# Impact of exercise on myopia in children and adolescents and its modifying factors: a systematic review and meta-analysis

**Authors:** Jiacheng Ren, Xuan Liu, Lu Peng, Wei Sun, Aona Chen, Miaomiao Zhou, Meizhu Chen, Zixuan Peng, Chenggen Guo  
**Published in:** BMC Pediatrics  
**DOI:** [10.1186/s12887-026-07266-8](https://doi.org/10.1186/s12887-026-07266-8)  
**Date:** 2026-07-09  
**Summary page:** https://www.summarizepaper.com/en/arxiv-id/doi_10.1186--s12887-026-07266-8/

## Key points

- A meta-analysis of 31 randomized controlled trials involving 9,892 children and adolescents assessed exercise’s effects on vision and myopia progression.
- Exercise was associated with improved dynamic and static visual acuity, a modest improvement in refractive error, and reduced axial elongation.
- Subgroup results linked different exercise types, settings, and doses with better outcomes, but these findings are not definitive recommendations.
- Intervention setting may independently influence dynamic visual acuity; no stable independent moderators were identified for static visual acuity.
- Axial-length findings showed low heterogeneity, and the results remained robust after the authors’ CRVE correction.
- Exercise may complement broader myopia prevention and management, but the abstract does not establish how it compares with proven myopia-control treatments.
- Because only the title and abstract were available, study quality, risk of bias, measurement differences, practical effect size, and applicability to different populations could not be assessed.

## Summary

This systematic review and meta-analysis examined whether exercise interventions improve vision and slow myopia progression in children and adolescents. It assessed functional outcomes—dynamic and static visual acuity—and structural measures, including refractive error and axial length. The authors also explored whether outcomes varied according to exercise type, frequency, duration, and setting. The researchers searched CNKI, Wanfang, PubMed, and Web of Science for randomized controlled trials of exercise interventions in children and adolescents. They included 31 studies involving 9,892 participants. Meta-analyses estimated overall effects, while subgroup and sensitivity analyses assessed differences between interventions and the robustness of the results. Multivariable meta-regression explored potential sources of variation across studies. Statistical analyses were conducted using Stata 18.0 and R 4.6.0. Exercise was associated with improvements in both measures of visual acuity. Dynamic visual acuity improved by a moderate amount (standardized mean difference [SMD] 0.58; 95% confidence interval [CI], 0.21 to 0.96; P < 0.001). Static visual acuity also improved (SMD 0.69; 95% CI, 0.46 to 0.92; P < 0.001). Exercise was associated with a smaller but statistically significant improvement in refractive error (SMD 0.29; 95% CI, 0.12 to 0.45; P < 0.001). For axial length, the pooled effect was −0.13 (95% CI, −0.19 to −0.07; P < 0.001), which the authors interpreted as evidence that exercise may inhibit axial elongation. Subgroup analyses suggested that the features associated with better outcomes differed by visual measure. Dynamic visual acuity improved more among students in grades 1–3 and in programs involving vision training, four to six sessions per week, or 120–300 minutes of exercise per week. Programs combining indoor and outdoor settings produced the largest effects for this outcome. More favorable static visual acuity results were associated with physical and mental health exercises, ball sports, one to three sessions per week, and weekly exercise durations of 120–300 minutes. In multivariable meta-regression, intervention setting remained a potential independent moderator of dynamic visual acuity, while differences among some exercise types weakened after adjustment. The authors found no stable or significant independent moderators of static visual acuity. Axial-length results showed low heterogeneity, indicating relatively consistent findings across the included studies. The reported results also remained robust after correction for CRVE, although the abstract does not explain this correction. The authors concluded that exercise may serve as a useful addition to broader myopia prevention and management. It appears to improve visual acuity and may modestly benefit refractive error while limiting axial elongation. Although intervention type, setting, and dose may influence outcomes, the subgroup findings should not be treated as definitive recommendations. This summary is based only on the title and abstract because the paper’s license does not permit access to the full text. As a result, information needed to assess the evidence—such as study quality, risk of bias, variation in outcome measurement, and the practical significance of the standardized effects—is unavailable. The abstract also does not provide enough information to determine how well the findings apply to different populations or how exercise compares with established myopia-control treatments.