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Associations of "Weekend Warrior" Physical Activity With Incident Disease and Cardiometabolic Health
TAKE-HOME MESSAGE
- This study assessed the associations between physical activity patterns and the incidence of 678 conditions in 89,573 UK Biobank participants using accelerometers, comparing "weekend warrior" patterns (activity concentrated in 1 or 2 days) with regular patterns (activity spread throughout the week). Compared with inactivity, both patterns were associated with reduced risks of incident disease, including hypertension, diabetes, obesity, and sleep apnea. No significant differences in disease outcomes were observed between the weekend warrior and regular activity patterns.
- These findings demonstrate that achieving the recommended physical activity targets, regardless of distribution, offers significant health benefits.
abstract
This abstract is available on the publisher's site.
Access this abstract nowBACKGROUND
Achievement of guideline-recommended levels of physical activity (≥150 minutes of moderate-to-vigorous physical activity per week) is associated with lower risk of adverse cardiovascular events and represents an important public health priority. Although physical activity commonly follows a "weekend warrior" pattern, in which most moderate-to-vigorous physical activity is concentrated in 1 or 2 days rather than spread more evenly across the week (regular), the effects of physical activity pattern across a range of incident diseases, including cardiometabolic conditions, are unknown.
METHODS
We tested associations between physical activity pattern and incidence of 678 conditions in 89 573 participants (62±8 years of age; 56% women) of the UK Biobank prospective cohort study who wore an accelerometer for 1 week between June 2013 and December 2015. Models were adjusted for multiple baseline clinical factors, and P value thresholds were corrected for multiplicity.
RESULTS
When compared to inactive (<150 minutes moderate-to-vigorous physical activity/week), both weekend warrior (267 total associations; 264 [99%] with lower disease risk; hazard ratio [HR] range, 0.35-0.89) and regular activity (209 associations; 205 [98%] with lower disease risk; HR range, 0.41-0.88) were broadly associated with lower risk of incident disease. The strongest associations were observed for cardiometabolic conditions such as incident hypertension (weekend warrior: HR, 0.77 [95% CI, 0.73-0.80]; P=1.2×10-27; regular: HR, 0.72 [95% CI, 0.68-0.77]; P=4.5×10-28), diabetes (weekend warrior: HR, 0.57 [95% CI, 0.51-0.62]; P=3.9×10-32; regular: HR, 0.54 [95% CI, 0.48-0.60]; P=8.7×10-26), obesity (weekend warrior: HR, 0.55 [95% CI, 0.50-0.60]; P=2.4×10-43, regular: HR, 0.44 [95% CI, 0.40-0.50]; P=9.6×10-47), and sleep apnea (weekend warrior: HR, 0.57 [95% CI, 0.48-0.69]; P=1.6×10-9; regular: HR, 0.49 [95% CI, 0.39-0.62]; P=7.4×10-10). When weekend warrior and regular activity were compared directly, there were no conditions for which effects differed significantly. Observations were similar when activity was thresholded at the sample median (≥230.4 minutes of moderate-to-vigorous physical activity/week).
CONCLUSIONS
Achievement of measured physical activity volumes consistent with guideline recommendations is associated with lower risk for >200 diseases, with prominent effects on cardiometabolic conditions. Associations appear similar whether physical activity follows a weekend warrior pattern or is spread more evenly throughout the week.
Additional Info
Disclosure statements are available on the authors' profiles:
Associations of "Weekend Warrior" Physical Activity With Incident Disease and Cardiometabolic Health
Circulation 2024 Sep 26;[EPub Ahead of Print], S Kany, MA Al-Alusi, JT Rämö, JP Pirruccello, TW Churchill, SA Lubitz, M Maddah, JS Guseh, PT Ellinor, S KhurshidFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Exercise daily, but, if you cannot, make it up on the weekends
A single vigorous exercise session reduces systolic and diastolic blood pressure for up to 9 hours1 and decreases fasting glucose and triglyceride levels within 24 hours of the exertion.2 Indeed, some of the beneficial effects of exercise on cardiovascular risk factors may be due to the cumulative effects of repetitive daily, or almost daily, exercise.3 On the other hand, Paul Dudley White, the Boston cardiologist and exercise advocate, recommended an hour of exercise daily and suggested that those who could not achieve that amount, should make it up on the weekend. So, is frequent exercise better for health or do “weekend warriors” accrue similar benefits from their concentrated physical activity?
Kany and colleagues examined the pattern of physical activity in 89,573 individuals in the United Kingdom Biobank to determine if the pattern of physical activity affected the 5-year cumulative incidence rates for 678 health conditions.4 Physical activity was determined objectively using wrist based accelerators worn for 7 days. Inactive people were defined as those not meeting the 2018 US Physical Activity Guidelines of at least 150 minutes/week of moderate to vigorous physical activity, such as brisk walking. Weekend warriors were defined as those accruing >50% of their recommended activity in 1 or 2 days. Importantly, given the number of health conditions examined, the results were adjusted for multiple statistical comparisons.
Health problems were reduced in both active groups compared with those individuals not meeting 2018 recommendations. The incidence was reduced for 264 medical conditions in the weekend warriors and for 209 conditions in the less concentrated exercise group, but there was no difference in the decreases for any malady between the two exercise groups. These results persisted despite using up to six other definitions for weekend warriors.
Such studies, despite statistical adjustments, can never exclude that the exercisers are somehow innately different from the sedentary individuals or that the two exercise groups are also somehow different. Conclusions are based on only a week of observation. Also, diagnoses for hospitalized patients were known for all subjects, but outpatient primary care diagnoses were available for only 45% of the participants. It is not clear how this could affect the conclusions. Nevertheless, these results should help remove one more excuse for why patients and the general public do not to achieve recommended physical activity goals. Patients should know and clinicians should recommend that, if people cannot achieve their recommended weekly goals by daily exercise, they should make it up on the weekend.
References
Kany S, Al-Alusi MA, Rämö JT, Pirruccello JP, et al. Associations of "Weekend Warrior" Physical Activity With Incident Disease and Cardiometabolic Health. 2024 Sep 26. doi:10.1161/CIRCULATIONAHA.124.068669. Online ahead of print. https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.124.068669