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Intraocular Pressure Fluctuation During Resistance Exercise

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Intraocular Pressure Fluctuation During Resistance Exercise BMJ Open Ophth: first published as 10.1136/bmjophth-2021-000723 on 13 May 2021. Downloaded from Original research Intraocular pressure fluctuation during resistance exercise Ehsan Vaghefi ,1,2 Catherine Shon,1 Stacey Reading,3 Taylor Sutherland,3 Victor Borges,3 Geraint Phillips,1 Rachael L Niederer ,4,5 Helen Danesh- Meyer5 To cite: Vaghefi E, Shon C, ABSTRACT Reading S, et al. Intraocular Objective To evaluate the effect of weightlifting (leg Significance of this study pressure fluctuation during press) on intraocular pressure (IOP). resistance exercise. BMJ Design Prospective cohort study. What is already known about this subject? Open Ophthalmology Subjects A total of 24 participants met the inclusion ► Resistance exercise that requires with Valsalva 2021;6:e000723. doi:10.1136/ Manoeuvre can significantly affect intraocular bmjophth-2021-000723 criteria and completed the study procedures. Participants had an average age of 22.7±2.7 years and included nine pressure. ► Additional supplemental women. The mean baseline IOP was 13.9 mm Hg (SD=2.4) What are the new findings? material is published online with an average body mass index of 24.5 (SD= 3.1). ► When pushed to their maximal muscular engage- only. To view, please visit the Methods The maximum load for a single lift was found ment during resistance exercise, the participants journal online (http:// dx. doi. for each participant. Participants then performed three leg org/ 10. 1136/ bmjophth- 2021- mean intraocular pressure (IOP) was increased by 000723). press regimens: one repetition using 95% of maximal load average 26.4 mm Hg. (1RM), six repetitions using 75% of maximal load (6RM) and isometric push against a weight much heavier than How might these results change the focus of Received 21 January 2021 maximal load (ISO). research or clinical practice? Revised 12 April 2021 Main outcome measure IOP was measured pre- ► While this study was performed on healthy subjects Accepted 13 April 2021 exercise, during and immediately following the exercise with no history of glaucoma or IOP fluctuations, using an iCare TA01i rebound tonometer. Blood pressure strenuous resistance exercise could be considered and HR were being monitored continuously during the lift. hazardous for individuals who are more susceptible Optical coherence tomography images were obtained pre to IOP changes and postexercise session. Results The average maximum weight lifted by our participants was 331.9 Kg (SD=97.3). Transient increased 3 IOP was observed across the 1RM, 6RM and ISO exercises forms of exercise. Aerobic exercise such as with an average increase in 26.4 mm Hg (23.7 mm Hg to running and jogging are associated with tran- http://bmjophth.bmj.com/ 28.7 mm Hg) to reach an average max IOP of 40.7 mm Hg sient lowering of IOP postexercise compared 3–8 (27.8 mm Hg to 54.2 mm Hg), with an absolute maximum with baseline values. The mechanism is of 70 mm Hg in one participant. presumed to be stimulation of the sympa- © Author(s) (or their employer(s)) 2021. Re- use Conclusions There is a transient and dramatic thetic pathway, resulting in increased aqueous 9–12 permitted under CC BY- NC. No fluctuation in IOP with resistance training. This coupled outflow via the trabecular meshwork. In commercial re- use. See rights with regular exposure to resistance training is potentially contrast, studies focused on muscle strength- and permissions. Published by a significant risk factor for glaucoma. It should be noted ening resistance exercise have produced BMJ. that this study has been carried out in a healthy young 1 mixed findings with both acute increases and population, and, thus, the external validity of these results on September 30, 2021 by guest. Protected copyright. Optometry and Vision Sciences, decreases in IOP being reported.13–19 The University of Auckland, in glaucoma participants requires further investigation. Auckland, New Zealand A fundamental principle in muscle- 2Auckland Bioengineering strengthening exercise is that strength is Institute, The University of developed when a muscle or muscle group Auckland, Auckland, New INTRODUCTION works against increasing amounts of resis- Zealand 3 The impact of exercise on intraocular pres- tance or weight over a period of weeks and Sports Sciences, The University 20 of Auckland, Auckland, New sure (IOP) and health is an area of increased months. Although muscle strength can be Zealand interest as the importance of physical activity gained by lifting relatively light loads, maximal 4Ophthalmology, Greenlane for maintenance of overall health is widely strength gains are made when muscles lift Clinical Centre, Auckland, New promoted.1 IOP results from the net balance heavy, near- maximal loads.21 22 Lifting heavy Zealand 5 between the production and drainage of loads requires core stability or bracing that Department of Ophthalmology, University of Auckland, aqueous humour. Elevated IOP is a significant is achieved by trunk muscle contraction Auckland, New Zealand risk factor for the development of glaucoma- and, although discouraged, the initial effort tous optic nerve damage.2 However, different phase of lifting a heavy load often results Correspondence to types of exercise are recognised to impact IOP in a Valsalva manoeuvre. Core bracing and Dr Ehsan Vaghefi; e. vaghefi@ differently. Acute changes in IOP have been Valsalva- induced increases in intra-abdominal auckland. ac. nz noted during and immediately after different and intrathoracic pressures are transmitted to Vaghefi E,et al . BMJ Open Ophth 2021;6:e000723. doi:10.1136/bmjophth-2021-000723 1 BMJ Open Ophth: first published as 10.1136/bmjophth-2021-000723 on 13 May 2021. Downloaded from Open access systemic vascular and intracranial transmural pressures.23 or cardiovascular limitations4 familiarity with a leg press IOP is known to be affected by changes in systemic and machine, with this exercise routinely performed during intracranial blood pressure and, thus, could be impacted training. Participants underwent a comprehensive by fluctuations in these pressures during weightlifting ophthalmological assessment including detailed general, exercise.24 A current gap in the literature is a detailed family and ocular history, visual acuity (Snellen visual understanding of the magnitude and time course of acuity), refraction arc perimetry (using confrontation effect acute strength training exercise with near-maximal fields by Bott wand), contact tonometry (Goldmann training loads has on systemic blood pressure and IOP. applanation tonometry), slit lamp examination and a The aim of the current study is to measure IOP and fundus examination. Retinal photographs and fundus systemic blood pressure responses during high inten- autofluorescence were taken using the Eidon Centervue sity weight- lifting exercise. We hypothesise that IOP and SLO or Optos (Optos plc) camera. Participants were blood pressure will be dramatically affected by near- excluded if they had any systemic health conditions maximum effort weightlifting (leg press),24 and the such as hypertension or previous physical injuries that effect will be much more significant compared with what could impact their safe participation. Participants is measured previously.25 26 We also hypothesise that such were excluded if they had a diagnosed chronic health sharp change of IOP could be affecting the retina and condition such as cardiovascular disease including hyper- choroid thicknesses.27 The focus of this study is to charac- tension and or previous physical injuries that could terise the time course of change measured before, during impact their safe participation as well as evidence of and after the leg press exercise. The novelty of our study ocular pathology due to narrow anterior chamber angles, is that the IOP is measured truly ‘during the rep’ while elevated IOP greater than or equal to 21 mm Hg, optic the participant is still bearing the weight. This is unlike nerve or retinal pathology, cup:disc ratio of greater than other studies where the IOP is measured ‘during the 0.7 or asymmetry of cup:disc ratio of greater than 0. 2. set’ when the weight is racked and muscular pressure is Participants were also excluded if they were not able to released. Furthermore, we performed optical coherence complete the study protocol. tomography (OCT) to investigate the effect of leg press- induced changes to IOP and systemic blood pressure on Experimental procedure retinal and choroidal thickness. The full study protocol is explained in the supplemen- Methods tary material (see text, Supplemental Digital Content This prospective study was approved by the University 1, which details the exercise protocol used in this of Auckland Human Participants Ethics Committee project). Briefly, the experiments included baseline (UAHPEC reference number 022578) and participants measurement of participants’ IOP, height and weight. provided written informed consent. All research adhered This is then followed by finding the measurements of to the tenets of the Declaration of Helsinki. ‘maximum weight to be lifted’ by each participant, http://bmjophth.bmj.com/ while performing a set of leg press exercises (figure 1). Study participants The participants are then asked to perform three types Healthy volunteers between the ages of 21 years and 30 of lifts of (a) one repetition at 95% of maximum weight years of age were recruited through social media from (1RM), (b) six repetitions at 75% of maximum weight local powerlifting clubs. Participants included1: indi- (6RM) and (c) isometric hold of 10 s against weight that viduals with at least 2 years of experience in resistance is much heavier than maximum weight that could be exercises training,2 a training history that included at lifted by the participant (ie, immovable) (ISO) (Supple- 3 least two sessions per week, free of any musculoskeletal mentary Figure 1)). on September 30, 2021 by guest. Protected copyright. Figure 1 The steps of performing the leg press exercise, while measurements are taken. Initially, the participants are seated in the inclined position, while the weights are racked (ie, no muscular tension) when the ‘baseline’ IOP is measured (A).
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