Can exercise help erectile dysfunction? For many men, yes, especially when the problem is linked to inactivity, extra weight, high blood pressure or heart disease. A systematic review of 10 studies recommended about 40 minutes of moderate-to-vigorous aerobic exercise four times a week for six months, and in a two-year trial, lifestyle change restored normal erectile function in about a third of obese men.
Just as important: erectile dysfunction and exercise share a common thread, your blood vessels. Erection problems can be an early warning sign of heart disease, so the first step is a check-up, not a new training plan.
Key takeaways
- Erectile dysfunction (ED) and cardiovascular disease are described as two signs of the same underlying problem with blood vessels, and ED often appears first.
- The American Urological Association advises counselling men that ED is a risk marker for heart disease, so see your doctor before you self-treat.
- A systematic review recommends supervised aerobic exercise of 40 minutes, four times a week (160 minutes) for about six months.
- In obese men, losing weight and moving more restored normal erectile function in 31% after two years, versus about 5% (3 of 55 men) in the control group.
- Pelvic floor exercises taught by a physiotherapist helped 40% of men regain normal function in a randomised trial.
Why erectile dysfunction can be an early warning sign for your heart
An erection depends on healthy blood vessels that can widen quickly. The same damage that narrows the arteries of the heart, driven by high blood pressure, high cholesterol, diabetes, smoking and inactivity, also affects the arteries of the penis.
A 2014 systematic review in European Urology described ED and cardiovascular disease as “two different manifestations of the same systemic disorder.” Because the penile arteries are smaller than the coronary arteries, the same degree of vessel damage can show up as erection problems before it causes chest pain or a heart attack.
That is why the American Urological Association (AUA) guideline says men should be told that ED is a risk marker for underlying cardiovascular disease and other health conditions. The review authors recommend a detailed heart assessment for men with ED who are at high cardiovascular risk. Our guide to heart health after 35 covers the numbers your doctor will check.
How common is erectile dysfunction?
Very. US National Institutes of Health figures estimate that up to 30 million American men have ED. Complete inability to get an erection affects about 4% of men in their 50s, nearly 17% in their 60s and 47% of men over 75.
Age raises the odds, but the NIH stresses that ED is not an inevitable part of ageing. The main causes it lists are problems with blood flow, diabetes, nerve conditions, smoking, heavy drinking, obesity and inactivity.
The NHS adds high blood pressure, high cholesterol, hormone problems, side effects of some medicines, stress, tiredness, anxiety and depression. It also suggests taking a break from cycling if you ride more than three hours a week.
What the research says about erectile dysfunction and exercise
Aerobic exercise: the best-studied option
A 2018 systematic review in Sexual Medicine looked at 10 intervention studies of men whose ED was linked to physical inactivity, obesity, high blood pressure, metabolic syndrome or cardiovascular disease. All 10 suggested that physical activity reduced ED.
From those studies, the authors recommended supervised aerobic training of 40 minutes at moderate to vigorous intensity, four times a week, for about six months. It is a systematic review rather than a meta-analysis, so it gives a practical dose rather than a precise size of benefit.
Weight loss plus more activity
In a randomised trial published in JAMA in 2004, 110 obese men aged 35 to 55 with ED, but without diabetes, high blood pressure or high cholesterol, were followed for two years. The intervention group got detailed guidance to lose at least 10% of their weight by eating less and moving more.
Their average BMI fell from 36.9 to 31.2 and their activity rose from 48 to 195 minutes a week. Seventeen of them (31%) regained normal erectile function, compared with three men in the control group.
The authors noted the trial was only partly blinded and might not reflect results in everyday practice. Still, a one-in-three chance of recovery without medication is a strong reason to start. See our guide to losing belly fat after 35 for the fat-loss side.
Pelvic floor exercises
Pelvic floor training is not just for women. In a randomised controlled trial by Dorey and colleagues, 55 men with ED were assigned to physiotherapist-taught pelvic floor exercises with biofeedback plus lifestyle advice, or to lifestyle advice alone.
After three months the exercise group had improved significantly while the advice-only group had not; when the control men then did the exercises, they improved too. At six months, 40% of men had regained normal erectile function, 35.5% had improved and 24.5% had not improved.
What helps erectile dysfunction: evidence and dose
| Habit | What the evidence shows | Practical dose |
|---|---|---|
| Aerobic exercise | Systematic review of 10 studies supports it | 40 min, moderate to vigorous, 4 times a week |
| Weight loss plus activity (if obese) | RCT: 31% regained normal function at 2 years | Aim to lose about 10% of body weight |
| Pelvic floor exercises | RCT: 40% regained normal function at 6 months | Strong squeezes lying, sitting and standing, twice a day |
| Cutting back on alcohol | NHS lists heavy drinking as a common cause | 14 units a week or less |
| Stopping smoking | NIH lists smoking as a contributor to vessel damage and ED | Ask your doctor or pharmacist about support |
Drink more than you’d like to admit? Our guide to alcohol and fitness after 35 has a realistic plan for cutting back.
A 12-week exercise plan for erectile health
This plan builds towards the 160 minutes a week used in the research. Get your doctor’s go-ahead first, especially if you have heart risk factors or haven’t exercised in a while.
| Weeks | Aerobic sessions | Also do |
|---|---|---|
| 1–4 | 3 x 30 min brisk walking, cycling or swimming at an easy-moderate pace | Pelvic floor exercises twice daily; 2 short strength sessions |
| 5–8 | 4 x 35 min, with one session including harder intervals | Keep pelvic floor and strength work |
| 9–12 | 4 x 40 min, moderate to vigorous (160 min a week) | Keep going: the research dose runs for about 6 months |
“Moderate” means you can talk but not sing. Our guide to zone 2 training explains how to pace easy sessions, and the harder sessions can be brisk hill walks, faster cycling or intervals.
How to do pelvic floor exercises
- Find the muscles. Tighten the muscles around your back passage and the base of your penis, as if holding in wind and stopping the flow of urine. A physiotherapist can confirm you have the right ones.
- Squeeze hard. In the Dorey trial, men did three maximum squeezes lying down, three sitting and three standing, twice a day.
- Use them on the move. The trial also advised gentle squeezes while walking.
- Breathe normally. Don’t hold your breath or clench your buttocks and thighs.
Talk to your doctor first: what to expect
Many men put off this conversation for years. Doctors hear about ED every day, and raising it can uncover high blood pressure, high cholesterol or diabetes early.
The AUA guideline recommends measuring morning testosterone in men with ED. Your doctor is also likely to check your blood pressure, cholesterol and blood sugar, and to ask about medicines, mood and alcohol. Our testosterone after 35 guide explains what the numbers mean.
Your 2-minute appointment checklist
Jot down answers to these before you go. It makes the conversation shorter and far less awkward.
- When did the problem start, and did it come on gradually or suddenly?
- Does it happen every time, or only sometimes or with certain partners or situations?
- Which medicines and supplements do you take, including anything bought online?
- How many alcohol units do you drink in a typical week, and do you smoke or vape?
- How many minutes of exercise do you get in a typical week?
- Has anyone in your family had a heart attack or stroke at a young age?
- Have you had chest pain, breathlessness, low mood or high stress lately?
Effective medical treatments exist, and the guideline says men should be told about the benefits and risks of each option. Whether to use them is a decision for you and your doctor; exercise and lifestyle changes work alongside them, not instead of a proper assessment.
Safety note: If you have chest pain, unusual breathlessness or dizziness during exercise or sex, stop and get medical help. See your doctor promptly if ED comes on suddenly, follows an injury or surgery, or comes with a painful bend in the penis, low sex drive or fatigue. An erection that won’t go down for hours is a medical emergency. Never buy erection medicines online without a prescription, as they can interact dangerously with heart medicines, and talk to your doctor before stopping any prescribed medicine you think may be the cause.
FAQ
Can exercise cure erectile dysfunction?
It can reverse or improve ED for many men, particularly when the cause is inactivity, excess weight, high blood pressure or heart disease. In one trial, a third of obese men regained normal function with weight loss and more activity. It won’t fix every cause, so get checked by a doctor.
What is the best exercise for erectile dysfunction?
Aerobic exercise has the strongest evidence: about 40 minutes at moderate to vigorous intensity, four times a week. Pelvic floor exercises are a useful addition.
How long does it take for exercise to help ED?
In the pelvic floor trial, men improved within three months. The aerobic exercise recommendations are based on programmes lasting about six months, so give it time.
Is erectile dysfunction a sign of heart disease?
It can be. ED and heart disease share the same blood vessel damage and risk factors, and ED often appears first. That is why urology guidelines treat it as a reason to check your heart health.
Does cycling cause erectile dysfunction?
Long hours in the saddle may contribute for some men. The NHS suggests taking a break from cycling if you ride more than three hours a week and notice erection problems.
Free tool: pace your aerobic sessions with the Zone 2 Heart Rate Calculator, and see which heart and metabolic checks are due for your age with the Health Check-Up Planner.
Sources
- Gandaglia G et al. A systematic review of the association between erectile dysfunction and cardiovascular disease. Eur Urol, 2014.
- Gerbild H et al. Physical activity to improve erectile function: a systematic review of intervention studies. Sex Med, 2018.
- Esposito K et al. Effect of lifestyle changes on erectile dysfunction in obese men: a randomized controlled trial. JAMA, 2004.
- Dorey G et al. Randomised controlled trial of pelvic floor muscle exercises and manometric biofeedback for erectile dysfunction. Br J Gen Pract, 2004.
- Burnett AL et al. Erectile dysfunction: AUA guideline. J Urol, 2018.
- National Institute of Diabetes and Digestive and Kidney Diseases (NIH). Erectile dysfunction (archived).
- NHS. Erection problems (erectile dysfunction): causes.
This article is for general education and is not medical advice. Check with your doctor before starting a new training or nutrition plan, especially if you have a health condition.
