TUESDAY, June 22, 2004 (HealthDayNews) -- Exercise and weight loss can improve the sexual performance of obese men suffering from impotence.
That's the conclusion of a two-year study by Italian researchers who found that such a lifestyle-enhancing program enabled one-third of the men to consistently achieve an erection.
The study, by researchers at the Center for Obesity Management of the Second University of Naples, appears in the June 23/30 issue of the Journal of the American Medical Association.
The 110 men ranged in age from 35 to 55, and all had a body mass index of 30 or higher -- the official marker for obesity -- when the study began. And all were suffering from erectile dysfunction.
For two years, 55 of the men took part in a program that counseled specific exercise and weight-loss goals. The other 55 men didn't receive such lifestyle counseling, but they were given general information about healthy food choices and exercise.
At the end of the study, nearly a third of the men who received the lifestyle counseling -- 17 -- reported improved sexual performance. Conversely, only three of 55 the men who didn't receive the lifestyle counseling experienced the same level of improvement in sexual performance, according to the study.
To measure improvement, the researchers used a scale called the International Index of Erectile Function. The scores of the men in the counseling group improved from 13.9 to 17. For other group, the scores were virtually unchanged -- 13.5 to 13.6.
The men who received the counseling had significant reductions in weight and increases in physical activity, while there was little change in men in the other group.
Two U.S. experts differ in their interpretation of the study's finding. Both agree that weight loss and physical activity offer clear benefits for overall health. They disagree, however, on whether they would try lifestyle changes before prescribing anti-impotence drugs such as Viagra to men like those in the Italian trial.
"The benefits of lifestyle changes are so strong that I would use them as a first-line treatment, with pharmacological intervention as a second line," said Dr. Christopher Saigal, an assistant professor of medicine at the University of California, Los Angeles, who wrote an editorial accompanying the journal report.
But Dr. Andrew McCullough, director of the Male Sexual Health facility at New York University Medical Center, said he would prescribe a drug in most cases, even while advising men to exercise more and eat less.
The Italian study showed that lifestyle changes can improve sexual performance for obese men, McCullough acknowledged. But the benefits came over two years, too long a time for most men to wait, he said.
"Two years for improvement requires a lot of sacrifice," McCullough said. "I would not withhold a drug from these men."
Another factor to be considered is that the study included only men who did not have diabetes, high blood pressure, or high cholesterol readings, all of which can have major effects on overall health and sexual performance, McCullough and Saigal said.
"The presence of these comorbid conditions may lessen the impact of exercise and weight loss on erectile dysfunction," Saigal wrote in the editorial, adding that "counseling overweight patients to begin and sustain effective weight-reducing behaviors can be a daunting challenge for clinicians."
But sexual performance is so important to most men that a desire for improvement would make them more likely to follow lifestyle advice, Saigal said. "I would tell them to take weight loss seriously," he said. "If it doesn't work, at least it doesn't hurt them."
And it doesn't need to be an either/or approach, McCullough said. "The two approaches [lifestyle changes and drug therapy] should be in concert," he said. "Why not try to eliminate all the issues associated with erectile dysfunction?"
The National Institute of Diabetes and Digestive and Kidney Diseases offers more on obesity and its accompanying problems.