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

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 randomized 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 nonexercising 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 randomized 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 nonpharmacologic 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.