Does engagement in moderate to vigorous physical activity, with most activity concentrated within 1 to 2 days of the week (ie, a “weekend warrior” pattern), confer similar cardiovascular benefits to more evenly distributed physical activity?
In an analysis of 89 573 individuals providing a week of accelerometer-based physical activity data, a weekend warrior pattern of physical activity was associated with similarly lower risks of incident atrial fibrillation, myocardial infarction, heart failure, and stroke compared with more evenly distributed physical activity.
Increased activity, even when concentrated within 1 to 2 days each week, may be effective for improving cardiovascular risk profiles.
Guidelines recommend 150 minutes or more of moderate to vigorous physical activity (MVPA) per week for overall health benefit, but the relative effects of concentrated vs more evenly distributed activity are unclear.
To examine associations between an accelerometer-derived “weekend warrior” pattern (ie, most MVPA achieved over 1-2 days) vs MVPA spread more evenly with risk of incident cardiovascular events.
Design, Setting, and Participants
Retrospective analysis of UK Biobank cohort study participants providing a full week of accelerometer-based physical activity data between June 8, 2013, and December 30, 2015.
Three MVPA patterns were compared: active weekend warrior (active WW, ≥150 minutes with ≥50% of total MVPA achieved in 1-2 days), active regular (≥150 minutes and not meeting active WW status), and inactive (<150 minutes). The same patterns were assessed using the sample median threshold of 230.4 minutes or more of MVPA per week.
Main Outcomes and Measures
Associations between activity pattern and incident atrial fibrillation, myocardial infarction, heart failure, and stroke were assessed using Cox proportional hazards regression, adjusted for age, sex, racial and ethnic background, tobacco use, alcohol intake, Townsend Deprivation Index, employment status, self-reported health, and diet quality.
A total of 89 573 individuals (mean [SD] age, 62 [7.8] years; 56% women) who underwent accelerometry were included. When stratified at the threshold of 150 minutes or more of MVPA per week, a total of 37 872 were in the active WW group (42.2%), 21 473 were in the active regular group (24.0%), and 30 228 were in the inactive group (33.7%). In multivariable-adjusted models, 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: 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: 0.65 [95% CI, 0.57-0.74]; and inactive: 1.00 [95% CI, 0.91-1.10]), heart failure (active WW: 0.62 [95% CI, 0.56-0.68]; active regular: 0.64 [95% CI, 0.56-0.73]; and inactive: 1.00 [95% CI, 0.92-1.09]), and stroke (active WW: 0.79 [95% CI, 0.71-0.88]; active regular: 0.83 [95% CI, 0.72-0.97]; and inactive: 1.00 [95% CI, 0.90-1.11]). Findings were consistent at the median threshold of 230.4 minutes or more of MVPA per week, although associations with stroke were no longer significant (active WW: 0.89 [95% CI, 0.79-1.02]; active regular: 0.87 [95% CI, 0.74-1.02]; and inactive: 1.00 [95% CI, 0.90-1.11]).
Conclusions and Relevance
Physical activity concentrated within 1 to 2 days was associated with similarly lower risk of cardiovascular outcomes to more evenly distributed activity.
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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.
Accepted for Publication: June 2, 2023.
Corresponding Author: Patrick T. Ellinor, MD, PhD, Cardiac Arrhythmia Service and Cardiovascular Research Center, Massachusetts General Hospital, 55 Fruit St, GRB 109, Boston, MA 02114 (email@example.com).
Author Contributions: Dr Khurshid had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Khurshid.
Acquisition, analysis, or interpretation of data: All authors.
Drafting of the manuscript: Khurshid, Guseh, Ellinor.
Critical revision of the manuscript for important intellectual content: Al-Alusi, Churchill, Guseh, Ellinor.
Statistical analysis: Khurshid.
Obtained funding: Ellinor.
Administrative, technical, or material support: Ellinor.
Supervision: Guseh, Ellinor.
Conflict of Interest Disclosures: Dr Al-Alusi has received grants from the National Institutes of Health (NIH) (T32-HL007208). Dr Churchill reported receiving grants from the NIH. Dr Guseh reported receiving grants from the American Heart Association (19AMFDP34990046) and the President and Fellows of Harvard College (5KL2 TR002542-04). Dr Ellinor reported receiving grants from the NIH (1RO1HL092577, 1R01HL157635, and 5R01HL139731), the American Heart Association Strategically Focused Research Networks (18SFRN34110082), the European Union (MAESTRIA 965286), Bayer AG (to the Broad Institute), IBM Health (to the Broad Institute), Bristol Myers Squibb (to Massachusetts General Hospital), and Pfizer (to Massachusetts General Hospital) and personal fees from Bayer AG, Novartis, and MyoKardia. No other disclosures were reported.
Data Sharing Statement: See Supplement 2.
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