Weekend Warrior Activity Patterns Associated with Low Risk of Cardiovascular Outcomes

A “weekend warrior” physical activity pattern, meaning most moderate to vigorous activity was achieved over 1 to 2 days, was associated with a similarly lower risk of cardiovascular outcomes as evenly distributed activity, according to new research.¹

The analysis of nearly 90,000 individuals providing a week of accelerometer-based physical activity data suggested a weekend warrior routine was associated with similarly lower risks of incident atrial fibrillation, myocardial infarction, heart failure, and stroke, as an even distribution.

“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,” wrote the investigative team, led by Patrick T. Ellinor, MD, PhD, of the cardiac arrhythmia service and cardiovascular research center at Massachusetts General Hospital. “Specifically, these findings suggest that engagement in physical activity, regardless of pattern, may optimize risk across a broad spectrum of cardiovascular diseases.”

Current guidelines from the World Health Organization and the American Heart Association recommend ≥150 minutes of moderate to vigorous physical activity per week but do not specify an optimal exercise pattern.² Prior studies on weekend warrior exercise patterns were limited by self-reported activity, modest sample sizes, and a limited set of outcomes. Here, a retrospective analysis of the UK Biobank cohort study involved 103,695 participants who provided a full week of accelerometer-based physical activity data between June 2013 – December 2015.

Using the guideline-based threshold, the investigative team compared 3 patterns of moderate to vigorous physical activity: active weekend warrior (active WW, ≥150 minutes with ≥¬50% of total moderate to physical activity achieved in 1-2 days), active regular (≥150 minutes and not meeting active weekend warrior status), and inactive (<150 minutes). Investigators then assessed the same patterns using the sample median threshold of ≥230.4 minutes of moderate to vigorous physical activity per week.

For the primary outcome, Ellinor and colleagues assessed associations between activity pattern and incident atrial fibrillation, myocardial infarction, heart failure, and stroke using Cox proportional hazards models adjusted for age, sex, racial and ethnic background, tobacco use, Townsend Deprivation Index, alcohol intake, educational attainment, employment status, self-reported health, and diet quality.

The analysis included a total of 89,573 individuals (mean age, 62 years; 56% women) who underwent activity measurements between June 2013 – December 2015. Stratified by the guideline-based threshold of ≥150 minutes of moderate to vigorous physical activity, a total of 37,872 participants were in the active weekend warrior group (42.2%), 21,473 were in the active regular group (24.0%), and 30,228 were in the inactive group (33.7%).

In the multivariable-adjusted analysis, both activity patterns were associated with similarly lower risks of incident atrial fibrillation (active WW: hazard ratio [HR], 0.78 [95% CI, 0.74 – 0.83]; active regular: HR, 0.81 [95% CI, 0.74 – 0.88]; inactive, HR, 1.00 [95% CI, 0.94 – 1.07), myocardial infarction (active WW, 0.73 [95% CI, 0.67 – 0.80]; active regular, HR, 0.65 [95% CI, 0.57 – 0.74]; inactive, HR, 1.00 [95% CI, 0.91 – 1.10]), heart failure (active WW, HR, 0.62 [95% CI, 0.56 – 0.68]; active regular, HR, 0.64 [95% CI, 0.56 – 0.73; inactive, HR, 1.00 [95% CI, 0.92 – 1.09]), and stroke (active WW, HR, 0.79 [95% CI, 0.71 – 0.88; active regular, HR, 0.83 [95% CI, 0.72 – 0.97]; inactive, HR, 1.00 [95% CI, 0.90 – 1.11).

The findings were consistent at the median threshold of ≥230.4 minutes of moderate to vigorous physical activity per week, although the associations with stroke were no longer significant (active WW, HR, 0.89; active regular, HR, 0.87; inactive, HR, 1.00)

Investigators noted that since weekend warrior patterns could be more feasible for certain schedules, targeted interventions over shorter timeframes may be more accessible for some patients. Regardless of concerns over musculoskeletal injury with weekend warrior activity, a similarly lower risk with both activity patterns was observed in the analysis.

“Future research is warranted to better define potential negative effects of concentrated activity,” investigators wrote.

References

1. 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
2. Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;140(11):e596-e646. doi:10.1161/CIR.0000000000000678