Effects and Moderators of Exercise Training on Erectile function in Male Adults with diagnosed erectile dysfunction: A Systematic Review and Meta-Analysis

Background Erectile dysfunction (ED) is widespread among adult men and affects their quality of life and psychological health. There is increasing evidence that physical exercise and sports training can effectively improve erectile function, but the effects of these interventions and the influencing factors require further systematic analysis. Objectives To evaluate the intervention effect of exercise training on erectile dysfunction (ED) in adult men through a systematic review and meta-analysis. Second, to explore the moderating effect of different exercise modes, intensity, and other factors on the intervention effect. Methods Electronic searches were conducted in Embase, Cochrane Central, Scopus, Ovid MEDLINE, PubMed, Web of Science, and China National Knowledge Infrastructure (CNKI) up to October 2024. Randomized controlled trials (RCTs) involving adult men with a precise diagnosis of erectile dysfunction (IIEF-5 scores <21) were included to investigate the effect of exercise training on erectile function (EF). The bias risk included in the studies was assessed using the Cochrane Risk of Bias tool 2.0 (Rob2). In addition, subgroup analyses were performed to identify the relative advantages of each intervention method in improving erectile function. Results 12 randomized controlled trials with 818 adult men were included in the meta-analysis. The results demonstrated that exercise training significantly improved erectile function by 2.9 points (95% CI 1.7–4.1, p < 0.001). Sub-group analyses by intervention types showed that the most considerable significant effects were observed for aerobic exercise combined with pharmacological treatment (MD = 3.04, 95% CI 1.15 to 4.92, p = 0.002) and traditional Asian exercise combined with pharmacological treatment (MD = 4.28, 95% CI 2.95 to 5.61, p < 0.001). Other subgroup analyses show consistent exercise effects in different age or medical condition groups and a tendency to have a more significant effect in low-intensity than moderate- or high-intensity exercise. Conclusions Interventions including exercise significantly improve erectile dysfunction in adult men, with subgroup analysis indicating that combining exercise with pharmacological treatments yields the greatest benefits. PROSPERO Registration CRD42024593228.