Effect of Physical Activity on Reducing the Risk of Diabetic Retinopathy Progression: 10-Year Prospective Findings from the 45 and Up Study

Background: The aim of this study is to examine the association of physical activities (PA) with DR progression based on 10 years follow-up on a large cohort of working-age diabetic patients in Australia.   Methods: Nine thousand and eighteen working-age diabetic patients were enrolled from the baseline of the 45 and Up Study from New South Wales, Australia. Self-reported PA collected by questionnaire at baseline in 2006 was graded into low (<5 sessions/week), medium (≥5-14), and high (≥14) levels. Retinal photocoagulation (RPC) treatment during the follow-up period was used as a surrogate for DR progression and was tracked through Medicare Benefits Schedule, which is available from 2004 to 2016. Cox regression was used to estimate the association between PA and RPC incidence.   Findings: In the fully adjusted model, higher PA level was significantly associated with a lower risk of RPC incident (Cox-regression, p-value for trend=0·002; medium vs. low, HR=0·78, 95%CI: 0·61-0·98; high vs. low, HR=0·61, 95%CI: 0·36-0·84). In addition, gender, body mass index, insulin treatment, family history of diabetes, history of cardiovascular disease were significant effect modifiers for the association between PA and RPC.   Interpretation: Higher PA level was independently associated with a lower risk of DR progression in working-age diabetic patients.    Funding: Professor Mingguang He receives support from the University of Melbourne at Research Accelerator Program and the CERA Foundation. The Centre for Eye Research Australia (CERA) receives Operational Infrastructure Support from the Victorian State Government. The specific project is funded by Australia China Research Accelerator Program at CERA. Professor Mingguang He is also supported by the Fundamental Research Funds of the State Key Laboratory in Ophthalmology, National Natural Science Foundation of China (81420108008). The sponsor or funding organization had no role in the design or conduct of this research. Declaration of Interest: The authors have no financial or other conflicts of interest concerning this study. Ethical Approval: Ethics approval of the 45 and Up Study was obtained from the University of NSW Human Research Ethics Committee. Approval to use data from the 45 and Up Study for the current study was received from the Center for Eye Research Australia Ethics Committee.