Exercise Good or Bad For the Eyes of People With Diabetes?

Assess your individual risk level before starting any activity.

By A.Paul Chous, MA, OD, FAAO

For people with diabetes, moderate physical activity (exercise) is perhaps the single most important component of any successful diabetes management plan. Regular exercise improves your sensitivity to insulin, lowers your blood pressure, raises your "good" HDL cholesterol, and improves circulation to every part of your body, including your eyes. Exercise also improves your cognitive function (memory) and sense of well being. For people with prediabetes, those at highest risk for developing diabetes, thirty minutes of walking, five days each week, lowered the risk of developing type 2 diabetes by almost 60% over a three-year period (see results of the Diabetes Prevention Program).

However, some health care professionals caution patients with diabetic retinopathy to refrain from exercise that might aggravate bleeding within the eye's light sensitive retina. For example, it is sometimes stated that people with diabetic retinopathy should avoid jarring exercise that causes rapid head movement (for example, basketball and kick boxing) or exercise that might elevate blood pressure (for instance, weight lifting), as these activities are said to increase the likelihood of retinal bleeding.

Although there is merit in being cautious, it is important for patients to understand that such restrictions concerning exercise and retinopathy apply to neither the majority of people with diabetes, nor even to the majority of patients with diabetic retinopathy. In fact, the only patients at risk for aggravation of retinal bleeding associated with certain forms of vigorous exercise are those with untreated, recently treated, and/or actively bleeding proliferative diabetic retinopathy, the most serious form of this condition. These patients have abnormally fragile, new blood vessel growth on the surface of the retina (retinal neovascularization) that can be broken quite easily, leading to significant bleeding that obstructs vision.

Another group of patients potentially at-risk for eye problems are those with diabetic macular edema, a distinct form of diabetic retinopathy characterized by fluid edema (swelling – not bleeding) within the macula, the part of the retina responsible for good detail and color vision. Acute or sustained elevation of blood pressure from vigorous exercise might, at least in theory, worsen macular edema by forcing fluid out of leaky blood vessels into retinal tissues (sort of like turning up the water pressure on a leaky garden hose).

The crucial points are that staging of diabetic retinopathy is the key to assessing your individual risk, and that you should openly discuss this risk, if any, with your eye doctor every time your retinas are evaluated (at least annually). With few exceptions, there is absolutely no eye health reason that people with non-proliferative diabetic retinopathy or those with successfully treated proliferative diabetic retinopathy cannot participate in vigorous physical activity, including moderate resistance (weight) training, as fragile, new blood vessels either do not exist or have regressed following laser therapy. Interestingly, the only study looking at the relationship between various forms of exercise and diabetic retinopathy found no increased risk for worsening eye problems with exercise, even for patients participating in vigorous sports, including weight lifting. The study had some important limitations, but the results are reassuring to those of us who realize the importance of regular exercise for good diabetes control. Of course, certain forms of physical activity may aggravate cardiovascular disease, or foot problems associated with diabetic neuropathy, so you should always check with your regular diabetes doctor about your favorite forms of exercise, especially before beginning any new exercise program.

For more information on diabetic eye disease, consult Dr. Chous' book Diabetic Eye Disease: Lessons From a Diabetic Eye Doctor, Fairwood Press, Seattle, 2003.

Read more about Dr. Chous here.

Visit Dr. Chous' website here.

NOTE: The information is not intended to be a replacement or substitute for consultation with a qualified medical professional or for professional medical advice related to diabetes or another medical condition. Please contact your physician or medical professional with any questions and concerns about your medical condition.



Last Modified Date: June 28, 2013

All content on dLife.com is created and reviewed in compliance with our editorial policy.

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