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Among the estimated 463 million adults living with diabetes, approximately 170 million exhibit some degree of DR, reflecting both the rising global burden of diabetes and persistent limitations in disease prevention and modification ( Clinically, early non-proliferative DR (NPDR) is characterized by microaneurysms, hemorrhages, and exudates, progressing toward widespread vascular dysfunction and ischemia ( Reviews focused on physical activity and DR predominantly emphasize epidemiological associations between exercise levels and DR prevalence or severity, with limited mechanistic resolution linking systemic exercise adaptations to specific retinal cell types or signaling pathways ( In this review, we integrate these perspectives by synthesizing current evidence on exercise-responsive exerkines within the established cellular framework of DR

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& Zeviani, M