CVD Risk Reduction With Exercise Also Seen in ‘Weekend Warriors’

When it comes to weekly physical activity, it doesn’t matter when you get your time in, as long as you get it done.

New research shows that weekend warriors, those getting 2 to 3 hours of physical activity on Saturdays and Sundays despite being less active during the week, derived just as much cardiovascular benefit as those who exercised more consistently.

“As physicians, we can be empowered to tell patients that every minute counts,” Shaan Khurshid, MD, MPH (Massachusetts General Hospital, Boston), told TCTMD. “The key is to acquire the overall volume that we know is healthy. It doesn’t matter so much how that’s distributed. Certain guidelines, like the National Health Service [NHS], say that it’s optimal if it’s spread out over 3 to 5 days, or even every day, but more and more we’re seeing that there isn’t that much evidence to back that up. The fewer constraints we can put on our recommendations, the easier it will be for a patient to adhere to them.”

The American Heart Association (AHA) and World Heart Organization (WHO), along with the United Kingdom’s NHS, recommend at least 150 minutes of moderate-intensity physical activity, or 75 minutes or vigorous activity, each week. The AHA and WHO don’t specify how to parcel those minutes out, but the NHS recommends a pattern that avoids concentrating physical activity over a single day or two.

Prior studies have looked into the relative benefits of different exercise patterns. In 2017, for example, researchers showed that concentrating the weekly recommended amounts of physical activity over 1 or 2 days was as good as spreading it out over the week when it came to reducing the risks of all-cause and cardiovascular mortality. One of the limitations of that study, said Khurshid, is that it was based on self-reported leisure-time physical activity, which can be unreliable.

In the new study, which was published last week in JAMA, the researchers analyzed data from 89,573 participants who wore a wrist-based accelerometer for 1 week as part of the prospective UK Biobank study. Moderate-vigorous physical activity (MVPA) included a broad range of activities, such as walking, running, and cycling, among others. Individuals were classified as weekend warriors if they exceeded the recommended MVPA threshold of 150 minutes per week with 50% or more of that activity done over 1 or 2 days.

The fewer constraints we can put on our recommendations, the easier it will be for a patient to adhere to them. Shaan Khurshid

Overall, 42.2% of the cohort were considered weekend warriors while 24.0% were regularly active (met the MVPA target with activity spread over 7 days). The remaining one-third of subjects were inactive. 

In a multivariable-adjusted model, weekend warriors and regularly active participants had similarly lower risks of incident atrial fibrillation (AF), MI, heart failure (HF), and stroke compared with inactive people over a median follow-up of 6.3 years. Among the weekend warriors, the risks of AF, MI, HF, and stroke were 22%, 27%, 28%, and 21% lower, respectively, when compared with inactive participants. The findings were consistent when investigators used the guideline-based exercise recommendation and median thresholds seen UK Biobank (≥ 150 and ≥ 230.4 minutes per week, respectively), although the reduction in stroke was no longer statistically significant at the higher MVPA threshold.

In an editorial, Peter Katzmarzyk, PhD (Pennington Biomedical Research Center, Baton Rouge, LA), and John Jakicic, PhD (University of Kansas Medical Center, Kansas City, MO), say the new findings “highlight the flexibility with which physical activity can be accumulated to achieve health benefits, which should further enhance opportunities for engagement for large segments of the population.” 

For researchers, the study shows the weekend-warrior exercise pattern is common, but that no matter how individuals get their weekly MPVA minutes in, physical activity can reduce risk across a broad spectrum of cardiovascular diseases. To TCTMD, Khurshid said there might be concerns about musculoskeletal injury in weekend warriors, but they did not see any heightened risk when compared with the more regularly active group.

“In fact, we saw a similarly lower risk of musculoskeletal issues with both weekend warrior and regular physical activity, which is consistent with prior data showing that exercise is actually good for your musculoskeletal health,” said Khurshid. “That’s encouraging. At the same time, I don’t want people to interpret this by going zero to 60, for them to suddenly become a major weekend warrior where they’re exercising for 3 hours a day when they haven’t done it before. Take it gradually, listen to your body.”

Like with all recommendations, Khurshid said that if people are embarking on a new exercise regime, it’s always best to discuss the plans with their doctor.