Effects of Exercise on Sexual Activity and Sexual Dysfunction in Patients with Prostate Cancer: A Systematic Review and Meta-Analysis

Exercise improved sexual activity (SMD 0.38) and sexual function (SMD 0.32) in prostate cancer patients across 10 RCTs of 558 men

Journal: The Journal of Sexual Medicine | Published: 2026-05-11 | Type: Systematic Review, Meta-Analysis | PMID: 42234465 Authors: Wen Zhuoxuan, Ding Feng, Ma Xiaochen, Zhu Yongguo (Capital University of Physical Education and Sports; Shanghai University of Sport) Funding/COI: Not disclosed

Summary

Exercise interventions produced small-to-moderate improvements in both sexual activity and sexual function in prostate cancer patients, with GRADE certifying high-quality evidence for the activity outcome and moderate for function. The total sample is thin — 558 men across 10 trials averaging about 56 per study — which keeps the confidence intervals wide and limits any firm conclusions about specific exercise prescriptions. Subgroup findings hint that what you do and how hard you do it may matter, but the evidence to nail that down isn't here yet.

Claims

• Exercise significantly improved sexual activity: SMD = 0.38 (95% CI 0.19–0.57, P < .001)
• Exercise significantly improved sexual function: SMD = 0.32 (95% CI 0.07–0.56, P = .01)
• GRADE certainty: high for sexual activity, moderate for sexual function
• Mean PEDro score of 7.0 across included trials (scale 0–10; ≥6 generally considered acceptable)
• A dose-response relationship was observed for sexual activity
• Intensity- and duration-related effects were observed for sexual function
• Effects varied by treatment modality and exercise prescription parameters in subgroup analyses
• All 10 included studies were randomized controlled trials (n = 558 total)

Study Quality

The methodological scaffolding is solid for a review this small. The authors searched four major databases through June 2025, pre-registered with PROSPERO, used both RoB 2 and PEDro for bias assessment (redundant by design — belt and suspenders), and applied GRADE to rate evidence certainty. The PEDro mean of 7 suggests the included trials were reasonably well-conducted. The GRADE high-certainty finding for sexual activity is notable; that rating is rare and means the effect estimate is unlikely to change substantially with more research.

The weak link is scale. Ten trials and 558 men total is a thin foundation for the subgroup analyses being drawn — when you slice 558 people by treatment modality, exercise type, intensity, and duration, the cells get very small fast. The RoB 2 finding that "most studies had some risk of bias" is the other caveat: acceptable-quality trials with partial bias are not the same as clean trials.

Red Flags

• No funding or COI disclosed — impossible to assess commercial influence; all four authors work in sports/physical education departments, which likely cuts toward pro-exercise conclusions
• Small total N — 558 patients across 10 trials means average trial size ~56 men; the wide CI on sexual function (0.07–0.56) reflects this
• RoB 2 bias present — "most studies had some risk of bias" per Cochrane's own tool; the abstract does not specify what domains were problematic
• Subgroup analyses are underpowered — dose-response and intensity/duration conclusions drawn from a 558-person base with unspecified subgroup sizes warrant skepticism
• Heterogeneity not reported — the abstract gives no I² statistic; without it, the meaningfulness of pooled SMDs is unclear
• No adverse event data — the abstract reports no information on exercise-related harms in a cancer patient population

Strengths

• Pre-registered with PROSPERO (CRD420251089117), reducing post-hoc outcome manipulation risk
• GRADE applied and reported — provides standardized evidence certainty rather than author interpretation
• Dual bias assessment (RoB 2 + PEDro) adds methodological rigor
• Includes sensitivity and publication bias analyses
• Restricts inclusion to RCTs only — no observational studies diluting the pool
• High GRADE certainty for the sexual activity outcome is a meaningful finding given typical evidence standards in this area

Verdict

This is a competent, well-structured meta-analysis hampered primarily by the small evidence base it had to work with — not by its own methodology. The sexual activity finding (SMD 0.38, high GRADE certainty) is worth taking seriously; the sexual function finding (SMD 0.32, wide CI, moderate certainty) is directionally consistent but looser. The subgroup claims about dose, intensity, and duration are the weakest part: slicing 558 patients into prescription-specific bins is a recipe for noise dressed up as signal. Undisclosed funding and COI are an automatic caution flag for any paper with a thumb on the scale. Read it as establishing that exercise probably helps — not as telling you which exercise prescription to follow.