Exercise and Physical Activity as Modifiable Risk Factors for Benign Prostatic Hyperplasia: An Update.

Abstract

Benign prostatic hyperplasia (BPH) is a highly prevalent urological condition in aging men, contributing to lower urinary tract symptoms (LUTS) and reducing the quality of life. The increasing burden of BPH underscores the need for preventive strategies targeting modifiable risk factors. This review examines the evidence on the association between physical activity (PA), exercise, and BPH risk, aiming to determine whether these two forms of activity exert different effects on BPH pathogenesis. A literature search was conducted in multiple databases to identify human studies evaluating the association between PA or exercise and the risk of developing BPH and/or LUTS. A total of 19 studies were included: 17 observational studies, one meta-analysis, and one two-sample Mendelian randomization study. Among the six studies evaluating exercise, four reported a protective effect against BPH development, while two found no significant association. Moderate-intensity exercise appeared to confer greater protection than high-intensity exercise. Of the 14 studies assessing PA, seven reported a protective effect, with most indicating that high-intensity PA provided the greatest benefit. Two studies yielded mixed results, while five found no significant association between PA and BPH risk. Although moderate-intensity exercise and moderate-to-high PA appear to reduce BPH risk, evidence remains inconsistent. Future research should prioritize randomized controlled trials with standardized protocols, clearly defined outcomes, and objective assessment of dose-response effects to elucidate underlying mechanisms. Such approaches are critical to clarify the role of exercise and PA in BPH prevention and to inform clinical and public health recommendations.