Exercise may improve erectile function in men with prostate cancer

A recent study published in JAMA Network Open found that 6 months of supervised resistance and aerobic exercise improved erectile function, compared with regular care, in men with prostate cancer.¹

According to the authors, these data support the use of exercise as a potential rehabilitation measure in these patients.

Daniel Galvão, PhD

“Erectile dysfunction is a major issue that affects [patients with] prostate cancer, but it also results in relationship issues,” explained lead author Daniel Galvão, PhD, of Edith Cowen University in Australia, in a news release on the findings.² “Most of these patients aren’t offered health interventions to support their sexual function, and we are hoping to address this.”

To that end, the study enrolled 112 participants who were randomly assigned 1:1:1 to 6 months of supervised, group-based resistance and aerobic exercise (n = 39), the same exercise program plus a brief psychosexual education and self-management intervention (PESM; n = 36), or to usual care (n = 37). Patients in the first 2 arms participated in the exercise intervention 3 days per week.

At 6 months, sexual function was significantly improved in the exercise arm, with a mean adjusted difference in International Index of Erectile Function (IIEF) erectile function scores of 5.1 points with exercise vs 1.0 with usual care (HR, 3.5; 95% CI, 0.3-6.6; P = .04). There was no significant difference between the 2 arms in the mean change in intercourse satisfaction scores (adjusted mean difference, 1.7; 95% CI, 0.1-3.2; P = .05). The addition of PESM did not lead to additional improvements in IIEF erectile function scores (adjusted mean difference, 1.1; 95% CI, −2.7 to 4.8; P = .89) or intercourse satisfaction scores (adjusted mean difference, −0.2; 95% CI, −2.1 to 1.6; P = .64).

Patients in the exercise arm and the standard care arm also did not differ significantly in regard to sexual function scores on the Expanded Prostate Cancer Index Composite (adjusted mean difference, 7.9; 95% CI, 0.2-15.6; P = .09) or sexual activity scores with EORTC QLQ-PR25 (adjusted mean difference, 2.9; 95% CI, −4.1 to 9.9; P = .70).

Subgroup analysis showed that patients who underwent radiotherapy (adjusted mean difference, 4.2; 95% CI, 0.4-8.0; P = .11) and ADT (adjusted mean difference, 4.4; 95% CI, 0.2-8.7; P = .08) demonstrated greater improvements in erectile function with exercise compared with patients who underwent prostatectomy (adjusted mean difference, 1.6; 95% CI, −2.5 to 5.7; P = .36). Additionally, patients with lower baseline levels of sexual desire, intercourse satisfaction, and overall satisfaction showed greater benefit with the exercise intervention.

Patients in the exercise arm demonstrated a greater change in body composition at 6 months, with a mean difference for fat mass of -0.9 kg (95% CI, −1.8 to −0.1 kg; P = .02) in favor of the intervention group. Those in the exercise arm also achieved an improvement in chair rise performance, with an adjusted mean difference of −1.8 seconds (95% CI, −3.2 to −0.5 seconds; P = .002). Upper (adjusted mean difference, 9.4 kg; 95% CI 6.9-11.9 kg; P < .001) and lower (adjusted mean difference, 17.9 kg; 95% CI, 7.6-28.2 kg; P < .001) body muscle strength were also improved with regular exercise.

Based on these findings, Galvão concluded in the news release,² “The study suggests that exercise would be an effective intervention for men with prostate cancer who express concern about sexual dysfunction, and that exercise medicine should be considered a key part of their treatment.”

REFERENCES

1. Galvão DA, Newton RU, Taaffe DR, et al. Exercise and psychosexual education to improve sexual function in men with prostate cancer: a randomized clinical trial. JAMA Netw Open. 2025;8(3):e250413. doi:10.1001/jamanetworkopen.2025.0413

2. Exercise key to improving sexual dysfunction for patients with prostate cancer. News release. Edith Cowan University. March 13, 2025. Accessed March 17, 2025. https://www.ecu.edu.au/newsroom/articles/research/exercise-key-to-improving-sexual-dysfunction-for-patients-with-prostate-cancer