Exercise instead of Viagra?

Good news for men with erectile dysfunction: Regular aerobic exercise can be an effective treatment for this condition.

A recent meta-analysis of 11 studies showed aerobic exercise sessions of 30-60 minutes done three to five times a week significantly improved symptoms for men with erectile dysfunction (ED). Men with the worst symptoms saw the greatest improvement, but symptoms were lessened for men with mild and moderate ED, as well.

The meta-analysis was published October 9, 2023 in The Journal of Sexual Medicine, and drew data from randomized studies involving 1,147 men, of whom 636 performed aerobic exercise and 511 in control groups did not.

“Aerobic exercise improves blood flow to all parts of the body,” said urologist Evangelos G. Geraniotis, MD, FACS. “ED is a cardiovascular or blood flow problem. Anything that improves blood flow is going to help.”

Dr. Geraniotis, who practices at Urology Associates of Cape Cod, with offices in Yarmouth Port, North Falmouth and Sandwich, was not involved with the meta-analysis. He said he recommends aerobic exercise to his patients with ED, along with losing weight and controlling their blood sugar and blood pressure.

“Every man who comes in here with ED wants to know why he has it,” he said. “Cardiovascular health, overall physical condition, diabetes, high blood pressure all relate to it.”

Undiagnosed Problems

The strength of the link between health and the ability to have an erection is such that the presence of ED may indicate undiagnosed problems, such as heart issues in younger men, Dr. Geraniotis said. Low levels of testosterone can also contribute to ED.

“Testosterone can decline with age, but it doesn’t always,” Dr. Geraniotis said. “You can have ED with testosterone and blood flow issues.”

Regular aerobic exercise improves testosterone levels and lowers cholesterol, which can form plaques that impede flow in small blood vessels throughout the body, he said. Exercise also helps counter obesity and high blood pressure, he added.

Dr. Geraniotis said he always assumed that a correlation exists between exercise and ED, but the meta-analysis provides evidence that exercise works. The authors of the meta-analysis wrote that aerobic exercise can be a low-risk, non-drug treatment for men with ED and those likely to develop it.

Dr. Geraniotis said he wasn’t surprised men with severe symptoms benefitted the most from aerobic exercise.

“They’re at the point where anything you do is going to help,” he said.

Options beyond medications to improve blood flow to the penis include injection therapy and penile implants, he said.

Discipline Required

“An exercise program will take about three months to take effect,” Dr. Geraniotis said. “Be patient – stick with it. You can exercise and take medication (for ED), plus weight loss – it will all make a difference.”

Getting a patient to commit to regular exercise can be difficult, he said. Younger men can have busy schedules and older men may be sedentary. Using just medication, such as Cialis or Viagra, seems like an easier route.

“There is a group of men who don’t want to follow recommendations,” Dr. Geraniotis said. “They come back six months later and have excuses for why they couldn’t exercise or lose weight and the problem still exists.”

“Many men who come in simply want to take a pill.”

However, some patients prefer to avoid medications, and an exercise program may appeal to them, he said.

“The condition is under their control – we help them make a change and their lives are better.”