The mediating roles of screen time and sleep duration in the association between extracurricular physical activity and visual acuity in primary school students

Objective This study aimed to examine the association between extracurricular physical activity (EPA) and visual acuity (VA) among primary school students in Macau and investigate the mediating roles of screen time (ST) and sleep duration (SD). Methods A stratified random cluster sampling method was used to recruit primary school students in Macau ( n  = 2,098). Data were collected using questionnaire surveys. Pearson correlation analysis and structural equation modeling were conducted. Results EPA, ST, SD, and VA were significantly correlated ( p   Conclusion EPA was positively correlated with VA among primary school students, and statistically detectable indirect associations were observed through ST, SD, and the sequential ST–SD pathway.