EXERCISE IN GLAUCOMA: TO DO OR NOT TO DO?

 

DR. ALIYA

P.G. SCHOLAR

DEPT OF ILAJ-BIT-TADBEER

STATE UNANI MEDICAL COLLEGE AND HOSPITAL

PRAYAGRAJ, INDIA

 

Controversy exists among the patients and the healthcare industry about whether exercise, especially certain exercises such as yoga, is useful or harmful for glaucoma patients.

Many articles have shown the positive and negative sides of exercises on glaucoma status.

PROS OF EXERCISE:

Studies have shown that aerobic exercises are particularly useful in glaucoma patients. These exercises improve circulation in the brain and therefore, are useful for the eye, especially in glaucoma patients who have vascular anomalies contributing to glaucomatous damage.

A prominent glaucoma expert, Dr. Robert Ritch recommends 45 minutes of aerobic exercise 3-4 times per week. Walking, swimming, biking, or working out on stationary machines lowers intraocular pressure (IOP) and improves blood circulation to the eye and brain.

A study by Lee et al reported that increased walking, greater time spent doing moderate-to-vigorous physical activity, and more time spent in non-sedentary activity were associated with slower rates of VF loss in a treated population of patients with glaucoma, with an additional 5000 daily steps or 2.6 hours of non-sedentary physical activity decreasing the average rate of VF loss by approximately 10%. [1]

A study by Janicijevic et al reported that low-intensity aerobic exercise had a lowering effect on IOP, being the beneficial effect more accentuated and prolonged in the High-fit group (IOP reduction compared to baseline lasted 30 minutes) than in the Low-fit group (IOP was only reduced at 6 minutes of exercise compared to baseline). [2] 

Ramulu and associates have also found that substantial reductions in physical activity and walking were noted with greater levels of VF loss. [3] 

In experiments on mice, Chrysostomou and collegues reported that exercise almost completely reversed age-related vulnerability of the optic nerve to injury such that exercised aged mice had a similar functional response to injury as non-exercised young (3-month-old) mice. Exercise also abrogated injury-induced astrocytic gliosis and macrophage activation in the aged retina. These data suggest that the known benefits of exercise also extend to the visual system and support further investigation of physical activity as a means of protecting against injury, dysfunction, and degeneration in the aging eye. [4] 

A meta-analysis has found that mild-intensity aerobic exercises are beneficial because of their diverse mechanisms in glaucoma patients. They can help in the transient reduction of IOP and have a beneficial effect on glaucoma severity and progression. [5] 

CONS OF EXERCISE:

A large study from the UK Biobank Eye and Vision Consortium did not find a significant association between exercise and glaucoma. Higher overall physical activity (PA) level and greater time spent in moderate and vigorous exercise were not associated with glaucoma status but were associated with thicker mGCIPL. Associations with IOP were modest and inconsistent. Despite the well-documented acute reduction in IOP after PA, there was no evidence that high levels of habitual PA are associated with glaucoma status or IOP in the general population. [6] 

Certain yoga postures are especially harmful for glaucoma patients. Studies have shown downward facing dog (adho mukha svanasana), standing forward bend (uttanasana), Plow (halasana), and legs up the wall (viparita karani) are especially harmful in glaucoma patients. A study found that the above mentioned four poses raised IOP in both the control group and the glaucoma patients, with the greatest increases associated with downward-facing dog. Once the subjects returned to a seated position, they were tested immediately and 10 minutes later. The IOP returned to baseline levels at these time points.

A study by Liu et al found that arterioles show increased stiffness with aging and it cannot be reversed with exercise.[7] 

CONCLUSION:

It can be inferred from the above studies that light aerobic exercises are useful, but heavy exercises like weight-lifting and certain yoga postures are deleterious for glaucoma patients and should be avoided.

REFERENCES:

1. Moon Jeong Lee, Jiangxia Wang, David S. Friedman, Michael V. Boland, Carlos G. De Moraes, Pradeep Y. Ramulu, Greater Physical Activity Is Associated with Slower Visual Field Loss in Glaucoma. Ophthalmology, Volume 126, Issue 7,2019,Pages 958-964.
2. Janicijevic, D., Redondo, B., Jiménez, R., Garcia-Ramos, A., & Vera, J. (2022). The intraocular pressure lowering-effect of low-intensity aerobic exercise is greater in fitter individuals: a cluster analysis. Research in Sports Medicine, 32(1), 86–97.
3. Pradeep Y. Ramulu, Eugenio Maul, Chad Hochberg, Emilie S. Chan, Luigi Ferrucci, David S. Friedman, Real-World Assessment of Physical Activity in Glaucoma Using an Accelerometer, Ophthalmology, Volume 119, Issue 6, 2012, Pages 1159-1166, https://doi.org/10.1016/j.ophtha.2012.01.013.
4. Chrysostomou V, Kezic JM, Trounce IA, Crowston JG. Forced exercise protects the aged optic nerve against intraocular pressure injury. Neurobiol Aging. 2014 Jul;35(7):1722-5. doi: 10.1016/j.neurobiolaging.2014.01.019. Epub 2014 Jan 23. PMID: 24524967.
5. Gildea, David MB BCh BAO; Doyle, Aoife MB, BCh; O’Connor, Jeremy MB, BCh. The Effect of Exercise on Intraocular Pressure and Glaucoma. Journal of Glaucoma 33(6):p 381-386, June 2024. | DOI: 10.1097/IJG.0000000000002411.
6. Madjedi KM, Stuart KV, Chua SYL, Ramulu PY, Warwick A, Luben RN, Sun Z, Chia MA, Aschard H, Wiggs JL, Kang JH, Pasquale LR, Foster PJ, Khawaja AP; Modifiable Risk Factors for Glaucoma Collaboration and the UK Biobank Eye and Vision Consortium. The Association of Physical Activity with Glaucoma and Related Traits in the UK Biobank. Ophthalmology. 2023 Oct;130(10):1024-1036. doi: 10.1016/j.ophtha.2023.06.009. Epub 2023 Jun 17. PMID: 37331483; PMCID: PMC10913205.
7. Liu C, Kobayashi T, Shiba T, Hayashi N (2022) Effects of aging and exercise habits on blood flow profile of the ocular circulation. PLoS ONE 17(4): e0266684.