to the editor: The authors of the article on chronic prostatitis effectively summarize the practical dilemmas that arise when managing this complex disease. Although the authors related this disease to other chronic pain syndromes, including fibromyalgia and irritable bowel syndrome, they did not highlight exercise as a useful therapy for chronic nonbacterial prostatitis/chronic pelvic pain syndrome (CNP/CPPS) despite its proven benefit in chronic pain syndromes. American Family Physician articles addressing fibromyalgia and irritable bowel syndrome highlight exercise as a valid treatment option with evidence ratings of A and B, respectively.^1,2 For CNP/CPPS specifically, a randomized, double-blind study demonstrated significant benefit with aerobic exercise in both pain and quality-of-life scores, and another study suggested that exercise can also lower the risk of CNP/CPPS.^3,4

in reply: I appreciate Dr. Meyers bringing this study¹ to my attention. The researchers surveyed 20,918 male professionals on lifestyle and symptoms over 22 years (surveys were performed in 1986, 1988, and 2008). The 2008 survey included symptoms suggestive of CNP/CPPS; men with this condition at the start of the surveys in 1986 were excluded. The surveys also included questions on tobacco use, hypertension, duration of weekly screen time in 1988, amount of physical activity, and type of physical activity. Based on symptoms, 689 men developed CNP/CPPS over the study period. There was a strong inverse relationship between the intensity and duration of physical activity and the incidence of CNP/CPPS. No other comorbidities or potential confounding factors were included in the surveys.

Table 3 of our article mentioned another study that randomized 103 men with CNP/CPPS to aerobic exercise or to a stretching routine. Aerobic exercise showed statistically significant but modest clinical benefits.

Although more research is needed to clarify the extent of benefit, I agree that the new study highlighted by Dr. Meyers strengthens the argument that exercise is effective in the prevention and treatment of CNP/CPPS.