Diabetes Research and Clinical Practice · Oct 27, 2026

Physical activity and diabetic retinopathy in individuals with diabetes: a systematic review and meta-analysis of observational studies

By Zekaj D, Grezda K, Morina K et al.

Physical activity is a cornerstone of diabetes management. Evidence regarding its association with diabetic retinopathy continues to evolve as more studies evaluate this relationship. This review examines the evidence on the association between physical activity and diabetic retinopathy among individuals with diabetes. CINAHL, Cochrane Library, Embase, PubMed, Scopus and Web of Science were searched from database inception to March 2026, supplemented by manual searches. Observational studies evaluating the association between physical activity and diabetic retinopathy among individuals with type 1 or type 2 diabetes were included. Random-effects meta-analyses and dose-response meta-analyses were performed to pool effect estimates. Thirty-two studies comprising 51,516 participants from 18 countries were included in this review. Higher physical activity was associated with a lower occurrence of diabetic retinopathy across all three designs: 0.59 (95% CI 0.47-0.74; 12 cross-sectional studies), 0.81 (0.71-0.93; 7 cohort studies), and 0.40 (0.22-0.72; 2 case-control studies). Subgroup analyses and crude-estimate sensitivity analyses showed a similar association. As diabetic retinopathy is prevalent, odds ratios overstate relative risk, so magnitudes are not comparable across designs. Dose-response meta-analysis was not significant. Higher physical activity levels are associated with a lower occurrence of diabetic retinopathy. However, we rated the certainty of evidence as low to very low. Well-designed prospective studies, ideally with standardised and objectively measured physical activity, are needed to establish whether this association is causal. Registration. The protocol was registered with PROSPERO. Registration number: CRD420261357943.

doi.org/10.1016/j.diabres.2026.113614 PubMed 42946061 Populations