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The comfort of modern life causes two important side effects: physical inactivity and obesity. The current lifestyle is strongly influenced by sedentary behavior with a possible effect on sexual activity. The objective of this research was to investigate the association between erectile dysfunction (ED) and physical inactivity, considering: a) the clinical characterization of patients; b) an evaluation of the level of physical activity and c) a possible correlation between ED and physical activity. We prospectively studied 50 patients with ED treated between August 2014 and February 2015. The analysis of the association between the degree of ED (moderate and severe) and qualitative variables (diabetes, alcoholism, smoking and physical activity) was investigated using Pearson's chi-square test. Contrary to our initial expectations, the results show that 38 participants (76%) presented ED even though they were physically active and thus regular physical activity did not prevent ED. These results do not explain why so many active seniors had ED but perhaps the sample size was too small to arrive at conclusive data.
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Published at: http://www.ijsciences.com/pub/issue/2015-12/
DOI: 10.18483/ijSci.881; Online ISSN: 2305-3925; Print ISSN: 2410-4477
Francisco Pedro Pinheiro (Correspondence)
pinheiro_pedro@ig.com.br
+55 17 3227 3994; fax: +55 17 3229 1777
Relationship between Sedentary Lifestyle and
Erectile Dysfunction
Francisco Pedro Pinheiro1, Aline Cristine Salum Fernandes
Maia1, José Germano Ferraz de Arruda2, Luis César Fava
Spessoto2, Pedro Francisco Ferraz de Arruda2, Fernando Nestor
Fácio Júnior2
1Masters Student of the Health Sciences course of the Medicine School in São José do Rio Preto (FAMERP), São
José do Rio Preto, SP, Brazil
2Department of Urology of the Medicine School in São José do Rio Preto (FAMERP), São José do Rio Preto, SP,
Brazil
Abstract: The comfort of modern life causes two important side effects: physical inactivity and obesity. The current
lifestyle is strongly influenced by sedentary behavior with a possible effect on sexual activity. The objective of this
research was to investigate the association between erectile dysfunction (ED) and physical inactivity, considering: a)
the clinical characterization of patients; b) an evaluation of the level of physical activity and c) a possible correlation
between ED and physical activity. We prospectively studied 50 patients with ED treated between August 2014 and
February 2015. The analysis of the association between the degree of ED (moderate and severe) and qualitative
variables (diabetes, alcoholism, smoking and physical activity) was investigated using Pearson's chi-square test.
Contrary to our initial expectations, the results show that 38 participants (76%) presented ED even though they were
physically active and thus regular physical activity did not prevent ED. These results do not explain why so many
active seniors had ED but perhaps the sample size was too small to arrive at conclusive data.
Keywords: Physical Activity, Erectile Dysfunction, Human Health, Sedentary Lifestyle
Introduction
The comfort of modern life causes two important side
effects: physical inactivity and obesity. The current
lifestyle is strongly influenced by sedentary behavior
(Souza & Oliveira, 2008). In the past, energy was
spent doing laundry, mowing grass, carrying objects
and plowing. However, nowadays, most daily
activities, such as watching television, using a
computer and driving a car, use little energy (Pereira
et al., 2003).
The less physical activity practiced, the more an
individual becomes sedentary and the greater the
degree of inactivity in the population, the higher
overweight and obesity rates become (Pereira et al.,
2003). In addition to sporting activities (walking,
running, cycling, swimming, aerobics, football),
energy is spent in everyday activities such as
gardening, parking the car further away to increase
the walking distance, walking to the bakery near
home, taking the dog for a walk, getting up to change
the TV channels, and exchanging using the elevator
for walking up the stairs etc.
A sedentary lifestyle is a risk factor for erectile
dysfunction (ED), defined as persistent total or partial
inability to initiate and/or maintain an erection
sufficient to penetrate and complete intercourse until
ejaculation (Cavalcanti & Cavalcanti, 2006). It is not
an sporadic event, but one that recurs; it can start
suddenly or progressively and can manifest at
different degrees (Cavalcanti & Cavalcanti, 2006).
Studies show that only 10-15% of affected men seek
treatment for ED, possibly because of embarrassment
or lack of knowledge about effective treatment
options (Barros, 2000). This can lead some to
consider the possibility of suicide, because they
consider ED a problem of their masculinity
(Figueiredo & Schraiber, 2011). In addition to
Relationship between Sedentary Lifestyle and Erectile Dysfunction
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69
negatively affecting the individual's self-esteem,
dysfunction can have serious consequences on other
aspects of the subject such as anxiety and social
isolation, as well as losses in interpersonal, family
and work relationships (Porst et al., 2013; Phé &
Rouprêt, 2012).
ED is considered a public health problem because it
is associated with factors including age, heart disease,
hypertension, diabetes, and hyperlipidemia, but it can
be related to an individual’s lifestyle such as physical
inactivity, obesity, smoking and alcohol abuse
(Efremov et al., 2015; Ramirez et al., 2015).
ED is closely linked to the general state of the
individual’s physical and psychological wellbeing
(Efremov et al., 2015) and there are even indications
that ED may be an early marker of depression (Grant
et al., 2013).
In 40- to 70-year-old men, the incidence of ED is
46% in Italy, 48% in Brazil, 52% in the United States
and 54% in Japan. Regarding the presence of other
diseases, the frequency is 33% in individuals with
high cholesterol, 46% in hypertensive subjects, 75%
in diabetic patients and 90% in depressed men (Berg,
2004). Worldwide, ED affects more than 100 million
men (Ramirez et al., 2015).
Sedentary individuals present ED rates between 43
and 70%, however, according to the literature, regular
physical activity reduces the risk of ED by one-third
(Li & Siegrist, 2012). In subjects with ED, it is
estimated that 60 minutes of exercise a day, 3 to 4
days per week using 70-80% of maximum aerobic
capacity can increase the frequency of intercourse,
and improve erectile function and regulation of
testosterone levels (Li & Siegrist, 2012). In addition,
regular exercise reduces the risk of acute myocardial
infarction during sexual intercourse (Gorge et al.,
2003).
A sedentary lifestyle harms the body; besides being
associated to obesity, it is a risk factor for diseases
including ED. On the other hand, physical exercise
can contribute effectively to the recovery,
maintenance, and promotion of health thereby
improving the quality of life of the individual with
ED.
Thus, research that assesses the impact of a sedentary
lifestyle on individuals with ED is needed. The
objective of this study was to investigate the
association between ED and physical inactivity,
considering the clinical and demographic
characteristics of patients with ED, thus evaluating
the association between ED and the level of physical
activity.
Patients and Methods
Fifty patients with ED, regardless of race, with ages
ranging from 38-79 years (mean: 57.7 ± 8.8 years)
from the region of São José do Rio Preto, Brazil were
prospectively studied. These individuals were
evaluated from August 2014 to February 2015. This
study was approved by the Research Ethics
Committee of FAMERP, and patients were only
enrolled after being informed about the purpose and
the importance of the study, and after signing
informed consent forms.
The inclusion criterion was patients with ED
diagnosed more than six months previously who were
already under treatment irrespectively of whether
they were sedentary or not. The exclusion criteria
were an inactive sex life, age under 18 years, morbid
obesity and physical disabilities.
The international Index of Erectile Function (IIEF-5)
was used to determine the degree of ED. The
summed scores are grouped as follows: from 17 to 24
indicates individuals with mild ED; scores between
10 and 16 indicate patients with moderate ED and
scores of less than 10 identified subjects with severe
ED (Rosen et al., 1999; Rosen et al., 1997).
The International Physical Activity Questionnaire -
IPAQ was used to measure the physical activity
(Matsudo et al., 2001). This questionnaire assesses
the time and intensity of physical activity performed
by the individual over one week. The IPAQ evaluates
the level of physical activity during work, travelling,
and leisure and sporting activities and of sitting. The
level of physical activity was classified as follows: a)
physically active individuals performed at least 150
minutes of activities per week on at least five days; b)
insufficiently active individuals practiced physical
activity for at least 10 continuous minutes per week
c) sedentary individuals did not perform physical
activity for at least 10 continuous minutes per week.
The final scores of the physical activity questionnaire
were obtained from the sum of the different
dimensions (work, transportation, domestic tasks,
leisure and sports).
A G-Tech digital weighing scales and Wiso tape
measure were used to measure and calculate
anthropometric indicators (weight, height, body mass
index (BMI), waist, hip, waist-hip ratio, body fat
percentage, percentage of hydration, percentage of
muscles, percentage of bone mass).
Descriptive statistics (mean, standard deviation,
minimum and maximum) were used in the data
analysis. Quantitative variables were compared using
the t-test for two independent samples. The analysis
of any possible association between the degree of ED
(moderate and severe) and qualitative variables
Relationship between Sedentary Lifestyle and Erectile Dysfunction
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70
(diabetes, alcoholism, smoking, physical activity)
was achieved using Pearson's chi-square test.
Analyses of risk assessment with results as odds
ratios (OR) were performed using binary logistic
regression. All analyzes were performed using the R-
64 computer software version 2.13.0 (The R
Foundation for Statistical Computing, Auckland,
New Zealand). The level of significance was set for
an α error greater than 5%.
Results
Twenty-one (42%) of the patients studied (n = 50)
had moderate ED (Grade 2) and 29 (58%) had severe
ED (Grade 3).
Of the 50 participants, 12 (24%) were aged between
38 and 49 years, 19 (38%) between 50 and 59 years,
13 (26%) between 60 and 69 years and six (12%)
between 70 and 79 years.
The BMIs of under 60-year-old participants were as
follows: seven (22.5%) had normal weights (10.5-
24.9 kg/m²), four (12.9%) were overweight (25.0-
29.9 kg/m²), 15 (48.4%) had Grade 1 obesity (30.0-
34.9 kg/m²), four (12.9%) Grade 2 obesity (35.0-39, 9
kg/m²) and one (3.3%) had Grade 3 obesity (≥ 40
kg/m²). In over 60-year-old participants, the results
were: one (5.3%) was underweight (<22.0 kg/m²),
eight (42.1%) had normal weights (22.0-27.0 kg/m²)
and ten (52.6%) were overweight (> 27.0 kg/m²).
There was no significant difference between the
degrees of ED (grade 2 and 3) in respect to
demographic and clinical variables (age, weight,
height, BMI, waist, hip and percentages of fat,
hydration, muscle and bone mass) (Table 1). The p-
values for the variables percentage of fat and
percentage of hydration were close to 0.05.
Table 1 - Comparison of demographic and clinical
variables in relation to grade 2 (n = 21) and 3 (n = 29)
erectile dysfunction using the t test for two
independent samples.
Variable
Degree
Mean
SD
p-value
Age (years)
2
55.6
8.3
0.14
3
59.3
8.9
Weight (kg)
2
87.2
20.1
0.59
3
84.3
16.7
Height (m)
2
1.68
0.10
0.48
3
1.70
0.08
BMI
2
30.5
4.9
0.27
3
28.9
4.8
Waist (cm)
2
104.1
14.5
0.60
3
102.0
13.3
Hip (cm)
2
101.8
10.9
0.77
3
100.9
9.9
Fat (%)
2
30.4
7.1
0.07
3
26.7
6.3
Hydration (%)
2
47.8
4.9
0.06
3
50.3
4.3
Muscles (%)
2
35.8
3.5
0.11
3
37.4
2.8
Bone mass (%)
2
12.0
0.9
0.93
3
11.9
1.0
SD: standard deviation; BMI: body mass index
The study of the relationship between waist-hip ratio and risk to the health of men (Table 2) showed that 36 (72%)
patients with ED are at high risk of developing diseases caused by an excess of abdominal fat.
Table 2 - Waist-hip ratio: risk to health according to age and stratification of patients in current study.
Age (years)
N
Moderate risk
n
n
30 39
0.84 - 0.91
1
40 49
0.88 - 0.95
11
50 59
0.91 - 0.98
7
12
60 79
1
0.91 - 0.98
6
12
n = number of patients
There was no significant association between the degree of ED (grade 2 and 3) and diabetes, smoking and alcohol
consumption (Table 3).
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71
Table 3 - Association of Moderate (2) and severe (3) erectile dysfunction with diabetes, smoking and alcohol
consumption.
ED degree
Diabetic
No Diabetic
Total
P
2
52.4
47.6
42.0
3
37.9
62.1
58.0
0.310
Total
100
100
100
ED degree
Smoker
Non-smoker
Total
P
2
25.0
45.2
42.0
3
75.0
54.8
58.0
0.288
Total
100
100
100
ED degree
Alcohol drinker
No alcohol drinker
Total
P
2
28.6
71.4
42.0
3
41.4
58.6
58.0
0.352
Total
100
100
100
Diabetes: Pearson chi-square = 1.032; GL = 1
Smoking: Pearson chi-square = 1.130; GL = 1
Alcoholism: chi-square = 0.867 Pearson; GL = 1
Regarding the level of physical activity of the participants, 38 (76%) said they were active, six (12%) said they were
insufficiently active and only six (12%) reported being sedentary (Table 4).
Table 4 - Degree of erectile dysfunction (ED) in respect to physical activity.
Degree of ED
Active
n (%)
Insufficiently Active
n (%)
Sedentary
n (%)
2
17 (81)
3 (14.2)
1 (4.8)
3
21 (72.5)
3 (10.3)
5 (17.2)
Total
38 (76)
6 (12)
6 (12)
There was no statistically significant association between the degree of ED (moderate and severe) and physical
activity (active, insufficiently active and sedentary) (p-value = 0.272) (Table 5).
Table 5 Degree of erectile dysfunction (ED) [Moderate (2) and severe (3)] and level of physical activity.
Degree of ED
Active
IA
Sedentary
Total
P-value
2
80.9
14.3
4.8
42.0
3
69.0
10.3
20.7
58.0
0.272
Total
100
100
100
100
IA = Insufficiently Active
Pearson chi-square = 2.601; GL = 2
Discussion
Participants of this study presented a high level of
physical activity, contrary to our initial expectations.
We thought we would find an association between
ED and lack of exercise because physical inactivity is
considered a high risk factor (Souza et al., 2011).
Furthermore, vigorous exercise is associated with a
30% reduction in risk compared to sedentary
individuals or those who do little physical activity
(Souza et al., 2011).
However, the results point in the opposite direction.
Of the 50 study participants, 38 (76%) presented with
ED even though they were physically active. Possibly
physiological aging and psychogenic factors, which
were not assessed in this study, may have negatively
influenced erectile function.
In this research, regular physical activity had no
positive impact on male sexual health. This is
contrary to what is reported in the medical literature
that physical activity may modify or prevent ED
Relationship between Sedentary Lifestyle and Erectile Dysfunction
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72
(Oliveira et al., 2010; Wang et al., 2014; Leoni et al.,
2014; Weber et al., 2013). For the individuals
analyzed, the systematic practice of exercise did not
contribute to any improvement in sexual intercourse.
This result was also found by Abdo et al. (2006) in a
population study with 2,862 Brazilians. These authors
found no statistically significant association between
ED and physical inactivity, attributing this to the fact
that most sedentary patients are young, and that there
was insufficient time for this condition to cause
physical harm and therefore ED.
In this series, we could not determine why so many
active seniors had ED. Perhaps the sample size was
too small for conclusive results. Therefore, it is
suggested that more research should be conducted in
order to check whether there is an association
between sedentary lifestyle and appearance and/or
worsening of ED or not.
Conclusion
Most patients with ED were obese or at least
overweight however, the level of physical activity of
most was high. This study did not find any significant
association between moderate and severe degrees of
ED and physical activity (active, insufficiently active
and sedentary).
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11.
... The rate of ED in sedentary individuals is between 43 and 70%, and thus regular physical activity can reduce the risk of ED by one third. However, some studies did not find any relationship between the practice of physical exercises and ED, possibly due to the negative influence of physiological aging and psychogenic factors, both of which were not considered in the studies 15 . ...
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... The risk factors most commonly associated with ED are high blood pressure (hypertension), diabetes mellitus, smoking, excessive alcohol consumption, obesity, prostate diseases, depression, age and socioeconomic factors (Morillo et al., 2002;Nicolosi et al., 2003;Spessoto et al., 2010;Almogbel, 2014;Pinheiro et al., 2015). ...
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... The risk factors most commonly associated with ED are high blood pressure (hypertension), diabetes mellitus, smoking, excessive alcohol consumption, obesity, prostate diseases, depression, age and socioeconomic factors (Morillo et al., 2002;Nicolosi et al., 2003;Spessoto et al., 2010;Almogbel, 2014;Pinheiro et al., 2015). ...
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Background: Erectile dysfunction (ED) affects more than 100 million men worldwide, with a wide variability in prevalence. An overall association of cardiovascular risk factors, lifestyle and diet in the context of ED in a Mediterranean population is lacking. Aims: To assess ED prevalence and associated factors in a Mediterranean cohort of non-diabetic patients with cardiovascular risk factors. Methods: Observational, cross-sectional study of patients aged over 40 treated at cardiovascular risk units in Catalonia. Anthropometric data, risk factors, lifestyle and diet habits were recorded. ED was assessed using the International Index of Erectile Function. Results: 440 patients included, 186 (42.3%) with ED (24.8% mild, 6.8% moderate and 10.7% severe). ED presence and severity were associated with age, obesity, waist circumference, hypertension, antihypertensive treatment and ischemic disease. Patients with ED were more frequently smokers, sedentary and consumed more alcohol. In multivariate analysis, consumption of nuts (> twice a week) (OR 0.41 [95% CI 0.25 to 0.67] and vegetables (≥ once a day) (OR 0.47 [95% CI 0.28 - 0,77]), were inversely related to ED. Obesity (as BMI ≥ 30 kg/m(2) ) (OR 2.49 [95% CI 1.48 -4.17]), ischemic disease (OR 2.30 [95% CI 1.22 to 4.33], alcohol consumption (alcohol-units a day) (OR 1.14 [95% CI 1.04 to 1.26], and age (year) (OR = 1.07 [95% CI 1.04-1.10] were directly related to ED. Conclusions: ED is a common disorder in patients treated in lipid units in Catalonia for cardiovascular risk factors. This condition is associated with age, obesity, ischemic disease and unhealthy lifestyle habits.
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Erectile dysfunction is closely linked to the general state of both physical and psychological wellness. Among the major risk factors are heart disease, arterial hypertension, diabetes, hyperlipidemia, as well as sedentary lifestyle, smoking and alcohol abuse. Also, the disease is more frequently found in men undergoing radiation therapy or surgery for prostate cancer. Psychological correlates include anxiety, depression and irritability. Despite a higher prevalence among older men, erectile dysfunction is not considered an inevitable part of aging. Due to polyetiology of the disease, sildenafil is regarded as the gold standard of treatment, and new high quality generic drugs are marketed. The article covers the use of sildenafil in patients with diseases of the cardiovascular system, diabetes, hypogonadism. Effectiveness of sildenafil in patients on chronic hemodialysis as well as in patients undergoing radical prostatectomy is discussed. The issue of addiction to sildenafil is outlined.
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To assess the association between physical exercise and erectile function in young and middle-aged men. Using Paffenbarger Physical Activity Questionnaire (PPAQ) and IIEF-15, we conducted an investigation among 30- to 45-year-old male outpatients at the clinic of urology. Based on the physical activity described in PPAQ, the patients were divided into a sedentary group (≤ 1,400 Kcal/wk) and an exercise group (> 1,400 Kcal/wk). The total score on IIEF-15 was signifi- cantly higher in the exercise group than in the sedentary group (62.2 vs 54.4), and so were the scores on the domains of erectile func- tion (26.4 vs 23.3), sexual desire (7.8 vs 6.9), orgasmic function (9.0 vs 8.3), intercourse satisfaction (11.5 vs 9.6), and overall satisfaction (7.5 vs 6.3) (all P < 0.05). Increased physical activity is associated with better sexual function in young and middle-aged men.
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Erectile dysfunction (ED) affects millions of men worldwide with implications that go far beyond sexual activity. ED is now recognised as an early marker of cardiovascular disease, diabetes mellitus (DM) and depression. The risk factors that are associated with ED (sedentary lifestyle, obesity, smoking, hypercholesterolaemia and the metabolic syndrome) are very similar to those for cardiovascular disease (CVD). Arguably, the awareness of ED as a symptomatic entity in the post-Viagra™ age is on the rise. Nevertheless, ED is commonly missed when evaluating patients in the hospital setting, either because of lack of consideration or awareness, or through simple embarrassment (of both clinician and patient). This article provides an overview of the aetiology, assessment and importance of ED and hopes to promote its consideration in day-to-day clinical practice.
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Introduction: Erectile dysfunction (ED) is the most frequently treated male sexual dysfunction worldwide. ED is a chronic condition that exerts a negative impact on male self-esteem and nearly all life domains including interpersonal, family, and business relationships. Aim: The aim of this study is to provide an updated overview on currently used and available conservative treatment options for ED with a special focus on their efficacy, tolerability, safety, merits, and limitations including the role of combination therapies for monotherapy failures. Methods: The methods used were PubMed and MEDLINE searches using the following keywords: ED, phosphodiesterase type 5 (PDE5) inhibitors, oral drug therapy, intracavernosal injection therapy, transurethral therapy, topical therapy, and vacuum-erection therapy/constriction devices. Additionally, expert opinions by the authors of this article are included. Results: Level 1 evidence exists that changes in sedentary lifestyle with weight loss and optimal treatment of concomitant diseases/risk factors (e.g., diabetes, hypertension, and dyslipidemia) can either improve ED or add to the efficacy of ED-specific therapies, e.g., PDE5 inhibitors. Level 1 evidence also exists that treatment of hypogonadism with total testosterone < 300 ng/dL (10.4 nmol/L) can either improve ED or add to the efficacy of PDE5 inhibitors. There is level 1 evidence regarding the efficacy and safety of the following monotherapies in a spectrum-wide range of ED populations: PDE5 inhibitors, intracavernosal injection therapy with prostaglandin E1 (PGE1, synonymous alprostadil) or vasoactive intestinal peptide (VIP)/phentolamine, and transurethral PGE1 therapy. There is level 2 evidence regarding the efficacy and safety of the following ED treatments: vacuum-erection therapy in a wide range of ED populations, oral L-arginine (3-5 g), topical PGE1 in special ED populations, intracavernosal injection therapy with papaverine/phentolamine (bimix), or papaverine/phentolamine/PGE1 (trimix) combination mixtures. There is level 3 evidence regarding the efficacy and safety of oral yohimbine in nonorganic ED. There is level 3 evidence that combination therapies of PDE5 inhibitors + either transurethral or intracavernosal injection therapy generate better efficacy rates than either monotherapy alone. There is level 4 evidence showing enhanced efficacy with the combination of vacuum-erection therapy + either PDE5 inhibitor or transurethral PGE1 or intracavernosal injection therapy. There is level 5 evidence (expert opinion) that combination therapy of PDE5 inhibitors + L-arginine or daily dosing of tadalafil + short-acting PDE5 inhibitors pro re nata may rescue PDE5 inhibitor monotherapy failures. There is level 5 evidence (expert opinion) that adding either PDE5 inhibitors or transurethral PGE1 may improve outcome of penile prosthetic surgery regarding soft (cold) glans syndrome. There is level 5 evidence (expert opinion) that the combination of PDE5 inhibitors and dapoxetine is effective and safe in patients suffering from both ED and premature ejaculation.