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

BACKGROUND: 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.