities, duration, intensity, and frequency) are insufficiently described(5) although clear guidance on these variables is essential for clinical management of patients with erectile dysfunction.
To fill this gap of knowledge, a recent systematic review was conducted to provide recommendations of levels of physical activity needed to decrease erectile dysfunction for men with physical inactivity, obesity, hypertension, metabolic syndrome, and/or apparent cardiovascular diseases(6).
Major Findings of This Research
The main outcome of this systematic review was to enhance the understanding of the levels of physical activity (i.e., modality, intensity, duration of sessions, frequency, weekly dose, and training period) needed to improve erectile function for men with physical inactivity, obesity, hypertension, metabolic syndrome, and/or manifest cardiovascular disease.Evidence indicates that continuous and interval-based aerobic training improve erectile function for men with arterial erectile dysfunction. Physical activity with moderate intensity and intervals of vigorous intensity seems to be one of the key elements in determining the efficiency of the applied physical exercise. Research also indicates that resistance training can complement aerobic exercises. It is recommended that four weekly sessions of aerobic activity are required to treat erectile dysfunction. Each session should be moderate to high intensity and last 40 minutes in duration, corresponding to a weekly dose of 160 minutes. Other important non-pharmacologic interventions such as diet, weight loss, pelvic floor muscle training, and smoking cessation also improve erectile function for men with arterial erectile dysfunction(7). Further research regarding the effect of physical activity on arterial erectile dysfunction for men with physical inactivity, obesity, hypertension, metabolic syndrome, and/or manifest cardiovascular diseases is needed.
Additionally, more data is needed to understand the benefits of resistance training in addition to aerobic training in mitigating erectile dysfunction. Importantly, more knowledge of improvements of specific physiologic markers of physical fitness correlated to the decrease of erectile dysfunction is important which would effectively increase our understanding of the positive effect of physical activity on erectile dysfunction.
Mechanisms of Action
The mechanism of action in causing erectile dysfunction seems to be caused by an increase in oxidative stress in the vascular endothelium. This increase in oxidative stress results in an imbalance in the production of vasodilator and vasoconstrictor substances, conducing to the appearance of the erectile dysfunction and therefore cardiovascular diseases.
Is it possible that a physically active lifestyle improves endothelial function, preventing and/or mitigating the onset of erectile dysfunction and cardiovascular diseases.
Figure: Possible influences of physical activity on endothelial dysfunction: a link between prevention/treatment of erectile dysfunction and cardiovascular diseases. EDHF - Endothelium-derived hyperpolarizing factor; ROS - reactive oxygen species; ED erectile dysfunction; CVDs cardiovascular diseases(2).
Recommendations and Clinical Implications
Physical activity is an effective intervention to treat arterial erectile dysfunction. Unfortunately, physical activity is rarely used in clinical practice to improve erectile function(5), which represents a paradox and is far from optimal considering the effect of physical activity on arterial erectile dysfunction.
Evidence supports supervised aerobic physical activity with moderate to vigorous intensity as a rational recommendation for men with erectile dysfunction, indicating a potential key role for physiotherapists in the treatment of arterial erectile dysfunction.Findings from this research emphasize the need for evidence-based guidelines for clinical practice that support physical activity-centered improvement of erectile function. A clearer understanding of the complex web of factors influencing erectile function and overall vascular health, physiotherapists and other health care providers can help their patients prevent vascular diseases and thereby improve their sexual health. The benefit is an opportunity for immediate motivation in men looking to change their lifestyle habits to improve their cardiovascular health.
Summary
Recommendations considering physical activity to decrease arterial erectile dysfunction should include supervised training consisting of aerobic exercise of moderate to vigorous intensity 4 times per week for 40 minutes.
An overall weekly exercise dose of 160 minutes for 6 months contributes to a decrease of erectile dysfunction for men with arterial erectile dysfunction due to physical inactivity, obesity, hypertension, metabolic syndrome, and/or manifest cardiovascular disease.Walking is the one of easiest ways to get in some cardiovascular activity on a daily basis. What happens when you walk just 1-mile per day? You can find out here.References: 1. Porst H, Burnett A, Brock G, et al: SOP conservative (medical and mechanical) treatment of erectile dysfunction. J Sex Med 10:130-71, 2013 2. Leoni LA, Fukushima AR, Rocha LY, et al: Physical activity on endothelial and erectile dysfunction: a literature review. Aging Male 17:125-30, 2014 3. Beckman N, Waern M, Gustafson D, et al: Secular trends in self reported sexual activity and satisfaction in Swedish 70 year olds: cross sectional survey of four populations, 1971-2001. BMJ 337:a279, 2008 4. Liu LH, Zhang T, Zhang YR, et al: Metabolic syndrome and risk for ED: a meta-analysis. Int J Impot Res 26:196-200, 2014 5. Silva AB, Sousa N, Azevedo LF, et al: Physical activity and exercise for erectile dysfunction: systematic review and meta-analysis. Br J Sports Med 51:1419-1424, 2017 6. Gerbild H, Larsen CM, Graugaard C, et al: Physical Activity to Improve Erectile Function: A Systematic Review of Intervention Studies. Sex Med 6:75-89, 2018 7. Maiorino MI, Bellastella G, Esposito K: Lifestyle modifications and erectile dysfunction: what can be expected? Asian J Androl 17:5-10, 2015 8. Meldrum DR, Gambone JC, Morris MA, et al: The link between erectile and cardiovascular health: the canary in the coal mine. Am J Cardiol 108:599-606, 2011 9. Kirby M: The Circle of Lifestyle and Erectile Dysfunction. Sex Med Rev 3:169-182, 2015 10. Johansen PP, Zwisler AD, Hastrup-Svendsen J, et al: The CopenHeartSF trial--comprehensive sexual rehabilitation programme for male patients with implantable cardioverter defibrillator or ischaemic heart disease and impaired sexual function: protocol of a randomised clinical trial. BMJ Open 3:e003967, 2013 11. Meldrum DR, Gambone JC, Morris MA, et al: Lifestyle and metabolic approaches to maximizing erectile and vascular health. Int J Impot Res 24:61-8, 2012
