## 2 Factors Affecting the IOP Response to Exercise
### Specific Training Devices  
Swimming and aquatic exercise have shown to offer numerous health benefits [95; 96]. The resistance of water reduces the stress on joints and muscles, which makes swimming an accessible and effective form of exercise for older adults [97; 98]. Therefore, this physical activity is a very interesting for glaucoma patients or those at risk. However, one factor that requires consideration when swimming is the use of swimming goggles. Studies have shown that wearing swimming goggles can lead to a small, but statistically significant, rise in IOP [99; 100; 101; 102]. While the increase in IOP is modest, it may still be relevant for individuals with glaucoma or those seeking to maintain stable IOP levels. However, the frequent use of swimming goggles was not associated with an increased risk of glaucoma over time in adults [103]. Interestingly, the rise in IOP associated with swimming goggles may be linked to the design of the goggles and how they fit on the face. The pressure exerted by the goggles on the eyes and surrounding tissues, particularly the ocular and periocular areas, can cause temporary changes in IOP [102]. This effect is thought to be due to the compression of the ocular structures, which might impede normal ocular drainage and increase the pressure within the eye [100]. It is hypothesized that the anatomical characteristics of the face and head, as well as the specific design of the goggles, may influence how much pressure is applied to the eye. As shown by [PERSON] and colleagues [101], the use of wider frames in swimming goggles causes smaller IOP elevation in comparison to smaller frames. In response to these concerns, researchers have proposed that redesigning swimming goggles to reduce the compressive forces on the eyes and surrounding tissues could be a valuable alternative. Innovations in goggle design, such as using softer materials or incorporating adjustable pressure mechanisms, could help minimize the potential IOP increases associated with their use [99]. While there is no definitive consensus on the optimal design, advancements in goggle technology could provide a solution for individuals with glaucoma who wish to engage in swimming without negatively affecting their IOP. Blood flow restriction training (BFR), which involves the application of cuffs or wraps to limit blood flow to the working muscles during exercise, has gained attention in recent years for its potential to enhance athletic performance and improve muscle strength in a more efficient manner [104]. This approach allows individuals to achieve similar gains in muscle mass and strength as traditional high-load resistance training, but with the added benefit of using lower weights, which can reduce the strain on joints and tissues. BFR is also seen as a promising strategy for individuals in fragile populations, such as older adults or those with joint issues, as it minimizes the risk of injury associated with heavy lifting [105,106]. However, the effects of blood flow restriction on IOP have not been extensively studied. To address this gap in knowledge, our research group has conducted two studies to investigate the impact of BFR on IOP levels. In our first study, we found that applying bilateral blood flow restriction to the upper and lower extremities at 60% and 40% of the participants' predicted arterial occlusion pressure did not result in significant changes in IOP during rest [107]. This suggests that, at least under resting conditions, BFR may not significantly affect IOP levels, offering some reassurance for individuals concerned about the potential impact of this training method on ocular health. In a follow-up study published in 2023, we further explored the acute effects of combining resistance training with blood flow restriction on IOP. We observed that applying BFR at 40% pressure during resistance exercises led to similar IOP responses compared to exercises performed without blood flow restriction [108].