## 4 A Practical Guide for Exercise Prescription in Glaucoma Patients or Those at Risk  
There is robust and irrefutable evidence supporting the regular practice of physical exercise as an essential component in reducing premature mortality and the prevalence of numerous chronic conditions, including cardiovascular diseases, diabetes, and obesity [112; 113]. Regular physical activity has been widely recognized for its broad spectrum of health benefits, both for general well-being and the management of specific medical conditions. As a result, various international organizations, such as the World Health Organization and the American Heart Association, have proposed general physical activity guidelines to promote public health. These recommendations typically suggest a threshold of 150 min per week of moderate to vigorous physical activity or 10,000 steps per day for both healthy individuals and those with clinical conditions [12; 40].  
However, while these threshold-centered recommendations have been widely adopted, there is growing recognition that they may not fully capture the nuanced relationship between physical activity and health outcomes, especially for individuals with specific health conditions like glaucoma. Specifically, there is a well-established dose-response relationship between physical activity and health status, where incremental increases in physical activity can lead to progressive improvements in health, particularly for those who are least active [112; 114]. For example, individuals who are sedentary or engage in low levels of physical activity tend to experience the greatest health benefits from even small increments in physical activity, such as moving from no exercise to engaging in light physical activity.  
Exercise prescription must be tailored to the individual's specific health needs and condition. For patients with glaucoma, for instance, the primary focus of exercise-based interventions should be on managing IOP, as it is a critical factor in the prevention and management of the disease. Exercise recommendations for glaucoma patients should consider the effects of different types of physical activity on IOP and how they can be optimally leveraged to achieve the best possible outcomes for disease control. Figure 1 provides an evidence-based summary of key exercise-related factors that eye care providers and sports specialists should consider when prescribing exercise for individuals with glaucoma. These factors include the type, intensity, duration, and frequency of exercise, all of which can influence IOP levels. By using this approach, clinicians can ensure that their exercise prescriptions are not only safe but also effective in managing IOP and preventing glaucoma progression.  
Furthermore, while the general public can benefit from a one-size-fits-all approach to physical activity, individuals with chronic conditions like glaucoma may require more individualized exercise recommendations. These recommendations should be based on factors such as the patient's current IOP levels, physical fitness, and any other comorbidities they may have. An individualized approach would help maximize the benefits of exercise for glaucoma management while minimizing any potential risks or adverse effects. Ultimately, a well-tailored exercise prescription, when combined with other therapeutic strategies, can significantly enhance the quality of life for individuals with glaucoma and improve long-term outcomes.  
Figure 1: Schematic illustration of exercise-based recommendations for intraocular pressure control during exercise practice. 1-RM = one repetition-maximum.