Accelerometer-derived moderate-to-vigorous physical activity patterns and incident dry eye disease: a prospective UK Biobank cohort study

BACKGROUND: To explore the associations between three accelerometer-derived moderate-to-vigorous physical activity (MVPA) patterns and the risk of dry eye disease (DED). METHODS: This prospective cohort study included UK Biobank participants who provided a full week of accelerometer-derived MVPA data collected between June 8, 2013, and December 30, 2015. Participants were categorized according to weekly MVPA volume using WHO guidelines (≥ 150 min/week): inactive (< 150 min), active weekend warrior (active WW, ≥ 150 min with ≥ 50% of weekly MVPA accumulated within 1–2 days), and active regular (≥ 150 min but not meeting active WW criterion). The association between MVPA patterns and the risk of DED was assessed using multifactorial Cox models and restricted cubic spline models. RESULTS: A total of 84,065 participants (55.82 ± 7.84 years; 54.13% women) without DED at baseline were included. During the follow-up period, 726 individuals developed DED. In multivariable-adjusted models, higher weekly MVPA was significantly associated with a lower risk of incident DED (P < 0.0001). The association was non-linear (P < 0.0001), with the steepest decline in risk observed between 0 and approximately 150 min/week, beyond which the risk plateaued. Compared to the inactive group, both active WW (hazard ratio [HR] 0.83, 95% CI 0.70–0.99) and active regular (HR 0.76, 95% CI 0.61–0.94) patterns were associated with a significantly lower risk of DED, with no evidence of a difference in protection between the two active patterns (P for difference = 0.894). Importantly, this trend persisted across multiple definitions of the WW pattern in the sensitivity analyses. Specially, subgroup analysis revealed a significant interaction by sex (P-interaction = 0.002), with women showing a marked protective association (active WW: HR 0.76 [0.62–0.94]; active regular: HR 0.57 [0.43–0.75]), while no significant association was observed in men (active WW: HR 1.14 [0.79–1.63]; active regular: HR 1.36 [0.93–2.01]). CONCLUSIONS: Achieving guideline-recommended MVPA levels is associated with a lower risk of DED. The benefit is similar for WW and active regular patterns, and is more pronounced in women. Future studies are warranted to explore the underlying biological mechanisms.