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Physical exercise reduces risk of BPH and LUTS

A systematic review and meta-analysis has shown that moderate to vigorous physical activity may prevent or attenuate the development of benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTS).

The review included 11 papers investigating the relationship between physical activity and the risk of BPH (seven studies) or LUTS (four studies). In total, the studies included a population of more than 43,000 patients.

Eight of the studies identified an inverse relationship between physical activity and risk of BPH or LUTS. No studies observed an increased risk.

Overall, the results suggested that moderate and vigorous physical activity may reduce the risk of BPH and LUTS by as much as 25%, relative to a sedentary lifestyle (OR 0.74, P=0.005 and OR 0.74, P=0.006 respectively). Even light physical activity was associated with a non-significant trend towards a protective effect.

It has long been assumed that BPH and subsequent LUTS are an inevitable consequence of ageing, driven by a combination of genetic predisposition, androgens and oestrogens. However, in recent years the association between the modifiable risk factors of CVD and BPH has been recognised. Given that these risk factors potentially contribute to BPH pathogenesis, it has been suggested that factors that protect against CVD may also protect against BPH and LUTS.

The link between the metabolic syndrome and an increased risk of BPH/LUTS has been previously identified; the syndrome is associated with systemic inflammation, and inflammation is known to drive BPH. The BPH/LUTS complex is also associated with an increased risk of erectile dysfunction, which is strongly associated with CVD. Indeed, increased physical activity has also been shown to be associated with a reduced risk of erectile dysfunction.

This study illustrates a further benefit of increased physical activity and can potentially be used in consultations when encouraging men to adopt lifestyle measures to reduce cardiovascular risk. It is not clear as yet whether increasing physical activity alters the natural history of established LUTS, but it is plausible.

Kellogg Parsons J, Kashefi C. Physical Activity, Benign Prostatic Hyperplasia, and Lower Urinary Tract Symptoms. Eur Urol 2008;53:1228-35

Reviewer

Dr Jonathan Rees
GPwSI Urology, Bristol

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