For the past few decades, male enhancement pills have grown in popularity and it is the need and want for millions to have a larger penis. Every man in the world has more than likely googled ‘how to get a bigger penis’ and we wanted to delve deep into the science and truth behind penis enlargement.
The majority of male phalluses are on average between 5 and 6 inches erect, but in some cases can be much bigger or smaller (micropenis). Should anyone decide to undertake any of these procedures and techniques, we highly recommend understanding how they work and the effects of each supplement.
The question everybody asks: Do they work? Are they safe? Let’s find out.
The 7 best male enhancement pills to improve sexual performance :
- 1 – VigRX Plus: The Best Overall.
- 2 – Male Extra: The most high-quality ingredients
- 3 – Max Performer: Boasting physical and mental health
- 4 – ExtenZe: Best for premature ejaculation
- 5 – Volume Pills: The Best Sperm Enhancers.
- 6 – ProSolution +: The 10 years experienced pill with well-researched ingredients
- 7 – Viasil: The most viable solution to erectile dysfunction.
- How Do Male Enhancement Pills Work?
- How To Choose The Best Pill For You?
- Pros and Cons of Male Enhancement Pills.
- Male Enhancement Pills: Our Thoughts and Conclusion.
- FAQ – On Male Enhancement Pills
- Will My Penis Grow In Size?
- Are Penis Enlargement Pills Safe To Use?
- How Effective Are Male Enhancement Pills?
- How Often Should You Use Male Enhancement Pills?
- When Should I Expect Results?
- What Happens If I Overdose?
- Should I Try Penis Enlargement Pills?
- How Long Does It Take For A Male Enhancement Pill To Kick In?
- What Happens If A Woman Takes A Male Enhancement Pill?
- How Long Does A Male Enhancement Pill Last?
- What Is Best For A Male Enhancement Pill Or Cream?
- What Are The Chemical Ingredients In Male Enhancement Pills?
- What Ages You Can Use Male Enhancement Pills?
1 – VigRX Plus: The Best Overall.
Benefits Of VigRX Pills
- Improves control of ejaculation.
- Made with 100% natural ingredients.
- Better orgasms.
- Improves erection size.
- Longer-lasting erections.
One of the best enlargement pills overall in the market: is VigRX Plus. It’s best known for having the largest and longest erections by stimulating the production of testosterone and restoring penis blood flow to have a more pleasing and long-lasting night with your partner.
When you have an erection your blood vessels expand to let more blood in.
VigRX Plus enlarges the blood vessels, even more, expanding the erectile tissues in your penis, eventually increasing the flow of blood to them when you have an erection. It’s rated 5/5 by their online customers.
How Does It Work?
All of the ingredients in VigRX Plus work together to enhance male sexual desires, performance, abilities, and during a sexual performance to feel confident. Better sexual health, performance, and stability are key selling points for VigRX Plus.
The two most common reasons for poor sexual performance is erectile dysfunction or mental health. Stress and anxiety can cause poor sexual performance and/or loss of libido. Some ingredients help reduce anxiety, which relaxes the body and improves libido.
Formulations of male enhancement pills often contain artificial or man-made ingredients. Whereas VigRX Plus uses all-natural ingredients. All of which offer the user a multitude of enhancement benefits. These ingredients include:
- Hawthorn Berry – Stimulates blood flow.
- Damiana – Increases blood flow and nerve impulse.
- Catuaba Bark Extract – Helps to improve libido.
- Ginkgo Bilbao – Enhances sexual performance.
- Saw Palmetto – Boosts testosterone levels.
- Asian Red Ginseng – Increases libido and sexual confidence.
- Muira Pauma Bark Extract – Helps improve loss of libido.
- Epimedium Leaf Extract – Increases testosterone.
Who is VigRX Plus For:
The brand is aimed at males. Particularly those who wish to increase libido, performance in the bedroom, or have sexual deficiencies.
A huge benefit of VigRX Plus is that it contains all-natural ingredients, making them safe to take. There have been no reports of contraindications of VigRX Plus, suggesting it is safe for most people to take. Yet, it is important to discuss taking such medication with your doctor to ensure safety. If you have allergies to any ingredients, it is advised to avoid taking VigRX Plus.
>> Read our complete review of VigRX Plus Pills <<
2 – Male Extra: The most high-quality ingredients
Benefits Of Male Extra Pills
- Intense Orgasms.
- Libido Boosting.
- Sex Drive Enhanced.
- Blood Flow To The Penis Increased.
- Increased Sexual Stamina.
- Increased Sexual Pressure.
- Strengthens Penis Tissues.
This is a male enhancement pill made from natural ingredients which makes it safe for human consumption (not like the blue pills for men – aka Viagra). Only the finest ingredients that are individually used to enhance and treat sexual dysfunctions of some sort were combined in one pill to give customers many benefits.
Male Extra has over a decade of service and it is still “all the rage” at this moment as one of the most trusted leading male enhancement pills on the market.
➡️ Related: Male Extra VS Vigrx Plus
How Does It Work?
The Male extra supplements good behavioral practice that will help you keep having a great sexual experience and feel confident with your long-lasting performance.
Our health and nutrition experts suggest you turn to a healthy diet. Also avoid alcohol, drugs, and cigarettes to increase your sexual performance.
Male Extra also delays fatigue during sex supporting longer and faster sexual performance. The product ensures there is enough supply of nutrients and oxygen to the body cells to replenish and revive tired cells.
Male Extra selected the specialized blend of compounds found naturally to create a good supplement that is used by hundreds of thousands of men worldwide. These ingredients include:
- L-Arginine HCL (600mg)
- Pomegranate 40% Ellagic Acid (500mg)
- Methyl Sulfonyl Methane (MSM) (100mg)
- L-Methionine (100mg)
- Zinc (as citrate) (14mg)
- Cordyceps (25mg)
- Niacin/ Vitamin B3(18mg)
Who is Male Extra For
Men with erectile dysfunction become less confident, stressed, or even depressed and it is more emasculating than anything else.
Luckily for men who are already experiencing erectile dysfunction of some sort, there is Male Extra to boost your self-confidence, reduce your stress and help you build long and lasting relationships.
>> Read our complete Male Extra Review here <<
3 – Max Performer: Boasting physical and mental health
Benefits Of Max Performer Pills
- Increased concentration.
- Improved self-esteem.
- Soaring confidence.
- Satisfies sexual desire.
- Enhances libido.
- Raises testosterone levels.
- Expands blood flow in the penis.
Best Pill for Mental and Physical health, the Max Performer formula focuses not only on the function of the penis but all areas within the body.
In addition to raising testosterone levels and expanding blood flow, the pill may also expand the brain’s alertness and decrease stress while potentially enhancing libido.
➡️ Related: Max Performer vs VigrX Plus
How Does It Work?
Although it may not be the best pill for penile enlargement in the long run, it does work to amplify your sexual desires thanks to improving your sexual stamina. It can make the experience more satisfying for both you and your woman.
- Horny Goats Weed
- Red Korean Ginseng
Who is Max Performer For
Max Performer is specialized in men who are under constant stress of premature ejaculation and not being able to have pleasurable sexual performance. It’s recommended for men over 21 years old and struggling with enhancing libido. It will boost self-confidence and improve your stamina. One of the many health options is raising testosterone levels to pump blood flow.
>> Read our Complete Review of Max Performer <<
4 – ExtenZe: Best for premature ejaculation
Benefits Of Extenze Pills
- Increased libido.
- Restores a longer erection.
- Increases duration of intimacy.
- Immediate action product.
- Improving blood flow.
- Sex drive enhanced.
Extenze is a natural supplement that promotes help and treatment for erectile dysfunction. ED is an issue where a male experiences difficulty achieving or maintaining a long or hard erection.
Extenze primarily promotes help for males who want to achieve the ultimate sexual performance.
The blend of ingredients increases testosterone levels and blood flow. This can help a male achieve an instant erection and deal with ED symptoms. Similar to that of viagra products.
How Does It Work?
Extenze is an American brand that entered the market in the early 2000s. Its two main functions are to increase sexual performance and help with erectile dysfunction symptoms. For the most part, Extenze is a blend of natural and herbal complexes, amino acids, and nutrients.
Extenze aims to increase sexual performance through maximum strength, extended-release, and fast-acting ingredients.
- Folate (Folic Acid): A natural sperm enhancer.
- Zinc (As An Oxide): Helps to increase testosterone.
- Micronized DHEA: Enhances strength and performance.
- Yohimbe Extract: Helps treat male infertility.
- Tribulus Terrestris Extract: Can increase sex drive.
- Korean Ginseng Extract: Combats erectile dysfunction symptoms.
- L-arginine: Helps achieve a normal erection.
- Horny Goat Weed: Improves blood flow for erections.
Who is Extenze For
Extenze is an enhancement pill targeted at males only. The effects and benefits will not be beneficial nor safe for women. For both genders, there is still not enough sufficient evidence to conclude that Extenze is safe or effective.
Due to the ingredient list being undeclared and not verified by the FDA, it is advised to seek professional advice before taking such products. It is also important to avoid taking new medication if you have any ongoing medical conditions and/or take other medicine.
>> Read our Complete Review of Extenze Supplement <<
5 – Volume Pills: The Best Sperm Enhancers.
Benefits Of Volume Pills
- Increase your libido.
- Intense orgasms.
- Harder erections.
- Increase volume of semen.
- Pleasurable sexual activities.
- Improved blood flow.
Volume Pills is one of the most popular and liked in the male enhancement pills community. Its 100% natural ingredients: herbs, nutrients, and aphrodisiacs claim to have zero side effects. It’s considered part of the supplement family, as you don’t require a prescription medicine to buy them off the counter in your nearby pharmacy.
It’s always recommended to test the male enhancement pills to see which one responds to your body better. There are many male enhancement pills on the market, but many reviews claim Volume Pills are the best.
How Does It Work?
Volume pills are composed of just natural ingredients with amino acids that help men struggling with erectile dysfunction have more pleasant sexual activities. It is recommended to take 2 capsules per day. This male enhancement pill is targeted at men only and should not be taken by women in any right. It could lead to a deadly effect.
- Solidilin: Increases pleasure and motivation for sex.
- Xi lan rou gui and Hong Hua fen: Increases blood flow for bigger erections.
- Ku Gua: Increases semen production.
- San Guo mu: Ejaculation control.
- Dong Chong Xia Cao: Helps with testosterone production.
- Zinc Gluconate: Semen and testosterone production.
Who Is Volume For
Volume Pills is intended for the male market and buyers who are struggling to fulfill their sexual needs. Its natural ingredients claim to not have any side effects and can take them up to 6 months continuously.
It’s recommended for males from 30-65 years old who are struggling with ejaculation control and low stamina. It will enhance your sexual encounters and have the best sex drive.
6 – ProSolution +: The 10 years experienced pill with well-researched ingredients
Benefits Of ProSolution Pills
- Better orgasms.
- Higher stamina.
- Enhance sexual vigor.
- Better sexual health.
- Ejaculation control.
- Boost testosterone levels.
ProSolution has more than 10 years of experience in the enhancement pill market. These pills can combat the impairment of erectile disfunction, manage to increase a low sex drive, and greatly enhance sexual vigor and stamina.
One of the best results in ProSolution that no other pill can get is ejaculation control.
How Does It Work?
As a popular choice for thousands of men over the last decade, ProSolution has seen a steady stream of customers who have reviewed this pill very highly.
This enhancement pill has grabbed much attention in this market because you will not find many of the ingredients in this pill in any other male enhancement products. Its all-natural ingredients and just 4 capsules a day, help a better blood flow to the penis.
- Korean Ginseng.
- Reishi Mushroom.
Who Is ProSolution For:
ProSolution is targeted at men who are having trouble with ejaculation control and had a bad sexual encounter. It’s important to see the difference between each set of pills to know which benefits best to the buyer.
Men ages 18-70 years old qualify to take ProSolution, it’s not recommended as there is no scientific conclusion of its effectiveness or bad in the long run.
>> Read our Complete review of Prosolution Plus Pills <<
7 – Viasil: The most viable solution to erectile dysfunction.
Benefits Of Viasil Pills
- Bigger erections
- Healthy blood flow.
- Boost your self-confidence.
- Support your body immune and energy.
- Better orgasms.
- Ejaculation control.
Viasil looks to improve your performance in the bedroom, in particular when it comes to thicker and firmer erections making your penis look and feel much bigger.
Your body naturally creates ATP and Nitric Oxide, however, age, stress, and illness causes that production to reduce. Viasil claims to have the ability to benefit and help support your body’s immune and energy systems by potentially boosting ATP and Nitric Oxide production – which both help feed your body energy and ensure healthy blood flows.
How Does It Work?
Viasil works in two forms: pills and injections. The difference between both would be that injections need to be supervised and controlled by a doctor. Off the counter, pills don’t need to be controlled. Viasil pills it’s recommended 3 times a day with a dose of 20mg.
Its ingredients bring men sexual pleasure in bigger erections and better stamina. It’s recommended for men between the ages of 30-60 with erectile dysfunction syndrome.
- Horny goat weed.
- Ginkgo biloba.
- Pomegranate leaf extract.
Who Is Viasil For:
Viasil is aimed at men who are struggling with erectile dysfunction (ED) and having a pleasurable sexual encounter. These men enhancement pills are the least natural and many customers review how many side effects they experience after taking them. Some side effects would be seizures, vomiting, diarrhea, nausea..etc.
How Do Male Enhancement Pills Work?
As far as we can see, penis enlargement’s big entrance into the industry began at the turn of the century, in popular men’s health magazines and erotic magazines.
In 2003 when the male enhancement pill first started to take off, sales increased and a few million bottles were being sold annually by at least 50 companies.
According to producers, makers, and dealers, the revenue of more than $100 million a year was being created for the male enhancement industry and the curve continued to rise.
There are many different male enhancement pills scattered on the internet for sale and it is very important to know how they are manufactured and the ingredients within each supplement to avoid any unnecessary health side effects.
For the majority of supplements sold on the market, all have herbal remedies and boast various positive effects especially when it comes to sex performance.
Male enhancement pills have not been scientifically proven to improve sexual performance in the same way real medications have been. Sometimes they might have a placebo effect, which means you might see some improvement in your sexual performance because you believe you’re getting treatment.
On the contrary, some studies and reviews from customers have had positive effects and seen major enlargement growth.
The majority of male supplements use only natural ingredients. The ingredients are made up of herbal extracts, such as L-arginine, Pomegranate 40% Ellagic Acid, Cordyceps, MSM, and L-Methionine but one of the most popular and well-known ingredients is the Epimedium leaf also known as ‘Horny Goat Weed’.
Known for fighting erectile dysfunction, production of new blood vessels, and relaxing penis muscles to increase blood flow, according to studies published by the American Chemical Society and the Journal of Sexual Medicine.
Other similar male enhancement pills use similar ingredients and may have more, for example,
Arginine, Zinc, and Muira Pauma Bark Extract. All have significant impacts on improving blood flow and muscle health. When used over a long period of time some research can be used as evidence of penis growth.
How To Choose The Best Pill For You?
Above we have listed the most well-known and used male enhancement pills on the market. Choosing the best one for you really depends on how important the positives of each product are in comparison to their negatives.
VigRx is very popular among users and boasts a huge increase in penis size, especially when erect. Although it does have the potential to have some side effects like all pills, choosing the pill with the highest quality ingredients is key to having a healthy balance.
Read more: Our article on the real average penis size
Male Extra has some of the highest quality ingredients in comparison to other male enhancement pills and has a similar price tag as VigRx. Other potential options depending on your preferences could be Viasil sold to provide an incredible sexual experience by enhancing performance claiming to have zero side effects.
Pros and Cons of Male Enhancement Pills.
|Increased blood flow to the penis.||Potential Serious Side Effects.|
|Uses ingredients known to boost sex drive.||Most products don’t increase penis size.|
|Boost your self-confidence.||Any effects are temporary.|
|No prescription is needed.||Not scientifically approved.|
Male Enhancement Pills: Our Thoughts and Conclusion.
Penis enlargement pills are primarily sold and marketed to increase penis size and improve sexual performance. Should you decide to try one of those listed above we recommend the MaleExtra as it has the highest quality ingredients and it has a long list of happy users but one of the most important reasons is that while it works similar to others it claims to greatly reduce contracting several diseases.
The primary results of the male enlargement pills conclude that they may improve your erection size and the time you have an erection but none of the companies claim to actually increase the size of the penis indefinitely.
In fact, male enlargement pills have never been truly scientifically proven to work by important pharmaceutical and medical bodies like the FDA and the NHS. Most recommend avoiding them as they can cause serious side effects, especially when used regularly.
Claims that these types of products work aren’t based on real scientific evidence, like real medications. There are one or two small studies that show some benefits, but that’s not enough to verify each male enhancement is guaranteed to work.
We highly recommend consulting your doctor first before consuming any enhancement supplements, especially if you have or think you have a health concern that needs prior checking before purchasing and using any type of supplement.
So, if you do plan to buy any male enhancement pills, make sure you are buying from a trusted seller. Look for the Traditional Herbal Registration logo if you can to make sure the product you’re buying is properly regulated.
If you enjoyed this article, feel free to share any feedback you have with us. You can read more male health articles such as XYY Syndrome and more in our Men’s Health Category.
FAQ – On Male Enhancement Pills
Here we answered all the frequently Asked Question On Male Enhancement Pills:
Will My Penis Grow In Size?
Many different pills promise to increase penis size. They tend to contain various vitamins, minerals, herbs, or hormones. There is no strong scientific evidence that any can affect or benefit the size of the penis.
Most sellers actually don’t promise a penis enlargement, instead, they promise longer and thicker erections. This is what they promote and may be true but the outcome is not guaranteed 100% for each user and you must be aware of the potential side effects when taking pills, especially over time.
A research study by a Professor of Urology in North Carolina on male enhancement supplements concluded that while certain natural supplements showed promise for improving mild sexual dysfunction, they lack extensive human evidence to longer erections.
Are Penis Enlargement Pills Safe To Use?
Using penis enlargement pills is not recommended. Usually, men who are looking to purchase, use these struggle with low self-esteem and low sexual confidence.
In a study published in the Journal of Sexual Medicine, they found that some of the supposedly all-natural products have traces of phosphodiesterase-5-inhibitors (PDE5Is), which is potentially addictive medication found in prescription-only drugs used to treat impotence.
One study reviewed by the researchers found that 81 percent of tested samples of over-the-counter male sexual enhancement products bought in the United States and Asia contained PDE5Is. Most importantly PDE5Is is not legal to buy over the counter. Men who use these enhancement pills run the risk of severe health issues.
Many side effects of these pills can be similar to a common cold like headaches, congestion, and a cough however in some rare cases it can lead to heart attacks, strokes, and even death depending on your health condition.
Most herbal medicines outside of male enhancement pills that are sold in local stores need to be properly regulated by the Medicines and Healthcare Regulatory Agency (MHRA). When approved research shows that they are given a traditional herbal registration (THR) and most male penis enhancements are not given this registration hence the high risk when trying a product. However, some can have this logo printed on the bottle. It will be easy to notice when buying from a store but not when buying online.
How Effective Are Male Enhancement Pills?
Male enhancement pills have very mixed reviews across the internet with many users claiming fast results but others claiming to not have any at all. One user of MaleExtra claimed super-fast results from the 2nd and 3rd week – feeling the effects as promised to have harder erections and increased libido.
MaleExtra contends all satisfied customers have seen an increase in their erectile penis size between 0.8 – 2.6 inches over a 3 – 6 month period by using the pill every day.
When using VigRx, the most popular on the market, most men had very mixed reviews with many not feeling any effects at all after 30 days and others feeling effects fast:
A study by the Pharmaceutical & Clinical Pharmacy Research Group (PCPRG) found that the available evidence leads to the conclusion that the ExtenZe product probably doesn’t work. The study shows a lack of accuracy supporting the product’s effectiveness, contradicting evidence regarding product safety, and absolutely untrue and impossible to deliver statements disallowing this product as meeting the standards of safe and good pharmaceuticals.
Many other male enhancement pills offered may claim similar benefits however a popular belief among scientists is, that while the pills cannot alter physiology, some say the mixture could have a stimulating effect on the mind, meaning most are placebos. The Placebo effect is powerful and rife in male enhancers. Some users will feel empowered by taking the pill and believe it is the pill that has made those changes.
On the contrary, probably the only positive study aiding the selling and popularity of male enhancement is the results from the US National Library of Medicine. When testing 78 males between the ages of 25 and 50 who suffer from erectile dysfunction and other sexual issues, 50% were given VigRx and the other 50% was a placebo. In subjects who took VigRx, male enhancement changes scores improved significantly as compared to placebo.
VigRX Plus is well tolerated and more effective than placebo in improving sexual function in men suggesting the placebo effect is not always the most effective.
Apart from the possible side effects, the biggest downside to buying male enhancement pills is that more than likely they won’t work how you need or want them to. Most scientists would agree that male enhancement pills may improve sexual experiences, especially in regards to erections but they cannot physiologically change the size of a penis.
How Often Should You Use Male Enhancement Pills?
When taking most male enhancers it is recommended to take one daily and possibly another, 30 minutes before a sexual experience. To experience all the benefits these pills provide, you should take the enhancer for several consecutive months without fail. The duration of taking these male enhancements should be no longer than 3 to 6 months otherwise you could risk more serious side effects.
When Should I Expect Results?
The ingredients within the products will not make an impact on the first day, it is said most positive effects will be noticed after a couple of weeks as it will take that amount of time for the natural ingredients to accumulate in your body and start performing correctly. During the 3 – 6 month period the longer you use the pills uninterruptedly the better effects you will have and they will last longer.
What Happens If I Overdose?
Taking more than once a day is only recommended only if you have a sexual experience. If you are not seeing any results after two weeks of staying on the correct dosage it is advised not to increase dosage as the risks will get higher. Should you not see any results after 4 weeks it is recommended to stop and claim the money-back guarantee. If you forget a dosage do not worry as it shouldn’t impact your chances of feeling positive effects.
For obvious reasons the manufacturers and sellers of these products don’t offer advice on when to stop taking these products but should you decide to try one we highly recommend not taking these any longer than 6 months as the long-term side effects could be much worse than any temporary side effects.
Should I Try Penis Enlargement Pills?
Penis enlargement pills do not work for everybody. They can, however, increase your sex drive and boost your sexual performance. Any evidence found on the success of penis enlargement pills is based on user experience and less scientific evidence.
The risk when taking these are high and the reward guarantee is low. Trying enlargement pills really depends on how safe you feel taking one of these products. More than likely improving your mental health condition with a balanced diet and exercise could lead to higher self-esteem and confidence and better sexual experiences.
How Long Does It Take For A Male Enhancement Pill To Kick In?
Usually, it would take between half an hour to forty minutes for the pill to take effect and feel the full effect. It lasts around two to three hours and may last longer with a greater prescription, but every brand it’s different, so each one has a different effect/endurance.
A side effect may lead to a painful erection, called priapism by restricting oxygen in the blood to the penis, which can lead to a paralyzed penis. If taken with a greater prescription than suggested it can lead to a series of medical issues like heart attack, heart palpitations, and stroke.
What Happens If A Woman Takes A Male Enhancement Pill?
It’s not recommended for women to take any type of male enhancement medication. The effects and benefits will not be the same nor safe for women. It can cause some serious damage like vomiting, stomachache, and organ failure.
For both genders, there is still not enough sufficient evidence to conclude that any type of male enhancement pill is safe or effective.
How Long Does A Male Enhancement Pill Last?
Due to mixed reviews of the product, there is no conclusive answer to verify how long the effects of male enhancement pills last.
Remember, male enhancement pills are not a verified product. There are no conclusive reports or results to state whether the ingredients are safe or effective. For better alternatives, it is best to seek advice from your doctor.
Whether you wish to use a male enhancer or need help with erectile dysfunction symptoms, there are other options out there to satisfy those needs.
What Is Best For A Male Enhancement Pill Or Cream?
Both men’s enhancement pills and creams do have the same effect to achieve a pleasurable sexual experience. Everything depends on what that person prefers if it’s easier to take a pill a day or apply lotion as desired.
There’s still no verified evidence to conclude if one is safer than the other one or more effective. All options and products are used and chosen by the buyer to try at their judgment.
What Are The Chemical Ingredients In Male Enhancement Pills?
Some ingredients in many male enhancement pills have great conclusive results for help with ED symptoms and improvement of erections. This includes DHEA and horny goat weed. But, not all ingredients have proved to be safe or effective.
Just a few years ago, more ingredients of the product were found to be dangerous. A report revealed that other ingredients can cause male appearance issues, such as man boobs.
What Ages You Can Use Male Enhancement Pills?
Usually, men between the ages of 40-70 years old are affected by ED (Erectile Dysfunction). They are the bigger range of users when it comes to male enhancement pills, but men between 18-70 years old can take it but it’s not advised. Many factors play an important part when having an ED, for example, smoking, large amounts of alcohol, drugs, and not enough exercise.