Exercise could work better than Viagra for some men with erectile dysfunction, according to a new study

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When most people think of erectile dysfunction (ED) treatments, pills like Viagra and Cialis often come to mind.

But there is a safer, healthier alternative that works just as good or better for some men, according to a new study published in The Journal of Sexual Medicine.

U.S. researchers analyzed the results of 11 previous studies involving hundreds of men, most middle-aged and overweight or obese. They found that regular aerobic exercise improved scores on a survey about erectile function, regardless of the severity of symptoms.

Men who reported severe erectile dysfunction—difficulty getting and keeping an erection—improved 4.9 points on a scale of 6-30, with higher scores indicating better function. For comparison, men with ED on prescription medications like Viagra and Cialis typically see an increase of 4-8 points—meaning that for some men with a severe form of the condition, exercise may work just as well or better.

What's more, unlike ED medications, exercise doesn't come with harmful potential side effects like headache, diarrhea, nosebleeds, numbness, vision changes, sudden loss of vision or hearing, chest pain, and difficulty breathing.

When it comes to exercise, the less severe the condition, the smaller the improvement in ED, researchers found. But score increases for all categories were statistically significant. Men with moderate ED saw a score increase of 3.3 points—2.3 for those with mild.

“Health care providers should consider recommending regular aerobic exercise as a low-risk,” drug-free therapy for ED, the authors wrote. And they’re not the only ones to come to the conclusion. Other studies have produced similar findings, including a 2006 Harvard University-based study involving more than 22,000 men ages 40-75 who were followed for 14 years.

Researchers found that men who ran for 1.5 hours or did 3 hours of rigorous outdoor work per week were 20% less likely to develop ED than those who didn’t exercise. Men who ran for 2.5 hours a week were 30% less likely to develop the condition. And regardless of exercise, men who were overweight or obese were at greater risk of having ED than men with an ideal BMI.

What causes erectile dysfunction?

There are a number of potential causes, scientists say, including:

  • decreased testosterone

  • decreased libido

  • health conditions like hypertension, diabetes, and obesity

  • aging

What are some side effects of erectile dysfunction?

Aside from unsatisfactory sexual performance, other potential health consequences include:

  • lower quality of life

  • anxiety

  • depression

  • relationship difficulties

ED may also serve as a warning sign of other diseases, like heart disease and diabetes.

What kind of exercises might improve erectile function?

The latest study looked at 11 previous studies, all of which differed from each other. But there were similarities. All generally involved 30-60 minutes of exercise, 3-5 times a week.

A variety of interventions were trialed, including:

  • providing weight-loss resources like exercise coaching (one with a goal of 7% weight reduction)

  • providing diet-improvement resources

  • cycling (sometimes interval)

  • walking

  • “moderate-somewhat strong” treadmill use

  • pelvic floor exercises

  • psychoeducation

  • resistance training

Men who wish to improve their erectile functioning should exercise for at least a half hour all or most days of the week, according to experts at Harvard. The 30-minute minimum can be broken up into 3, 10-minute segments.

More than a dozen activities qualify, they say, including:

  • jogging

  • using the treadmill

  • bicycling

  • swimming

  • brisk walks around the block

  • hiking

  • raking leaves

  • gardening

  • dancing

  • golfing

  • tennis

  • racquetball

  • rowing

  • basketball

  • cross-country skiing

Why does exercise seem to help erectile dysfunction?

There are a few reasons, according to experts:

  • Exercise promotes cardiovascular health, which is closely linked to erectile function.

  • Regular exercise helps reduce weight, lower blood pressure, and improve blood sugar control in people with diabetes—all of which improve ED risk factors.

  • Exercise improves the function of endothelial cells, which line the walls of blood vessels and help regulate exchange between the bloodstream and surrounding tissue. This results in improved vascular and erectile function.

  • Exercise can briefly increase testosterone levels.

  • Regular exercise helps reduce oxidative stress and inflammation, both of which can contribute to ED.

This story was originally featured on Fortune.com

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