Exercise and Sexual Function- Review of Studies

[Nelson Vergel]

This article is a systematic review investigating the relationship between physical activity and sexual function in adults, drawing from multiple studies to synthesize existing evidence. It specifically examines the impact of exercise on erectile function in men, where consistent aerobic activity shows promise as a non-pharmacological intervention. The review also acknowledges the limited research on females, highlighting a gap in understanding how physical activity affects their sexual function. Ultimately, it suggests that health policymakers should advocate for exercise as a preferred alternative to drug-based treatments for improving sexual health in both genders.

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[Nelson Vergel]

Briefing Document: The Relationship Between Physical Activity and Sexual Function in Adults​

Source: Excerpts from "A Systematic Review on the Relationship Between Physical Activity and Sexual Function in Adults - PMC" (Almuqahwi et al., 2023)

1. Executive Summary​

This systematic review investigates the correlation between physical activity (PA) and sexual function in adult men and women. The findings strongly suggest that consistent aerobic exercise is a "hopeful and efficient non-drug intervention for enhancing erectile function in men." However, the evidence regarding the effects of PA on female sexual function is significantly limited, making it challenging to draw clear conclusions. The review highlights the broader importance of sexual health as a vital component of overall well-being and quality of life, emphasizing that PA positively influences various health dimensions, including cardiovascular and psychological well-being, which indirectly benefit sexual health.

2. Key Themes and Findings​

2.1. Physical Activity and Male Sexual Function​

• Positive Impact on Erectile Dysfunction (ED): The review identifies ten randomized controlled trials predominantly focusing on males and consistently demonstrates that PA, particularly aerobic exercise, can significantly improve erectile function.
• "Consistent aerobic exercise proves to be a hopeful and efficient non-drug intervention for enhancing erectile function in men."
• A home-based walking program showed a "remarkable 71% decrease in erectile dysfunction after 30 days."
• Regular aerobic exercise "contributes to an improvement in the erectile function of men."
• Mechanism of Action: PA improves cardiovascular health, which is "intricately linked to erectile function." It also helps reduce body weight, lower blood pressure, and enhance glycemic control—all critical risk factors for ED, especially in individuals who are overweight, obese, or have diabetes.
• Variability in Outcomes: While positive, the extent of improvement in ED scores varied across studies, suggesting that the "type and intensity of PA" are important considerations. Interventions ranged from home-based walking to structured exercise training, with durations from eight weeks to two years.
• Non-Pharmacological Intervention: The review strongly advocates for PA as an "effective, non-invasive, and non-pharmacologic intervention for reducing ED."
• Limited Impact on Prostate Cancer Patients: One study noted that aerobic training did not significantly improve erectile function in prostate cancer patients after radical prostatectomy, despite cardiovascular improvements. This suggests that the intervention duration might have been "inadequate to impact erectile function."

2.2. Physical Activity and Female Sexual Function​

• Significant Research Gap: A major finding is the "significant gap in research focusing on females." Only two studies were included in this systematic review regarding PA's effect on female sexual function.
• Challenges in Drawing Conclusions: Due to the limited number and differing designs of studies, "the results present challenges in drawing clear conclusions" about the effects of PA programs on female sexual function and quality of sexual life.
• Indications of Positive Effects: Despite the limitations, some positive effects were observed:
• One study found a "significant time effect on sexual desire, with higher desire observed during the experimental exercise arm" (exercising immediately before sexual activity).
• Another study, while not directly reporting on a PA group's sexual function, indicated that yoga (a form of PA) improved Menopause-Specific Quality of Life scores, including the sexual domain.
• Need for Further Research: There is a clear need for "more comprehensive research in this area" to explore diverse aspects of female sexual function, considering factors like age, menopausal status, and specific types of PA.

2.3. Overall Importance of Sexual Health and Physical Activity​

• Cornerstone of Well-being: Sexual health is deemed a "cornerstone of overall well-being for individuals, couples, and families," contributing to physical, mental, and emotional health.
• Interconnectedness of Health Aspects: The review emphasizes the "intricate interplay between physical, psychological, and social aspects of sexual function," making it logical to consider PA's role in promoting sexual health.
• Health Policy Implications: Health policymakers are encouraged to "play an important role in providing guidelines and recommendations to healthcare professionals, encouraging them to prescribe exercise as a preferable alternative to pharmacological treatments for enhancing sexual functions in both men and women."

3. Important Facts and Ideas​

• Measurement Tools: The studies reviewed utilized the International Index of Erectile Dysfunction (IIEF-5) questionnaire for males and the Female Sexual Function Index (FSFI) for females to assess sexual function.
• Review Methodology: The systematic review followed PRISMA guidelines, searching four electronic databases (MEDLINE via Ovid, SCOPUS, Google Scholar, and Web of Science) and including 12 randomized controlled trials.
• Risk of Bias: The overall risk of bias in the included studies was "moderately low," with strengths in random sequence generation and selective reporting. However, "high-bias risks were consistently identified across all trials for performance and detection biases, primarily attributed to difficulties in blinding the treatment groups."
• Clinical Relevance: The findings "endorse the thoughtful recommendation of supervised PA as a rational approach for men dealing with ED." Physiotherapists are identified as key professionals in guiding and supervising PA for this purpose.
• Motivational Incentive: A holistic approach that links PA to both cardiovascular and sexual health can offer a "motivational incentive for men to make lifestyle changes."

4. Conclusion and Recommendations​

The systematic review provides strong evidence for the benefits of physical activity, particularly aerobic exercise, in improving erectile function in men. It underscores the potential for PA to be a first-line, non-pharmacological intervention for ED. However, the lack of robust research on female sexual function presents a significant challenge and highlights a critical need for more dedicated studies in this area.

Recommendations:

• For Men's Health: Healthcare professionals should actively recommend and, where appropriate, prescribe consistent aerobic exercise as a primary intervention for improving erectile dysfunction.
• For Women's Health: Further comprehensive research is urgently needed to understand the optimal types, durations, and intensities of PA that can positively influence female sexual function across different age groups and menopausal statuses.
• Health Policy: Policymakers should develop and disseminate evidence-based guidelines encouraging healthcare providers to integrate PA recommendations into patient care for sexual health.
• Future Research: Future studies should focus on elucidating the mechanisms by which PA influences sexual function in both genders, considering physiological, psychological, and social factors. Efforts should also be made to address the inherent biases in lifestyle intervention studies, where blinding is often difficult.