研究顯示，運動對勃起功能障礙（Erectile dysfunction, ED）的療效與威而鋼一樣好
Courtney Southwick / 2023 年 10 月 23 日 / 新聞 / WebMD 健康新聞
根據對迄今為止有氧運動和勃起功能的最佳研究的最新分析，每週運動三次、每次至少 30 分鐘，在改善勃起功能方面與威而鋼和類似藥物一樣有效。
這項發表在本月《性醫學雜誌》上的研究發現，有氧活動（例如步行或騎自行車）可以改善所有患有勃起功能障礙的男性的勃起功能，無論體重、整體健康狀況或藥物使用情況如何。患有最嚴重勃起功能障礙的男性受益最大。
研究作者 Larry E. Miller 博士說：「這項研究為醫生和患者提供了明確推薦有氧運動作為 ED 管理一部分所需的證據」。
醫生早就知道勃起功能與心血管健康有關，但關於運動對這種疾病的影響的高品質證據有限。
研究人員查閱了科學文獻，發現了 11 項隨機對照試驗——這是一種黃金標準的研究設計，參與者被隨機分配接受或不接受干預。在參與研究的 1,100 名男性中，600 人被分配到「實驗」組，通常每週運動 3 到 5 次、每次 30 到 60 分鐘，而 500 人被分配到沒有運動計畫的「對照組」。
研究人員發現，勃起功能障礙越嚴重，運動的幫助就越大。以 6 到 30 的標準評分，患有嚴重 ED 的男性進行運動後，勃起功能提高了 5 分。輕度和中度 ED 的患者分別改善了 2 分和 3 分。
研究作者指出，相較之下，磷酸二酯酶 5 抑制劑 (phosphodiesterase-5 inhibitors)——如西地那非（sildenafil，威而鋼）或他達拉非（tadalafil，犀利士）——可以帶來 4 到 8 分的改善。而睪固酮 (testosterone) 替代療法可以帶來2分的改善。
米勒說：「我們對這一發現印象特別深刻，即患有更嚴重勃起功能障礙的男性通過運動得到了更大的改善，這些改善與服用偉哥等藥物的男性所見的改善相似」。
勃起功能障礙和心臟健康
勃起功能障礙通常可以追溯到與心血管疾病相同的原因，包括發炎、動脈狹窄（內皮功能障礙）或動脈硬化（動脈粥狀硬化）。
「重要的是要認識到勃起功能障礙通常可以作為潛在心血管健康的指標或晴雨表」，邁阿密 Prime 研究所專門研究男性性健康的泌尿科醫生 Amy Pearlman 醫學博士說。
皮爾曼並沒有參與這項研究，但認為結果是有道理的。「按理說，任何旨在增強心血管健康的介入措施也可能對勃起健康產生積極影響」。
但令人驚訝的是，有氧運動減輕症狀的效果與服用威而鋼等藥物相當，位於亞利桑那州梅薩的東谷泌尿中心創始人、泌尿科醫生拉胡爾·梅漢醫學博士說。（梅漢也沒有參與這項研究。）
雖然勃起功能障礙藥物通常價格實惠且容易取得，但有些患者不想服用它們或無法忍受副作用。梅漢說，這些症狀可能包括「頭痛、胃灼熱、噁心、潮紅以及肌肉、背部、手臂或腿部疼痛」。他補充道，「每個人都可以鍛煉」。
包括 Mehan 在內的一些醫生已經向勃起功能障礙 (ED) 患者推薦運動。
米勒說，現在他們可以告訴患者，這是「一種經過隨機研究的高品質數據支援的行之有效的方法」。「運動風險低且負擔得起，使其成為勃起困難的理想一線治療選擇，特別是對於不願意或無法使用藥物的患者」。
資料來源：
Larry E. Miller 博士，米勒科學顧問公司總裁兼創辦人，位於田納西州約翰遜城。
Rahul Mehan，醫學博士，東谷泌尿中心創始人； 首席醫療官，蓋維蒂，梅薩，亞利桑那州。
Amy Pearlman，醫學博士，邁阿密 Prime Institute 的泌尿科醫生，專門研究性和荷爾蒙健康。
克利夫蘭診所：「磷酸二酯酶抑制劑」。
性健康雜誌：「有氧運動對勃起功能的影響：隨機對照試驗的系統回顧和薈萃分析」。
引用此內容：對於 ED 來說，運動和威而鋼一樣好：研究 – Medscape – 2023 年 10 月 23 日。
Exercise as Good as Viagra for ED: Study
Courtney Southwick / October 23, 2023 / News / WebMD Health News
Exercising for at least 30 minutes three times a week can be just as effective as Viagra and similar medications at improving erectile function, according to a new analysis of the best research to date on aerobic exercise and erectile function.
The study, published this month in The Journal of Sexual Medicine, found that aerobic activities – such as walking or cycling – improved erectile function in all men with erectile dysfunction, regardless of body weight, overall health, or medication use. Men with the most severe erectile dysfunction saw the greatest benefit.
“This study provides physicians and patients the proof needed to definitively recommend aerobic activity as part of ED management,” said study author Larry E. Miller, PhD.
Doctors have long known that erectile function is linked to cardiovascular health, but there is limited high-quality evidence on the impact of exercise on the disorder.
The researchers scoured the scientific literature and found 11 randomized, controlled trials – a gold-standard study design where participants are randomly assigned to receive an intervention or not. Of the 1,100 men involved in the studies, 600 were assigned to “experimental” groups that typically exercised for 30 to 60 minutes, three to five times a week, while 500 were assigned to “control” groups with no exercise plan.
The worse the ED was, the more exercise helped, the researchers found. On a standardized scale of 6 to 30, men with severe ED who exercised reported a 5-point improvement in erectile function. Those with mild and moderate ED saw improvements of 2 and 3 points, respectively.
By comparison, phosphodiesterase-5 inhibitors — like sildenafil (Viagra) or tadalafil (Cialis) – can lead to improvements of 4 to 8 points, the study authors note. And testosterone replacement therapy can lead to an improvement of 2 points.
“We were particularly impressed by the finding that men with more severe erectile dysfunction saw greater improvements with exercise, and these improvements were similar to those seen in men taking” drugs like Viagra, Miller said.
ED and Heart Health
Erectile dysfunction can often be traced to the same causes as cardiovascular disease, including inflammation, a narrowing of the arteries (endothelial dysfunction), or a hardening of the arteries (atherosclerosis).
“It’s important to recognize that erectile dysfunction can often serve as an indicator or barometer of underlying cardiovascular health,” said Amy Pearlman, MD, a urologist specializing in male sexual health at Prime Institute in Miami.
Pearlman was not involved in the study but thinks the results make sense. “It stands to reason that any intervention aimed at enhancing cardiovascular health may also have a positive impact on erectile health.”
But what was surprising was that aerobic exercise reduced symptoms on par with medications like Viagra, said urologist Rahul Mehan, MD, founder of East Valley Urology Center, in Mesa, AZ. (Mehan was also not involved in the study.)
While erectile dysfunction medications are generally affordable and accessible, some patients don’t want to take them or can’t tolerate the side effects. These can include “headache, heartburn, nausea, flushing, and pain in muscles, back, arms, or legs,” said Mehan. He adds, “Everyone can exercise.”
Some doctors, including Mehan, already recommend exercise to their patients with ED.
Now they can tell patients that it’s “a proven approach backed by high-quality data from randomized studies,” Miller said. “Exercise is low risk and affordable, making it an ideal first-line treatment option for erectile difficulties, especially for patients unwilling or unable to use medications.”
Sources：
Larry E. Miller, PhD, president, founder, Miller Scientific Consulting, Johnson City, TN.
Rahul Mehan, MD, founder, East Valley Urology Center; chief medical officer, Geviti, Mesa, AZ.
Amy Pearlman, MD, urologist specializing in sexual and hormonal health, Prime Institute, Miami.
Cleveland Clinic: “Phosphodiesterase Inhibitors.”
The Journal of Sexual Health: “Effect of aerobic exercise on erectile function: systematic review and meta-analysis of randomized controlled trials.”
Cite this: Exercise as Good as Viagra for ED: Study – Medscape – Oct 23, 2023.