Background Erectile dysfunction (ED) is prevalent among older men and negatively associated
with lower physical fitness and cardiovascular health. While previous studies often
rely on self-reported activity levels, this study uses objective measures of cardiorespiratory
endurance (CRE), specifically peak oxygen uptake (VO₂peak), to investigate its relationship
with ED severity.
Objective To assess the association between objectively measured CRE (VO₂peak) and ED severity
in healthy men aged 55–75 years and evaluate the influence of age, BMI, and depressive
symptoms as potential confounders.
Methods This cross-sectional analysis included 329 men from the AMCOHF*cohort. VO₂peak was
measured via maximal cardiopulmonary exercise testing. ED severity was assessed with
the IIEF-5 questionnaire. Correlation and multiple regression analyses were conducted,
and group differences between men with and without ED were compared using t-tests.
Results ED prevalence was 18%. VO₂peak was positively correlated with IIEF-5 scores (ρ=0.36,
p=.003), indicating that higher CRE was associated with lower ED severity. A 1.0 L/min
increase in VO₂peak predicted a clinically meaningful 4.73-point increase in IIEF-5
scores. VO₂peak alone explained 13.2% of the variance in ED severity; this increased
to 16% when adjusted for age, BMI, and depressive symptoms. Men with ED had significantly
lower VO₂peak and were older than those without ED (both p<.05), while BMI and depressive
symptoms showed no significant group differences.
Conclusion Cardiorespiratory endurance is a clinically relevant and modifiable predictor of
erectile dysfunction severity. Given the association and clinical impact of VO₂peak,
combinig endurance training with pelvic floor physiotherapy may enhance outcomes for
older men with ED. These findings highlight the need for further longitudinal and
interventional research to support the role of physiotherapy in sexual health.
