Association of Physical Activity and Sedentary Behaviors with the Risk of Refractive Error in Chinese Urban/Rural Boys and Girls

Background: Research shows physical activity (PA) is negatively associated with refractive error, especially outdoor activity. Our study aimed to examine the association of PA levels and sedentary time (SED) with refractive error in boys and girls living in urban and rural areas. Methods: A total of 8506 urban/rural boys and girls (13.5 ± 2.8 years old) in Shaanxi Province, China participated in this study. Questions about PA, SED, outdoor exercises, and digital screen time were asked in the study survey. Non-cycloplegic refractive error was measured by an autorefractor. The differences between sex/area groups have been analyzed by one-way ANOVA. The association of PA/SED with spherical equivalent (SE) and cylinder power was analyzed by general linear regression. The association between PA/SED and the risk of refractive error was determined using the binary logistic regression model. Results: Of the 8506 participants, the prevalence of refractive error was significantly higher in girls and urban students ( p < 0.05). Less SED and digital screen time, and more outdoor activity were significantly associated with SE ( p < 0.05), respectively. More PA and less SED were significantly associated with lower cylinder power ( p < 0.05), respectively. More PA and less SED were significantly associated with lower risks of myopia and astigmatism, respectively ( p < 0.05). Conclusions: PA and SED were associated with the risk of refractive error. Maintaining a healthy lifestyle can help to reduce the risk of refractive error in boys and girls.