Exercise guide
Diabetic retinopathy is damage to the small blood vessels at the back of the eye, caused by diabetes. Exercise is still one of the best things you can do with it: it helps control blood sugar and blood pressure, which are what slow retinopathy down, and more active people have less of it in long-term studies, though no trial has yet shown that exercise protects the eyes directly. With no retinopathy or mild changes, all activities are fine.
As retinopathy advances, a few kinds of effort need to change: very heavy or breath-held lifting, hard holds, jumping and jarring, and head-down positions, because sharp rises in blood pressure and jolts could set off a bleed in the eye. These limits are expert advice rather than trial evidence. This guide explains which stage needs which changes, how to stay safe with hypos, what to do after laser treatment, injections or surgery, and the symptoms that need urgent help. Your diabetes and eye teams set the limits for your stage.
The American Diabetes Association (ADA) recommends exercise for everyone with diabetes unless something specifically rules it out, and the advice of the National Health Service (NHS) diabetic eye screening programme is to exercise regularly, following medical advice.
Tight blood pressure control cut the risk of retinopathy getting worse by about a third in a major UK trial, and good blood sugar control slows it too. More active people have less retinopathy in long-term studies, but no trial has shown that exercise itself slows it.
With no retinopathy or mild changes, all activities are fine. With moderate changes, avoid efforts that send blood pressure very high, such as powerlifting and sprinting. With severe non-proliferative or proliferative retinopathy, avoid vigorous exercise, heavy and overhead lifting, holding your breath, hard holds, jumping, jarring and head-down positions.
The American College of Sports Medicine (ACSM) says exercise is contraindicated then, while an NHS laser leaflet says most people continue their normal activities the next day. Our reading of both: follow your unit's leaflet, and ask your eye team before more than everyday activity until your retinopathy is treated and stable.
Walking, cycling and swimming at a steady, moderate effort, and strength work 2 to 3 times a week with moderate weights, breathing out on every effort.
Eyesight that suddenly gets worse needs an urgent GP (general practitioner) appointment or NHS 111, and sudden loss of sight needs A&E (accident and emergency) or 999. If your vision blurs during exercise and you take insulin or a sulfonylurea, check your blood sugar: blurred vision can be a hypo.
High blood sugar damages the small blood vessels of the retina, the light-sensitive layer at the back of the eye. It often has no symptoms at first, and finding and treating it early reduces the risk of sight loss. Diabetes UK says diabetes is one of the main causes of preventable sight loss in the UK.
The NHS describes background retinopathy (some damage to blood vessels, with your vision not affected), pre-proliferative retinopathy (more damage, with a risk to your vision in future), proliferative retinopathy (new, weak blood vessels that bleed easily, which needs treatment) and maculopathy (changes that can affect your central vision). Screening letters in England grade retinopathy from R0 (none) to R3 (proliferative).
The American guidelines this page quotes use other words: mild, moderate and severe non-proliferative, and proliferative. Our reading of the two: background retinopathy covers their mild and some moderate changes, and pre-proliferative is closest to their severe non-proliferative stage. Confirm your own stage with your eye team.
Everyone with diabetes aged 12 or over is invited for screening every 1 or 2 years. If your eyes need watching more closely, you may be seen every 3, 6, 9 or 12 months, and may have an OCT (optical coherence tomography) scan of the retina.
Laser treatment (panretinal photocoagulation, or PRP, for proliferative retinopathy), injections of anti-VEGF (anti-vascular endothelial growth factor) medicine, steroid implants and vitrectomy surgery protect sight. Gloucestershire's leaflet says laser for early proliferative retinopathy prevents severe sight loss in over 90% of cases. The Royal National Institute of Blind People (RNIB) says laser doesn't make your sight better; it aims to stop it getting a lot worse.
A rapid fall in HbA1c (a measure of your average blood sugar) when treatment is stepped up can make retinopathy worse at first. The ADA advises checking the eyes when treatment is intensified, and Diabetes UK suggests lowering blood sugar gradually, over weeks or months, with your diabetes team. We found no source linking exercise itself to this.
The ADA recommends 150 minutes or more of moderate to vigorous activity a week over at least 3 days, with no more than 2 days off in a row; strength training 2 to 3 times a week on non-consecutive days; and, for older adults, balance and flexibility work 2 to 3 times a week. Structured exercise for 8 weeks or more lowered HbA1c by 0.66 percentage points in type 2 diabetes.
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Across 22 studies, more active people had a slightly lower risk of retinopathy (about 6% lower) and of sight-threatening retinopathy (about 11% lower), and people who sat more had a higher risk. Across 8 prospective studies, the most active had about a quarter fewer complications of the small blood vessels. In 9,018 Australians, the most active were about 40% less likely to need laser treatment, and in 1,814 Japanese adults with type 2 diabetes, the two most active groups developed retinopathy less often. These studies can't show cause and effect: in 1,612 Finnish adults with type 1 diabetes, the link went away after allowing for blood sugar and smoking.
We found no randomised trial showing that exercise prevents or slows retinopathy. In one uncontrolled study, 12 weeks of moderate aerobic exercise in 40 people with non-proliferative retinopathy lowered fasting blood sugar and swelling at the centre of the retina, but there was no comparison group.
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We found no study measuring it. The limits for severe and proliferative retinopathy are expert consensus, based on the sharp rises in blood pressure that come with breath-holding and very hard effort, and on jolts to the head. The ADA says vigorous exercise may be contraindicated because of the risk of triggering a bleed or a detachment.
In a 1989 rehabilitation study of 29 people with diabetes and blindness or retinopathy, blood sugar fell by about 4.2 mmol/L in each low-effort session, and people whose blood pressure dropped when they stood up coped better on an exercise bike than walking.
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In the UK Prospective Diabetes Study (UKPDS), 1,148 people with type 2 diabetes and high blood pressure were followed for 8.4 years on average. Tight control (an average of 144/82 against 154/87 mmHg, millimetres of mercury) cut the risk of retinopathy getting worse by 34%, and of losing 3 lines on a sight chart by 47%. A Cochrane review of 29 trials found more intensive control lowered the chance of developing retinopathy over 5 years, but didn't clearly slow it once it was there. The ADA says very strict targets (a top number below 120 mmHg) add no extra benefit.
Better blood sugar control reduced the development and progression of retinopathy in the major trials, with benefits lasting up to 10 years, and the ADA recommends reaching your blood sugar, blood pressure and cholesterol goals to slow it.
Exercise lowers blood sugar and can lower blood pressure: our high blood pressure guide has the numbers. What sends blood pressure very high is straining against a held breath with very heavy weights, which is why the limits for advanced retinopathy focus on it.
These stage names are the American guidelines'. Our reading of how they match your screening letter is above, in "Stages, in UK and US words": confirm your own stage with your eye team.
All activities are fine, and keep up your screening. The ADA's position statement says people with mild or moderate changes have limited or no risk of eye damage from physical activity.
Avoid activities that send blood pressure very high: powerlifting is the ADA's example, and Diabetes UK names sprinting and lifting weights. Everything else, at a steady effort, is fine. This advice is expert consensus rather than trial evidence.
The ADA's position statement says "Vigorous aerobic or resistance exercise; jumping, jarring, head-down activities; and breath holding should be avoided" with severe non-proliferative and unstable proliferative retinopathy. The ACSM adds heavy and overhead lifting, isometric holds, and yoga or gymnastics that lower the head, and suggests keeping your effort at 10 to 12 on the 6 to 20 effort scale, which feels light to somewhat hard. This advice is expert consensus rather than trial evidence.
The guidelines' strictest limits are written for unstable disease. Our reading: keep to them until your eye team says they can ease, and ask at your clinic visits.
The ACSM says "Exercise is contraindicated for anyone with unstable or untreated proliferative retinopathy, recent panretinal photocoagulation, or other recent surgical eye treatment". The ADA says vigorous exercise may be contraindicated, and Diabetes Canada says retinopathy should be treated and stabilised before vigorous exercise. Gloucestershire Hospitals' 2026 laser leaflet says "You can usually return to work and continue your normal activities, including driving, the next day". Our reading: follow your unit's leaflet, and ask your eye team before more than everyday activity, such as walking, until your retinopathy is treated and stable.
The ADA's position statement says no exercise should be done during a vitreous haemorrhage (bleeding into the gel inside the eye).
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We found no source that gives separate exercise limits for maculopathy or macular swelling. Follow the limits for your retinopathy stage, and ask your eye team.
Until your eye team says otherwise.
Downward dog, forward folds such as touching your toes, sun salutations, inchworms, pike push-ups, and inversions such as headstands, shoulder stands and handstands. The ACSM names yoga and gymnastics among activities that lower the head. Legs up the wall keeps your head level with your heart, so it isn't on this list (our reading).
Heavy barbell squats, deadlifts and bench presses, heavy leg presses, overhead presses, wall sits and hard squeezes. The ACSM gives weight lifting and isometric holds as examples of breath-holding activities to avoid.
Jump squats, box jumps, burpees, skipping, jumping jacks and other jumps.
Diabetes UK says avoid high-intensity activity, such as high-intensity interval training (HIIT), if you have eye complications, and the ADA's position statement says avoid vigorous exercise with severe or unstable proliferative retinopathy.
Breath holding is on the ADA's list, so choose slow, even breathing rather than box breathing or 4-7-8 breathing, which use holds (our suggestion).
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Build towards 150 minutes a week over at least 3 days (ADA) at a steady, moderate effort; with severe or proliferative retinopathy, keep it light to somewhat hard. The recumbent bike and elliptical trainer pages' dose is 10 to 20 minutes at a moderate effort to start, building towards 30, and the indoor rowing page's is 3 rounds of 4 to 5 minutes at a pace you could hold a conversation at, resting a minute between. Get into the pool by the steps rather than diving in (our suggestion).
3D demoTreadmill walkingBeginner · Cardio machine
3D demoStationary cyclingBeginner · Cardio machine
3D demoRecumbent exercise bikeBeginner · Cardio machine
3D demoElliptical trainerBeginner · Cardio machine
3D demoIndoor rowing (rowing machine)Beginner · Cardio machine
Front crawl (freestyle swimming)Intermediate · Other / check instructions
3D demoStanding marchBeginner · No equipment
3D demoSeated marchBeginner · A bench or box2 to 3 times a week on non-consecutive days (ADA). Use a weight you could lift at least 15 times and breathe out on every effort (our editorial starting point). The band row page's dose is 3 sets of 10 to 15, stopping 2 to 3 reps short of failure; with severe or proliferative retinopathy, use a lighter band and stop well short (our suggestion). Wall and incline push-ups keep your head above your heart.
3D demoSit to stand from a chairBeginner · A bench or box
3D demoWall push-upBeginner · A wall
3D demoIncline push-upBeginner · A bench or box
3D demoBand rowBeginner · A band + An anchor point
3D demoSeated cable rowBeginner · A cable machine
3D demoChest press machineBeginner · Strength machine
3D demoLat pulldownBeginner · A cable machine
3D demoStep-upBeginner · A step
3D demoSlow calf raiseBeginner · A wallFor older adults, 2 to 3 times a week (ADA), next to a counter and in good light, especially if laser has narrowed your side vision. The side-stepping page's dose is 10 steps each way, next to a counter.
These keep your head above your heart (our selection, following the ACSM's advice to avoid poses that lower the head). The mountain pose page's dose is 5 to 10 slow breaths, 2 or 3 times, and the slow breathing page's is at least 5 minutes, done regularly as part of your daily routine.
3D demoMountain pose (Tadasana)Beginner · No equipment
3D demoChair pose (Utkatasana)Beginner · No equipment
3D demoWarrior II (Virabhadrasana II)Intermediate · No equipment
3D demoTree pose (Vrksasana)Beginner · No equipment
3D demoCat-cowBeginner · No equipment
3D demoSlow breathing (6 breaths a minute)Beginner · No equipmentGloucestershire Hospitals says "You can usually return to work and continue your normal activities, including driving, the next day". The ACSM says exercise is "contraindicated" after "recent panretinal photocoagulation". Our reading: follow your unit's leaflet, and ask your eye team before more than everyday activity until your retinopathy is treated and stable. If your vision isn't back to normal within 24 hours, contact the eye clinic.
Keep water out of the eye and don't swim for 48 hours (Southampton), a couple of days (Milton Keynes) or a week (Royal Berkshire): follow your leaflet, and don't rub the eye. Moorfields says there are no special precautions after injections and you can travel. None of the NHS leaflets we read set other limits on exercise.
The same rules apply as after retinal detachment surgery: posturing, no flying or altitude with gas in the eye, no lying on your back while gas or oil is in, and limits on lifting and swimming. Our retinal detachment guide explains them.
This is when bleeds are most likely. Our suggestion: keep to everyday walking until your eye team says otherwise.
Never change a diabetes medicine yourself because you've started exercising. If you think a dose may need to change, talk to your GP or diabetes team.
Hypos with exercise are mainly a risk if you take insulin, a sulfonylurea or a meglitinide; otherwise they're uncommon. The ADA says people on these medicines may need some carbohydrate if their blood sugar is below 5.0 mmol/L before exercise, and that hypos can come hours after exercise. The ACSM says carry fast-acting carbohydrate, and glucagon if you're prone to severe hypos.
Blurred vision is one of the NHS's hypo symptoms, along with feeling hungry, dizzy, anxious or irritable, sweating, shaking, tingling lips, palpitations, feeling tired or weak, and confusion. If your vision blurs during exercise and you take one of these medicines, stop and check your blood sugar before assuming it's your eyes (our suggestion). Sudden loss of sight, a curtain or a shower of floaters is different: see the warning signs below.
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If you have symptoms or your blood sugar is below 4 mmol/L, the NHS says:
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Our type 1 and type 2 diabetes guides set out when to restart, and what to change next time.
If someone becomes unconscious, don't give them food or drink. Put them in the recovery position and give a glucagon injection straight away if one is available and you know how to use it. Call 999 if glucagon isn't available, if they haven't recovered within 10 minutes of it, or if they've been drinking alcohol.
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The ACSM consensus: don't start exercise with blood sugar above 13.9 mmol/L and moderate or high ketones; above 16.7 mmol/L without ketones, be cautious, drink enough, and only start if you feel well.
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In 9,481 adults in Singapore, people with retinopathy were more likely to have fallen in the past year than people without diabetes, especially those with mild or moderate changes. It was a one-off survey, so it can't show cause and effect.
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PRP can narrow your side vision and make it harder to see at night. Gloucestershire says 1 in 5 people notice some loss of side vision and 3 in 100 have to stop driving, and Wigan says over half notice some difficulty with night vision. Moorfields says more than 90% keep enough side vision to drive. Our suggestion: practise your balance, and take care with kerbs and steps in dim light.
Tell the Driver and Vehicle Licensing Agency (DVLA) if you've had laser treatment for retinopathy in both eyes, or in your only seeing eye.
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The ADA recommends balance training 2 to 3 times a week for older adults with diabetes.
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Diabetes UK says avoid high-intensity activity such as HIIT if you have eye complications. With no retinopathy or mild changes and no other complications, the ADA says shorter vigorous or interval sessions may be enough for fitter people.
With no retinopathy or mild changes, running is fine. The guidelines don't name running for the later stages: the ADA's position statement says avoid "vigorous" exercise and "jarring", and the ACSM says avoid activities that "jar the head", without defining either. Our suggestion: with severe or proliferative retinopathy, choose walking, cycling or swimming instead of running, and ask your eye team before you run.
With severe or proliferative retinopathy, avoid sports that jar the head. Boxing and other combat sports also risk blows to the eye, so our suggestion is to leave them out.
Diabetes UK lists swimming among the gentler, low-impact exercises that suit people with eye complications. After an eye injection, wait as your leaflet says.
The UK Diving Medical Committee doesn't allow diving with any retinopathy beyond background changes.
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The ADA says there's no evidence that vigorous exercise speeds up kidney disease, though exercise raises the protein in your urine for a while afterwards. Its position statement says avoid vigorous exercise the day before a urine protein test. Our kidney disease guide has more.
The ADA says wear proper footwear and check your feet every day, and with a foot injury or open sore, keep to activities that don't put weight on your feet. Our peripheral neuropathy guide has more.
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If diabetes has affected the nerves that control your heart rate and blood pressure (autonomic neuropathy), the ADA says you should have heart checks before starting exercise that's harder than you're used to. Our suggestion: judge your effort by how it feels.
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All suit every stage at a steady effort. With severe or proliferative retinopathy, swap the child's pose in the beginner home workout for a seated rest, and keep the leg press in the gym workout light (our suggestions). Leave out interval, jumping, head-down and heavy lifting workouts until your eye team says otherwise.
A 10-minute routine for straight after a meal: an easy walk, a few simple standing moves from blood sugar trials, then a short walk to finish.
10 minBeginner6 movesCardio machine, A bench or boxA steady 30 to 45 minute cardio session at talk-but-not-sing pace: walk, cycle, row or cross-train, counting toward weekly activity guidelines.
40 minBeginner3 movesCardio machine, A wallA steady bike ride for a first triathlon or fitness: 5 to 10 minutes easy, a ride you can talk through, optional short faster bursts and an easy cool-down.
45 minBeginner4 movesCardio machine, A wallA 25-minute standing cardio circuit with no jumping: marching, step jacks, sit-to-stands, punches, step-ups and wall push-ups, with a seated option for most moves.
25 minBeginner9 movesA bench or box, A stepA 20-minute seated workout for older adults who cannot stand for long: marching, leg and arm strength, posture, and sit-to-stands that lead back to standing.
20 minBeginner11 movesA bench or box, Something with weightA free 20-minute chair yoga class for older adults: slow breathing, gentle seated stretches and twists, standing poses holding the chair, and a calm finish.
20 minBeginner18 movesA bench or box, Something with weightA gentle 20-minute beginner home workout with a chair, a wall and a band: sit-to-stands, wall push-ups, band rows, step-ups and dead bugs.
20 minBeginner11 movesA bench or box, A wallA 40-minute strength and balance session for over-65s, built from the Otago home programme and NHS exercises, using a chair, a counter and a step.
40 minBeginner18 movesA bench or box, Something with weightA 50-minute gym session for older adults and sarcopenia: 7 machines for the legs, chest and back from the UK prescription, then a short balance finish.
50 minBeginner12 movesCardio machine, A bench or boxA 30 to 45-minute beginner pool swim: a shoulder warm-up on the side, easy lengths, a main set of repeats with rests, and an easy swim down, any stroke.
35 minBeginner5 movesOther / check instructionsThe walking plan builds to 150 minutes a week, and the plan for seniors adds strength and balance.
A free 8-week walking plan for beginners: build to 150 minutes of brisk walking a week, with intervals, hills and two short strength sessions.
6 training days40 minBeginner3 days a weekA 12-week exercise plan for over-65s: strength and balance three times a week, short balance sessions and daily walks, based on falls-prevention trials.
3 training days40 minBeginnerThis is general information, not a diagnosis. In the US, call 911 where this page says 999.
The NHS says ask for an urgent GP appointment or get help from NHS 111 if your eyesight suddenly gets worse or you get blurred vision. Contact a GP, your diabetes care team or an optician if your eyesight is getting worse over time, you have floaters, or you find it hard to see in low light. Diabetes UK says don't wait until your next screening appointment.
Go to A&E or call 999 if you suddenly can't see from one or both eyes, or suddenly have severe eye pain. Floaters that suddenly appear or increase, flashes of light, or a dark curtain or shadow across your vision can mean a bleed or a detached retina: get help from NHS 111 straight away.
Stop if you notice sudden new floaters, a dark shadow, a sudden drop in vision or eye pain, and get help as above. If your vision blurs and you take insulin or a sulfonylurea, check your blood sugar first (our suggestion). Don't exercise during a bleed in the eye.
Call 999 if someone with a hypo is unconscious or not responding normally and glucagon isn't available, they haven't recovered within 10 minutes of it, or they've been drinking alcohol.
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Call 999 for chest pain that feels tight or spreads, signs of a stroke, or signs of diabetic ketoacidosis: our type 2 diabetes guide lists them.
If your vision isn't back to normal within 24 hours, contact the eye clinic. If the pain is severe or your eyesight gets worse, contact your eye clinic straight away, or go to A&E if you can't.
Go to eye casualty or A&E without delay if the eye becomes increasingly red, painful, sensitive to light or swollen, you get a discharge, floaters increase, or your sight gets worse. Southampton says infections usually show between 2 and 7 days after the injection.
Your diabetes team, GP or practice nurse, your eye clinic or screening service, or NHS 111. Diabetes UK's helpline is on 0345 123 2399, and RNIB's on 0303 123 9999.
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The ADA recommends exercise for everyone with diabetes unless something rules it out, and the NHS screening programme says exercise regularly, following medical advice. The limits apply to some kinds of effort at the moderate, severe and proliferative stages.
No trial has shown it. More active people have less retinopathy in observational studies, and exercise helps through blood sugar and blood pressure. Laser and injections are what protect sight once retinopathy threatens it.
Strength training 2 to 3 times a week is recommended. What to avoid is powerlifting-type effort with moderate changes, and heavy, overhead or breath-held lifting with severe or unstable proliferative retinopathy.
The ACSM names yoga and gymnastics among activities that lower the head, to avoid with severe or unstable proliferative retinopathy. Head-up yoga is fine.
The NHS says retinopathy does not usually have any symptoms at first, and is usually found at diabetic eye screening. Keep going to your appointments.
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It can be a hypo: blurred vision is one of the NHS's hypo symptoms. Sudden loss of sight, a curtain or a shower of floaters is different and needs urgent help.
A fast fall in HbA1c when treatment is stepped up can make retinopathy worse at first. The ADA advises checking the eyes when treatment is intensified, and Diabetes UK advises lowering blood sugar gradually with your team. Never change a medicine yourself.
Gloucestershire's leaflet says you can usually continue your normal activities, including driving, the next day. The ACSM limits exercise after recent laser, so ask your eye team before anything vigorous.
Diabetes UK lists swimming among the gentler exercises that suit people with eye complications. After an eye injection, wait as your leaflet says, from 2 days to a week.
Yes. Exercise is recommended for everyone with diabetes unless something specifically rules it out, and the NHS screening programme advises regular exercise, following medical advice. What changes is the kind of effort, as retinopathy advances.
It helps indirectly, by lowering blood sugar and blood pressure, the two things that slow retinopathy. More active people have less retinopathy in long-term studies, but no trial has yet shown that exercise protects the eyes directly.
With moderate changes, efforts that send blood pressure very high, such as powerlifting and sprinting. With severe or proliferative retinopathy, also vigorous exercise, heavy or overhead lifting, holding your breath, hard holds, jumping, jarring and head-down positions.
Yes, with moderate weights you could lift at least 15 times, breathing out on every effort, 2 to 3 times a week; that weight rule is our editorial starting point. With severe or proliferative retinopathy, avoid heavy, maximal and overhead lifts.
Head-up yoga is fine, such as standing poses, chair yoga and slow breathing. With severe or proliferative retinopathy, leave out head-down poses such as downward dog, forward folds and inversions.
With no retinopathy or mild changes, yes. With severe or proliferative retinopathy, the guidelines say avoid jarring and vigorous exercise without defining them, so our suggestion is walking, cycling or swimming instead, and asking your eye team before you run.
Diabetes UK advises avoiding high-intensity interval training if you have eye complications. With no retinopathy or mild changes and no other complications, the American Diabetes Association recognises interval training as an option.
Most people go back to their normal activities, including driving, the next day, but one guideline says exercise is contraindicated straight after laser. Follow your unit's leaflet, ask your eye team before more than everyday activity until your retinopathy is treated and stable, and contact the clinic if your vision isn't back to normal within 24 hours.
Yes, everyday activity is fine. Keep water out of the eye and don't swim for 2 days to a week, as your leaflet says, and get help at once if the eye becomes increasingly red or painful or your sight gets worse.
It makes it more likely to get worse: tight blood pressure control cut progression by about a third in a major UK trial. Regular exercise can lower blood pressure, but straining against a held breath with heavy weights sends it very high.
Mainly if you take insulin, or a medicine such as a sulfonylurea that can cause them. Blurred vision during exercise can be a hypo, so check your blood sugar and treat it as our diabetes guides explain.
The UK Diving Medical Committee doesn't allow diving with any retinopathy beyond background changes. Swimming is fine at every stage.
Exercise education, not a diagnosis or treatment plan, and clinical review of these guides is pending. Stop and get advice for chest pain, unusual breathlessness, dizziness or fainting, or new pain, and check with your doctor or midwife first if they have told you to limit activity. Health disclaimer.
