If you want to exercise and maintain a healthy routine of activity but are unsure whether that’s safe for people with glaucoma, the first thing you should do is talk to your ophthalmologist about your unique case to figure out what’s right for you. Many glaucoma patients ask their ophthalmologists for advice about working out and what’s okay to do, such as aerobic exercise, strength training, and yoga. 

Evidence-based recommendations from experts suggest that exercise may be done, with some limits and modifications in certain workouts.*

Aerobic exercise

According to the research, aerobic exercises, such as walking, swimming, and biking are good for glaucoma and crucial to overall health. Dr. Robert Ritch, New York Eye and Ear Infirmary of Mount Sinai in New York City, New York, advises 45 minutes of aerobic exercise three to four times a week. 

Multiple studies found positive effects of aerobic exercise on glaucoma, which included:  

• Lower intraocular pressure (IOP) and improved blood flow to the brain and eye with 30 to 45 minutes of aerobic exercise at least three days a week. 

• Slower rates of visual field (VF) loss were experienced with increased activity level, including average steps per day, minutes of basic (non-sedentary) movement, and greater time spent doing moderate-to-vigorous physical activity. 

• Exercise in sedentary (non-active) people had a greater improvement in IOP than people who were already active. 

Strength training 

Few studies have been conducted with glaucoma and strength training. Moreover, the studies available are contradictory.  

According to Dr. Ritch, recommendations for strength training will vary among patients. He explains, “I caution patients with glaucoma about bench pressing 200 pounds, but a definitive study has not been done. If a person has mild glau­coma, I tell them to go ahead with their routine unless they [experience] severe damage. I had one patient who lost his 3-degree island of vision in the middle of doing a crunch, and IOP can also rise in patients doing push-ups. I basi­cally tell them to use common sense.”  

It also is recommended to continue to exhale during periods of maximum exertion, as it can dramatically increase IOP. If you are unsure strength training is safe for you, discuss the idea further with your physician.  

Yoga 

While there is no researched evidence to suggest certain yoga poses are detrimental to a person’s glaucoma, there are a few poses to do with caution: 

• Headstands may be dangerous for glaucoma patients, particularly for those with moderate to severe glaucoma. Dr. Ritch admits having a 45-year-old patient who would stand on her head for 20 minutes a day, every day, for 20 years. Her glaucoma steadily worsened. When measured, her IOP nearly quadrupled when she was doing headstands. Therefore, Dr. Ritch discourages his patients from doing headstands, especially for extended periods.

• Dr. Ritch and his colleagues researched four different yoga positions on IOP for both healthy participants and glaucoma patients. The four positions included downward-facing dog, standing forward bend, plow, and up-the-wall poses. All of these poses led to increased IOP in both groups, with the greatest increase occurring during the downward-facing dog. After a few minutes of rest though, all pressures returned to normal. 

For patients with moderate to severe glaucoma, it may be best to avoid all yoga poses where eyes are below the heart. For those with mild glaucoma and a passion for yoga, modifications to decrease the vertical distance in poses may be made by your yoga teacher or ophthalmologist.  

*Weiner, G. (2020, May 26). Glaucoma and Exercise: What to Tell Your Patients. American Academy of Ophthalmology. https://www.aao.org/eyenet/article/glaucoma-and-exercise

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