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Lifestyle for Erectile Dysfunction: A Good Choice

Lifestyle for Erectile Dysfunction: A Good Choice Gupta et al1 report the results of a systematic review and meta-analysis comprising 4 randomized controlled clinical trials of lifestyle modifications, measuring its effects on the IIEF-5 (International Index of Erectile Function [not “Dysfunction,” as repeatedly reported in the article]) score in 597 patients with erectile dysfunction at baseline. The authors found that, after a follow-up lasting 2 to 24 months, the lifestyle modifications were associated with an improvement of 2.4 points in the IIEF-5 score. As the authors acknowledge, the minimal clinically important difference in the erectile function domain is accepted to be a 4-point improvement in IIEF-5 score; intuitively, minimal clinically important difference may vary significantly according to the baseline ED severity. A way to circumvent the lack of individual patient data would have been to report how many patients regained sexual function, as indicated by an IIEF-5 score of 22 or higher after lifestyle interventions. In the article by Esposito et al,2 for example, 17 men in the intervention group and 3 in the control group (P = .001) reported an IIEF score of 22 or higher, with 31% of men in the intervention group regaining sexual function. This may be in line with epidemiological evidence3 that physical activity was associated with a 30% lower risk of erectile dysfunction, while obesity was associated with a 30% higher risk of erectile dysfunction. In metaregression, the length of study follow-up did not have an impact on the effect size. Unfortunately, other important determinants of lifestyle interventions were not, or could not, be explored. In the study by Esposito et al,2 both body mass index reduction and physical activity increase were independent predictors of IIEF score and explained almost one-half of the variability in score changes. Improvement of sexual (erectile) function in men should be added to the growing list of clinical benefits brought about by healthy lifestyles in human beings. Lifestyle change should not be regarded as an antagonist to drug use, since it also is a good companion of phosphodiesterase-5 inhibitors therapy. Back to top Article Information Correspondence: Dr Esposito, Division of Metabolic Diseases, University of Naples, Piazza L. Miraglia 2, 80138 Naples, Italy (Katherine.esposito@unina2.it). Financial Disclosure: None reported. References 1. Gupta BP, Murad MH, Clifton MM, Prokop L, Nehra A, Kopecky SL. The effect of lifestyle modification and cardiovascular risk factor reduction on erectile dysfunction: a systematic review and meta-analysis. Arch Intern Med. 2011;171(20):1797-180321911624PubMedGoogle ScholarCrossref 2. Esposito K, Giugliano F, Di Palo C, et al. Effect of lifestyle changes on erectile dysfunction in obese men: a randomized controlled trial. JAMA. 2004;291(24):2978-298415213209PubMedGoogle ScholarCrossref 3. Bacon CG, Mittleman MA, Kawachi I, Giovannucci E, Glasser DB, Rimm EB. Sexual function in men older than 50 years of age: results from the health professionals follow-up study. Ann Intern Med. 2003;139(3):161-16812899583PubMedGoogle Scholar http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Lifestyle for Erectile Dysfunction: A Good Choice

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Publisher
American Medical Association
Copyright
Copyright © 2012 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinternmed.2011.785
Publisher site
See Article on Publisher Site

Abstract

Gupta et al1 report the results of a systematic review and meta-analysis comprising 4 randomized controlled clinical trials of lifestyle modifications, measuring its effects on the IIEF-5 (International Index of Erectile Function [not “Dysfunction,” as repeatedly reported in the article]) score in 597 patients with erectile dysfunction at baseline. The authors found that, after a follow-up lasting 2 to 24 months, the lifestyle modifications were associated with an improvement of 2.4 points in the IIEF-5 score. As the authors acknowledge, the minimal clinically important difference in the erectile function domain is accepted to be a 4-point improvement in IIEF-5 score; intuitively, minimal clinically important difference may vary significantly according to the baseline ED severity. A way to circumvent the lack of individual patient data would have been to report how many patients regained sexual function, as indicated by an IIEF-5 score of 22 or higher after lifestyle interventions. In the article by Esposito et al,2 for example, 17 men in the intervention group and 3 in the control group (P = .001) reported an IIEF score of 22 or higher, with 31% of men in the intervention group regaining sexual function. This may be in line with epidemiological evidence3 that physical activity was associated with a 30% lower risk of erectile dysfunction, while obesity was associated with a 30% higher risk of erectile dysfunction. In metaregression, the length of study follow-up did not have an impact on the effect size. Unfortunately, other important determinants of lifestyle interventions were not, or could not, be explored. In the study by Esposito et al,2 both body mass index reduction and physical activity increase were independent predictors of IIEF score and explained almost one-half of the variability in score changes. Improvement of sexual (erectile) function in men should be added to the growing list of clinical benefits brought about by healthy lifestyles in human beings. Lifestyle change should not be regarded as an antagonist to drug use, since it also is a good companion of phosphodiesterase-5 inhibitors therapy. Back to top Article Information Correspondence: Dr Esposito, Division of Metabolic Diseases, University of Naples, Piazza L. Miraglia 2, 80138 Naples, Italy (Katherine.esposito@unina2.it). Financial Disclosure: None reported. References 1. Gupta BP, Murad MH, Clifton MM, Prokop L, Nehra A, Kopecky SL. The effect of lifestyle modification and cardiovascular risk factor reduction on erectile dysfunction: a systematic review and meta-analysis. Arch Intern Med. 2011;171(20):1797-180321911624PubMedGoogle ScholarCrossref 2. Esposito K, Giugliano F, Di Palo C, et al. Effect of lifestyle changes on erectile dysfunction in obese men: a randomized controlled trial. JAMA. 2004;291(24):2978-298415213209PubMedGoogle ScholarCrossref 3. Bacon CG, Mittleman MA, Kawachi I, Giovannucci E, Glasser DB, Rimm EB. Sexual function in men older than 50 years of age: results from the health professionals follow-up study. Ann Intern Med. 2003;139(3):161-16812899583PubMedGoogle Scholar

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Feb 13, 2012

Keywords: erectile dysfunction,life style

References