Effects of exercise on sexual dysfunction in patients with prostate cancer - A systematic review

Journal article

Reimer, Nadine, Zopf, Eva Maria, Böwe, Rebecca and Baumann, Freerk Theeagnus. (2021). Effects of exercise on sexual dysfunction in patients with prostate cancer - A systematic review. Journal of Sexual Medicine. 18(11), pp. 1899-1914. https://doi.org/10.1016/j.jsxm.2021.09.001
AuthorsReimer, Nadine, Zopf, Eva Maria, Böwe, Rebecca and Baumann, Freerk Theeagnus
Abstract

Background
Emerging evidence suggests that exercise interventions may improve sexual dysfunction, one of the most common and distressing long-term adverse effects of cancer treatment.

Aim
The aim of this systematic review is to provide an overview of the effects of exercise on sexual dysfunction in prostate cancer patients.

Methods
A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. The systematic literature search was performed on 13th July 2021 using CINAHL, Cochrane Central Register of Controlled Trials, Embase, Medline and Web of Science. Studies were included if they were randomized controlled trials (RCTs) assessing sexual function in prostate cancer patients conducting an exercise intervention alone or in combination with other supportive interventions. The methodological quality was assessed using the Physiotherapy Education Database Score and Jadad scale. Outcomes were reported as between-group differences. Intragroup differences were also reported if significant.

Outcomes
Positive intervention effects on sexual function were primarily observed in patients following prostatectomy and undergoing anti-hormone treatment and for pelvic floor muscle exercises as well as aerobic and resistance exercise.

Results
22 RCTs (n = 1.752 patients) met the eligibility criteria, conducting either an exercise-only intervention (n = 10), a multimodal (exercise plus other supportive therapy) intervention (n = 4), or pelvic floor muscle exercises (n = 8). 6 RCTs assessed sexual dysfunction as a primary endpoint and 8 RCTs used dedicated assessment methods. 9 of the 22 RCTs found significant between-group differences in favor of the intervention group.

Clinical Implications
The multifaceted etiology of sexual dysfunction provides a strong rationale to further investigate the effects of exercise on sexual dysfunction in prostate cancer patients and also to consider a multidisciplinary approach.

Strengths and Limitations
A strength is the comprehensive literature search to identify RCTs involving different exercise interventions and a wide range of sexual function assessments. Further, this is the first systematic review on this topic. The main limitations include the difficulty to compare studies due to the heterogeneity of exercise interventions and low questionnaire completion rates in some studies.

Conclusion
Preliminary data from a small number of studies suggest that certain exercise interventions may improve sexual dysfunction in prostate cancer patients, however further trials involving sexual dyfunction as a primary outcome and more comprehensive assessment tools are needed to confirm the rehabilitative and preventive effects of exercise on sexual dysfunction in prostate cancer patients.

Keywordsprostate cancer; sexual dysfunction; erectile dysfunction; exercise; pelvic floor muscle exercises
Year2021
JournalJournal of Sexual Medicine
Journal citation18 (11), pp. 1899-1914
PublisherElsevier Inc.
ISSN1743-6095
Digital Object Identifier (DOI)https://doi.org/10.1016/j.jsxm.2021.09.001
Scopus EID2-s2.0-85117212278
Research or scholarlyResearch
Page range1899-1914
Publisher's version
License
All rights reserved
File Access Level
Controlled
Output statusPublished
Publication dates
Online13 Oct 2021
Publication process dates
Accepted02 Sep 2021
Deposited12 Jan 2022
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