The intraocular pressure response to lower-body and upper-body isometric exercises is affected by the breathing pattern

Acute intraocular pressure responses changes during dynamic resistance training in primary open-angle glaucoma patients and age-matched controls

BACKGROUND

Physical exercise has been proposed as a feasible strategy for preventing and managing glaucoma by modulating intraocular pressure (IOP) and ocular perfusion pressure (OPP). The primary objective of this cross-sectional study was to assess the IOP and OPP responses to dynamic resistance exercises (leg extension and biceps curl).

METHODS

Twenty-six patients with primary open-angle glaucoma (POAG) (age = 68.9 ± 8.1 years) and 18 healthy age-matched controls (age = 69.6 ± 5.9 years) were recruited. Participants performed one set of 10 repetitions of both exercises at low- (light bar) and moderate-intensity (15RM). IOP and blood pressure were measured at baseline and after 1 and 5 min of passive recovery. Additionally, IOP was measured during training after each of the 10 repetitions.

RESULTS

Our data showed a progressive IOP increase throughout the sets of leg extension and biceps curl exercises when performed at moderate intensity (p < 0.001). Remarkably, POAG patients showed a smaller IOP increase compared to controls (p = 0.048). The between-group differences for IOP changes were higher during the 10 exercise repetitions at moderate-intensity for both leg extension (average IOP rise: POAG = 0.3 ± 0.6 mmHg vs. control = 2.3 ± 0.7 mmHg) and biceps curl (average IOP rise: POAG = 1.4 ± 0.6 mmHg vs. control = 3.4 ± 0.8 mmHg) exercises. No changes in OPP were observed.

CONCLUSIONS

The findings of this study suggest that moderate-intensity dynamic resistance training is a safe intervention for potentially improving physical fitness in medically treated POAG patients.

Effects of Phenylcapsaicin on Intraocular and Ocular Perfusion Pressure During a 30-Min Cycling Task: A Placebo-Controlled, Triple-Blind, Balanced Crossover Study

The main objective of this placebo-controlled, triple-blind, balanced crossover study was to assess the acute effects of phenylcapsaicin (PC) intake (2.5 mg) on intraocular pressure (IOP), ocular perfusion pressure (OPP), and heart rate (HR) during a 30-min cycling task performed at 15% of the individual maximal power. Twenty-two healthy young adults performed the cycling task 45 min after ingesting PC or placebo. IOP was measured with a rebound tonometer before exercise, during cycling (every 6 min), and after 5 and 10 min of recovery. OPP was assessed before and after exercise. HR was monitored throughout the cycling task. We found an acute increase of IOP levels related to PC consumption while cycling (mean difference = 1.91 ± 2.24 mmHg; p = .007, ηp2=.30), whereas no differences were observed for OPP levels between the PC and placebo conditions (mean difference = 1.33 ± 8.70 mmHg; p = .608). Mean HR values were higher after PC in comparison with placebo intake (mean difference = 3.11 ± 15.87 bpm, p = .019, ηp2=.24), whereas maximum HR did not differ between both experimental conditions (p = .199). These findings suggest that PC intake before exercise should be avoided when reducing IOP levels is desired (e.g., glaucoma patients or those at risk). Future studies should determine the effects of different ergogenic aids on IOP and OPP levels with other exercise configurations and in the long term.

Systematic review on the impact of exercise on intraocular pressure in glaucoma patients

Due to limited studies, we systematically reviewed evidence on the impact of physical exercise on intraocular pressure (IOP) in glaucoma patients, adhering to PRISMA guidelines. Using MEDLINE/Web of Science, PubMed, and Scopus, we selected English, Portuguese, or Spanish studies excluding case reports and yoga-based interventions. From 1001 records, 15 studies were independently evaluated. Evaluated through the MMAT scoring system, two quantitative randomised controlled studies scored 100% while 13 non-randomised studies averaged 84.62%. Our findings indicated that both aerobic and resistance training led to an immediate IOP reduction post-exercise. However, these findings were largely from single-session experiments. In contrast, the effects of longer-term exercise programmes on IOP varied. Although our review underscores the potential utility of exercise in IOP management, the evidence remains inconclusive due to variations in study design, participant demographics, and exercise parameters. This lack of consistency in the research highlights the necessity for larger, standardised, and longer-term studies to robustly corroborate these preliminary findings.

Acute Effects of Resistance Exercise on Intraocular Pressure in Healthy Adults: A Systematic Review

ABSTRACT

Hackett, DA, Li, J, Wang, B, Way, KL, Cross, T, and Tran, DL. Acute effects of resistance exercise on intraocular pressure in healthy adults: A systematic review. J Strength Cond Res 38(2): 394-404, 2024-Intraocular pressure (IOP) tends to fluctuate during a resistance exercise (RE). This systematic review examines the acute effects of RE on IOP in healthy adults and factors that influence changes in IOP. Five electronic databases were searched using terms related to RE and IOP. A strict inclusion criterion was applied, which included being 55 years or younger with no medical conditions and RE intensity needing to be quantifiable (e.g., based on a maximal effort). Thirty-four studies met the inclusion criteria for this review. Isometric and isotonic contractions produced similar changes in IOP during RE up to 28.7 mm Hg. Exercises that involved larger muscle mass, such as squats and leg press, were found to produce changes in IOP during exercise ranging from 3.1 to 28.7 mm Hg. Smaller changes in IOP during RE were found for exercises engaging less muscle mass (e.g., handgrip and bicep curls). Intraocular pressure was found to increase during RE when lifting heavier loads and with longer exercise durations (e.g., greater repetitions). The Valsalva maneuver (VM) and breath-hold during RE accentuated the change in IOP, with more extreme changes observed with the VM. However, most studies showed that postexercise IOP returned to baseline after approximately 1 minute of recovery. An acute increase in IOP is observed during RE in healthy adults with fluctuations of varying magnitude. Factors that independently increase IOP during RE include exercises involving larger muscle mass, heavy loads, greater set duration, and when the VM or breath-hold is performed.

The intraocular pressure lowering-effect of low-intensity aerobic exercise is greater in fitter individuals: a cluster analysis

This study aimed to determine the influence of physical fitness level and sex on intraocular pressure (IOP) during the low-intensity aerobic exercise. Forty-four participants (twenty-two men) cycled 30 minutes at low intensity (10% of the maximal power). Maximal power was determined by asking participants to perform maximal sprints of 6 seconds against 3-4 different resistances separated by 3 minutes of rest. The IOP was measured on 9 occasions (1) prior to the warm-up, (2) after the warm-up, (3-7) every 6 minutes during the low-intensity cycling task, and (8-9) 5 and 10 minutes after the cycling task. 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). Participants´ sex had no effect on the IOP behaviour at any time point (p = 0.453). These findings indicate that individuals who need to reduce IOP levels (i.e., glaucoma patients or those at risk) should increase or maintain a high fitness level to benefit more from the IOP lowering effect during low-intensity aerobic exercises.

Effect of wearing different types of face masks during dynamic and isometric resistance training on intraocular pressure

CLINICAL RELEVANCE

The use of face masks has demonstrated to be an effective strategy to prevent transmission of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Wearing face masks, mainly Filtering Face Piece 2 (FFP2) masks, during exercise practice has demonstrated to affect several physiological measures.

BACKGROUND

This study was aimed at assessing the intraocular pressure (IOP) behaviour during the execution of the dynamic and isometric biceps-curl exercise with a surgical and FFP2 face mask.

METHODS

Twenty two physically active young adults performed sets of 10 repetitions against the 10-RM (repetition maximum) load and 1-minute isometric effort against a load 15% lower than the 10-RM load with the FFP2 and surgical mask and without any mask. A total of six exercise sets (3 experimental conditions [FFP2, surgical and control] × 2 exercise modalities) were performed. A rebound tonometer was used to measure IOP before, during (10 measurements), and after (30-seconds of passive recovery) each training set.

RESULTS

At rest, there were not statistically significant IOP differences (p = 0.222). During dynamic exercise, there was a progressive IOP rise (p < 0.001), and a higher IOP response with the FFP2 than without the mask (corrected p-value = 0.003). For the isometric exercise, there was a greater IOP response as a function of accumulated effort (p < 0.001), which was dependent of the face mask used (FFP2> surgical>control; corrected p-values< 0.01).

CONCLUSIONS

The FFP2 masks cause a heightened IOP response during the execution of dynamic and isometric biceps-curl exercise, suggesting that, when possible, glaucoma patients should limit the use of FFP2 masks during resistance training.

Immediate and cumulative effects of upper-body isometric exercise on the cornea and anterior segment of the human eye

Objectives

The execution of isometric resistance training has demonstrated to cause changes in the ocular physiology. The morphology of the cornea and anterior chamber is of paramount importance in the prevention and management of several ocular diseases, and thus, understating the impact of performing isometric exercise on the eye physiology may allow a better management of these ocular conditions. We aimed to determine the short-term effects of 2-minutes upper-body isometric effort at two different intensities on corneal and anterior eye morphology.

Methods

Eighteen healthy young adults performed a 2-minutes isometric biceps-curl exercise against two loads relative to their maximum strength capacity (high-intensity and low-intensity) in a randomized manner. An Oculus Pentacam was used to measure the corneal morphology and anterior chamber parameters in both experimental conditions at baseline, during the isometric effort (after 30, 60, 90 and 120 seconds), and after 30 and 120 seconds of passive recovery.

Results

We found that isometric effort causes an increase in pupil size (P < 0.001), and a decrease in the iridocorneal angle (P = 0.005), anterior chamber volume (P < 0.001) and K-flat (P < 0.001) during isometric effort, with these effects being more accentuated in high-intensity condition (P < 0.005 in all cases).Performing 2-minutes upper-body isometric effort did not alter anterior chamber depth, central corneal thickness, corneal volume, and K-steep (P > 0.05 in all cases).

Conclusions

Our data exhibit that performing 2-minutes of upper-body isometric exercise modifies several parameters of the corneal morphology and anterior eye biometrics, with these changes being greater for the high-intensity exercise condition. The findings of this study may be of relevance for the prevention and management of corneal ectasias and glaucoma.

Therapeutic and preventive eff ect of physical exercises in primary open-angle glaucoma

The review assesses physical exercises as an additional non-pharmacological mean of combating the progression of primary open-angle glaucoma. The ophthalmic hypotensive effect is determined by the type of exercise, its duration and intensity. Moderate aerobic activity is preferred. Among dynamic exercises, jogging has the greatest hypotensive effect. Upper body isometric resistance training provides a more lasting decrease in ophthalmotonus. The decrease in intraocular pressure (IOP) in patients with glaucoma is several times more pronounced in comparison with healthy people and occurs regardless of the nature of the local drug antihypertensive therapy. After the termination of classes IOP returns to the previous level on average within a month. An increase in ocular perfusion pressure associated with physical activity dictates the appropriateness of physical exercise for patients with pseudo-normal pressure glaucoma. The combination of hypotensive, vascular, neuroprotective effects of physical activity with a high level of physical fi tness does not exclude a decrease in the risk of development and progression of primary open-angle glaucoma. The development of indications for the use of physical activity by patients with advanced glaucoma, including those who have undergone hypotensive surgery, remains relevant. The type, intensity, dosage and mode of performing the recommended physical exercises require an individual choice.

Intraocular pressure fluctuation during resistance exercise

Objective

To evaluate the effect of weightlifting (leg press) on intraocular pressure (IOP).

Design

Prospective cohort study.

Subjects

A total of 24 participants met the inclusion criteria and completed the study procedures. Participants had an average age of 22.7±2.7 years and included nine women. The mean baseline IOP was 13.9 mm Hg (SD=2.4) with an average body mass index of 24.5 (SD= 3.1).

Methods

The maximum load for a single lift was found for each participant. Participants then performed three leg press regimens: one repetition using 95% of maximal load (1RM), six repetitions using 75% of maximal load (6RM) and isometric push against a weight much heavier than maximal load (ISO).

Main outcome measure

IOP was measured pre-exercise, during and immediately following the exercise using an iCare TA01i rebound tonometer. Blood pressure and HR were being monitored continuously during the lift. Optical coherence tomography images were obtained pre and postexercise session.

Results

The average maximum weight lifted by our participants was 331.9 Kg (SD=97.3). Transient increased IOP was observed across the 1RM, 6RM and ISO exercises with an average increase in 26.4 mm Hg (23.7 mm Hg to 28.7 mm Hg) to reach an average max IOP of 40.7 mm Hg (27.8 mm Hg to 54.2 mm Hg), with an absolute maximum of 70 mm Hg in one participant.

Conclusions

There is a transient and dramatic fluctuation in IOP with resistance training. This coupled with regular exposure to resistance training is potentially a significant risk factor for glaucoma. It should be noted that this study has been carried out in a healthy young population, and, thus, the external validity of these results in glaucoma participants requires further investigation.

Intraocular pressure responses to walking with surgical and FFP2/N95 face masks in primary open-angle glaucoma patients

Purpose

The use of face mask is globally recommended as a preventive measure against COVID-19. However, the intraocular pressure (IOP) changes caused by face masks remain unknown. The objective of this study was to assess the impact of wearing surgical and FFP2/N95 face masks during a 400-m walking protocol on IOP in primary open-angle glaucoma (POAG) patients.

Methods

Thirteen subjects diagnosed of POAG (21 eyes) were enrolled in this study. IOP was measured at baseline, during the 400-m walking protocol and after 5 min of passive recovery while POAG patients wore a surgical mask, FFP2/N95 mask and no mask in randomized order. From the 21 POAG eyes, we analyzed the IOP changes caused by physical exercise with two face masks and without wearing any face mask.

Results

At rest (baseline and recovery measurements), the use of the different face masks did not affect IOP levels (mean differences ranging from 0.1 to 0.6 mmHg). During physical activity, wearing an FFP2/N95 mask caused a small (mean differences ranging from 1 to 2 mmHg), but statistically significant, IOP rise in comparison to both the surgical mask and control conditions (Cohen’s d = 0.63 and 0.83, respectively).

Conclusion

Face masks must be used to minimize the risk of SARS-CoV-2 transmission, and POAG patients can safely use FFP2/N95 and surgical masks at rest. However, due to the IOP rise observed while walking with the FFP2/N95 mask, when possible, POAG patients should prioritized the use of surgical masks during physical activity.

Effects of Wearing the Elevation Training Mask During Low-intensity Cycling Exercise on Intraocular Pressure

PRCIS

Low-intensity aerobic exercise is recommended to reduce intraocular pressure (IOP) levels. However, this effect depends on several factors. We found that using an elevation training mask (ETM) during low-intensity aerobic exercise causes an IOP rise.

PURPOSE

The aim was to assess the influence of wearing an ETM on IOP during low-intensity endurance training.

METHODS

Sixteen physically active young adults (age=23.9±2.9 y) cycled during 30 minutes at 10% of maximal power production with and without an ETM in 2 different days and randomized order. A rebound tonometer was used to measure IOP at baseline, after a warm-up of 5 minutes, during cycling (6, 12, 18, 24, and 30 min), and recovery (5 and 10 min) by rebound tonometry.

RESULTS

The use of an ETM significantly affects the IOP behaviour during exercise (P<0.001, ηp²=0.66). In the ETM condition, there was an IOP increment during exercise (P<0.001, ηp²=0.28) whereas an IOP-lowering effect was observed in the control condition (P<0.001, ηp²=0.41). Post hoc comparisons showed that there were greater IOP values during exercise in the ETM condition in comparison to the control condition (average IOP difference=3.7±2.2 mm Hg; corrected P<0.01, and the Cohen d's >1.10, in all cases).

CONCLUSION

Low-intensity endurance exercise causes an increment in IOP when it is performed wearing an ETM and a decrease in IOP when the air flow is not restricted (control condition). Therefore, the ETM should be discouraged during low-intensity endurance exercise for individuals who need to reduce IOP levels (eg, glaucoma patients or those at risk). However, the external validity of these results needs to be addressed in future studies with the inclusion of glaucoma patients.