Suggested mechanisms by which weight loss, healthy diet, and physical exercise can improve ED include the amelioration of endothelial dysfunction, insulin resistance, and a low-grade inflammatory state associated with diabetes and metabolic diseases, all of which are risk factors for ED. The resulting improved inflammatory status may contribute to reducing the burden of sexual dysfunction in men.
Lifestyle changes, such as increased physical activity, healthy diet, and reduced caloric intake, have been associated with the improvement of ED in the general male population.
In a landmark study, Esposito and colleagues conducted a randomized controlled trial involving 110 obese men with ED.[6] Men assigned to the intervention group were entered into an intensive weight-loss program involving personalized dietary and exercise counseling. Men in the control group were given general oral and written information about healthy food choices and exercise but were not placed in specific, individualized programs.
After 2 years, men assigned to the intervention group lost significantly more weight, increased their physical activity, experienced favorable changes in physiologic measures of endothelial dysfunction, and had significant improvement in their ED score compared with men in the control group. Moreover, the number of men without ED was significantly higher in the group assigned to intensive lifestyle changes than in the control group.
Similar conclusions were reached in a group of diabetic men. Wing and colleagues studied 1-year changes in ED in 306 overweight men with type 2 diabetes mellitus participating in the Look AHEAD trial.[7] At 1 year, 8% of men assigned to the intensive lifestyle intervention reported worsening of erectile function, compared with 22% of the control participants. The overall IIEF domain score improved from 17.3 to 18.6 in the intervention group.
In this case, after counseling from his physician, the patient decided to pursue aggressive lifestyle modification with smoking cessation, diet, and exercise. At the same time, he decided to use an oral phosphodiesterase type 5 inhibitor on a daily basis to treat both the ED and BPH. He was given an alternative treatment of an oral phosphodiesterase type 5 inhibitor on an as-needed basis in combination with oral BPH therapies, such as a selective alpha blocker or a 5 alpha-reductase inhibitor.
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