## 3 Limitations and Future Research  
The available scientific evidence about the association between physical activity and IOP is mainly based on results from non-clinical populations. While these studies provide insights into the general effects of exercise on IOP, the unique pathophysiology of glaucoma means that findings from non-glaucoma individuals should be interpreted cautiously [1]. Glaucoma patients are particularly vulnerable to IOP fluctuations, which may lead to optic nerve damage and retinal ganglion cell loss [61]. Therefore, it is crucial to prioritize research that specifically involves glaucoma patients to better understand how different types of exercise impact IOP and glaucoma progression.  
When possible, researchers should prioritize the inclusion of glaucoma patients for their studies. Also, the primary goal of an exercise intervention is to promote long-term benefits on the underlying condition (i.e., glaucoma). Thus, more longitudinal studies are required to shed light on the link between exercise practice and glaucoma prevention and management [19]. The design of well-powered randomized controlled trials with a sufficient period of follow-up aiming to test the effects of physical exercise interventions on glaucoma prevention and management would be very relevant [13]. The main goal of this report is to provide an evidence-based guide for exercise prescription in subjects who need to maintain IOP levels as low as possible. Nevertheless, exercise prescription should be individualized considering risk factors, medical history, musculoskeletal limitations, functional ability, tolerance, and personal preferences [109].  
While the focus of this report is on exercise interventions, it is important to acknowledge that glaucoma management extends beyond physical activity. Modifiable lifestyle factors such as diet, mental stress, sleep hygiene, and smoking cessation all influence IOP and overall eye health [8; 9]. Healthcare providers should consider these factors when developing comprehensive treatment plans for glaucoma patients. For example, dietary changes could improve ocular blood flow, while stress reduction techniques, such as meditation and yoga, may help mitigate IOP increases associated with mental stress.  
Given the multifactorial nature of glaucoma management, future research should explore the potential of multi-component lifestyle interventions that combine exercise with other behavioral modifications [9]. This approach could offer a more holistic solution for preventing glaucoma progression and improving patient outcomes. By investigating the combined effects of exercise, diet, and mental health strategies, researchers may identify synergistic benefits that enhance the management of IOP and protect against optic nerve damage. In addition, glaucoma types such as pigmentary glaucoma should be carefully considered. There is evidence that dynamic exercise may cause significant intraocular pressure elevation in these cases due to exercise-induced iris concavity, which enhances mechanical rubbing of the iris against the zonular bundles and results in pigment release [110; 111].  
In summary, while the existing evidence on exercise and IOP is promising, further research is needed to understand the long-term effects of exercise in glaucoma patients. Future studies should prioritize the inclusion of glaucoma patients, investigate the effectiveness of different exercise modalities, and consider other modifiable lifestyle factors that contribute to IOP management. Such research will be vital in developing individualized, evidence-based recommendations for glaucoma prevention and management, ultimately improving the quality of life and visual outcomes for patients with this condition.