Physical fitness is unquestionably one of the keys to good health, but those with glaucoma should take evidence-based recommendations to heart. Various exercises can have different effects on people living with glaucoma.
Aerobic exercise:
Moderately intense aerobic exercise lowers eye pressure (intraocular pressure or IOP) in individuals with and without glaucoma, though the effect may be more pronounced in glaucomatous eyes.1,2
Aerobic exercise helps lower eye pressure. However, the studies were not exclusively conducted in glaucoma patients and hence an approval from your primary care physician before any exercise regimen is a must.
Studies have confirmed that aerobic exercise (such as walking, swimming, biking, or working out on stationary machines) at a brisk level for 30 to 45 minutes three to four times a week lowered IOP and improved blood flow to the brain and the eye. The IOP reduction was quantified to approximately 20 percent when previously sedentary people did vigorous aerobic exercise on a stationary bike four times per week for 12 weeks.3
Aerobic exercise has been shown to acutely lower IOP proportional to exercise intensity by up to 4.7 mm Hg.4
Although IOP reduction after intense exercise may only last an hour in unconditioned individuals and will also fade in fit individuals within weeks of deconditioning. 5,6
This highlights the importance of sustained physical activity from a perspective of glaucoma control.
Moderate to vigorous physical activity also decreased the average rate of visual field (VF) loss by approximately 10 percent.
Meditation:
Aside from the possible advantages to patients with glaucoma, meditation has other potential benefits to an individual’s physical and mental health. These include lower blood pressure, less depression and anxiety, improved memory, and better sleep.
A recent study suggested doing that meditation on a regular basis reduced IOP by >25 percent (about 4-5 mmHg) by the end of a month. 7
Factors that may be detrimental to the optic nerve or eye pressure, such as cortisol (our body’s stress hormone) were decreased in the meditation group.
Factors that have been proposed to help maintain optic nerve health and may lower eye pressure such as beta-endorphin (our pain relief hormone) were increased after meditation.
Strength Training/ Weight lifting:
Physicians recommend using caution and common sense when it comes to weight training due to a lack of large studies on the effect of weight training on IOP.
The Valsalva maneuver, which involves a person exhaling forcefully with a closed mouth and nose, blocking the windpipe by the closed epiglottis—is not recommended because it can dramatically increase IOP.
Weightlifting may increase IOP modestly during workouts through the Valsalva maneuver mechanism, that dissipates following completion of the exercise.8 The clinical significance of this elevation is unclear, and, as a form of exercise, weightlifting may still have long-term benefits.
Yoga:
The ancient practice of yoga includes various types and disciplines, some of which may help people with glaucoma and others that should be avoided.
Preliminary evidence from various studies supports that yoga-based Tratak ocular exercise might decrease IOP in glaucoma patients and may halt further damage of retinal ganglion cells (RGCs). In addition, this intervention might be helpful in the prevention of the onset of glaucoma in high-risk individuals.
The safest way for people with glaucoma to practice yoga is to avoid inversions altogether. And, individuals with elevated intraocular pressure (IOP) need to be careful with certain yoga positions, including the following that can elevate IOP levels:
o The Adho Mukha Svanasana yoga position, commonly known as a downward-facing dog
o The Halasana position, also known as the yoga plow
o The Viparita Karani position, or the “legs up the wall” position
Yoga has become increasingly popular, and its practice often involves various head-down positions that can potentially double IOP after a few minutes.9
Yoga positions that involve a headstand or that place the eyes below the heart can almost double IOP temporarily, but the IOP returns to baseline a few minutes later.10,11
As such, patients should be counseled to avoid maintaining these positions for sustained periods of time, especially those with progressive or advanced disease.
In conclusion, exercise does cause a decrease in blood pressure and possibly ocular perfusion pressure, but whether this impacts glaucoma risk or progression is unknown.12 That said, individuals with glaucoma should avoid exercise that produces prolonged Valsalva responses or positional engorgement of the choroid, as can occur with isometric heavy weight lifting, long-lasting inverted yoga poses, or tilt tables for the back.
REFERENCES
1. Liang YB, WuY, Li SZ, et al. Physical exercise and intraocular pressure. Chin J Opthalmol. 2011;47(9):854-7.
2. Risner D, Ehrlich R, Kheradiya NS, et al. Effects of exercise on intraocular pressure and ocular blood flow: a review. J Glaucoma. 2009;18(6):429-36.
3. Passo MS, Goldberg L, Elliot DL, Van Buskirk EM. Exercise training reduces intraocular pressure among subjects suspected of having glaucoma. Arch Ophthalmol. 1991;109(8):1096-1098.
4. Qureshi IA, Xi XR, Huang YB, Wu XD. Magnitude of decrease in intraocular pressure depends upon intensity of exercise. Korean J Ophthalmol. 1996;10(2):109-115.
5. Marcus DF, Krupin T, Podos SM, Becker B. The effect of exercise on intraocular pressure. I. Human beings. Invest Ophthalmol. 1970;9:749-52.
6. McDaniel DR, Tribbey CL, Tobias GS. Effects of moderate exercise on intraocular pressure. Am J Optom Physiol Opt. 1983;60:154-7.
8. Vieira GM, Oliveira HB, de Andrade DT, Bottaro M, Ritch R. Intraocular pressure variation during weight lifting. Arch Ophthalmol. 2006;124(9):1251-1254.
9. Baskaran M, Raman K, Ramani KK, Roy J, Vijaya L, Badrinath SS. Intraocular pressure changes and ocular biometry during Sirsasana (headstand posture) in yoga practitioners. Ophthalmology. 2006;113(8):1327-1332.
10. Baskaran M, Raman K, Ramani KK, et al. Intraocular pressure changes and ocular biometry during Sirsasana (headstand posture) in yoga practitioners. Ophthalmology. 2006;113(8):1327-32.
11. Cramer H, Krucoff C, Dobos G. Adverse events associated with yoga: a systematic review of published case reports and case series. PLoS One. 2013;8(10):e75515.
12. Kokkinos P. Physical activity and cardiovascular disease prevention: current recommendations. Angiology. 2008;59:26S-9S.
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