How to Safely Exercise with DME

Diabetic macular edema (DME) is a condition involving damage to the small blood vessels in the eye. It affects an estimated 10% of people living with diabetes.

If DME is left untreated and damaged blood vessels leak, this can cause swelling in the center of the macula, called the fovea. This is the area of your retina that processes sharp, central vision.

Any type of diabetes can lead to DME. Persistently high blood sugar is the main cause of blood vessel damage that leads to macular edema.

You may not notice vision changes in the early stages of DME. It’s important to have a dilated eye exam every year so that an eye doctor can check your retina for changes characteristic of DME.

One of the ways you can slow the progression of DME is through regular exercise, which can improve glucose metabolism to help maintain blood sugar levels. Regular exercise can also help you maintain a moderate weight and further boost your body’s response to insulin.

Certain types of activities are safer than others though, so it’s important to speak with your doctor before starting a new exercise routine.

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Once you’ve spoken with your doctor about safe exercise for DME, the next steps are choosing activities you enjoy and fitting them into your schedule.

The Centers for Disease Control and Prevention (CDC) recommends at least 150 minutes of moderate-intensity physical activity each week. That’s as little as 30 minutes per day, 5 days per week.

If 150 minutes each week seems like more than you have time for, start smaller. Keep in mind that some activity is better than none.

Suggestions for exercises include:

• scheduling a weekly walk with a friend
• running errands on foot when possible
• attending a dance class
• following an exercise video at home

Beneficial physical activity is anything that uses some of your energy to engage your skeletal muscle in movement but without jarring movements. It also shouldn’t increase the pressure inside your eyes.

This doesn’t mean you have to spend money on a gym membership or exercise class. You can still benefit from activities like household chores and yard work if you avoid heavy lifting and bending down with your head below your waist.

The goal is to move more, which helps your blood sugar stay in range more often. This will benefit your eye health.

Potentially harmful activities are those that cause too much pressure or movement in your eyes, like a high impact exercise class. Isometric exercises are also not recommended, as they may temporarily raise your blood pressure by tightening a muscle or group of muscles.

Beneficial

Physical activities that can help you manage DME include:

• light housework
• walking
• cycling
• swimming
• dancing
• low impact exercise
• activities that don’t require your head to be lower than your waist

Potentially harmful

Exercises you should avoid with DME include:

• heavy lifting
• straining
• holding your breath while lifting or straining
• high impact activities
• contact sports
• isometric exercises
• activities that require your head to be lowered

Regular exercise offers many benefits, such as improved control of:

• blood sugar
• blood pressure
• blood lipids

Elevated levels of each are common in diabetes and can contribute to diabetic retinopathy, which can lead to DME.

Moderate, low impact cardio may also decrease eye pressure called intraocular pressure.

Research shows that high intraocular pressure can occur with elevated hemoglobin A1c (HbA1c) levels. High glucose levels can lead to blockages in the trabecular meshwork — the drainage area of the eye. This prevents the fluid in your eyes from circulating properly.

A 2016 study found that 20 minutes of aerobic exercise created a sympathetic nervous system response that lowered intraocular pressure.

The study authors suggested several possible reasons for this eye pressure drop:

• Exercise-induced sweat and water loss could reduce plasma colloidal osmotic pressure.
• Exercise redirects blood supply to the limbs, which reduces the amount of aqueous fluid in the eyes.
• Sympathetic nervous system activation narrows the vessels supplying the eye, which reduces ocular blood flow and intraocular pressure.
• Increased catecholamine — a type of neurohormone that includes dopamine and epinephrine — concentrations decrease the accumulation of fluid in the eyes.

Evidence from epidemiologic studies and clinical trials alike suggests that ocular perfusion pressure (OPP) — the difference between IOP and systemic blood pressure (BP) — as well as other factors such as BP, vasospasm, and ischemia may all contribute to glaucoma risk.

Research suggests that excess intraocular pressure can reduce retina blood circulation. This is because of the way that intraocular pressure elevations can reduce OPP.

Ocular perfusion pressure brings oxygen and nutrients to your retina and carries away metabolic waste. When excess intraocular pressure lowers ocular perfusion pressure, this reduces the level of oxygen in your retina and can contribute to DME.

Low vision is reduced eyesight that doctors can’t correct with treatments or glasses.

Low vision is something you adjust to and learn strategies to manage. You may not have to give up activities, but instead, learn new ways to participate.

Exercise is one such example. Once you’ve spoken to your doctor about the types of exercises that are safe for your eyes, you’re ready to get started.

Ways to exercise with low vision include:

• walking with a friend
• walking on a treadmill
• riding a stationary bike
• using light hand weights
• doing stretching exercises
• doing yoga
• doing tai chi
• doing individual or paired dancing

It can also help to work with a fitness instructor, who can recommend safe and effective activities.

DME is a progressive condition that leads to central vision loss. It affects up to 10% of people living with any type of diabetes.

Exercise can help to prevent DME and slow its progression. Some of the benefits are from the effects exercise has on blood sugar, blood pressure, blood lipids, and eye pressure.

Certain exercises are safer than others. Before you start a new workout routine, talk with your doctor about your specific situation. Your doctor may recommend avoiding high impact exercises, or those that might worsen symptoms of DME.

Last medically reviewed on March 23, 2023