Lifestyle and Metabolic Effects on Erectile, Vascular Health
Lifestyle and Metabolic Effects on Erectile, Vascular Health
The most important lifestyle factor influencing ED is exercise, both systemic and penile (coital). Physical exercise causes increased systemic endothelial NO production through shear stress caused by the mechanical effect of increased blood flow, and with erection the increase of penile blood flow is many times greater than with physical exercise. In a study of men aged 55–75 years, more frequent coitus was associated with about a 50% reduction of ED, although establishing cause and effect would require a randomized study. 'Penile rehabilitation' is increasingly used to preserve erectile function following radical prostatectomy, using either a vacuum device or PDE-5 inhibitors. In a randomized, crossover study, pelvic floor exercises also reduced ED, most likely by reducing venous outflow from the penis.
A sedentary lifestyle increases ED by 2–10-fold, whereas 'moderate' activity has been reported to reduce ED by two-thirds and 'high' activity by over 80% (unfortunately, these degrees of activity were not defined). Because penile blood flow presumably does not increase with physical exercise, the principal mechanism whereby physical exercise improves ED may be the pronounced effect of increased systemic NO on glucose disposal and insulin sensitivity (reviewed above). However, physical exercise also increases PON-1 activity, a circulating HDL-associated antioxidant enzyme reported to be lower in men with ED. The effect of exercise on NO is influenced by frequency as well as intensity. In an animal model, acute exercise increased NO release for 48 h, whereas daily exercise induced fourfold higher levels of NO production that lasted for a week. Moderate exercise may be preferable to extreme exercise. FMD is improved with moderate exercise, but extreme exercise increases oxidative stress and reduces FMD. Athletes also burn more calories and commonly load up with sugar and carbohydrates before participating in extreme exercise, which would further worsen those effects.
Exercise
The most important lifestyle factor influencing ED is exercise, both systemic and penile (coital). Physical exercise causes increased systemic endothelial NO production through shear stress caused by the mechanical effect of increased blood flow, and with erection the increase of penile blood flow is many times greater than with physical exercise. In a study of men aged 55–75 years, more frequent coitus was associated with about a 50% reduction of ED, although establishing cause and effect would require a randomized study. 'Penile rehabilitation' is increasingly used to preserve erectile function following radical prostatectomy, using either a vacuum device or PDE-5 inhibitors. In a randomized, crossover study, pelvic floor exercises also reduced ED, most likely by reducing venous outflow from the penis.
A sedentary lifestyle increases ED by 2–10-fold, whereas 'moderate' activity has been reported to reduce ED by two-thirds and 'high' activity by over 80% (unfortunately, these degrees of activity were not defined). Because penile blood flow presumably does not increase with physical exercise, the principal mechanism whereby physical exercise improves ED may be the pronounced effect of increased systemic NO on glucose disposal and insulin sensitivity (reviewed above). However, physical exercise also increases PON-1 activity, a circulating HDL-associated antioxidant enzyme reported to be lower in men with ED. The effect of exercise on NO is influenced by frequency as well as intensity. In an animal model, acute exercise increased NO release for 48 h, whereas daily exercise induced fourfold higher levels of NO production that lasted for a week. Moderate exercise may be preferable to extreme exercise. FMD is improved with moderate exercise, but extreme exercise increases oxidative stress and reduces FMD. Athletes also burn more calories and commonly load up with sugar and carbohydrates before participating in extreme exercise, which would further worsen those effects.
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