PERFORMANCE
Does cardio really improve erections? What the research says
Erections run on blood flow, so it makes sense that fitness matters. Here is what the trials found, how much exercise they used and how long it took.
Yes, cardio does improve erections for many men, and the evidence now comes from randomised trials rather than just surveys. The effect is real but modest, it is biggest in men whose erections are worst to begin with, and it takes months rather than days.
A 2023 meta-analysis of 11 randomised trials found aerobic exercise improved erectile function scores by 2.8 points on average, and by 4.9 points in men with severe erectile dysfunction.
Erections depend on healthy blood vessels, and erection problems often appear before heart disease, so the same habits protect both.
The programmes that worked mostly involved moderate to vigorous aerobic exercise, roughly 40 minutes four times a week, kept up for months.
Men who started exercising in midlife had a lower risk of later erectile dysfunction than men who stayed sedentary.
Cycling does not appear to harm erections compared with running or swimming, though saddle and handlebar set-up affect numbness.
Exercise works alongside treatment rather than instead of it, and new erection problems deserve a GP check because of the heart link.
Does cardio actually improve erections?
Yes. Pooled results from randomised trials show that regular aerobic exercise improves erectile function compared with not exercising, with the biggest gains in men who have more severe problems.1 It is one of the best-supported non-drug steps for erectile dysfunction.
For years the link between fitness and erections came mainly from observational studies: active men reported better erections than inactive ones. That is suggestive but not proof, because healthier men may simply exercise more. The picture firmed up once randomised controlled trials started assigning men to exercise or no exercise and measuring what happened.
A 2023 meta-analysis pooled 11 of those trials. On the erectile function part of the International Index of Erectile Function, a questionnaire scored from 6 to 30, aerobic exercise improved scores by an average of 2.8 points compared with control groups. The benefit scaled with severity: 2.3 points in mild, 3.3 in moderate and 4.9 in severe erectile dysfunction.1
To put that in context, a few points on this scale is the difference many men would notice in day-to-day reliability, but it is not the same as the effect of a tablet taken before sex. Exercise shifts the baseline; it does not flip a switch.
“Regular aerobic exercise can improve the erectile function of men, particularly those with lower baseline IIEF-EF scores.”
Why would running or cycling affect your erections?
Because an erection is a blood-flow event. It depends on the lining of the arteries relaxing so blood can pour into the penis, and the same damage that narrows heart arteries affects the smaller penile arteries first.2 Aerobic exercise improves the health of blood vessels throughout the body.
When you are aroused, nerve signals tell the smooth muscle in the penile arteries and erectile tissue to relax. Blood rushes in, the tissue expands and the outflow veins are squeezed shut. Every step relies on the endothelium, the thin lining of the blood vessels, doing its job. When that lining is inflamed or stiffened by smoking, high blood pressure, high blood sugar or excess weight, the arteries cannot open as fully.
A systematic review in European Urology described erectile dysfunction and cardiovascular disease as two faces of the same systemic disorder. Because penile arteries are smaller than coronary arteries, the same degree of vessel damage cuts blood flow to the penis more noticeably, so erection problems often show up first.2 This is sometimes called the artery size hypothesis.
The practical consequence was shown in a large US trial that followed 9,457 men aged 55 and over. Men with erectile dysfunction had a 45% higher risk of later cardiovascular events, a risk the authors compared with current smoking or a family history of heart attack.3 So when exercise helps erections, it is almost certainly helping the rest of the circulation too.
It isn't only the arteries
In an Italian trial of 110 obese men with erectile dysfunction, the group that lost weight and increased activity saw falls in inflammatory markers such as C-reactive protein and interleukin 6 as well as better erections. In the statistics, changes in body mass index, physical activity and C-reactive protein were each independently linked to the improvement in erectile function.4 Exercise also helps sleep, mood and stress, all of which feed into sexual function, as our guide to stress, erections and libido explains.
What do the studies on exercise and erectile dysfunction show?
The randomised trials and meta-analyses point the same way: aerobic exercise, alone or as part of wider lifestyle change, improves erectile function scores. The effects are moderate, and the evidence is strongest for aerobic training rather than weights or pelvic floor work alone.1,5
Study
Who took part
What they did
What changed
Esposito 2004, trial
110 obese men with erectile dysfunction
Weight loss plus more activity
Erection score rose from 13.9 to 17
Maio 2010, trial
60 men using PDE5 tablets
Tablets plus 3+ hours aerobic weekly
Normal function in 77.8% versus 39.3%
Gupta 2011, meta-analysis
6 trials, 740 men
Lifestyle and risk-factor treatment
Erection score up 2.66 points on average
Khera 2023, meta-analysis
11 randomised trials
Aerobic exercise versus no exercise
Up 2.8 points; 4.9 in severe cases
Chen 2024, meta-analysis
7 trials, men not on tablets
Aerobic, combined or pelvic floor training
Aerobic alone clearly helped; others unclear
The Italian trial is worth knowing in detail because it ran for two years. Men in the intervention group raised their activity from about 48 to 195 minutes a week and cut their body mass index from 36.9 to 31.2. Their average erectile function score rose from 13.9 to 17, while the control group barely moved, and 17 men in the intervention group reached a score of 22 or higher, the study's threshold for normal function, compared with 3 controls.4 The authors summed it up as improvement in about one third of obese men.
A meta-analysis of six trials with 740 men found that lifestyle change and treatment of cardiovascular risk factors improved scores by 2.66 points on average, or 2.40 points when only the four lifestyle trials were counted.6 A 2024 meta-analysis restricted to men who were not taking erection tablets found a clear benefit from aerobic training alone. Combined aerobic and resistance training and pelvic floor training did not reach statistical significance, although only a handful of trials looked at them.5
That last point does not mean weights or pelvic floor exercises are useless. It means there are too few trials to be confident, and different trials have tested different things. Pelvic floor training has its own evidence base, covered in our pelvic floor guide.
How much cardio do you need to improve erections?
The trials that worked mostly used moderate to vigorous aerobic exercise for around 160 minutes a week, often as 40-minute sessions four times a week.7 Other successful trials used about three hours or more a week.8
A 2018 systematic review set out to answer exactly this question for men whose erection problems were linked to inactivity, obesity, high blood pressure, metabolic syndrome or heart disease. Looking across ten intervention studies, it recommended supervised training of 40 minutes of moderate to vigorous aerobic exercise four times a week, adding up to about 160 minutes weekly, kept up for six months.7
Those figures line up with the trials above. In the Italian weight-loss trial, the intervention group reached about 195 minutes a week.4 In a trial that combined exercise with erection tablets, men were asked to do at least three hours of aerobic activity a week and averaged 3.4 hours.8
What counts as moderate to vigorous?
Moderate: you are breathing harder and warm, and can talk but not sing. Brisk walking, easy cycling and steady swimming usually fit here.
Vigorous: you can only say a few words before needing a breath. Running, hard cycling, rowing and fast swimming usually fit here.
The type matters less than the habit. The trials used a range of aerobic activities. What they had in common was regularity over months.
These are the amounts trials used, not a personal prescription. If you are starting from very little, building up gradually is sensible, and anyone with heart disease or chest symptoms should talk to a doctor before increasing intensity.
How long does it take for exercise to improve erections?
Expect months, not weeks. Measurable improvements have been reported after about three months in a trial combining exercise with tablets, while longer programmes of six months to two years have produced the clearest lifestyle effects.8,7,4
In the trial of 60 men taking PDE5 tablets, those who added regular aerobic exercise were assessed after three months. Their erectile function scores had improved, and 77.8% had scores in the normal range, compared with 39.3% of men taking the tablets alone.8 The review recommending 160 minutes a week based its advice on programmes lasting six months.7 The two-year Italian trial showed that the gains kept building as weight came down.4
This timeline reflects what is happening underneath. Blood vessel function, blood pressure, weight and blood sugar all change gradually. It is also why a single gym session before a date will not do much, and why a dip in motivation after a few weeks is worth pushing through.
Quick self-check: could fitness be part of the picture?
I rarely do exercise that leaves me properly out of breath.
I spend most of my day sitting, at work and at home.
I carry extra weight, especially around my middle.
I have been told my blood pressure, cholesterol or blood sugar is high.
I smoke or have smoked for many years.
My erections have become less reliable gradually, over months or years.
I get out of breath more easily on stairs or hills than I used to.
Tap the statements that apply to you.
If several of these apply, blood flow is a plausible part of the story, and more regular aerobic exercise is one of the best-supported things you can do. It is also worth asking a GP to check your blood pressure, cholesterol and blood sugar. Our sexual health check can help you pull the picture together.
Is it too late to start exercising for erections after 40?
No. In a long-running study of middle-aged men, those who took up exercise in midlife were, alongside men who had always been active, the group with the lowest risk of erectile dysfunction. Men who stayed sedentary had the highest risk.9
The Massachusetts Male Aging Study followed 593 men aged 40 to 70 who had no erectile dysfunction at the start, for nearly nine years on average. The highest risk of developing erectile dysfunction was among men who remained sedentary; the lowest was among those who stayed active or started being active during the study.9 In that analysis, stopping smoking or cutting heavy drinking in midlife was not linked to a lower risk of erectile dysfunction, and the authors suggested midlife changes may come too late to reverse those effects on erections. Quitting smoking still brings major benefits for the heart and lungs. Exercise stood out as the change that did track with lower risk.
A much larger survey of 31,742 US health professionals aged 53 to 90 found that the most active men had a 30% lower risk of erectile dysfunction than the least active, while obesity raised the risk. Physical activity and leanness were the lifestyle factors most strongly associated with good erectile function, even after accounting for other illnesses.10 If you are over 40 and wondering how testosterone fits in, our guide to testosterone after 40 covers it.
Does cycling cause erectile dysfunction?
The best available evidence says no. A large survey found that cyclists had erectile function at least as good as runners and swimmers, although cyclists were more prone to urethral problems and genital numbness depended on bike set-up.11
Cycling gets singled out because a saddle presses on the perineum, where nerves and arteries run to the penis. A multinational study of 3,932 men compared cyclists with swimmers and runners using validated questionnaires. After adjusting for other factors, cyclists scored no worse on erectile function; if anything, their scores were slightly higher. Cyclists did have higher odds of urethral stricture, a narrowing of the urine tube.11
Standing on the pedals for more than 20% of the ride was linked to lower odds of genital numbness.11
Handlebars set level with or higher than the saddle were linked to less numbness and fewer saddle sores.11
Persistent numbness after rides is a signal to adjust your position or saddle, and to see a GP if it does not settle.
Can exercise replace erection medication?
For some men with milder problems, lifestyle change alone may be enough, but exercise works best as part of a plan rather than a substitute for proper assessment. In one trial, men who combined tablets with regular exercise did better than men on tablets alone.8
PDE5 inhibitors such as sildenafil and tadalafil work on the day. Exercise changes the underlying conditions over months. They are not rivals, and the trial evidence suggests they add together.8 Some men find they need less help from tablets as their fitness improves; others find tablets help them rebuild confidence while the slower changes take hold.
What exercise should not replace is a check-up. Because erection problems can be an early sign of heart disease, a GP will usually want to look at your blood pressure, cholesterol and blood sugar.3,2 If erections are fine during sleep and alone but not with a partner, performance anxiety may be part of it, and our guide to morning wood explains why that pattern matters.
When to see a doctor
See a GP if erection problems have lasted more than a few weeks, especially if you also have high blood pressure, diabetes, high cholesterol, a family history of early heart disease, or you smoke. Erection problems can come before heart symptoms, so this is a useful early check rather than an embarrassing one.
Stop exercising and seek urgent help if you get chest pain, pressure or tightness, unusual breathlessness, fainting or a racing irregular heartbeat. If you already have a heart condition, ask your doctor how hard it is safe to train before stepping things up.
Myth or fact?
Myth: You need punishing workouts to see any benefit.
Fact: The programmes that worked used moderate to vigorous aerobic exercise, around 40 minutes four times a week, rather than extreme training.7
Myth: Cycling will ruin your erections.
Fact: In a study of 3,932 men, cyclists had erectile function at least as good as swimmers and runners. Bike set-up affected numbness and saddle sores.11
Myth: If you've been inactive for decades, there's no point starting now.
Fact: Men who took up exercise in midlife had a lower risk of later erectile dysfunction than those who stayed sedentary.9
Frequently asked questions
Is running good for erections?
Running is an aerobic exercise, and aerobic exercise is the type with the strongest trial evidence for improving erectile function.1 What matters most is doing it regularly over months, at an intensity that gets you breathing harder.
Does walking count as cardio for erections?
Brisk walking that leaves you warm and breathing harder counts as moderate activity. The trial evidence favours moderate to vigorous aerobic exercise, so a gentle stroll is less likely to be enough on its own, but it is a good starting point.
Is weight training good for erections?
Strength training is good for overall health, but there are few trials looking at it for erections. A 2024 meta-analysis found combined aerobic and resistance training did not show a statistically clear benefit, largely because the evidence was thin.5 Keep lifting if you enjoy it, and make sure aerobic work is in the mix too.
Can exercise cure erectile dysfunction?
For some men it can make a big difference. In the Italian weight-loss trial, about a third of obese men improved, and 17 reached normal scores.4 For others, exercise helps but is not enough on its own, particularly where diabetes, nerve damage or medicines are involved.
Can I exercise if I take sildenafil or tadalafil?
Most men can, and a trial found tablets plus regular exercise worked better than tablets alone.8 If you have a heart condition, take nitrates or have been told to limit exertion, check with your doctor before starting a new exercise plan.
Will exercise raise my testosterone?
One small trial recorded a slight rise in testosterone within the exercise group, although levels did not differ significantly between the exercise and tablet-only groups.8 In the Italian weight-loss trial, the changes most closely linked to better erections were weight, activity and the inflammation marker C-reactive protein.4 If you have low desire and other symptoms of low testosterone, a blood test is the way to find out.
[1] Khera M, Bhattacharyya S, Miller LE. Effect of aerobic exercise on erectile function: systematic review and meta-analysis of randomized controlled trials. J Sex Med. 2023;20(12):1369-75. PubMed
[2] Gandaglia G, Briganti A, Jackson G, et al. A systematic review of the association between erectile dysfunction and cardiovascular disease. Eur Urol. 2014;65(5):968-78. PubMed
[3] Thompson IM, Tangen CM, Goodman PJ, et al. Erectile dysfunction and subsequent cardiovascular disease. JAMA. 2005;294(23):2996-3002. PubMed
[4] 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):2978-84. PubMed
[5] Chen Z, Wang J, Jia J, et al. Effect of different physical activities on erectile dysfunction in adult men not receiving phosphodiesterase-5 inhibitors therapy: a systematic review and meta-analysis. Andrology. 2024;12(8):1632-41. PubMed
[6] Gupta BP, Murad MH, Clifton MM, et al. 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):1797-803. PubMed
[7] Gerbild H, Larsen CM, Graugaard C, Areskoug Josefsson K. Physical activity to improve erectile function: a systematic review of intervention studies. Sex Med. 2018;6(2):75-89. PubMed
[8] Maio G, Saraeb S, Marchiori A. Physical activity and PDE5 inhibitors in the treatment of erectile dysfunction: results of a randomized controlled study. J Sex Med. 2010;7(6):2201-8. PubMed
[9] Derby CA, Mohr BA, Goldstein I, et al. Modifiable risk factors and erectile dysfunction: can lifestyle changes modify risk? Urology. 2000;56(2):302-6. PubMed
[10] Bacon CG, Mittleman MA, Kawachi I, et al. Sexual function in men older than 50 years of age: results from the health professionals follow-up study. Ann Intern Med. 2003;139(3):161-8. PubMed
[11] Awad MA, Gaither TW, Murphy GP, et al. Cycling, and male sexual and urinary function: results from a large, multinational, cross-sectional study. J Urol. 2018;199(3):798-804. PubMed
Eric Stephens
Eric Stephens writes and edits every guide on Load Boosting. He reads and summarises peer-reviewed research and major medical-society guidance on men’s health, and links to every source.