## 2 Factors Affecting the IOP Response to Exercise  
### Exercise Type and Intensity  
Exercises can generally be categorized into endurance-oriented and strength-oriented types, yet the specific outcomes of these activities can vary significantly based on their implementation [22]. Endurance exercises performed at low-to-moderate intensities, which are targeted to enhance the aerobic system, have shown promise for glaucoma prevention and management, with studies linking such activities to acute reductions in IOP [23, 24]. Activities like walking, jogging, or cycling at low intensities typically yield short-term IOP reductions ranging between \(\sim\)2 to 5 mmHg, with these effects persisting for fewer than 20 min post-exercise [25, 26]. Longitudinal observations and retrospective studies reinforce these findings, suggesting that regular engagement in such activities reduces the likelihood of glaucoma onset and progression [13, 14, 15, 16, 17, 18, 19]. Furthermore, a non-controlled prospective study conducted by [PERSON] (2015) demonstrated that open-angle glaucoma patients using topical anti-glaucoma medications experienced greater IOP reductions when advised to perform 30 min of daily low-intensity exercise for a month compared to those who did not exercise [27]. However, due to limitations inherent to observational and retrospective designs, causal relationships remain speculative, underscoring the need for controlled clinical trials to validate these results. High-intensity endurance exercises, tailored to enhance anaerobic capacity, present a more nuanced picture. For example, studies examining the immediate effects of high-intensity interval training (HIIT) protocols have identified acute reductions in IOP during exercise, with outcomes varying based on the recovery periods between sprints. Less physically demanding HIIT protocols, characterized by longer recovery intervals, demonstrated a progressive IOP decrease, whereas more strenuous protocols exhibited a U-shaped response, negating the beneficial effects [28]. Another investigation found that maximal cycling sprints caused IOP reductions when performed against lighter resistances, but heavier loads triggered IOP increases [29]. These findings highlight the potential of HIIT as an efficient exercise modality for IOP reduction, provided that protocols are designed to avoid excessive physical strain. Additionally, HIIT offers time-efficient strategies for individuals with busy lifestyles, making it a promising option for integrating physical activity into glaucoma prevention programs. Future studies should explore how variations in intensity, duration, and recovery time influence IOP responses to ensure optimal protocol design. In contrast, strength-based exercises, particularly those performed at moderate-to-high intensities, consistently induce acute IOP elevations [30]. Research indicates a direct relationship between resistance training intensity--defined by the load lifted--and IOP levels. Additionally, exercises completed closer to failure result in more pronounced IOP increases [31, 32, 33, 34, 35]. As a result, highly demanding resistance training (e.g., heavy lifting and sets to failure) may be counterproductive for IOP reduction in the short term. Exercises such as bench press and leg press exercises can cause acute IOP increases, with the magnitude of the change being positively correlated with the load used [36, 37]. In addition, larger muscle mass involvement and breath-holding strategies during exercise exacerbates this effect [38]. However, most studies found transient IOP decreases after resistance exercises [30]. Nevertheless, strength-based exercises contribute significantly to the management of chronic conditions and overall health improvement [39]. Incorporating multi-componenttraining programs--including endurance, strength, and balance exercises--could provide comprehensive health benefits while minimizing risks [40].