Men with erectile dysfunction may get nearly as much help from a regular walk as from a little blue pill, according to new research published in the Journal of Sexual Medicine in October.

In an analysis of 11 randomized controlled trials, researchers found that aerobic exercise—such as brisk walking or pedaling a stationary bike—helped men with erectile dysfunction (ED) boost their sexual performance over the following months to years.

In fact, exercise had the greatest benefits for men with severe ED, improving their erectile function to almost the same degree seen with medications like Viagra (sildenafil) and Cialis (tadalafil).

The findings suggest that getting the heart pumping with aerobic exercise can offer men an alternative, or add-on, to ED medication. And given the wide-ranging health benefits of physical activity, there’s a good chance of reaping rewards beyond sexual function.

The studies used for the analysis were conducted between 2004 and 2021 and included over 1,100 men with ED in total; many had additional health conditions like obesity, high blood pressure, or diabetes. All of the trials randomly assigned participants to either an exercise group or a comparison group; in the latter case, those men most often stuck with their usual care. In a few trials, at least some participants were already taking ED medication.

The exercise regimens varied, but most involved moderately intense activity that gets the heart rate up—like treadmill walking or jogging, or riding a stationary bike—for 30 to 60 minutes per day, three to five days per week. The trials lasted anywhere from two months to two years.

Overall, the analysis found, men who exercised had a greater improvement in sexual function, versus their non-exercising counterparts. On average, they gained about 3 points on a standard questionnaire that asks men about their erectile function over the past month. This measure, the International Index of Erectile Function, is scored on a scale of 5 to 25 or 6 to 30, with higher scores indicating better function.

To give some context, that improvement is a bit more than would be expected with testosterone replacement therapy (for men whose ED is related to “low T“), and a little less than the gains seen in studies of PDE5 inhibitors (the group of ED drugs that includes Viagra, Cialis, and others).

But the value of exercise actually went up the more debilitating the ED was: Among men with severe problems, exercise improved erectile function by an average of 5 points. That’s within the range expected with PDE5 inhibitors.

Those medications work by relaxing smooth muscle in the penis, which allows for better blood flow. The downside is, they can have side effects like dizziness, headache, and nausea. And some men cannot take them due to certain health conditions, such as a recent heart attack or uncontrolled high blood pressure.

Aerobic exercise may help manage ED for several reasons. The benefits may be more direct—improved blood flow throughout the body and to the penis in particular—or indirect, to the extent that exercise helps rein in ED risk factors like high blood pressure, obesity, and diabetes.

Beyond that, there’s evidence that exercise enhances testosterone concentrations in the blood while reducing body-wide inflammation, two other potential ways exercise could benefit men with ED.

There are already plenty of reasons to be physically active, and this latest research adds to previous evidence that better erectile function can be added to the list. What’s more, you don’t have to go full-throttle: Brisk walking is a good place to start.

That said, if you are currently sedentary and have any chronic health conditions, you should talk to your doctor about how to add an exercise routine to your life.

On a final note, it’s important to discuss with your doctor the whole range of options for managing ED. Other lifestyle changes, like limiting alcohol and stopping smoking, can help. If your ED is related to side effects from medications for other health conditions, your doctor may be able to change the drug or the dose. And besides the well-known pills, there are also ED medications that are injected or inserted into the urethra as “pellets.”