Physical activity and the risk of cataract and age-related macular degeneration: a systematic review and meta-analysis of cohort studies

Physical activity has been associated with a lower risk of cataract and age-related macular degeneration in some studies; however, the available evidence has not been fully consistent. We conducted a meta-analysis of cohort studies to clarify the association between physical activity and cataract and age-related macular degeneration. The PubMed and Embase databases were searched for relevant prospective studies up to September 18, 2025. Random effects models were used to calculate summary relative risks (RRs) and 95% confidence intervals (CIs) for the association between physical activity and the risk of cataract and age-related macular degeneration. World Cancer Research Fund (WCRF) criteria was used to evaluate the strength of evidence. A total of 10 cohort studies (8 publications) with 163,065 cases and 1,914,137 participants were included in the analysis of physical activity and cataract and 14 cohort studies (9 publications) with 17,653 cases and 566,895 participants were included in the analysis of age-related macular degeneration. The summary RR for high vs. low physical activity and cataract was 0.90 (95% CI: 0.86–0.94, I2 = 74%, n = 10) and for age-related macular degeneration was 0.92 (95% CI: 0.84–1.01, I2 = 60%, n = 14). The summary RR per 20 MET-hours/week increment in leisure-time physical activity was 0.91 (0.84–0.99, I2 = 66%, n = 3) for cataract and 0.92 (0.74–1.13, I2 = 48%, n = 3) for age-related macular degeneration, and there was no indication of nonlinear dose-response relationships (pnonlinearity=0.32 and pnonlinearity=0.34, respectively). There was no indication of publication bias. The evidence (judging the likelihood of causality) using WCRF criteria was judged as probable for cataract and limited-no conclusion for age-related macular degeneration. This meta-analysis provides further support for an inverse association between physical activity and risk of cataract, but an association with age-related macular degeneration was less evident. Any further studies should clarify the dose-response relationship and associations between different domains of physical activity in relation to these outcomes. These findings support public health recommendations to the general population to be physically active.