Associations of "Weekend Warrior" Physical Activity With Incident Disease and Cardiometabolic Health

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.

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.

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).

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.