Exercise and Diet for Erections: What the Trials Actually Show

This is the rare case where the lifestyle advice is not a consolation prize handed out because the real treatment is expensive. In men with severe erectile dysfunction, the measured effect of aerobic exercise lands within range of a prescription drug.

Does exercise actually improve erections?

The best evidence here is a 2023 systematic review and meta-analysis in the Journal of Sexual Medicine. It pooled 11 randomised controlled trials covering 1,147 men: 636 assigned to exercise, 511 to control.

Erectile function was measured on the International Index of Erectile Function erectile function domain, which runs from 6 to 30. Aerobic exercise improved scores by a mean of 2.8 points (95% confidence interval 1.7 to 3.9).

The more interesting result is what happened when the analysis split men by how bad their dysfunction was to begin with:

The difference across those groups was statistically significant. The men with the most to gain gained the most, which is the opposite of how most interventions behave and is a point in this one’s favour.

How much exercise do you need?

Worth stating precisely, because “exercise more” is not a prescription and the trials were specific.

Sessions ran 30 to 60 minutes, at a frequency of three to five times per week. Trial durations ranged from two to twenty-four months, with a median of six. Six of the eleven trials supervised the sessions; five relied on counselling and unsupervised activity.

This is aerobic exercise — the kind that raises your heart rate and keeps it there. Note that this is a different finding from the testosterone literature, where resistance training showed no effect on resting hormone levels. Different mechanism, different outcome: here you are training blood vessels, not hormones.

How does exercise compare with Viagra?

The review’s authors put their result alongside the other treatments on the same scale, which is unusually helpful of them.

Read honestly: for a man with mild dysfunction, exercise is worth doing but is not going to match a tablet. For a man with severe dysfunction, the exercise effect is in the same range as shockwave therapy and the lower end of the drug range, and it treats the disease underneath rather than the symptom.

These are not alternatives to choose between. Nothing stops you doing both, and the drug works on the evening while the exercise works on the cause.

Does losing weight fix erectile dysfunction?

The other solid piece of evidence is older and, in its way, more striking.

A randomised controlled trial enrolled 110 obese men aged 35 to 55, all with erectile dysfunction. Fifty-five received detailed support to lose at least 10% of their body weight; fifty-five received general healthy-lifestyle information. It ran for two years.

Roughly one man in three in the intervention group recovered normal erectile function without any treatment aimed at erections. The control group, over the same two years, went nowhere.

Why does exercise help erections at all?

An erection depends on the endothelium, the lining of your blood vessels, producing nitric oxide on demand. Endothelial dysfunction is what breaks that, and it is also the first stage of atherosclerosis.

Aerobic exercise improves endothelial function. So does losing visceral fat, which is metabolically active tissue that drives inflammation and insulin resistance. You are not doing something vague and wholesome to your general wellbeing; you are improving the specific tissue that has to work for an erection to happen.

That is also why these interventions do more than the erections. The same endothelium supplies your heart.

What does smoking do to erections?

Smoking is a direct and dose-related cause of vascular erectile dysfunction, through exactly the same endothelial mechanism. It is listed among the medical causes in the clinical guidance on distinguishing organic from psychogenic ED.

There is not much nuance to offer here. If you smoke and you have erectile dysfunction, you have found a cause, and it is one you can remove.

What can exercise not fix?

Three honest limits.

It is slow. The trials ran a median of six months, and the weight loss trial ran two years. Nothing here works this weekend.

It does not replace finding out what is wrong. Erectile dysfunction is a recognised marker for cardiovascular disease, typically arriving years before heart symptoms. Starting to exercise is an excellent response; it is not a substitute for having your blood pressure, glucose and lipids checked. That argument is laid out in why this is a heart warning first.

It will not fix a non-vascular cause. If the problem is a medication, a hormone deficiency, nerve damage after surgery, or is largely psychological, better endothelial function is not the lever. Which of those you are dealing with is the subject of telling physical from psychological.

This article is for information only and is not medical advice. It cannot account for your individual circumstances. Talk to a doctor about your own situation, particularly before starting or stopping any prescription medication.