Concentrated Exercise Reduces Cardiovascular Risk Similarly to Distributed Exercise

Engaging in intense physical activity for 1-2 days was found to have a comparable effect in reducing the risk of cardiovascular events as engaging in moderate physical activity spread out across several days, according to research published today in JAMA.

Current guidelines from the World Health Organization and American Heart Association recommend at least 150 minutes of moderate to vigorous physical activity (MVPA) per week for overall health benefits, but the impact of concentrated versus evenly distributed activity has remained unclear. The researchers’ objective was to investigate the associations of cardiovascular event risk between a “weekend warrior” pattern of physical activity, where the majority of MVPA is achieved over 1-2 days, and a pattern of more evenly distributed MVPA across multiple days. The study involved a retrospective analysis of data from the UK Biobank cohort study, focusing on participants who provided a full week of accelerometer-based physical activity data between June 8, 2013, and December 30, 2015.

With this data, the researchers compared 3 MVPA patterns:

• The active weekend warrior (active WW) group, where participants achieved at least 150 minutes of MVPA with at least 50% of the total activity completed in 1-2 days
• The active regular group, where participants achieved at least 150 minutes of MVPA but did not meet active WW criteria
• The inactive group, where participants completed less than 150 minutes of MVPA

They also assessed the same patterns using a median threshold of 230.4 minutes or more of MVPA per week. Associations between these activity patterns and incident atrial fibrillation, myocardial infarction, heart failure, and stroke were analyzed. The researchers used Cox proportional hazards regression to adjust for various factors such as age, sex, lifestyle habits, and overall health.

The analysis included 89,573 individuals with a mean (SD) age of 62 (7.8) years, of whom 56% were women, who underwent accelerometry. Results showed that both concentrated and evenly distributed activity patterns were associated with similarly lower risks of all 4 included cardiovascular events.

For the 150-minute threshold, 42.2% of participants were in the active WW group, 24.0% were in the active regular group, and 33.7% were in the inactive group. In multivariable-adjusted models, both activity patterns were associated with similarly lower risks for all 4 cardiovascular events.

For incident atrial fibrillation, the researchers measured an HR of 0.78 (range, 0.74-0.83) for the active WW group, 0.81 (0.74-0.88) for the active regular group, and 1.00 (0.94-1.07) for the inactive group. For myocardial infarction, the HR was 0.73 (0.67-0.80) for the active WW group, 0.65 (0.57-0.74) for the active regular group, and 1.00 (0.91-1.10) for the inactive group.

For heart failure, the HR was 0.62 (0.56-0.68) for the active WW group, 0.64 (0.56-0.73) for the active regular group, and 1.00 (0.92-1.09) for the inactive group. Finally, for stroke, the HR was 0.79 (0.71-0.88) for the active WW group, 0.83 (0.72-0.97) for the active regular group, and 1.00 (0.90-1.11) for the inactive group. All CIs were 95%.

The researchers found that these results were consistent at the median threshold of 230.4 minutes but noted that associations with stroke were no longer significant.

The HRs were 0.89 (0.79-1.02) for the active WW group, 0.87 (0.74-1.02) for the active regular group, and 1.00 (0.90-1.11) for the inactive group, all with a CI of 95%.

According to the authors, these findings hold important implications for cardiovascular health promotion through physical activity. First, the use of accelerometry revealed that a weekend warrior pattern is common, with more than half of active individuals accruing most of their MVPA in 1-2 days across various activity thresholds.

Second, regardless of the specific activity pattern, the researchers saw similar associations between the patterns and reduced risks of atrial fibrillation, myocardial infarction, heart failure, and stroke over a 5-year period.

“These observations thereby extend prior work reporting improved cardiovascular outcomes with increasing moderate and vigorous activity, as well as reports suggesting that concentrated physical activity is associated with similar reductions in mortality to more regular activity,” the authors said. “Specifically, these findings suggest that engagement in physical activity, regardless of pattern, may optimize risk across a broad spectrum of cardiovascular diseases.”

Third, interventions targeting cardiovascular health through physical activity may be effective even if concentrated within 1-2 days per week. This finding is particularly relevant for individuals with time constraints, according to the authors, as it suggests shorter timeframes for physical activity may still yield positive results.

The authors noted several limitations to the study, including the fact that exercise behavior could have been modified throughout the week and that MVPA classification was broad.

“Within nearly 90,000 individuals providing wrist-based activity quantification, physical activity concentrated within 1 to 2 days was associated with similarly lower risk of cardiovascular outcomes to more regular activity,” the authors concluded. “Future prospective studies are warranted to assess whether interventions to increase physical activity, even when concentrated within a day or 2 each week, improve cardiovascular outcomes.”

Reference

Khurshid S, Al-Alusi MA, Churchill TW, Guseh JS, Ellinor PT. Accelerometer-derived “weekend warrior” physical activity and incident cardiovascular disease. JAMA. 2023;330(3):247-252. doi:10.1001/jama.2023.10875