Effects of physical activity all week versus weekend only on mortality risk

In an analysis of 2 large prospective cohorts, exercising ≥150 min weekly was associated with reduced rates of all-cause, CV, and cancer mortality compared with inactivity. It did not matter if participants were active throughout the week or mostly during 1–2 days (“weekend warrior”).

This summary is based on the publication of Ren R, Wang W, Liu Q, et al. - Dual Cohort Insights Into Accelerometer-Derived Weekend Warrior Physical Activity and Its Impact on Mortality. J Am Heart Assoc. 2025 May 26:e039852 [Online ahead of print]. doi: 10.1161/JAHA.124.039852.

Introduction and methods

Background

As moderate‐to‐vigorous physical activity (MVPA) reduces the risks of all‐cause mortality, CV death, and cancer mortality [1-3], PA guidelines recommend ≥150 min of moderate aerobic exercise weekly [4-6]. However, it is unclear whether condensing an equivalent total MVPA time into 1–2 sessions weekly (hereafter called “weekend warrior” activity) or dispersing it more evenly throughout the week result in a similar mortality risk reduction.I

Aim of the study

The authors examined the relationships of weekend warrior versus evenly spread MVPA (based on accelerometer measurements) with the risks of all-cause, CV, and cancer mortality.

Methods

Accelerometer-based PA data were collected from 2 prospective, longitudinal, observational cohort studies: the UK Biobank (time period 2013–2015; n=89,488) and the US National Health and Nutrition Examination Survey (NHANES; 2003–2006; n=6198). Median follow‐up periods were 6.9 and 6.0 years, respectively. Mortality data were derived from national death registries. Study participants were divided into 3 categories: active weekend warrior (i.e., ≥150 min MVPA weekly with ≥50% over any 1–2 days), regularly active (i.e., ≥150 min MVPA weekly with a more even distribution throughout the week), and inactive (i.e., <150 min MVPA weekly).

Main results

• In the UK Biobank cohort, Cox regression analysis adjusted for baseline variables such as age, sex, BMI, smoking status, healthy diet, and comorbidity score showed the risk of all-cause mortality was lower in weekend warriors (adjusted HR (aHR): 0.70; 95%CI: 0.65–0.75) and regularly active participants (aHR: 0.78; 95%CI: 0.71–0.85) compared with inactive participants.
• Compared with inactive participants, the risk of CV death was also decreased in weekend warriors (aHR: 0.67; 95%CI: 0.57–0.80) and those with regular activity throughout the week (aHR: 0.73; 95%CI: 0.59–0.90), as was the cancer mortality risk (aHR: 0.79; 95%CI: 0.71–0.87 vs. aHR: 0.83; 95%CI: 0.73–0.94).
• When PA was defined as the median of MVPA or the 25th or 75th percentile of the sample, comparable findings were observed.
• Similar results were found in the US NHANES cohort, with significantly lower mortality risks at the guideline-recommended MVPA threshold (150 min) and sample 25th percentile threshold.

Conclusion

This analysis of 2 large prospective UK and US cohorts showed MVPA concentrated within 1–2 days or dispersed more evenly throughout the week was associated with similar risk reductions of all-cause, CV, and cancer mortality compared with inactivity. According to the authors, “[t]his implies that cumulative PA volume, rather than frequency or temporal distribution, is the principal determinant of health outcomes.” In addition, they offer the following advice: “Individuals can select an approach that best aligns with their daily routines.”

Find this article online at J Am Heart Assoc.

References

1. Sattelmair J, Pertman J, Ding EL, Kohl HW, Haskell W, Lee IM. Dose response between physical activity and risk of coronary heart disease: a meta-analysis. Circulation. 2011;124:789–795. doi: 10.1161/CIRCULATIONAHA.110.010710
2. Hupin D, Roche F, Gremeaux V, Chatard JC, Oriol M, Gaspoz JM, Barthélémy JC, Edouard P. Even a low-dose of moderate-to-vigorous physical activity reduces mortality by 22% in adults aged ≥60 years: a systematic review and meta-analysis. Br J Sports Med. 2015;49:1262–1267. doi: 10.1136/bjsports-2014-094306
3. Stamatakis E, Ahmadi MN, Friedenreich CM, Blodgett JM, Koster A, Holtermann A, Atkin A, Rangul V, Sherar LB, Teixeira-Pinto A, et al. Vigorous intermittent lifestyle physical activity and cancer incidence among nonexercising adults: the UK biobank accelerometry study. JAMA Oncol. 2023;9:1255–1259. doi: 10.1001/jamaoncol.2023.1830
4. Bull FC, Al-Ansari SS, Biddle S, Borodulin K, Buman MP, Cardon G, Carty C, Chaput JP, Chastin S, Chou R, et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med. 2020;54:1451–1462. doi: 10.1136/bjsports-2020-102955
5. Department of Health and Social Care. UK chief medical officers’ physical activity guidelines. 2019 Accessed July 23, 2024. https://www.gov.uk/government/publications/physical-activity-guidelines-uk-chief-medical-officers-report.
6. Arnett DK, Blumenthal RS, Albert MA, Buroker AB, Goldberger ZD, Hahn EJ, Himmelfarb CD, Khera A, Lloyd-Jones D, McEvoy JW, et al. ACC/AHA guideline on the primary prevention of cardiovascular disease: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. Circulation. 2019;140:e596–e646. doi: 10.1161/CIR.0000000000000678