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Physical Exercise for Erectile Dysfunction: A Mini review on Unresolved Controversies and the Path to Precision
Thomas Zandonai1, Ana María Peiró1, Inés Nuño2
1Pharmacology, Health, and Addiction in Exercise Laboratory (PHAE Lab), Department of Pharmacology, Paediatrics and Organic Chemistry, Miguel Hernandez University of Elche, Alicante, Spain; Pharmacogenetic Unit, Clinical Pharmacology Department, Alicante Institute for Health and Biomedical Research (ISABIAL), Dr. Balmis General University Hospital, Alicante, Spain.
European Urology Focus
|May 13, 2026
Summary
Exercise may improve erectile function (ED), but optimal protocols are debated. Personalized approaches considering individual factors are needed for effective treatment of this vascular disease marker.
Area of Science:
- Cardiovascular Medicine
- Exercise Physiology
- Urology
Background:
- Erectile dysfunction (ED) is an early indicator of systemic vascular disease.
- Exercise is proposed to improve endothelial function and nitric oxide bioavailability.
- Clinical evidence on exercise for ED is inconsistent, with ongoing controversy regarding optimal strategies.
Purpose of the Study:
- To critically review controversies surrounding exercise as a therapy for erectile dysfunction.
- To identify gaps in current knowledge and conflicting evidence.
- To advocate for a precision medicine approach in exercise prescription for ED.
Main Methods:
- Rapid review of existing literature on exercise and erectile dysfunction.
- Analysis of mechanistic studies and clinical trials.
- Examination of unresolved debates including exercise modality, dosage, hormonal interactions, genetics, and risks.
Main Results:
- Mechanistic data support exercise benefits for vascular health relevant to ED.
- Clinical trial outcomes are highly variable across different populations.
- Key debates persist regarding optimal exercise type, intensity, duration, and individual response factors.
Conclusions:
- Exercise prescription for ED requires a personalized, precision medicine strategy.
- Interventions should consider individual physiology, training history, genetics, and comorbidities.
- Future research should focus on mechanistically-driven, tailored exercise protocols to optimize vascular and hormonal adaptations while mitigating risks.
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