Sexercise

Episode 100: Sexercise. 

Written by Valerie Civelli, MD. Comments by Namdeep Grewal, MD; and Hector Arreaza, MD.

Have you ever wondered if sex is a good workout? Drs. Civelli, Grewal and Arreaza discuss the topic based on evidence offered by science. 

The following episode is not recommended for young children or people who consider sex a sensitive topic. This is the Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California. Our program is affiliated with UCLA, and it’s sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. 

This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.

___________________________

Sexercise. 
Written by Valerie Civelli, MD. Comments by Namdeep Grewal, MD; and Hector Arreaza, MD.

A: If I say “bow chika wow wow” what’s the first thing that comes to mind? The Chipmunks movie right?

B: Yes, exactly, I can hear Alvin in his high-pitched voice, [higher tone] “bowchicka wow wow”. For those of you unfamiliar with this movie, don’t feel too left out because even Alvin was hinting to exactly what you’re thinking.

A: Yep, we’re going there today people.  Let’s talk about sex.  Medically speaking of course. 

B: That’s right because 1. If you’re doing it, your risk for heart attacks and strokes are decreased after age 50 and 2. If you’re not doing it, ask you’re doctor, we should be discussing it and why not.

A: Yes, that is the guideline-directed recommendation actually. We’re recognizing more and more the importance of sexual activity in medicine and its impact on overall health, quality of life and even level of risk for mortality. However, given the sensitive nature of sexuality, few studies have been done to better correlate and define exactly what this means for our health specifically. Sex can be an embarrassing topic to discuss by patients, doctors and researchers which has been largely influenced by culture, religion and other societal norms.  Well, today let’s break this proverbial glass. 

B: I agree, let’s talk about sexuality activity and what research do we have.

A: It has been said that Dr. Masters and Dr. Johnson were the earliest pioneers of this type of investigation. They published the first study of its kind in 1966, which examined the physiological responses of sexual activity. This was an 11-year observational study involving 382 females, ages 18 to 78, and 312 male volunteers, 21 to 89 years of age. The study identified a progressive increase in respiratory rates, up to 40 per minute, an increased heart rate 110 to 180 beats/min and an increase in systolic blood pressure by 30 to 80mmhg during sexual activity. 

In 1970, Hellerstein and Friedman identified the mean heart rate at the time of orgasm was 117.4 beats per minute with a range of 90 to 144. This was done in middle-age men, average age 47.5. Interestingly, the 24-hr ekg monitoring also identified a lower peak post coital heart rate, which was usually lower than the heart rates achieved with normal daily activities (around 120.1 beats per minute). 

In 1984, Bohlen et al. did a racier study with 10 couples using ECG, oxygen consumption (measured using a fast-responding polarographic O2 gas analyzer), heart rate and blood pressure monitoring before and during 4 types of sexual activity. This study obtained data during self-stimulation, partner stimulation, man-on-top and woman-on-top coitus.  The men were aged 25 to 43 years of age.  Results showed that self-stimulation increased the heart rate by 37 % from baseline to orgasm compared with a 51 % increase with man-on-top coitus. 

B: So already it was clear in 1966 to 1984 that physical exertion in the bedroom correlates to physiologic responses like increased heart rate, blood pressure, etc.  However, our question of the day is, does sexual activity count as exercise, and to that question we ask why or why not?

A: When I think about exercise, I think about heart rate and blood pressure.  I think about indicators of energy expenditures and/or intensity. And specifically, while I’m working out…I’m talking about at the gym, and I’m running on the treadmill for example, my mental state is, how much longer until I can quit.  Duration and level of intensity while under this physical exertion feels most important. And according to the AHA, this has been heavily studied.  That’s why 150 active intentional minutes of exercise are recommended per week to improve cardiovascular health. Does this translate to sexual activity? 

B: Well before we answer this, let’s first mention the Bruce protocol. Have you ever heard of this? The Bruce protocol is a standard test of cardiovascular health, comprised of multiple stages of exertion on a treadmill, with three minutes spent per stage. Also at each stage, the incline and speed of the treadmill are elevated to increase cardiac work output, which is called METS. Stage 1 of the Bruce protocol is performed at 1.7 miles per hour and a 10% incline. Stage 2 is 2.5 mph and 12%, while Stage 3 goes to 3.4 mph and 14%. If you’re a pilot for example, the FAA expects testing to achieve 85-100% of Maximum Predicted Heart Rate (220 minus your age) for a 9-minute duration.  

With the Bruce protocol in mind, we circle back to our question of the day, does sex count as exercise?

A: In 2007, Palmeri et al. reported that in 19 men and 13 women aged 40-75 years old, the intensity of sexual activity was comparable to stage II of the standard multistage Bruce protocol (moderate intensity) on a treadmill for men and stage I (low intensity) for women. In addition, maximal heart rate and blood pressure during sexual activity was approximately 75 % of that attained during maximum treadmill stress testing of the Bruce protocol. Collectively, based on these above studies, the physiological responses of sexual activity seem to be at a moderate intensity. 

B: Okay, so “you’re saying there’s a chance.” Right, one in a million Lloyd. Another movie reference, if you’ve seen the American classic Dumb and Dumber, you can appreciate it.  The point is, the level of intensity was identified by Palmeri’s research but are we convinced sex may be used as exercise based on studies that were conducted more than a quarter of a century ago? As a studious, thriving resident physician, with a heavy background in research, I turned to Up to date for more data, and recommendations.  I had zero findings. 

Naturally I turned to Men’s Health magazine to see what is out there to the general public:

A: “You’re in bed with your partner and you just finished a vigorous sex session. You’re hot and sweaty, worked past that side cramp you got while thrusting, and are convinced you just burned as many calories as you would at the gym. You figure you can skip the treadmill today since your sex workout—a.k.a sex exercises, a.k.a sexercises—got you plenty of cardio.

Well, we may have bad news: it depends on the type of sex you’re having—specifically, how active you are during it, and how long you’re having it—but unless you’re really going at it for a couple of hours, odds are, it wasn’t that great of a workout.

To better quantify this, couples were evaluated while running on a treadmill for 30 minutes and compared to their sexercise.

The results, which were published in the journal PLOS ONE, concluded that men burn 100 calories during the average sex session, while women burn about 69 calories. The researchers estimated that men burn roughly 4.2 calories per minute during sex, while women burn 3.1 calories.

B: Men may be more physically active during sex which potentially explains why they burn more calories, study author Antony Karelis. But the main reason, Karelis told Time, is that “Men weigh more than women, and because of this, the energy expenditure will be higher in men for the same exercise performed.”

It's also worth knowing that sex sessions in the study lasted an average of 25 minutes That's far longer than average. Times varied in the study, ranging from 10 to 57 minutes. 

A: The longer the session, the more calories burned. 

B: One study in the New England Journal of Medicine found that most sex sessions last six minutes.

A: Here are some tips for burning more calories during sex:

Make some moans and sighs to burn some extra calories.

Change your position to make it more of a workout, especially women. If you're on top, move your hips like a belly dancer. It will feel good while giving you a workout.

Experiment with a position where you squat on top of your partner and then bounce up and down. That's a great way to work out your thighs and rear.

Try being on top rather than on the bottom, because research suggests that requires more energy.

Kiss in unusual positions. Have the guy on his back. Do a push up on top of him. Come down to kiss him and then push back up.

Take off your clothes in ways that burn calories. Draw it out and make it part of your foreplay. Or tease him as you get undressed. Do a seductive dance with a silk scarf, for example.

Give a good massage to get your heart rate up. Ramp things up by going deeper. It's more sensual and works different muscles. Take turns so you can both get the calorie burn and its arousing impact.

B: Harvard source:  During sexual intercourse, a man's heart rate rarely gets above 130 beats a minute, and his systolic blood pressure nearly always stays under 170. All in all, average sexual activity ranks as mild to moderate in terms of exercise intensity. 

A: As for oxygen consumption, it comes in at about 3.5 METS (metabolic equivalents), which is about the same as taking a walk or playing ping pong. Sex burns about five calories a minute; that's four more calories used than watching TV.

B: How do we decide if one is fit enough for sexual activity? For a 50-year-old man, the risk of having a heart attack in any given hour is about one in a million; sex doubles the risk, but it's still just two in a million. For men with heart disease, the risk is 10 times higher — but even for them, the chance of suffering a heart attack during sex is just 20 in a million. In short, if you are able to climb 3 flights of stairs, you are safe to proceed. 

A: Circling back to exercise, keep in mind 4-5 calories burned per minute is still better than zero. Any time spent engaging in any level of physical activity is better than sitting on the couch. 

B: Further, “Having sex for at least 10 minutes contributes to your cardiorespiratory health, increased serotonin levels (the happy hormone), and improved sleep,” Silberstang says. Studies have found that sex can relieve everything from anxiety and depression to high blood pressure. 

A: When men orgasm, their bodies release serotonin, oxytocin, and prolactin, all hormones associated with better moods, relaxation, and lowered stress. Multiple studies have also found links between regular sex and a reduced risk for heart disease and prostate cancer, and a stronger immune system. One reason that sex isn’t classified as a workout is due to its average duration: 3 to 13 minutes,” Silberstang explains. “So, naturally, one of the ways to make sex more of a cardio workout is to increase the time of the act.”

C: The present study indicates that energy expenditure during sexual activity appears to be approximately 85 kcal or 3.6 kcal/min and seems to be performed at a moderate intensity in young healthy men and women. These results suggest that sexual activity may potentially be considered, at times, as a significant exercise. Moreover, both men and women reported that sexual activity was a highly enjoyable and more appreciated than the 30 min exercise session on the treadmill. Therefore, this study could have implications for the planning of intervention programs as part of a healthy lifestyle by health care professionals. 

B: We look forward to future studies that may further show the relationship between psychosocial/qualitative factors and energy expenditures which could explain how these variables could affect overall health and quality of life.

____________________________

Now we conclude episode 100, “Sexercise.” If you ever wondered if sexual intercourse was a good workout, today we learned that in general it is not an energy-demanding activity. The average man burns just 24 kilocalories during sex, but with some adjustments you can burn more calories, especially if the activity takes longer. If your patient is not having sex, they do not have to start having it just to exercise, remind everyone to be sexually responsible to prevent the spread of sexually transmitted infections and unintended pregnancies. Even without trying, every night you go to bed being a little wiser.

Today we thank doctors Valerie Civelli, Namdeep Grewal, and Hector Arreaza. Thanks for listening to Rio Bravo qWeek Podcast. If you have any feedback, contact us by email at [email protected], or visit our website riobravofmrp.org/qweek. Audio edition: Suraj Amrutia. See you next week!

_____________________

References:

Frappier, Julie; Isabelle Toupin, Joseph J. Levy, Mylene Aubertin-Leheudre, and Antony D. Karelis. Energy Expenditure during Sexual Activity in Young Healthy Couples, PLOS One, plos.org, Published: October 24, 2013, https://doi.org/10.1371/journal.pone.0079342.

Casazza, Krista, Ph.D., R.D.; Kevin R. Fontaine, Ph.D.; Arne Astrup, M.D., Ph.D.; et al. Myths, Presumptions, and Facts about Obesity, N Engl J Med 2013; 368:446-454 DOI: 10.1056/NEJMsa1208051

Blaha, Michael Joseph, M.D., M.P.H. Is Sex Dangerous If You Have Heart Disease?. Health. Jons Hopkins Medicine, accessed June 20, 2022. https://www.hopkinsmedicine.org/health/wellness-and-prevention/is-sex-dangerous-if-you-have-heart-disease   

Jackson G. Erectile dysfunction and cardiovascular disease. Arab J Urol. 2013;11(3):212-216. doi:10.1016/j.aju.2013.03.003. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4442980/  

DeBusk R, Drory Y, Goldstein I, Jackson G, Kaul S, Kimmel SE, Kostis JB, Kloner RA, Lakin M, Meston CM, Mittleman M, Muller JE, Padma-Nathan H, Rosen RC, Stein RA, Zusman R. Management of sexual dysfunction in patients with cardiovascular disease: recommendations of The Princeton Consensus Panel. Am J Cardiol. 2000 Jul 15;86(2):175-81. doi: 10.1016/s0002-9149(00)00896-1. PMID: 10913479.

Davey Smith G, Frankel S, Yarnell J (1997) Sex and death: are they related? Findings from the Caerphilly Cohort Study. BMJ 315: 1641-1644. doi:https://doi.org/10.1136/bmj.315.7123.1641. 

Ebrahim S, May M, Ben Shlomo Y, McCarron P, Frankel S et al. (2002) Sexual intercourse and risk of ischaemic stroke and coronary heart disease: the Caerphilly study. J Epidemiol Community Health 56: 99-102. doi:https://doi.org/10.1136/jech.56.2.99. 

Laumann EO, Glasser DB, Neves RC, Moreira ED Jr. (2009) A population-based survey of sexual activity, sexual problems and associated help-seeking behavior patterns in mature adults in the United States of America. Int J Impot Res 21: 171-178. doi:https://doi.org/10.1038/ijir.2009.7. 

Lindau ST, Gavrilova N (2010) Sex, health, and years of sexually active life gained due to good health: evidence from two US population based cross sectional surveys of ageing. BMJ 340: c810. doi:https://doi.org/10.1136/bmj.c810. 

Lindau ST, Schumm LP, Laumann EO, Levinson W, O'Muircheartaigh CA et al. (2007) A study of sexuality and health among older adults in the United States. N Engl J Med 357: 762-774. doi:https://doi.org/10.1056/NEJMoa067423. 

McCall-Hosenfeld JS, Jaramillo SA, Legault C, Freund KM, Cochrane BB et al. (2008) Correlates of sexual satisfaction among sexually active postmenopausal women in the Women's Health Initiative-Observational Study. J Gen Intern Med 23: 2000-2009. doi:https://doi.org/10.1007/s11606-008-0820-9. 

Bartlett RG Jr. (1956) Physiologic responses during coitus. J Appl Physiol 9: 469-472. 

Bohlen JG, Held JP, Sanderson MO, Patterson RP (1984) Heart rate, rate-pressure product, and oxygen uptake during four sexual activities. Arch Intern Med 144: 1745-1748. doi:https://doi.org/10.1001/archinte.144.9.1745.  

Hellerstein HK, Friedman EH (1970) Sexual activity and the postcoronary patient. Arch Intern Med 125: 987-999. doi:https://doi.org/10.1001/archinte.125.6.987.  

Larson JL, McNaughton MW, Kennedy JW, Mansfield LW (1980) Heart rate and blood pressure responses to sexual activity and a stair-climbing test. Heart Lung 9: 1025-1030.  

Masini V, Romei E, Fiorella AT (1980) Dynamic electrocardiogram in normal subjects during sexual activity. G Ital Cardiol 10: 1442-1448. 

Nemec ED, Mansfield L, Kennedy JW (1976) Heart rate and blood pressure responses during sexual activity in normal males. Am Heart J 92: 274-277. doi:https://doi.org/10.1016/S0002-8703(76)80106-8.  

Palmeri ST, Kostis JB, Casazza L, Sleeper LA, Lu M et al. (2007) Heart rate and blood pressure response in adult men and women during exercise and sexual activity. Am J Cardiol 100: 1795-1801. doi:https://doi.org/10.1016/j.amjcard.2007.07.040. 

Casazza K, Fontaine KR, Astrup A, Birch LL, Brown AW et al. (2013) Myths, presumptions, and facts about obesity. N Engl J Med 368: 446-454. doi:https://doi.org/10.1056/NEJMsa1208051. 

Haskell WL, Lee IM, Pate RR, Powell KE, Blair SN et al. (2007) Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc 39: 1423-1434. doi:https://doi.org/10.1249/mss.0b013e3180616b27.  

Drenowatz C, Eisenmann JC (2011) Validation of the SenseWear Armband at high intensity exercise. Eur J Appl Physiol 111: 883-887. doi:https://doi.org/10.1007/s00421-010-1695-0.  

Johannsen DL, Calabro MA, Stewart J, Franke W, Rood JC et al. (2010) Accuracy of armband monitors for measuring daily energy expenditure in healthy adults. Med Sci Sports Exerc 42: 2134-2140. doi:https://doi.org/10.1249/MSS.0b013e3181e0b3ff. 

Mackey DC, Manini TM, Schoeller DA, Koster A, Glynn NW et al. (2011) Validation of an armband to measure daily energy expenditure in older adults. J Gerontol A Biol Sci Med Sci 66: 1108-1113.  

Mignault D, St-Onge M, Karelis AD, Allison DB, Rabasa-Lhoret R (2005) Evaluation of the Portable HealthWear Armband: a device to measure total daily energy expenditure in free-living type 2 diabetic individuals. Diabetes Care 28: 225-227. doi:https://doi.org/10.2337/diacare.28.1.225-a.  

Ryan J, Gormley J (2013) An evaluation of energy expenditure estimation by three activity monitors. Eur J Sport Sci: 1-8. 

St-Onge M, Mignault D, Allison DB, Rabasa-Lhoret R (2007) Evaluation of a portable device to measure daily energy expenditure in free-living adults. Am J Clin Nutr 85: 742-749. 

Welk GJ, McClain JJ, Eisenmann JC, Wickel EE (2007) Field validation of the MTI Actigraph and BodyMedia armband monitor using the IDEEA monitor. Obesity (Silver Spring) 15: 918-928. doi:https://doi.org/10.1038/oby.2007.624. 

Wetten AA, Batterham M, Tan SY, Tapsell L (2013) Relative Validity of Three Accelerometer Models for Estimating Energy Expenditure During Light Activity. J Phys Act Health. 

Brazeau AS, Karelis AD, Mignault D, Lacroix MJ, Prud'homme D et al. (2011) Test-retest reliability of a portable monitor to assess energy expenditure. Appl Physiol Nutr Metab 36: 339-343. doi:https://doi.org/10.1139/h11-016. 

Haskell WL, Lee IM, Pate RR, Powell KE, Blair SN et al. (2007) Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Circulation 116: 1081-1093. doi:https://doi.org/10.1161/CIRCULATIONAHA.107.185649. 

Ainsworth BE, Haskell WL, Herrmann SD, Meckes N, Bassett DR Jr. et al. (2011) 2011 Compendium of Physical Activities: a second update of codes and MET values. Med Sci Sports Exerc 43: 1575-1581. doi:https://doi.org/10.1249/MSS.0b013e31821ece12. 
 

Steinke EE, Jaarsma T, Barnason SA, Byrne M, Doherty S et al. (2013) Sexual Counseling for Individuals With Cardiovascular Disease and Their Partners: A Consensus Document From the American Heart Association and the ESC Council on Cardiovascular Nursing and Allied Professions (CCNAP). Circulation.