Cramming Weekly Physical Activity Into 1 or 2 Days Still Yields Benefits

So-called weekend warriors—those who cram a week’s worth of recommended physical activity into Saturday and Sunday—are at significantly lower risk for developing a host of diseases and conditions, including hypertension, diabetes, and obesity, when compared with people who are inactive, a new study has shown.

These results, say investigators, show again that it’s the total volume of exercise, rather than the pattern of physical activity, that’s most important for reducing the risk of incident disease.

“When I counsel patients, I tell them that it's important to get physical activity and to achieve those guideline-recommended levels, but the rest is up to you,” senior investigator Shaan Khurshid, MD, MPH (Massachusetts General Hospital, Boston, MA), told TCTMD. “However way you do it, do it in a way where you're going to most likely be consistent over time. If you’re doing that, you appear to be getting the benefits.”

The American Heart Association and World Heart Organization recommend at least 150 minutes of moderate-intensity physical activity, or 75 minutes of vigorous activity, each week. The groups make no mention of how best to spread that activity out over 7 days, but the National Health Service (NHS) in the United Kingdom suggests doling it out evenly throughout the week. 

The “weekend warrior” pattern, however, is increasingly common and potentially more convenient, given people’s busy lifestyles, said Khurshid. In 2023, his group showed that people concentrating their weekly recommended physical activity into 1 or 2 days derived as much cardiovascular benefit as those who exercised more consistently throughout the week. In that study, weekend warriors and regularly active people had similarly lower risks of incident atrial fibrillation, MI, heart failure, and stroke when compared with inactive people over more than 6 years of follow-up.

Other reports have supported the weekend warrior approach, with a recent meta-analysis showing that this pattern results in similar reductions in cardiovascular and all-cause mortality as regular physical activity.  

I-Min Lee, MD, ScD (Harvard Medical School, Boston, MA), who has studied the role of exercise in preventing chronic diseases and was the first to show in the Harvard Health Alumni Study that the weekend warrior pattern of physical activity was associated with a lower risk of mortality, said the results of this new analysis are “very encouraging in showing that we can be active in a pattern that fits our lifestyle.”

“[The] benefits appear similar whether ‘bunched’ or spread more evening throughout the week,” she told TCTMD in an email.

Technically, said Lee, the current study doesn’t address the weekend warrior pattern, which is typically no exercise during the week followed by a couple of hours activity on Saturday and Sunday. Instead, the pattern of moderate-to-vigorous physical activity is best described as “bunched,” in that it was concentrated over 1 to 2 days per week, which could have fallen anytime over the 7-day span, she said.

“These activities could include, for example, walking or biking to run errands or for transport rather than exercise, per se,” said Lee.

Gary O’Donovan, PhD (Universidad de los Andes, Bogotá, Colombia), who has also looked into the benefits of the weekend warrior phenomenon in US and United Kingdom cohorts, as well as most recently in the Mexico City Prospective Study, said the “study is more good news for busy people around the world.”

While none of the current guidelines advocate for concentrated physical activity, and the NHS goes against it, O’Donovan said future iterations should take the accumulating data into account and let people know that it’s alright to get their weekly dose of exercise over just a couple days.

“The evidence is much stronger now,” O’Donovan told TCTMD. “I've always thought the one-size-fits-all idea was unhelpful, and I don't understand why the policymakers don't recognize that many people enjoy taking part in sport and exercise once or twice a week and that there are huge benefits to be had.”

More Than 200 Diseases

The new study, which was published recently in Circulation, pulled back the lens to look at the risks and/or benefits of concentrated physical activity on 678 incident diseases/conditions using a phenome-wide association approach that’s analogous to what is commonly done in genome-wide association studies.

“You take one exposure, which in this case is physical activity, and you perform serial association testing across a broad number of diseases,” explained Khurshid. The risk models were adjusted for multiple baseline variables, such as age, sex, and socioeconomic status, among others, that could affect the relationship between physical activity and disease outcomes, and they also corrected for multiplicity.

In total, 89,573 participants in the UK Biobank study with accelerometer data were stratified into three groups based on activity levels and patterns: those who performed more than 150 or more minutes of moderate-to-vigorous physical activity weekly, with at least half of the exercise done over 1 or 2 days; the regularly active (≥ 150 minutes/week), and the inactive.

One-third of people were inactive, 42.2% were weekend warriors, and 24.0% were regularly active throughout the week. Those who were regularly active exercised at moderate-to-vigorous intensity for a median of 418 minutes per week, followed by weekend warriors at 288 minutes and inactive people at 72 minutes.

Both regular and concentrated physical activity patterns were broadly associated with reduced disease risk. The weekend-warrior pattern was significantly associated with 267 of all diseases tested, among which there was a lower risk of disease for all but three. With regular physical activity, there were 209 significant disease associations, among which there was a lower risk for 205; these links were largely for circulatory, metabolic, and digestive conditions. The few diseases with higher risks were mostly disorders of muscle, ligament, and fascia.

Overall, the strongest associations were observed for hypertension, diabetes, obesity, and sleep apnea. When compared with inactive people, weekend warriors and the regularly active had 23% and 28% lower risks of hypertension, respectively, and 43% and 46% lower risks of diabetes, respectively. Risks of obesity were 45% and 56% lower in the two groups.

The 5-year risks of hypertension, diabetes, obesity, and sleep apnea were similar for both regularly active and weekend warrior patterns, and these two groups had significantly lower risks when compared with inactive people. For both weekend warriors and the regularly active, the risks were lower in those who performed more exercise (ie, ranked by quartile of moderate-to-vigorous physical activity).

Khurshid said that despite testing hundreds of diseases, they were surprised to see no conditions where the effect of physical activity differed between weekend warriors and regularly active people. Future studies testing this concentrated activity pattern on public health would be warranted, according to the investigators.