A randomized clinical trial has shown that supervised resistance and aerobic exercise programs can improve erectile function in men with prostate cancer.

In the study, researchers led by Daniel A. Galvão, PhD, of the Exercise Medicine Research Institute at Edith Cowan University in Australia, found that a 6-month exercise intervention provided significant benefits compared with usual care, while a brief psychosexual education and self-management intervention (PESM) offered no additional improvements.

"In this randomized clinical trial of supervised exercise, erectile function in patients with prostate cancer was improved," the study authors wrote in JAMA Network Open. "Patients with prostate cancer should be offered exercise following treatment as a potential rehabilitation measure," they added.

The researchers conducted a three-arm, parallel-group, single-center randomized clinical trial at university-affiliated exercise clinics between July 2014 and August 2019. They enrolled 112 men (mean age = 66.3 years) with prostate cancer who had previously undergone or were currently undergoing treatment and were concerned about sexual dysfunction.

The patients were randomly assigned to one of three groups:

• Six months of supervised, group-based resistance and aerobic exercise (n = 39)
• The same exercise program plus psychosexual education and self-management (PESM) (n = 36)
• Usual care (n = 37).

The exercise intervention consisted of aerobic and resistance training undertaken 3 days per week. The aerobic component involved 20 to 30 minutes of cardiovascular exercise at moderate to vigorous intensity (approximately 60% to 85% of estimated maximal heart rate). Resistance training included six to eight exercises targeting major muscle groups, ranging from six to 12 repetitions maximum using one to four sets per exercise.

After 6 months, the mean adjusted difference in International Index of Erectile Function (IIEF) score favored exercise compared with usual care (3.5, 95% confidence interval [CI] = 0.3–6.6, P = .04). The researchers noted that the 5.1-point improvement in the exercise group indicated a potentially clinically relevant improvement, since the minimal clinically significant difference was 4.0 points.

"Those with the lowest tertile values prior to the initiation of exercise benefited the most following supervised exercise for sexual desire, intercourse satisfaction, and overall satisfaction," the study authors reported.

Additionally, the exercise intervention showed significant improvements in:

• Fat mass (mean adjusted difference = −0.9 kg, 95% CI = −1.8 to −0.1 kg, P = .02)
• Chair rise performance (mean adjusted difference = −1.8 seconds, 95% CI = −3.2 to −0.5 seconds, P = .002)
• Upper body muscle strength (mean adjusted difference = 9.4 kg, 95% CI = 6.9–11.9 kg, P < .001)
• Lower body muscle strength (mean adjusted difference = 17.9 kg, 95% CI = 7.6–28.2 kg, P < .001).

"Sexual dysfunction is a critical adverse effect of prostate cancer treatment and a major survivorship issue for patients and their partners," the study authors stated. They noted that while exercise is recommended in national and international cancer survivorship guidelines, "the evidence is less clear for sexual function in prostate cancer."

The study provided evidence that structured exercise could be an effective intervention for managing sexual dysfunction in patients with prostate cancer. The researchers emphasized that "screening patients for sexual dysfunction and rehabilitation goals following treatment could assist directing patients to exercise as a countermeasure, forming part of an accessible evidence-based survivorship intervention."

The researchers acknowledged that the study had limitations, including being underpowered because of recruitment difficulties that resulted in closing enrollment at 112 patients prior to reaching the target accrual of 240 patients.

Despite these limitations, the findings suggested that exercise should be considered an integral component of treatment for men with prostate cancer concerned about sexual function.

The authors declared having no competing interests.