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Editors Selection IGR 19-1

Miscellaneous: Exercise and IOP

Comment by Pradeep Ramulu & Elyse McGlumphy on:

82262 Long-term regular exercise and intraocular pressure: the Hisayama Study, Fujiwara K; Yasuda M; Hata J et al., Graefe's Archive for Clinical and Experimental Ophthalmology, 2019; 257: 2461-2469

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Examining influences of lifestyle or behavior on intraocular pressure may provide an avenue for empowering patients in the treatment of their glaucoma. As a part of the Hisayama Study, a long-term cohort study on cardiovascular disease, Fujiwara and colleagues examined the role of regular exercise and intraocular pressure over a five-year period. Here, a subset of the cohort, including 1871 individuals, not using IOP-lowering medications and with no previous ophthalmic surgery were included in their analyses. To reduce confounding factors, all IOP measurements were obtained within standardized time intervals along with concomitant measurement of blood pressure. Exercise practices, including type of activity, frequency, and duration, were collected using a patient survey. The authors adjusted for multiple other confounding factors such as age, sex, baseline IOP, systolic blood pressure, diabetes, total cholesterol, HDL cholesterol, BMI, waist circumference, smoking, alcohol intake, and work intensity of daily life.

A possible beneficial effect on IOP in older adults which could protect against glaucoma

In multivariable regression analyses, higher exercise frequency and duration were associated with trend towards lower IOP over time as compared to persons who exercised infrequently/for less time. In subgroup analyses, greater downward IOP trends were seen only in those who exercised frequently (three to six times per week) or for considerable amounts of time (> 210 minutes weekly). Even then, differences in the IOP trajectory across exercise status were modest (5 year ∆IOP = -0.75 mm Hg in non-exercisers vs. -1.12 mmHg in those exercising 3-6 times weekly), which would have limited protective effects against glaucoma. Additionally, individuals with incident medical IOP-lowering or surgery were excluded, and we do not know if these outcomes differed by exercise status. Thus, the article suggests a possible beneficial effect on IOP in older adults which could protect against glaucoma, though further studies including functional outcomes (visual field preservation) and accounting for treatment are required to more strongly establish the possible benefits of exercise.

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