Very Strenuous Aerobic Exercise Bad for Glaucoma?
3
Entering edit mode
2.5 years ago
Daywalker • 240
@_245

So we know general exercise is good if you have glaucoma, but does anyone know if really strenuous AEROBIC exercise at ALTITUDE is bad for glaucoma? I have primary open angle glaucoma and not any of the other sub-types.

For instance, climbing a mountain at altitude (such as Mount Whitney which is 14,505 feet in altitude here in the United States and the hike consists of 22 miles total and 6,000 feet (or 600 stories) in elevation gain, usually a 10-17 hour hike for most people.). I go every summer to climb different peaks in the Sierra Nevada mountains between 10,000’ and 14,500’ altitude. A lot of these trips are 3-5 day trips with over 50 miles and 15,000’ (1,500 stories) of elevation gain!

I don’t see much consensus on very strenuous aerobic exercise and whether bad for glaucoma or not, and am confused if I should be doing these very strenuous exercise (10+ hour hikes is outside the norm of what people do) anymore. I enjoy them, and would hate to stop doing them.

Should I stop?

exercise • 1.3k views
ADD COMMENTlink
2
Entering edit mode
2.5 years ago
david 4.3k
@david_fe

I don’t see much consensus on very strenuous aerobic exercise and whether bad for glaucoma or not...

The research I have seen done on glaucoma and exercise is (in my opinion) often flawed and poorly done. I have been critical of some of this research since I started FitEyes in 2006. Here is one blog post I wrote in Nov 2006 that is still relevant to this topic today:

Weight Lifting Lowers My Eye Pressure | FitEyes.com

Ophthalmologists who briefly read papers like that may tend to discourage their patients from even moderately intense exercise (such as weight lifting), when in fact, proper weight lifting can be used to help manage IOP (because in many patients it safely and effectively reduces IOP very quickly). That's just one example of how the published research may not adequately address a situation like the one you describe.

Also, keep in mind that the majority of glaucoma patients are older; many researchers may not even recognize the importance of this level of exercise to glaucoma patients. But in the FitEyes community, exercise is of great interest and many FitEyes members do exercise very intensely.

I don't believe you will find adequate research on "really strenuous AEROBIC exercise" (or any other type of extreme training) and glaucoma. You are going to have to extrapolate.

really strenuous AEROBIC exercise ...climbing a mountain at altitude

While extreme exercise and its long term impact on glaucoma have not been adequately studied as far as I know, there are multiple studies on altitude and glaucoma. NASA has even done some research on this topic. Here's one paper that will interest you, if you have not already seen it:

Intraocular pressure during a very high altitude climb - PubMed

However, that paper doesn't directly address your question. You will have to consider the effects of extreme exercise on general health and make educated guesses about the impact on glaucoma.

Here's my personal opinion. I guess I could fairly call myself a form "extreme athlete", so I think I understand that perspective. Knowing that exercise is generally good for us, like many people I assumed more is better. I discounted the common medical advice to exercise in moderation because I thought of that advice as inadequate for a person with sophisticated training knowledge and a lot of experience as a competitive athlete. (Also, I was able to find flaws in many of the earlier studies, so I felt comfortable dismissing the common medical advice.)

However, over the past few decades we have accumulated a mountain of much better evidence that pushing ourselves too hard in exercise is indeed harmful to our health. While moderate exercise promotes health and longevity, extreme exercise can tend toward the opposite outcome. There is simply too much good evidence pointing to that conclusion for me to deny it now.

If overall health and longevity are your top priorities, you may want to avoid pushing your body to the extremes. On the other hand, pushing ourselves to the extremes adds an element to life (for some of us), so it is a very personal decision.

ADD COMMENTlink
1
Entering edit mode

Fabulous response, David. Your encyclopedic knowledge is such a gift to the community, and I'm so grateful you share it so generously and have added this Ask FitEyes site to harvest it for future consumption!

ADD REPLYlink
1
Entering edit mode
2.5 years ago
BrianB • 250
@brianb

I qualify on the extreme end of things: bike racer since 1994, with 10k miles per year on the bike being pretty typical, with 40-60 days of racing, and a significant amount of pretty intense training (at least up until this year). While I am very fit, I don't think it has been particularly healthy. It's a lot of stress on the body.

I started measuring IOP last April, and while I have not made a definititive causal link, I have noticed that the more intense sessions, including a couple of races, have resulted in a higher IOP several hours afterward. Right after exercise it's been fine, but 4-6 hours later I have seen some significant increases. I've really backed off on the intensity this year. I've wondered if it could be something with the body's overall reaction to training stress -- whether that is something with the adrenal system or otherwise.

I mentioned this to my doctor, and her view was that it's not typically associated with POAG but rather pigmentary glaucoma (as has been discussed here), which I don't have. She's offered to have me schedule an appointment where I could do a training session beforehand and come in. To really make the linkage I think I would need to do some more controlled experiments and make sure to factor out other things that could have an influence (not always easy to do).

ADD COMMENTlink
0
Entering edit mode

BrianB - your feedback is particularly useful.

It seem quite possible that your delayed IOP increase is not due to pigmentary glaucoma. It would be useful to rule out pigmentary glaucoma, but I think the right glaucoma specialist should be able to do that on any visit. Has anyone looked for a Krukenberg spindle or transillumination defects in your iris, for example? (Maybe so, and maybe that's what allows you to say, "which I don't have.")

I would investigate studies in PubMed related to testing of serious cyclists (and similar competitive athletes) and follow up on any biomarkers or specific changes in physiological state that occur in that 4-6 hour post-exertion window. Then you'll have a starting point for correlating those biomarkers / physiological states with your IOP changes. (I'm reminded of past studies I have seen on serious marathoners where the researchers followed the subjects for several weeks after the event.)

ADD REPLYlink
1
Entering edit mode

I'm not sure what my doctor looked at. I can ask her next time. All I know is that she said "I don't see any signs of that, and typically people with that problem tend to have the IOP spike during or immediately after exercise" (and the spikes tend to be greater than what I was seeing)

I know from past reading that cortisol levels can increase quite a lot in the hours after intense exercise. So that is one possibility, and I've thought about doing a test for that. Also over-hydration I think could be a possibility, but if anything I under-hydrate.

ADD REPLYlink
0
Entering edit mode

BrianB - I have a few more thoughts:

I'm not sure what my doctor looked at.

I think you would know if she looked for transillumination defects. It requires a (simple) test but it is not a routine glaucoma test. So you would have known that she was doing a new test to look for that. In contrast, your doctor can check for a Krukenberg spindle during a routine exam without you knowing it -- no separate exam or test is required from your prespective. So she may have looked for this, as well as pigment and not looked for transillumination defects. But those who specialize in pigmentary glaucoma, like Dr. Ritch, would go further in order to make the correct diagnosis. Anyway, I tend to think pigmentary glaucoma is not the right explanation in your case.

cortisol levels can increase quite a lot in the hours after intense exercise.

Yes, that's a valid theory to follow up on. Other biomarkers can increase too. Inflammation can increase and it could also be a potential cause.

Also over-hydration I think could be a possibility, but if anything I under-hydrate.

Yes, another good idea to investigate. It is also possible that under-hydrating and then partially correcting that could result in an IOP elevation. I've seen this pattern in people before and I concluded that it is best for my IOP to not become under-hydrated (and to not correct under hydration too quickly if it happens).

ADD REPLYlink
1
Entering edit mode

thanks for the thoughts. I definitely don't correct under-hydration quickly, so I've kind of ruled that out. I actually have a physical scheduled this week and will discuss with my doctor. But bottom line, if I make that connection between strenuous exercise and IOP increase, the solution is going to be "don't do that", I think.

ADD REPLYlink
1
Entering edit mode
2.5 years ago
BrianB • 250
@brianb

A more direct answer to the original question: since starting to measure my IOP at home (~10 months now), I've had two trips to Colorado where I was staying at ~9k feet and doing 3-4 hour hikes each day. Which is much less than what you're talking about. First trip I didn't notice any increase in IOP, but I was also taking a low dose (half the usual) of Diamox, because I can get altitude headaches. The low dose didn't cause any noticeable side effects.

Second trip, I didn't take any Diamox, and noticed my IOP seemed slightly higher, maybe 2mmHg, but it was not every day, and I would have needed more time to really say that it was due to being at altitude or exertion at altitude.

If you have the means and are so inclined, you could buy or rent an Icare Home and measure it yourself to be sure. I think that's probably going to be the only way to know for sure.

ADD COMMENTlink
0
Entering edit mode
ADD REPLYlink

Login before adding your answer.

Traffic: 8 users visited in the last hour

Use of this site constitutes acceptance of our User Agreement and Privacy Policy.