Comparative effectiveness of outdoor and exercise interventions for myopia control in children and adolescents: a systematic review and network meta-analysis of randomized clinical trials
In brief
Racket sports slow eye growth by about 0.3 mm in myopic children
A network meta-analysis of 16 randomized trials involving 9,084 school-aged kids found that playing racket sports produced the greatest reduction in axial elongation (≈0.30 mm), outperforming increased outdoor time (≈0.08 mm). Visual-tracking exercises and racket sports also yielded the largest gains in spherical equivalent. The findings suggest targeted sports could be incorporated into myopia-control programs, though long-term effects remain to be clarified.
- Journal
- Frontiers in public health (Q1)
- Published
- 9 July 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Xiaoquan Weng, Yang Yang, Shuo Zhou, Lingyan Yuan
- PMID
- 42494903
- DOI
- 10.3389/fpubh.2026.1833405
Why clinicians should know about it
- Picked for Pediatrics and Child Health (top studies of the week, 26 July 2026): Ranked by evidence level and journal quartile
- Picked for Ophthalmology (top studies of the week, 26 July 2026): Racket sports rank highest for axial elongation control
Abstract
OBJECTIVE: To compare and rank the effects of different sports and outdoor activities on myopia control in children and adolescents using network meta-analysis. METHODS: We systematically searched PubMed, Web of Science, Embase, the Cochrane Library, and major Chinese databases from database inception to Dec 31, 2025, for randomized controlled trials involving school-aged children and adolescents with myopia or at risk of myopia progression. Data were analysed using network meta-analysis in Stata 18.0. Treatment effects were expressed as mean differences (MDs) with 95% CIs, and interventions were ranked using the surface under the cumulative ranking curve (SUCRA). RESULTS: Sixteen randomized controlled trials involving 9,084 participants were included. Racket sports ranked highest for slowing axial elongation (MD -0.30 mm, 95% CI -0.58 to -0.01; SUCRA 94.9%), followed by increased outdoor time (MD -0.08 mm, 95% CI -0.13 to -0.02; SUCRA 55.7%). For refractive outcomes, visual tracking exercise ranked highest for improving spherical equivalent (MD 0.38 D, 95% CI -0.04 to 0.80; SUCRA 83.7%), followed by racket sports (MD 0.29 D, 95% CI 0.00 to 0.59; SUCRA 77.0%). Subgroup analyses showed that increased outdoor time remained effective in children aged 8.5 years or younger and in interventions lasting more than 24 weeks. Sensitivity analyses supported the robustness of the findings. CONCLUSION: Sports and outdoor activities may affect myopia control differently across outcomes. Racket sports showed the most consistent signal for slowing axial elongation, while visual tracking exercise and racket sports ranked higher for spherical equivalent. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD420261339612, identifier (CRD420261339612).
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.