Benefits of Exercise
Chat Highlights
April 2, 2008

On Wednesday, April 2, 2008, Dr. Michael Pro, a glaucoma specialist at Wills, and the glaucoma chat group discussed "Benefits of Exercise".

Moderator: Welcome back to chat Dr. Pro. Thank you for joining us; we have several new chatters this evening.

Dr. Pro:  Hello, welcome to all!

New P:  I'm in New York City and my mother is in Tennessee. She's here on the chat too.

Moderator: Tonight our topic is “Benefits of Exercise”. Dr. Pro, is there a specific exercise regiment that helps glaucoma patients?

Dr. Pro:  Well, there are a few studies I'll be referring to.

In 1991 Passo looked at nine sedentary glaucoma suspects. After three months of conditioning they found that the IOP reduced by an average of 4.6 mmHg. With cessation of exercise and subsequent detraining, intraocular pressure returned to elevated preconditioning levels by three weeks. So that study indicated that sustained cardiovascular exercise was best.

(Passo MS, Goldberg L, Elliot DL, Van Buskirk EM. Exercise training reduces intraocular pressure among subjects suspected of having glaucoma. Arch Ophthalmol. 1991 Aug;109(8):1096-8.)

Moderator: Many emailers ask about weight lifting. What do you tell your glaucoma patients that are into heavy weight lifting? It is advised for glaucoma patients?

Dr. Pro:  Heavy weight lifting like squat thrusts can increase the IOP during the manouever. In 2003 Chromiak found that dynamic resistance exercises such as chest press and leg press induce modest postexercise decreases in IOP. So I tell my patients that they certainly can continue to exercise or lift weights, but to avoid a Valsalva manouever—holding your breath while lifting a heavy object—as it will increase the IOP which can be harmful to a patient with moderate to severe glaucoma.

(Chromiak JA, Abadie BR, Braswell RA, Koh YS, Chilek DR. Resistance training exercises acutely reduce intraocular pressure in physically active men and women. J Strength Cond Res. 2003 Nov;17(4):715-20)

P:  Does holding your breath while your IOP is taken increase your IOP?

Dr. Pro:  It could if you hold it for a while.

Moderator: We also get many emailers asking about Pilates and yoga. Some of those positions lower the head below the heart. Is that bad for eye pressure?

Dr. Pro:  The only position that is proven to increase the IOP is the yoga head stand, so that position should be avoided. I don't know about the other positions, but I think it is possible that keeping the head below the heart for extended time could increase the IOP.

P:  What about swimming? It's a low-impact form of exercise. Do goggles pose any problems, especially for patients with trabeculectomies or who have had other eye surgery?

Dr. Pro:  Swimming is good. It fits into the category of sustained cardiovascular exercise and there is no Valsalva. The goggles are really not a problem, as they should not be pressing on the eyes. I advise immediate post-op patients to hold off from swimming until the eye has healed a bit.

P:  And scuba diving? It may not be exercise per se, but the swimming can raise the heart rate. Are there concerns for glaucoma patients who like to scuba dive?

Dr. Pro:  There are no additional risks in scuba diving for glaucoma patients that I can think of.

P:  Is it safe for Glaucoma patients to swim in lakes, or are we risking eye infections?

Dr. Pro:  I guess you mean patients who have had surgery? If so, the answer is, that you would be at higher risk of infection. Of course, the chance of getting an eye infection is still low. I would say to enjoy your swim in the lake. Avoid any water that is contaminated or has posted warnings, and be aware that any redness, irritation, or decreased vision in a post-surgical patient can indicate an infection and needs to be examined immediately.

P:  Are there any adverse effects from power walking?

Dr. Pro:  No, power walking is good.

P:  Which is better to lower your IOP, daily outdoor walking for 30 minutes or walking on a treadmill?

Dr. Pro:  There is no study that compared the two, but I think each would be equally beneficial. It is probably some improvement in ocular perfusion and subsequent improvement in aqueous outflow, which helps IOP after exercise.

P:  I guess water walking is also good?

Dr. Pro:  Also good.

P:  This question is for Dr. Pro and everyone. How many have a routine exercise program and do you stick to it? What words of encouragement can you pass along to those of us having a difficult time getting started and sticking to it?

Dr. Pro:  I feel more energetic when I exercise regularly and I motivate myself that way.

P:  I just had my second anniversary of walking every day for 40 minutes. I only skip it in blizzards and monsoons, and my IOPs and optic nerve have been stable for two years. Actually, my IOPs went down.

Moderator: Congratulations! That's quite an accomplishment.

P:  My word of encouragement: after medical compliance, regular exercise is one positive action I can take to benefit my eyes and overall health. That's my motivation.

Dr. Pro:  I agree with that.

P:  People should just go out one day and walk for 15 minutes. Just concentrate on the first day. Then concentrate on the second day, and so on. And it helps to have a dog that needs to be walked!

P:  Walking also picks up my mood when I'm feeling blue.

Dr. Pro:  My patients want to take control over their glaucoma and exercising is a great way to do that.

Dr. Pro:  There is one subset of glaucoma where exercise may raise the IOP. Pigmentary Dispersion Syndrome (PDS) is usually seen in younger individuals. It is characterized by free pigment granules in the anterior chamber. These granules probably "clog up" the outflow pathway and lead to higher IOP.

In 1980 Schenker reported on a “32-year-old man with pigmentary dispersion syndrome who had blurred vision and halos after strenuous exercise, associated with a release of pigment into the anterior chamber and increased intraocular pressure.” He reported that the increase in IOP was prevented by pilocarpine 0.5% before exercise.

(Schenker HI, Luntz MH, Kels B, Podos SM. Exercise-induced increase of intraocular pressure in the pigmentary dispersion syndrome. Am J Ophthalmol. 1980 Apr;89(4):598-600.)
In 1995 Jenson reported that sustained exercise could cause pigment release in pigment dispersion patients.

(Jensen PK, Nissen O, Kessing SV. Exercise and reversed pupillary block in pigmentary glaucoma. Am J Ophthalmol. 1995 Jul;120(1):110-2)
But in 1989 Smith did not find elevated IOP with exercise in 10 patients with pigment dispersion syndrome.

(Smith DL, Kao SF, Rabbani R, Musch DC. The effects of exercise on intraocular pressure in pigmentary glaucoma patients. Ophthalmic Surg. 1989 Aug;20(8):561-7.)

P:  How do you know if you have PDS? What affects pigment sufficiency? Do brown eyes usually have more pigment?

Dr. Pro:  It runs strongly in families, so if I find it in someone, I ask to see that person's immediate relatives. It is not the iris color that matters, but it is much more rare in non-white persons.

P:  Could shovelling heavy snow be considered too strenuous for someone with pigmentary glaucoma?

Dr. Pro:  Like I said above, some studies showed higher pressure with exercise. If I have a patient with pigmentary glaucoma and I am worried about physical activity, I have them come in for a pressure check right after they exercise. I had one patient see me right after hockey practice. I think your snow shovelling is probably OK; but I worry more about impact sports or running.

P:  Is walking good for pseudoexfoliation glaucoma?

Dr. Pro:  I would think so, yes.

P:  Do the studies indicate how long and how hard one would have to exercise to see a reduction in IOP, generally speaking?

Dr. Pro:  About open angle glaucoma? I think that the best study was from Passo in 1991. They took sedentary patients and conditioned them for three months. I don't know how long the patients exercised during each session, but I think it was not excessive. So I think any exercise that gets the heart pumping is good, and usually advise 20 minutes of cardiovascular exercise, three or four days a week

P:  What about sex, Doctor? Can sustained sex lower eye pressure or can it be hazardous to eye health?

Dr. Pro:  Sex can be part of a healthy physical and mental lifestyle and is OK in glaucoma patients.

Moderator: Dr. Pro, thank you for your time. We'll see you again in two weeks.

Dr. Pro:  Thank you, and good night.

On April 16, Dr. Pro discussed "High Risk Patients" in the Chat room. Click here for highlights of that meeting.

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