Accelerometer-Measured Physical Activity and the Risk of Diabetic Retinopathy
June 2026
Levenson JN, Dias CG, Shah J, Kovacs KD. Association of Accelerometer-Measured Physical Activity With Presence of Diabetic Retinopathy. Journal of VitreoRetinal Diseases. 2026;10(3):482-485.
Diabetes and its microvascular complications impose significant social and economic burdens worldwide, highlighting an urgent need for targeted prevention and individualized care. While personal fitness trackers have grown immensely popular, their clinical utility in predicting or monitoring specific microvascular complications like diabetic retinopathy (DR) is still being understood. This study evaluated whether objectively quantified physical activity data obtained from consumer-grade wearable technology correlates with the presence of DR in patients with diabetes.
The retrospective database cohort study utilized data from the All of Us Research Program Registered Tier dataset (Version 7). Participants required a documented diagnosis of diabetes mellitus and a minimum of 1 month of linked, continuous activity tracking data via personal wearable devices (Fitbit). Ultimately, 668 participants met inclusion criteria (mean age 64.3 years; 63% female). Binary logistic regression models were constructed to evaluate the adjusted associations between mean daily steps, mean daily minutes spent in moderate-to-vigorous physical activity (MVPA), and the presence of DR.
Results showed that physical activity was strongly and inversely correlated with the presence of diabetic retinopathy. Specifically, a unit increase of every 1,000 daily steps walked by participants was significantly associated with a 45% reduction in the odds of having diabetic retinopathy (OR: 0.55; 95% CI: 0.33–0.91). Furthermore, a 1-minute unit increase in the mean number of daily minutes spent on moderate-to-vigorous activity was significantly associated with a 24% reduction in the odds of DR (OR: 0.76; 95% CI: 0.63–0.92).
The findings underscore a powerful potential role for consumer-grade wearable technology in personalizing and optimizing diabetes management plans. While traditional exercise tracking relies on self-reported patient metrics – which are notoriously prone to recall bias – the objective verification provided by continuous accelerometer tracking allows clinicians to confidently map real-world behavior to microvascular risks.
Given that this was a retrospective dataset analysis, the timeline of physical activity changes relative to the exact onset and exact severity stage of diabetic retinopathy cannot be definitively untangled. Additionally, the cohort analyzed was heavily skewed toward non-Hispanic White individuals (80%) who possessed the means and digital literacy to operate wearable trackers, which limits immediate generalizability across broader, more diverse patient populations. “Further investigation through large, prospective studies is imperative to substantiate the therapeutic potential” of prescribing step-count or activity-minute targets via wearable tech to actively halt the development or progression of diabetic retinopathy.
