Lifestyle Interventions Improve Erectile Function in Men With ED: Meta-Analysis

This systematic review and meta-analysis of randomized controlled trials assessed the effect of diet- and/or exercise-based lifestyle interventions on erectile function in adult men with erectile dysfunction (ED). The analysis included 1477 participants across multiple trials, though the specific number of studies and their settings were not reported. Interventions included exercise-only, diet-only, or combined diet-and-exercise programs, compared with usual care, standard treatment, or no intervention. The primary outcome was change in erectile function score measured by the International Index of Erectile Function (IIEF). Follow-up duration was not reported.

The pooled analysis showed a statistically significant improvement in erectile function scores favoring lifestyle intervention, with a mean difference (MD) of 2.35 (95% CI 1.68-3.01). The absolute change was not reported. The effect size is modest, as a 2.35-point increase on the IIEF may not reach the threshold for a minimally clinically important difference in all patients. No secondary outcomes were reported.

Safety and tolerability data were not reported, including adverse events, serious adverse events, and discontinuations. The absence of safety information limits the ability to assess the risk-benefit profile of these interventions.

Compared with prior studies, these findings align with existing evidence that lifestyle modifications can improve vascular health and erectile function, but the modest effect size underscores that lifestyle intervention alone may not be sufficient for many patients. Previous trials have shown that phosphodiesterase-5 inhibitors produce larger improvements in IIEF scores, though lifestyle changes may offer additional cardiovascular benefits.

Key methodological limitations include clinical heterogeneity across studies, inconsistent reporting of ED etiology and baseline severity, variation in intervention design and adherence, and inclusion of some mixed clinical populations. The certainty of evidence was rated as moderate using GRADE, indicating that further research may change the estimate. Importantly, the meta-analysis reports an association, not causation, and the observational nature of some included studies may introduce bias.

For clinical practice, these results suggest that lifestyle interventions may serve as a useful adjunctive nonpharmacological strategy in the management of ED. Clinicians should consider recommending diet and exercise modifications as part of a comprehensive treatment plan, particularly in patients with lifestyle-related risk factors. However, the modest effect size means that lifestyle changes alone are unlikely to resolve ED in most cases, and pharmacological or other therapies may still be needed.

Several questions remain unanswered. The optimal type, intensity, and duration of lifestyle intervention are unclear. Long-term effects and adherence rates were not assessed. Future large-scale, methodologically standardized trials are needed to clarify optimal strategies and to evaluate safety and long-term outcomes. Additionally, the impact of lifestyle interventions in specific ED subgroups (e.g., those with diabetes, cardiovascular disease, or psychogenic ED) requires further investigation.