ECSS Paris 2023: CP-MH25
INTRODUCTION: Glaucoma is a leading cause of irreversible blindness, with intraocular pressure (IOP) reduction currently representing the only established therapeutic target. Increasing evidence suggests that physical activity and exercise may serve as complementary strategies, potentially influencing the incidence, severity, progression, and quality of life in primary open-angle glaucoma (POAG). Therefore, this scoping review aims to systematically map the existing evidence on the role of physical activity and exercise in POAG across these key disease-related dimensions. METHODS: A systematic literature search was conducted in MEDLINE (via PubMed), Embase (via Elsevier), and SPORTDiscus (via EBSCOhost), including studies published up to 13 June 2024. Eligible studies examined the association or effects of physical activity and exercise on outcomes related to primary open-angle glaucoma, including ophthalmological markers, systemic parameters, and quality of life. All study designs were considered, encompassing randomized controlled trials, non-randomized interventions, and observational studies. Study characteristics, participant demographics, and primary outcomes were extracted and summarized using descriptive tables and narrative synthesis. RESULTS: Eighteen studies were included, comprising 14 observational studies and 4 randomized controlled trials. Physical activity, particularly aerobic exercise, was associated with acute reductions in intraocular pressure and improvements in ocular perfusion pressure. Higher levels of physical activity and exercise were further associated with lower glaucoma prevalence and incidence, as well as reduced disease progression. No eligible studies examined disease severity or quality of life outcomes. Across studies, key limitations included short follow-up durations, small sample sizes, incomplete outcome assessment, reliance on self-reported physical activity measures, and heterogeneous or suboptimal glaucoma definitions. CONCLUSION: The available evidence suggests that physical activity and exercise may be associated with reduced glaucoma progression, potentially through both intraocular pressure–dependent and intraocular pressure–independent mechanisms, including improvements in ocular perfusion pressure. However, the current evidence base remains limited and insufficient to support formal recommendations of physical activity or exercise as adjunctive treatment strategies in glaucoma care. Future research should prioritize adequately powered, long-term randomized controlled trials with standardized and comprehensive outcome measures, encompassing both intraocular pressure–related and non–intraocular pressure–related endpoints, as well as quality of life, to clarify the therapeutic potential of physical activity and exercise in glaucoma prevention and management.
Read CV Valentin SchuhmannECSS Paris 2023: CP-MH25
INTRODUCTION: Open-angle glaucoma (OAG) causes peripheral visual field loss and might alter saccadic eye movements. Moreover, a strong morpho-functional interconnection between the eye and the brain in OAG suggests shared neurodegenerative pathways and diminished cognitive function, similar to those observed in Alzheimer’s disease. Since glaucomatous visual field defects and impaired cognitive performance might promote the risk of falls, strengthening skeletal muscles with resistance training represents a potential countermeasure. The effect might be enhanced using motor-cognitive training addressing visual, motor, and cognitive mechanisms. Targeting executive functions, such training may increase the efficiency of visual search strategies. Notably, studies on motor-cognitive training have demonstrated increased functional connectivity between the visual cortex and premotor regions, including the frontal eye fields, which play a key role in motion planning and sensorimotor integration. The present study investigated the effects of a 12-week resistance training (unimodal, UM) and resistance plus motor-cognitive training (multimodal, MM) on gaze behavior in OAG patients during visuo-cognitive-motor tasks involving changes in movement direction. METHODS: Nineteen OAG patients performed either UM (N=9, 69.8±4.9years) or MM (N=10, 71.5±6.7years) twice weekly (60min) for 12 weeks. Before and after the interventions, participants performed two visuo-cognitive-motor tasks with a change of movement direction:(i) the “Speed-Court-Test” (SCT), requiring stepping on sensors which were displayed on two screen sizes (165”, 55”), (ii) the “Trail-Walking-Test” (TWT) requiring walking to 16 cones labeled with numbers (1-8) or letters (A-G) in an alternately ascending order. During these tasks, the time needed for completing each task was measured and gaze behavior was recorded via eye tracking (e.g. saccade duration, fixation duration). RESULTS: Due to drop out/processing issues, 15 participants (UM=8, MM=7) were included in the final analyses. Independent of UM or MM and based on the effect sizes, both interventions decreased saccade frequency (p=0.085, η_p^2=0.246) during the SCT. Furthermore, both interventions decreased task completion time (p=0.018, η_p^2=0.358) and increased saccade frequency (p=0.068, η_p^2=0.271) during the TWT. CONCLUSION: Both interventions improved the performance during the cognitively demanding TWT, which might indicate an improved physical and/or cognitive performance. Furthermore, it seems that both UM and MM changed saccade frequency, indicating an optimized task-dependent visual search strategy. These results could help to understand the impact of therapeutic training approaches on movement and gaze behavior in glaucoma patients. Trial Registration: German Clinical Trial Register ID: DRKS00022519
Read CV Constantin FreitagECSS Paris 2023: CP-MH25
INTRODUCTION: Physical activity (PA) and exercise appear promising as adjunctive interventions in Alcohol Use Disorder (AUD). However, findings regarding alcohol craving, psychoaffective symptoms, and alcohol outcomes remain inconsistent and may be partly explained by poor PA adherence. Therefore, understanding how to enhance engagement and adherence to PA is essential to favor its effects. Our mixed-methods systematic review aimed to identify barriers and facilitators that could impact PA adherence in individuals with AUD. We included both intervention and observational studies, as well as qualitative research, conducted among populations presenting with mild to severe AUD. METHODS: This review was conducted using five health-related databases and registers up to September 2024. Original peer-reviewed articles published in English or French and conducted in adult human populations with AUD were eligible. Only studies reporting study attrition, PA adherence or explicit facilitators and barriers to PA were included. The risk of bias was assessed using the Mixed Methods Appraisal Tool (MMAT). A convergent integrated approach and descriptive analysis were used for data synthesis. RESULTS: This review initially included 36 eligible references. One study was excluded due to poor methodological quality, and multiple publications derived from the same clinical trials were grouped and considered as single studies, resulting in a final sample of 29 studies: 20 intervention studies, 5 observational studies, 3 qualitative studies and 1 mixed-methods study. Data synthesis revealed substantial variability in dropout rates within exercise intervention groups, with 11 out of 20 studies reporting attrition rates exceeding 20%. Barriers and facilitators to PA were identified across all the four levels of the socio-ecological model (intraindividual, interpersonal, environmental and policy). A greater number of factors were reported at the environmental and intraindividual levels, particularly those related to PA intervention design, substance use, momentary emotional and physical states, as well as beliefs and attitudes toward PA. CONCLUSION: This review highlights the central role of PA engagement and adherence, when evaluating PA-based interventions in AUD and identifies key multilevel barriers and facilitators influencing PA participation in both daily life and clinical settings. While adherence to PA, and to treatment more broadly, remains a major challenge in AUD care, future research should explicitly integrate these barriers and facilitators into intervention design. Developing PA programs tailored to the specific needs, constraints, and motivational profiles of individuals with AUD may be crucial to improving adherence and, ultimately, alcohol-related outcomes.
Read CV Aude BarraudECSS Paris 2023: CP-MH25