Older men worried about their sexual performance might consider another form of huffing and puffing.
An Australian study examining links between lifestyle and reproductive health in males aged over 40 years shows exercise is not only good for the heart, but sexual health as well.
While other studies have shown links between erectile dysfunction and depression, this survey shows for the first time links with other male reproductive health disorders.
Published recently online in BMC Public Health, the study shows a strong link between a lack of physical activity and erectile dysfunction and a perception of a lack of testosterone.
It also links diabetes and cardiovascular disease to erectile dysfunction, while high blood pressure is strongly linked to lower urinary tract symptoms and perceived symptoms of androgen deficiency.
Androgen is the term used for all male sex hormones, of which testosterone is the predominant hormone.
Co-author Professor Rob McLachlan, of the Prince Henry's Institute and director of Andrology Australia, says the study highlights that reproductive concerns of men are related to other health matters.
"Erectile dysfunction is a canary in the coal mine for other diseases that may not be apparent," he says.
The study suggests doctors should discuss reproductive health with men suffering chronic illnesses such as cardiovascular disease, diabetes and high blood pressure.
It also re-emphasises the importance of men maintaining fitness and remaining active into old age, McLachlan says.
The findings come from an analysis of the 2003 Men in Australia telephone survey, which involved almost 6000 men aged over 40 years.
The survey included more than 90 questions across areas such as marital status, occupation and education; general health and lifestyle and sexual function.
McLachlan says the study has limitations because it is self-reported and for that reason it is difficult to determine the exact amount of exercise necessary to affect reproductive health.
But it is sensible to follow healthy heart guidelines of a half-hour of vigorous exercise daily, he says.
Further research needed
McLachlan says the survey highlights the need for a longitudinal study that tracks men's health from 20 years into old age.
He says one of the surprises of the study was the link between being very underweight and erectile dysfunction.
McLachlan also has a word of warning for younger males.
"They need to realise today's 30-year-old overweight, diabetic and sedentary [man] in 10 years will be 40," he says. "If you start your middle age in less than ideal circumstances it gets no easier.