Exercise and ED: aerobic activity and pelvic floor training, what trials show

In short: exercise is one of the few things on the ED list that has been tested in randomized trials, and the results are modestly encouraging. Pooled trials of aerobic activity, such as walking, cycling or treadmill work, found higher erectile function scores than in men who did not exercise. Pelvic floor training, often called Kegel exercises, has a smaller and weaker evidence base. This page sets out what the National Institutes of Health (NIH), the American Urological Association (AUA) and the published trials found, how large the effects were, and where the evidence runs out.

Can exercise improve erectile function?

Yes, on average, in trials. A 2023 meta-analysis in The Journal of Sexual Medicine pooled 11 randomized controlled trials with 1,147 men and found that aerobic exercise raised scores on the erectile function part of the International Index of Erectile Function (IIEF-EF, a 6 to 30 questionnaire scale) by 2.8 points more than in men who did not exercise (95% confidence interval 1.7 to 3.9) (Khera et al., J Sex Med 2023). An earlier 2017 meta-analysis in the British Journal of Sports Medicine, of 7 trials and 478 men with diagnosed ED, also found a statistically significant improvement; its authors concluded that the results suggest physical activity and exercise improve patient-reported ED, “particularly aerobic exercise with moderate-to-vigorous intensity” (Silva et al., Br J Sports Med 2017).

The AUA guideline is more cautious about strength of evidence. It asks clinicians to counsel men with ED who have conditions known to affect erections that lifestyle changes, “including changes in diet and increased physical activity, improve overall health and may improve erectile function,” and it grades the underlying evidence C, the lowest of its three levels (AUA ED Guideline). Exercise sits alongside smoking, alcohol and weight in our wider guide to lifestyle and ED.

Why would exercise affect erections?

The NIH explanation is about blood flow. Its treatment page says physical activity increases blood flow through the body, including the penis, and can help keep a healthy weight; it adds that a healthy weight can help prevent diabetes and high blood pressure, which can cause ED (NIDDK, Treatment for ED). The authors of the 2023 meta-analysis list further possible routes, including lower blood pressure, better blood sugar control in diabetes, and better function of the lining of blood vessels, but those are proposed mechanisms, not things the trials measured directly (Khera et al., 2023). Because the same blood vessel problems can show up in the heart, our guide to ED and heart disease covers why a change in erections can be worth a broader health check.

What kinds of activity did trials test?

Mostly ordinary aerobic activity. In the 11 trials pooled in 2023, programs included supervised cycling, treadmill sessions, supervised walking, and advice or resources to be more active on one’s own. Sessions were typically 30 to 60 minutes, 3 to 5 times a week, and programs lasted 2 to 24 months. Three trials also added resistance training (Khera et al., 2023).

The men in these trials were not a random sample. Most trials focused on a particular group, such as men who were overweight or obese, had high blood pressure, metabolic syndrome, type 2 diabetes or heart disease, or had had prostate surgery (Khera et al., 2023). A 2018 systematic review of 10 intervention studies in men with ED linked to inactivity, obesity, high blood pressure, metabolic syndrome or heart disease reached a similar picture, and its authors suggested programs built around about 160 minutes a week of moderate to vigorous aerobic exercise for 6 months (Gerbild et al., Sex Med 2018). The 2023 authors were more cautious, writing that the best duration, intensity and frequency “remain unclear” (Khera et al., 2023). For general health, the CDC says adults need at least 150 minutes of moderate-intensity activity a week plus 2 days of muscle-strengthening activity (CDC, Adult Activity).

How big was the improvement in the trials?

Modest on average, and larger for men who started with worse function. In the 2023 analysis, the gain over no exercise was about 2.3 points for mild ED, 3.3 for moderate ED and 4.9 for severe ED on the 6 to 30 scale. The authors compare those figures with the published minimum clinically important difference, the smallest change counted as clinically important, which is 2.4 points for mild ED, 6.0 for moderate and 8.4 for severe, putting the average exercise effect at roughly 60% to 100% of that threshold depending on severity (Khera et al., 2023). The authors describe the effect as clinically meaningful, but by those same thresholds the average gain for men with moderate ED (3.3 against 6.0) or severe ED (4.9 against 8.4) fell below the minimum.

There are other limits worth knowing. Exercise cannot be blinded, so every trial carried a high risk of bias from men and staff knowing who exercised, even though the authors rated the overall risk of bias as moderately low. Some programs also changed diet, which makes the exercise effect hard to separate. That analysis was funded by Boston Scientific, which was involved in the study design and data interpretation, and one author is a Boston Scientific employee (Khera et al., 2023). The 2017 meta-analysis likewise rated its trials at moderate to high risk of bias (Silva et al., 2017). Our guide on how to read ED evidence explains what these questionnaire scores and confidence intervals do and do not tell you.

Do pelvic floor exercises help ED?

Possibly, but the evidence is thin. The best-known trial, published in the British Journal of General Practice in 2004, randomized 55 men with ED from a UK urology clinic. One group was taught pelvic floor exercises one to one, with biofeedback and lifestyle advice, over five weekly sessions and practised daily at home; the other got lifestyle advice only. After 3 months, the exercise group scored 6.74 points higher on the IIEF erectile function domain. The control group then switched to the exercises too, and at the end, across all 55 men, 40% had normal function on blinded assessment, 34.5% had improved and 25.5% had not improved (Dorey et al., Br J Gen Pract 2004). The exercises involved tightening and lifting the pelvic floor muscles “as if preventing the flow of urine,” the same muscles often targeted by Kegel exercises.

Reviews since then are mixed. A 2019 systematic review of 10 trials found that every trial measuring ED showed improvement, but rated the studies low to moderate quality, could not pool them because they differed so much, and found “no optimal training protocol” (Myers and Smith, Physiotherapy 2019). A 2024 meta-analysis of 7 randomized trials in men not taking ED pills found a clear benefit for aerobic training alone, but no significant improvement for pelvic floor training (Chen et al., Andrology 2024). Taken together, pelvic floor training has one encouraging small trial and uncertain support beyond it. In the Dorey trial, the exercises were taught one to one with biofeedback, and the researcher who assessed the men was an experienced physiotherapist.

Do pelvic floor exercises help after prostate surgery?

There is some early evidence, mostly from small studies. In a 2012 randomized trial of 52 men having radical prostatectomy, the group given weekly pelvic floor biofeedback sessions for 3 months plus home exercises had higher recovery of erectile function at 12 months (8 of 17 men assessed, 47.1%) than the group given only verbal instructions to contract the pelvic floor (2 of 16, 12.5%) (Prota et al., Int J Impot Res 2012). A 2020 systematic review of 9 studies found that most showed improvement, but said a lack of methodological rigor and varied training programs limited what could be concluded (Wong et al., J Sex Med 2020). Our guide to ED after prostate treatment covers the wider recovery picture, and pelvic floor training is worth asking your surgical team about rather than starting on your own.

Can diet and exercise reverse ED?

For some men, function improved enough to reach the normal range, but not for most. In a 2004 JAMA trial, 110 obese men aged 35 to 55 with ED and without diabetes, high blood pressure or high cholesterol were randomized. The intervention group got detailed advice to lose at least 10% of body weight by eating fewer calories and being more active; their weekly activity rose from about 48 to 195 minutes. After 2 years their average IIEF score rose from 13.9 to 17, while the control group stayed level at about 13.5. Seventeen men in the intervention group and 3 in the control group reached a score of 22 or higher, and the authors describe improvement in “about one third” of the men (Esposito et al., JAMA 2004).

A 2011 meta-analysis of randomized trials points the same way: in 4 trials of lifestyle change with 597 men, erectile function scores improved by 2.40 points on average (Gupta et al., Arch Intern Med 2011). Those are group averages from programs that combined diet and activity, so they cannot say which part helped or whether it will help any one man. Our comparison of natural remedies and medication for ED looks at where lifestyle change sits next to other options.

Does exercise work alongside ED medicine?

The trials suggest it can be used with medicine rather than instead of it. In the 2023 meta-analysis, the share of men taking a PDE5 inhibitor (the class of ED pills) ranged from none to all, and that share did not significantly change the benefit seen from exercise. The authors describe exercise as complementing traditional ED treatments (Khera et al., 2023). The NIH lists increasing physical activity among the lifestyle changes a health care professional may suggest, next to medicines, counseling and other options (NIDDK, Treatment for ED).

Is exercise safe if I have heart disease or other conditions?

Two of the 11 pooled trials enrolled men with heart disease, and in both the exercise sessions were supervised (Khera et al., 2023). The CDC says adults with chronic health conditions who are able should be active, and that they should consult a health care professional or physical activity specialist about the right types and amounts of activity (CDC, Chronic Conditions and Disabilities Activity). The 2023 meta-analysis authors also note that exercise may not be feasible or safe for everyone and that barriers should be addressed first (Khera et al., 2023). The AUA advises that men be counseled that ED is a risk marker for underlying cardiovascular disease and other conditions that may warrant evaluation (AUA ED Guideline), which is one more reason to see a clinician before starting a harder program.

The bottom line

Randomized trials suggest that regular aerobic exercise raises erectile function scores on average, with the largest gains in men whose ED was more severe, though the average effect is modest and the trials could not be blinded. Pelvic floor training helped in one small trial and after prostate surgery in another, but reviews rate that evidence as low to moderate quality. In one trial of obese men, 17 of 55 given diet and activity advice reached a normal-range score after 2 years, against 3 of 55 controls. The AUA says lifestyle change improves overall health and may improve erectile function, so exercise is worth doing for its own sake and is best paired with a check of what is behind your ED.

Sources

Every clinical statement on this page traces to a primary or guideline source:

• NIH NIDDK, Treatment for Erectile Dysfunction (last reviewed October 2024): increasing physical activity among the lifestyle changes for ED; activity increases blood flow through the body, including the penis, and helps keep a healthy weight; the 150-minute Physical Activity Guidelines figure.
• American Urological Association, Erectile Dysfunction Guideline (Burnett et al., J Urol 2018): Statement 7 on lifestyle modification (Moderate Recommendation; Evidence Level Grade C), and counseling that ED is a risk marker for cardiovascular disease.
• Khera M, Bhattacharyya S, Miller LE. Effect of aerobic exercise on erectile function: systematic review and meta-analysis of randomized controlled trials (J Sex Med, 2023): 11 trials, 1,147 men; mean difference 2.8 IIEF-EF points (95% CI 1.7 to 3.9); 2.3, 3.3 and 4.9 points by severity; minimum clinically important differences; programs and study populations; risk of bias; limitations; PDE5 inhibitor use; and funding by Boston Scientific.
• Silva AB, et al. Physical activity and exercise for erectile dysfunction: systematic review and meta-analysis (Br J Sports Med, 2017): 7 trials, 478 men with ED; mean difference 3.85; moderate to high risk of bias.
• Gerbild H, et al. Physical Activity to Improve Erectile Function: A Systematic Review of Intervention Studies (Sex Med, 2018): 10 studies in men with ED linked to inactivity, obesity, hypertension, metabolic syndrome or heart disease; suggested about 160 minutes a week of aerobic exercise for 6 months.
• Chen Z, et al. Effect of different physical activities on erectile dysfunction in adult men not receiving phosphodiesterase-5 inhibitors therapy (Andrology, 2024): 7 trials; benefit with aerobic training alone, no significant improvement with pelvic floor training.
• Gupta BP, et al. The effect of lifestyle modification and cardiovascular risk factor reduction on erectile dysfunction (Arch Intern Med, 2011): 6 trials, 740 men; 4 lifestyle-only trials with 597 men, weighted mean difference 2.40 on the IIEF-5.
• Esposito K, et al. Effect of lifestyle changes on erectile dysfunction in obese men: a randomized controlled trial (JAMA, 2004): 110 obese men; 2-year weight-loss and activity program; IIEF score 13.9 to 17 versus stable controls; 17 versus 3 men reaching 22 or higher.
• Dorey G, et al. Randomised controlled trial of pelvic floor muscle exercises and manometric biofeedback for erectile dysfunction (Br J Gen Pract, 2004): 55 men; 6.74-point IIEF erectile function gain at 3 months; controls then crossed over; across all participants at study end, 40% normal, 34.5% improved, 25.5% not improved.
• Myers C, Smith M. Pelvic floor muscle training improves erectile dysfunction and premature ejaculation: a systematic review (Physiotherapy, 2019): 10 trials of low to moderate quality; no data pooling; no optimal protocol identified.
• Wong C, et al. A Systematic Review of Pelvic Floor Muscle Training for Erectile Dysfunction After Prostatectomy (J Sex Med, 2020): 9 studies; most showed improvement, limited by methodological rigor and varied protocols.
• Prota C, et al. Early postoperative pelvic-floor biofeedback improves erectile function in men undergoing radical prostatectomy (Int J Impot Res, 2012): 52 men; erectile function recovered at 12 months in 47.1% with biofeedback versus 12.5% with verbal instructions.
• CDC, Adult Activity: An Overview: at least 150 minutes of moderate-intensity activity and 2 days of muscle-strengthening activity a week.
• CDC, Chronic Conditions and Disabilities Activity: adults with chronic conditions should consult a health care professional about appropriate types and amounts of activity.