Physical activity and risk of diabetic retinopathy: a systematic review and meta-analysis

A Letter to the Editor to this article was published on 06 February 2020



Diabetic retinopathy (DR) is an important microvascular complication of diabetes mellitus (DM) and a leading cause of visual impairment and blindness among people of working age. Physical activity (PA) or exercise is critical and beneficial for DM patients, whereas studies evaluating the relationship between PA and DR have yielded inconsistent and inconclusive results. The American Diabetes Association’s “Standards of Medical Care in Diabetes” has also pointed out the indeterminate roles of PA in DR prevention. The purpose of this systematic review and meta-analysis was to explore the association between PA and DR risk.


Medline (accessed by PubMed), EmBase, and Cochrane Library were systematically searched for studies up to June 2018, and the reference lists of the published articles were searched manually. The association between PA and DR risk was assessed using random-effect meta-analysis.


Twenty-two studies were included in this meta-analysis. PA was found to have a protective association with DR [risk ratio (RR) = 0.94, 95% confidence interval (95% CI) 0.90–0.98, p = 0.005] in diabetic patients, and the impact was more pronounced on vision-threatening DR (RR = 0.89, 95% CI 0.80–0.98, p = 0.02). Sedentary behavior could increase the risk of DR (RR = 1.18, 95% CI 1.01–1.37, p = 0.04). Moderate-intensity PA was likely to have a slight protective effect (RR = 0.76, 95% CI 0.58–1.00, p = 0.05).


PA is associated with lower DR risk, and more studies should focus on the causality between them.

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This work was partly supported by the National Natural Science Foundation of China (NSFC No. 81671641), Natural Science Foundation of Jiangsu Province (No. BK20151208), Jiangsu Provincial Medical Innovation Team (No. CXTDA2017039), and the Soochow Scholar Project of Soochow University (No. R5122001).

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CR and PL conceived of the idea and designed the study. CR, WL, and JL collected the data. CR, JX, and YC performed the data analysis. CR, WL, and PL participated in the critical revision of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Peirong Lu.

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Ren, C., Liu, W., Li, J. et al. Physical activity and risk of diabetic retinopathy: a systematic review and meta-analysis. Acta Diabetol 56, 823–837 (2019).

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  • Physical activity
  • Diabetic retinopathy
  • Sedentary behavior
  • Meta-analysis