Muscles, especially those important in maintaining an erection, sometimes lose tone and strength. Exercise may help to reverse erectile dysfunction (ED). These can include Kegel or pelvic floor exercises, Pilates, and more.

ED occurs when a man cannot get or maintain an erection. It is common in men of all ages.

Causes and risk factors for ED include:

Doctors may prescribe phosphodiesterase type 5 inhibitors, such as Viagra, for ED. Lifestyle changes, including exercise and weight loss, are also effective in treating ED.

Treating the cause of ED will have long-lasting results, while medication only provides temporary relief. Also, some people find medication to be ineffective.

Sometimes, psychological factors are responsible for ED. In these cases, a person can benefit from forms of talking therapy.

What types of exercise can help?

Exercises that strengthen the muscles of the pelvic floor can benefit people with ED.

The pelvic floor muscles are key in sustaining blood flow to the penis and maintaining erections.

The muscles do this by putting pressure on the penile veins. The pressure prevents blood from leaving the area, making an erection possible.

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Exercise may treat the some of the causes of ED.

Pelvic floor exercises, or Kegels, are the most beneficial for ED.

These exercises target the muscles at the bottom of the pelvis, and particularly one called the pubococcygeus. This loops from the pubic bone to the tailbone and supports the pelvic organs.

When this muscle weakens, it is unable to prevent blood from flowing out of the erect penis.

Performing pelvic floor exercises will strengthen and improve tone in the pubococcygeus. It can take 4–6 weeks before a person notices a difference in erections.

1. Activating pelvic floor muscles

This exercise is simple but important. It teaches a person to activate their pelvic floor muscles.

  • Lie down with the knees bent, the feet flat on the floor, and the arms by the sides.
  • Exhale and squeeze the pelvic floor muscles for a count of three.
  • Inhale and release for a count of three.
  • Take time identifying the right group of muscles — those at the bottom of the pelvis. It can be easy to accidentally contract other muscles instead, particularly those of the stomach, buttocks, or legs.

2. Sitting pelvic floor activation

  • Sit with the arms at the sides and the feet flat on the floor, hip-width apart.
  • Using the same technique as above, activate the pelvic floor muscles for a count of three, and release for a count of three.
  • Ensure that the stomach, buttocks, and leg muscles are not contracting.

3. Standing pelvic floor activation

  • Stand straight with the arms by the sides, and the feet hip-width apart.
  • Using the technique above, activate the pelvic floor muscles for a count of three, and release for a count of three.
  • Ensure that the stomach, buttocks, and leg muscles are not contracting.

Once a person is comfortable performing Kegel exercises three times a day, it can help to add exercises that involve more movement.

These Pilates exercises activate the right group of muscles and challenge a person to maintain pelvic floor strength while moving.

4. Knee fallouts

This is a beginners’ exercise that involves small movements.

  • Lie down with the knees bent, the feet flat on the floor, and the arms by the sides.
  • Keep the spine in a neutral position, with a small space between the middle of the back and the floor.
  • Exhale, squeeze the pelvic floor muscles, and slowly lower one knee to the floor. Only lower it as far as possible while maintaining activation of the pelvic floor muscles. Keep the pelvis stable.
  • Inhale, release the muscles, and bend the knee again.
  • Repeat on the other side.
  • Start with four or five repetitions on each side and build up to 10.

5. Supine foot raises

This exercise builds on knee fallouts and involves small movements.

  • Lie down with the knees bent, the feet flat on the floor, and the arms by the sides.
  • Exhale, engage the pelvic floor muscles, and slowly raise one foot off the floor. Keep the pelvis and the spine still.
  • Inhale, lower the foot back to the ground.
  • Alternate sides.

6. Pelvic curl

This exercise is common in Pilates.

  • Lie down with the knees bent, the feet flat on the floor, and the arms by the sides.
  • Keep the spine in a neutral position, with a small space between the middle of the back and the floor.
  • Exhale, and engage the pelvic floor muscles.
  • Tilt the pelvis upward toward the belly button, while pressing the back flat against the floor.
  • Slowly lift the buttocks and push the heels into the floor.
  • Squeeze the buttocks while lifting it and the lower and middle back.
  • The body’s weight should be resting on the shoulders.
  • Take three breaths and squeeze the buttocks and pelvic floor muscles.
  • Slowly lower the buttocks and back, vertebra by vertebra, to the floor.
  • Repeat three to four times initially, and build up to 10 repetitions.

At first, a person may only be able to perform an exercise three or four times.

Build strength by practicing the exercises daily. Eventually, work up to 10 repetitions of each exercise per day.

If a person stops doing the exercises, the muscles may weaken, and ED may return.

Aerobic exercise can also benefit people with ED.

People who practiced an aerobic exercise four times a week saw the best results, according to the authors of a 2018 systematic review.

Each exercise session should be of moderate or high intensity and last a minimum of 40 minutes.

Some examples of aerobic exercises include:

  • cycling
  • spin classes
  • boxing
  • rowing
  • running
  • skipping

A person should keep up their aerobic exercise routine for at least 6 months.

Exercise is essential for maintaining the health of the blood vessels and the heart. Also, people with cardiovascular disease have an increased risk of ED.

Diet and weight loss are also important aspects of ED treatment and prevention. People with ED are more likely to be inactive and overweight. Alcohol also plays a role.

Following dietary guidelines and limiting the intake of alcohol and foods with added salt, sugar, and fat will help to reduce the risk of developing ED.

These efforts will also reduce a person’s risk of stroke, metabolic disease, and cardiovascular disease, all of which are linked to ED.

A person with ED will often see improvement after making lifestyle changes. These should also reduce the need for medication and benefit overall health in the long term.

Adjusting the diet and performing exercises, particularly those that target the pelvic floor muscles, can help to reduce or eliminate ED.