***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: INTRODUCTION Obesity and inactivity are associated with erectile dysfunction and hypogonadism . AIM To compare the effects of low volume ( LV ) and high volume ( HV ) of moderate-intensity exercise  on sexual function , testosterone , lower urinary tract symptoms ( LUTS ) , endothelial function , and quality of life ( QoL ) in obese men . MAIN OUTCOME MEASURES Weight , waist circumference ( WC ) , body composition , International Index of Erectile Function 5-item ( IIEF-5 ) , International Prostate Symptom Scale ( IPSS ) ( for LUTS ) , and 36-item Short Form Survey version 2 Instrument ( SF-36 ) ( for QoL ) scores , plasma testosterone , sex-hormone binding globulin , glucose , insulin and lipids , and endothelial function ( by Reactive Hyperaemia Index [ RHI ] using finger plethysmography ) were measured at baseline and 24 weeks . METHODS Ninety abdominally obese ( body mass index > 27.5 kg/m(2 ) , WC > 90 cm ) , sedentary ( exercise ≈ 80 minutes/week ) Asian men ( mean age 43.6 years , range 30 - 60 ) were prescribed a diet to reduce daily intake by ≈ 400 kcal below calculated requirement and r and omized to perform moderate-intensity exercise of LV ( < 150 minutes/week ) or HV ( 200 - 300 minutes/week ) ( n = 45 each ) for 24 weeks . Seventy-five men ( 83.3 % ) completed the study .  RESULTS Weekly exercise volume was significantly greater in the HV ( 236 ± 9 minutes ) than the LV ( 105 ± 9 minutes ) group . The HV group had significantly greater increases in IIEF-5 score ( 2.6 ± 0.5 points ) and testosterone ( 2.06 ± 0.46 nmol/L ) and reductions in weight ( -5.9 ± 0.7 kg , -6.2 % ) , WC ( -4.9 ± 0.8 cm , -4.9 % ) , and fat mass ( -4.7 ± 1.0 kg , -14.5 % ) than the LV group ( -2.9 ± 0.7 kg , -3.0 % ; -2.7 ± 0.7 cm , -2.5 % ; -1.1 ± 0.8 kg , -3.2 % ; 0.79 ± 0.46 nmol/L ; and 1.8 ± 0.5 points ) . Improvements in IPSS and SF-36 scores , and RHI , were similar . CONCLUSIONS Moderate-intensity HV aerobic exercise > 200 minutes/week produces greater improvements in sexual function , testosterone , weight , WC , and fat mass than smaller exercise volume Introduction Sexuality is an important part of people ’s physical and mental health . Patients with heart disease often suffer from sexual dysfunction . Sexual dysfunction has a negative impact on quality of life and well-being in persons with heart disease , and sexual dysfunction is associated with anxiety and depression . Treatment and care possibilities seem to be lacking . Studies indicate that non-pharmacological interventions such as exercise training and psychoeducation possess the potential of reducing sexual dysfunction in patients with heart disease . The CopenHeartSF trial will investigate the effect of a comprehensive sexual rehabilitation programme versus usual care . Methods and analysis CopenHeartSF is an investigator-initiated r and omised clinical superiority trial with blinded outcome assessment , with 1:1 central r and omisation to sexual rehabilitation plus usual care versus usual care alone . Based on sample size calculations , 154 male patients with impaired sexual function due to implantable cardioverter defibrillator or ischaemic heart disease will be included from two university hospitals in Denmark . All patients receive usual care and patients allocated to the experimental intervention group follow a 12-week sexual rehabilitation programme consisting of an individualised exercise programme and psychoeducative consultation with a specially trained nurse . The primary outcome is sexual function measured by the International Index of Erectile Function . The secondary outcome measure is psychosocial adjustment to illness by the Psychosocial Adjustment to Illness Scale , sexual domain . A number of explorative analyses will also be conducted . Ethics and dissemination CopenHeartSF is approved by the regional ethics committee ( no H-4 - 2012 - 168 ) and the Danish Data Protection Agency ( no 2007 - 58 - 0015 ) and is performed in accordance with good clinical practice and the Declaration of Helsinki in its latest form . Registration Clinical trials.gov identifier : NCT01796353 The purpose of this study was to evaluate the influence of a home-based walking program on erectile function and the relation between functional capacity and erectile dysfunction ( ED ) in patients with recent myocardial infa rct ions . Patients with acute myocardial infa rct ions deemed to be at low cardiovascular risk were r and omized into 2 groups : ( 1 ) a home-based walking group ( n = 41 ) , instructed to participate in a progressive outdoor walking program , and ( 2 ) a control group ( n = 45 ) , receiving usual care .  Functional capacity was determined by the 6-minute walk test and evaluation of sexual function by the International Index of Erectile Function question naire ; the 2 tests were performed at hospital discharge and 30 days later . In the overall cohort , 84 % of patients reported previous ED at hospital discharge . After 30 days , ED had increased by 9 % in the control group in relation to baseline ( p = 0.08 ) . However , the home-based walking group had a significant decrease of 71 % in reported ED ( p < 0.0001 ) . The 6-minute walk distance was statistically significant higher in the home-based walking group compared with the control group ( p = 0.01 ) . There was a significant negative correlation between 6-minute walk distance and ED 30 days after hospital discharge ( r = -0.71 , p < 0.01 ) . In conclusion , an unsupervised home-based progressive walking program led to significant improvements in functional capacity in men at low cardiovascular risk after recent acute myocardial infa rct ions . In addition , this intervention demonstrated a link between functional capacity and exercise training and erectile function improvement INTRODUCTION Limited data are available supporting the notion that treatment of lifestyle risk factors may improve erectile dysfunction ( ED ) . AIM In the present study , we analyzed the effect of a program of changing in lifestyle design ed to improve erectile function  in subjects with ED or at increasing risk for ED . METHODS Men were identified in our data base of subjects participating in r and omized controlled trials evaluating the effect of lifestyle changes . A total of 209 subjects were r and omly assigned to one of the two treatment groups . The 104 men r and omly assigned to the intervention program received detailed advice about how to reduce body weight , improve quality of diet , and increase physical activity .  The 105 subjects in the control  group were given general information about healthy food choices and general guidance on increasing their level of physical activity . MAIN OUTCOME MEASURES Changes in erectile function score ( International Index of Erectile Function-5 [ IIEF-5 ] ; items 5 , 15 , 4 , 2 , and 7 from the full-scale IIEF-15 ) and dependence of the restoration of erectile function on the changes in lifestyle that were achieved . RESULTS Erectile function score improved in the intervention group . At baseline , 35 subjects in the intervention group and 38 subjects in the control group had normal erectile function ( 34 % and 36 % , respectively ) . After 2 years , these figures were 58 subjects in the intervention group and 40 subjects in the control group , respectively ( 56 % and 38 % , P = 0.015 ) . There was a strong correlation between the success score and restoration of erectile function . CONCLUSIONS It is possible to achieve an improvement of erectile function  in men at risk by means of nonpharmacological intervention aim ing at weight loss and increasing physical activity BACKGROUND In addition to a beneficial effect on exercise tolerance and an associated reduction of global cardiovascular risk , modification of physical activity has a positive effect on the quality of life , reducing , among other things , the severity of erectile dysfunction ( ED ) . AIM The specific nature of sexual activity , which combines the need to maintain appropriate exercise tolerance and good erection quality , prompted us to evaluate the association between exercise tolerance and severity of ED in an intervention group of subjects with ischaemic heart disease ( IHD ) and ED in the context of cardiac rehabilitation ( CR ) . METHODS A total of 138 men treated invasively for IHD ( including 99 treated with percutaneous coronary intervention and 39 treated with coronary artery bypass grafting ) who scored 21 or less in the initial IIEF-5 test were investigated . Subjects were r and omised into two groups . The study group included 103 subjects ( mean age 62.07 ± 8.59 years ) who were subjected to a CR cycle . The control group included 35 subjects ( mean age 61.43 ± 8.81 years ) who were not subjected to any CR .  All subjects filled out an initial and final IIEF-5 question naire and were evaluated twice with a treadmill exercise test . The CR cycle was carried out for a period of 6 months and included interval endurance training on a cycle ergometer ( three times a week ) and general fitness exercises and resistance training ( twice a week ) . RESULTS The CR cycle in the study group result ed in a statistically significant increase in exercise tolerance ( 7.15 ± 1.69 vs. 9.16 ± 1.84 METs , p < 0.05 ) and an increase in erection quality ( 12.51 ± 5.98 vs. 14.39 ± 6.82 , p < 0.05 ) which was not observed in the control group . A significant effect of age on a progressive decrease in exercise tolerance and erection quality was found in the study group . Exercise tolerance and erection quality were also negatively affected by hypertension and smoking . A significant correlation between exercise tolerance and erection quality prior to the rehabilitation cycle indicates better erection quality in patients with better effort tolerance . The improvement in exercise tolerance did not correlate significantly with initial exercise tolerance or age of the subjects . In contrast , a significantly higher increase in erection quality was observed in younger subjects with the lowest baseline severity of ED.The relative increase in exercise tolerance in the group subjected to CR was significantly higher than the relative increase in erection quality but these two effects were not significantly correlated with each other . CONCLUSIONS 1 . In subjects with IHD and ED , erection quality is significantly correlated with exercise tolerance . 2 . Exercise training had a positive effect on both exercise tolerance and erection quality but the size of these two effects was different and they ran independently of each other INTRODUCTION Physical activity ( PhA ) has proven to be a protective factor for normal erectile function in numerous epidemiological studies . AIM The aim of this study was to establish if PhA could have a therapeutic role in the treatment of  erectile dysfunction ( ED ) . METHODS This was a r and omized , open-label study . A total of 60 patients complaining of ED were studied . Patients were assessed at baseline and after 3 months of study treatment . At baseline , patients were r and omized to receive phosphodiesterase type 5 inhibitor ( PDE5i ) alone ( group A ) or PDE5i plus regular ( ≥3 hours/week ) , aerobic , non-agonistic PhA ( group B ) . MAIN OUTCOME MEASURES All subjects completed the International Index of Erectile Function ( IIEF-15 ) question naire and performed total testosterone ( TT ) . RESULTS Mean PhA was 3.4 hours/week in group B vs. 0.43 in group A ; mean energy expenditure in group B was 1,868 kcal/ week or 22.8 metabolic equivalent (MET)/week . IIEF restoration of ED occurred in 77.8 % ( intervention group ) vs. 39.3 % ( control ) ( P < 0.004 ) . The IIEF-15 score result ed in statistical improvement in intervention group in all the domains but one ( orgasm ) : erectile function 24.7 vs. 26.8 ( P = 0.003 ) ; confidence ( Q15 ) 3.53 vs. 4.07 ( P = 0.006 ) ; sexual desire 6.46 vs. 7.18 ( P = 0.028 ) ; intercourse satisfaction 9.85 vs. 11.25 ( P = 0.001 ) ; total satisfaction 7.17 vs. 8.07 ( P = 0.009 ) ; total score 56.2 vs. 61.07 ( P = 0.007 ) . TT was statistically similar in the two groups ; separate analysis in each group showed statistical increase in group B 4.24 vs. 4.55 ( P = 0.012 ) . At multivariate logistic regression analysis , PhA was the only independent variable for normal erection ( P = 0.010 ) ( 95 % confidence interval [ CI ] 0.036 - 0.643 ) , higher sexual satisfaction ( P = 0.022 ) ( 95 % CI 0.084 - 0.821 ) and normal total IIEF-15 score ( P = 0.023 ) ( 95 % CI 0.85 - 0.837 ) . CONCLUSION In this r and omized controlled pilot study , PDE5i plus PhA was more effective than PDE5i 
    Output:
    
The results of the review provided sufficient research evidence for conclusions regarding the levels of PA  necessary to decrease ED .
Overall , weekly exercise of 160 minutes for 6 months contributes to decreasing  erectile problems in men with ED caused by physical inactivity , obesity , hypertension , metabolic syndrome , and /or cardiovascular diseases .