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A study has revealed that regular exercise can improve erectile dysfunction after treatment for prostate cancer, highlighting the importance of physical activity in sexual rehabilitation, particularly in men who have undergone radiotherapy or antiandrogen treatment.

Sexual dysfunction is often present after treatment for prostate cancer. Erectile function declines progressively for up to 15 years after prostatectomy and prostate radiotherapy and is often associated with a decrease in libido, alterations in ejaculatory and orgasmic function, and changes in relationships with sexual partners.

The pathogenesis of these disorders is complex and involves physical, psychological, and iatrogenic factors. However, most affected men do not receive targeted interventions for sexual dysfunction after prostate cancer.

Engaging in physical activity is one potential treatment owing to its somatic effects that counteract the bodily feminization and muscle wasting associated with androgen deprivation treatments, as well as their psychological effects (by preserving libido and improving a person’s sense of masculinity).

Randomized Trial

A research team led by Daniel A. Galvão, PhD, from Edith Cowan University in Perth, Australia, studied the effects of resistance and aerobic exercise, alone or combined with a brief intervention on psychosexual education and self-management (PESM), vs standard care in men diagnosed with prostate cancer. They conducted a single-center, parallel-group randomized trial, consisting of three arms. Patient recruitment took place in Perth between July 2014 and December 2018.

The study participants had to present with sexual dysfunction with a global satisfaction score less than 8 on the International Index of Erectile Function (IIEF) scale (range, 2-10); have undergone treatment with radiotherapy, prostatectomy, or antiandrogens; and have the consent of their physician.

Patients were excluded if their prostatectomy did not preserve the pelvic nerves, if more than 12 months had passed since the end of oncologic treatment, or if they were already regularly engaging in physical activity.

Of 394 eligible men, 112 (mean age, 66.3 years) were randomly assigned to three groups in a 1:1:1 ratio: physical exercise (n = 39), exercise plus PESM (n = 36), or a control group (n = 37). Stratification was based on age, current sexual activity, and type of oncologic treatment.

Aerobic and resistance-based exercises were performed three times a week for 6 months, under strict supervision, in groups of 10-12 people. They included 20-30 minutes of cardiovascular exercise at 60%-85% of maximum heart rate and, if possible, exercises performed at home up to 150 minutes weekly.

Participants in the PESM group also received an intervention for stress management and assistance in resolving issues related to their treatments and defined their goals for sexual rehabilitation. Control group participants maintained their usual physical activity during the 6 months of the trial.

The primary evaluation criterion was sexual function, measured using the IIEF. Secondary criteria included changes in body composition, physical activity, and muscle strength. Additionally, prostate-specific antigen, testosterone, and C-reactive protein were measured. All analyses were conducted on an intention-to-treat basis.

Improvement in Erectile Dysfunction

No notable side effects related to physical exercise were reported. The adjusted mean difference in IIEF scores at 6 months between the physical exercise group and the standard care group was approximately 3.5 points (P =.04).

In contrast, the PESM program did not appear to provide additional benefits, with the difference in IIEF scores calculated at -0.2 (P =.60).

Compared with standard care, engaging in physical exercise was associated with a significant improvement in fat mass and performance in standing up from a chair. There was also a noted gain in both upper-body and lower-body muscle strength.

In subgroup analysis, the benefit of muscle exercises over 6 months on erectile function was more pronounced in patients who underwent radiotherapy and those treated with antiandrogens compared with the prostatectomy subgroup.

When variations in IIEF by tertiles were analyzed, patients with the lowest tertile values before the trial were those who benefited the most from the exercises, both in terms of libido improvement and overall satisfaction.

Overall, this randomized trial confirms the value of a muscle exercise program on sexual function within 12 months of treatment for prostate cancer. A brief PESM program did not provide addition gains.

Of note, the impact of such measures was smaller after radical prostatectomy and in patients with advanced-stage cancer. Furthermore, regular physical exercise contributed to improvement in patients' self-perception of body image, with a potentially beneficial effect on their sexual function.

The strengths of this study are its highly significant results regarding sexual function and excellent participant adherence. Conversely, this was a single-center trial that included only 112 patients owing to problems with recruitment, and it may not necessarily be representative of all men treated for prostate cancer.

Thus, engaging in physical exercises should be considered an integral part of therapeutic measures aimed at improving sexual function after treatment for prostate cancer.

This story was translated from JIM.