Weekend Warriors Also See Mortality Benefits With Exercise

Concentrating the weekly recommended amount of moderate-to-vigorous physical activity (MVPA) over a couple of days is associated with a significantly lower risk of mortality when compared with inactivity, and a similarly low risk of mortality when contrasted with a more evenly spread-out pattern, according to a new analysis.

The study, which was led by Dan-Qing Liao, MD, and Hong-Min Li, MD (Southern Medical University, Guangzhou, China), and published this week in the Journal of the American Heart Association, provides yet more reassurance for busy people with so-called “weekend warrior” exercise habits, say investigators.   

“The finding that MVPA concentrated within 1 or 2 days per week can yield similar mortality benefits to more evenly distributed activity may motivate individuals to adopt [physical activity] patterns that better fit their lifestyles,” write the investigators. “Clinicians and public health practitioners should consider advising individuals that it is feasible to achieve [physical activity], whether spread out over several days or concentrated into fewer days each week, thereby offering comparable health benefits.”

Emerging research has shown that people who cram a week’s worth of physical activity into a day or two—typically over the weekend when they’re not working—derive the same health benefits as those who get in their exercise over the course of a week. There are several reports showing that the weekend-warrior pattern is associated with similarly lower risks of all sorts of diseases, including cardiovascular disease, compared with when exercise is spread out more evenly and contrasted against physical inactivity.     

The American Heart Association and World Health Organization recommend at least 150 minutes of MVPA, or 75 minutes of vigorous activity, each week and the groups make no mention of how best to spread that activity out over 7 days. The National Health Service in the United Kingdom, however, suggests spacing it out evenly throughout the week.

Shaan Khurshid, MD (Massachusetts General Hospital, Boston, MA), who has investigated the weekend-warrior pattern, said the current data support the idea to get the recommended amount of exercise any way possible.

“Given the importance of maintaining exercise over time, I think it makes sense to focus on a pattern that is sustainable,” he told TCTMD. “I do agree that older recommendations specifically mentioning the importance of spreading the volume out do seem at odds with the data at this point.”

Setor Kunutsor, PhD (University of Manitoba, Winnipeg, Canada), who wasn’t involved in the new study, believes the current evidence is “good enough, albeit based on observational studies which do not imply causality,” that guidelines could recommend people get their weekly recommended exercise in a way that best suits their schedules.

“However, I would rather tell people that the regular pattern is preferable,” he told TCTMD. “You can adopt the ‘weekend approach’ if your busy schedule doesn’t allow for regular physical activity. Any physical activity is better than none. We also need to caution people that weekend-warrior physical activity patterns are more likely to be associated with musculoskeletal injuries and may not be suitable for people with chronic conditions such as diabetes.”

Mortality Findings

The new study included 93,409 participants (mean age 62.4 years; 56.4% women) in the UK Biobank substudy who wore an accelerometer for 7 days. More than 42% of people were weekend warriors, which was defined as achieving the recommended amount of MVPA with 50% or more of the activity concentrated over 1 or 2 days per week. In addition, 23.6% were active, defined as getting the recommended amount of MVPA but with 50% or more of the activity spread over 3 or more days, and 33.8% were inactive. The weekend warriors, compared with the inactive people, were younger, were more likely to be men, and had a lower body mass index (BMI) and prevalence of diabetes.

After adjustment, the weekend warriors and regularly active participants had significant 32% and 26% lower risks of all-cause mortality, respectively, compared with the inactive people over a median 8.1 years of follow-up. They also had significant 31% and 24% lower risks of cardiovascular mortality and 21% and 13% lower risks of cancer mortality, respectively. The findings were consistent across different amounts of MVPA, suggesting that physical activity is protective even when people fail to achieve the recommended targets, say researchers.

There was no significant difference in the risk of mortality between the regularly active individuals and weekend warriors. 

In 2022, Kunutsor and colleagues published a meta-analysis of observational studies investigating the relationship between weekend-warrior and regularly active exercise patterns in more than 425,000 participants. Like the present analysis, both activity patterns were associated with significantly lower risks of all-cause and cardiovascular mortality compared with physical inactivity.

To TCTMD, Kunutsor noted that while the observational research has shown similar benefits between regular activity and the weekend-warrior pattern, there are reasons to believe that more regular activity might still yield greater health benefits. For example, there is evidence that regular activity might lead to a more favorable cardiovascular risk profile, such as improved lipids, lower blood pressure, lower BMI, lower HbA1c levels, and less inflammation. It could also lead to better cardiorespiratory fitness.

“Every sustained bout of aerobic exercise has acute physiological effects that may last for 24 hours,” he said. “Most of the beneficial effects of physical activity are acute—for example, reductions in blood pressure and lipids—and need to be sustained by regular physical activity.”

Get out and move more, aiming for those guideline-recommended levels of at least 150 minutes per week. Shaan Khurshid

In their analysis, Khurshid found that weekend warriors tended to do less exercise than those who spread physical activity out more evenly (288 vs 418 minutes per week of regular activity). Even in UK Biobank, weekend warriors performed less MVPA (349 vs 486 minutes per week). While that make sense, the difference in the amount of exercise does not affect disease risk nor mortality, “which is the most important thing,” he said.  

Higher total MVPA does appear to lower the amount of visceral fat, a phenomenon they observed in one study using MRI, said Khurshid.

“For some things that are particularly dose-responsive to MVPA, such as visceral fat, getting the highest MVPA levels possible does seem particularly important, and this does appear more easily achievable with regular activity,” said Khurshid. “With that said, even the differences in fat were no longer apparent after adjusting for total MVPA. So, for a given volume of exercise, it again does not appear to matter whether it is [a weekend warrior pattern] or regular physical activity.”

The bottom line, said Khurshid, is to “get out and move more, aiming for those guideline-recommended levels of at least 150 minutes per week.” As long as it’s done in a way that people can do consistently, the benefits of exercise can accrue over months, years, and decades, he said.