Exercise to prevent and treat ED
WHAT IS THE RELATIONSHIP BETWEEN ERECTILE DYSFUNCTION AND HEART DISEASE?
Erectile dysfunction (ED) is the inability to attain or sustain erection of sufficient quality for or during sexual intercourse and performance.
Worldwide, it is estimated that 150 million men have some degree of erectile dysfunction. The figure is likely to double by 2025.
It is one of the most common men’s health problems, especially among those above 40.
In Malaysia, the prevalence of ED is estimated between 26.8-69 per cent in this age group. It means that, in every 10 males aged more than 40, there are about three to seven persons with ED.
Higher prevalence was shown in urban areas, where 70.1 per cent of males in urban areas in Malaysia has ED. ED increases with age. Most (65 per cent) will usually seek traditional medicine for treatment.
ED is associated with other medical conditions like hypertension, diabetes and heart disease. The causes of ED are vascular, neurological, hormonal and psychological.
The most common is vascular problem. ED shares the same risk factor as heart disease. ED is not a life-threatening condition, if it does not occur alongside heart disease.
However, most patients presented with coronary heart disease will usually have ED.
At the same time, patients presented with ED may have heart disease too. A study in Malaysia showed that 90.4 per cent of patients with ischemic heart disease have some degree of ED.
Two-thirds have moderate to severe ED. Lifestyle is the most important modifiable risk factor in ED and heart disease. The lifestyle risk factors are smoking, physical inactivity, obesity, bad diet and alcohol intake. Controlling these factors such as taking up exercise will help reduce the risk of getting ED (and heart disease too).
HOW DOES EXERCISE PREVENT ERECTILE DYSFUNCTION?
Lack of exercise is one of the important lifestyle risk factors of ED after smoking. If you are physically inactive, you have three to four times chance of getting ED than active people.
Exercise at moderate and high intensity has been shown to reduce risk of ED by 37 and 58 per cent respectively. The higher the intensity of exercise, the lower the risk of getting ED. A population study reveals that exercise of more than 18 METs-hour per week will cause better erectile function.
This is equivalent to brisk walking of 3.6 hours per week, or 30 minutes of brisk walking per day. This is similar to the recommendation of exercise by the World Health Organisation, which is more than 30 minutes of exercise per day, five times a week. The more the exercise, the more benefit you will reap.
The most common cause of erectile dysfunction is vascular problem, where there is a problem of artery supplying blood to the region, known as endothelial dysfunction.
In endothelium dysfunction, the artery is not able to produce nitric oxide, which causes occlusion and narrowing of the artery, reducing blood flow and impairing the erection process.
Exercise is able to prevent ED by ensuring availability of nitric oxide through improvement of endothelial function of the artery.
The availability of nitric oxide production by normal endothelium will ensure normal erection process.
CAN EXERCISE TREAT ERECTILE DYSFUNCTION?
Lifestyle modification is the first line of treatment for ED. Exercise is part of lifestyle modification and improvement of ED by exercise has been shown in many studies.
Erectile dysfunction is assessed using International Index of Erectile Function 5 (IIEF-5). Its range of score is between 5 and 25. A score of 22 or more is considered as normal erection function.
There is a systematic review published in Sexual Medicine Journal in 2018. The aim of the study is to provide recommendation of exercise for men with ED.
The review analysed 10 intervention studies, using physical activity to reduce ED.
The study showed that there is improvement of IIEF score between 15 per cent86 per cent in the intervention group (with exercise).
The study concludes that the recommended exercise to decrease ED is 40 minutes of aerobic exercise at moderate to vigorous intensity four times per week.
A total of 160 minutes of exercise per week for six months will decrease erectile problem in men with ED due to physical inactivity, obesity, hypertension, metabolic syndrome, and/or cardiovascular diseases.
Lack of exercise is one of the important lifestyle risk factors of erectile dysfunction after smoking.