Adult men with erectile dysfunction may benefit from diet- and exercise-based interventions, which have been shown in a recent study to result in modest but significant improvements in erectile function.
“Favourable effects were observed across different intervention categories and participant subgroups, although no statistically significant subgroup differences were identified,” the investigators said.
Sixteen randomized controlled trials involving a total of 1,477 participants met the eligibility criteria following a search of PubMed, Embase, Web of Science, and the Cochrane Library from inception to December 2025. These studies compared exercise-only, diet-only, or combined diet-and-exercise interventions with usual care, standard treatment, or no intervention.
Lifestyle interventions significantly correlated with improved erectile function compared with control conditions (mean difference [MD], 2.35, 95 percent confidence interval [CI], 1.68‒3.01; I2=53 percent). [J Sex Med 2026;doi:10.1093/jsxmed/qdag137]
In subgroup analyses, diet-only (MD, 2.16, 95 percent CI, 0.46‒3.85; I2=38 percent), exercise-only (MD, 2.50, 95 percent CI, 1.32‒3.67; I2=68 percent), and combined diet-and-exercise (MD, 1.94, 95 percent CI, 0.87‒3.00; I2=0 percent) interventions also yielded improvements, but differences between groups were not statistically significant (p=0.95; I2=0 percent).
In exploratory analyses, favourable effects were observed across exercise modalities and baseline severity categories, but no specific modality or subgroup showed superiority over the others. Similarly, improvements were noted across intervention duration, age, BMI, and supervision categories.
In sensitivity analyses, the overall findings were not significantly different. The certainty of evidence was moderate.
“Given the clinical and methodological heterogeneity across studies, these findings should be interpreted cautiously,” the investigators said. “Overall, lifestyle intervention may serve as a useful adjunct to erectile dysfunction management rather than a replacement for established therapies.”
Potential mechanisms
Erectile function relies on the coordinated integrity of vascular, metabolic, hormonal, and neural pathways. Thus, the benefits of lifestyle interventions may be mediated through improvements in endothelial function, reduction of systemic inflammation, and partial normalization of the metabolic and endocrine milieu, according to the investigators.
“Regular physical activity, particularly moderate-intensity aerobic exercise, can increase vascular shear stress and stimulate endothelial nitric oxide (NO) synthase, thereby enhancing NO bioavailability and promoting cavernosal smooth muscle relaxation,” they said. [J Sex Med 2024;21:587-588; Int J Surg 2018;56:184-187; Int J Mol Sci 2023;26:3073]
Furthermore, healthy dietary patterns such as the Mediterranean diet contain antioxidants and anti-inflammatory components that help lower oxidative stress and preserve NO signalling. [J Sex Med 2014;11:211-221; BMC Urol 2023;23:39; Br J Sports Med 2021;55:1419-1425]
“Together, these mechanisms provide a biologically plausible basis for the observed improvement in erectile function following lifestyle intervention,” the investigators said.
Metabolic remodelling
Lifestyle interventions also provide long-term benefits through metabolic remodelling and structural vascular repair. For instance, weight loss via dietary change and increased physical activity may reduce circulating inflammatory markers (eg, C-reactive protein and interleukin-6) in men with obesity or metabolic dysfunction. [Front Physiol 2021;12:754731]
Previous studies have also observed the association of regular exercise with mobilization of endothelial progenitor cells and reduction of apoptotic microparticles, indicating its role in endothelial repair and vascular homeostasis. [Eur Heart J Open 2022;2:oeac078; Eur J Cardiovasc Prev Rehabil 2011;18:406-414]
“These interconnected mechanisms may help explain why lifestyle interventions can benefit erectile function across different clinical settings, although the relative contribution of vascular, metabolic, hormonal, and neuromuscular pathways likely varies according to the underlying aetiology of erectile dysfunction and the specific intervention used,” the investigators said.
“Further large-scale studies with longer follow-up and better clinical characterization are needed to define the most effective intervention strategies and their long-term benefits,” they added.