Promoting Moderate/High-Intensity Exercise Essential to Reduce DR Incidence

Physical activity is associated with beneficial retinal microvascular changes, par­ticularly in peripheral areas. Promoting awareness and engagement in moderate/high-intensity exercise in patients with diabetes may enhance their health management. Photo: Getty Images. Routine exercise helps the body in countless ways, of course, and some ocular conditions show specific positive associations. Evidence regarding the association be­tween physical activity and diabetic retinopathy (DR) remains inconsistent, however, and its effects on retinal vessel diameters in type 2 diabetes are not well estab­lished. In a recent study, researchers aimed to investigate the relationship between all three by exploring underlying mechanisms and identifying protective exercise regimens. They found that promoting higher-intensity exercise is essential in these patients, as physical activity was associated with beneficial retinal microvascular changes—particularly in peripheral areas. The findings were included in Journal of Global Health.Patients with type 2 diabetes from the Shanghai Cohort Study of Diabetic Eye Disease were categorized by their DR status. Those without DR were divided into active and inactive groups and followed for three years to assess the effect of physical activity. Ret­inal vessel diameters were measured using computer vi­sion and deep learning. Anthropometric data were col­lected using standard methods and physical activity data through interviews.The cross-sectional analysis included nearly 43,000 type 2 diabetes patients, with a mean age of 64.4. Physical activity was associated with reduced odds of moderate and severe nonprolifer­ative DR, and with wider retinal arterioles and venules.In the longitudinal cohort, 3,669 individu­als (mean age 63.1) were analyzed. Physical activity was a protective factor against incident DR and was associated with increased peripheral retinal arteriolar caliber and arterio-venous ratio.Age, duration of diabetes, glycemic control, blood pressure and medica­tion use influence DR, but exercise can help improve metabolic control of diabetes—especially blood glucose levels. “The metabolic control effect of exercise is beneficial for reducing the progression of DR,” the authors wrote in their paper. “However, in our study, poorer blood pressure control was observed in the active group, potentially attributable to a higher proportion of males, smokers and drinkers.”Physical activity significantly increased peripheral retinal artery width and increased the peripheral arteriole-to-venule ratio (AVR) longitudinally. This was independently associated with DR prevalence and incidence, suggesting that microvascular changes in smaller peripheral vessels may be an early indicator of DR risk. “The lack of association with central AVR may relate to the smaller cohort size and shorter follow-up,” the authors explained in their paper. “However, the putative mechanisms underlying physical activity, DR and retinal ves­sel changes warrant validation in extended longitudinal cohorts or controlled animal studies.”Exercise intensity was a primary factor, which is consistent with previous studies. “Dose-response curves suggested opti­mal benefits at approximately ≥5 sessions/week and ≥180-minutes/week,” the authors wrote. “Furthermore, among those performing moderate/high-intensity exercise, high-intensity activity provided no signifi­cant additional benefit over moderate intensity.”In conclusion, physical activity was associated with beneficial retinal microvascular changes, par­ticularly in peripheral areas. Since most patients met frequency and duration targets but only a minority engaged in moderate/high-intensity activity, promoting higher-inten­sity exercise is essential, the researchers concluded in their paper. They added that because the physiological mechanisms linking physical activity to retinal health remain unclear, further investigation in longer-term and experimental studies is warranted.Click here for the journal source. Xiang Z, Lin S, Xu L, et al. The effects of physical activity on diabetic retinopathy in type 2 diabetes using automated vascular analysis: a cohort study. J Glob Health. December 5, 2025. [Epub ahead of print.] This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.