The “weekend warrior” exercise pattern and cardiovascular disease risk Original paper

In this prospective cohort study, being physically active was associated with a lower risk of cardiovascular events, with benefits observed whether people concentrated 50% or more of their physical activity into 1–2 days (“weekend warriors”) or spread their physical activity more evenly throughout the week.

The relationship between a “weekend warrior” pattern of physical activity and the risk for cardiovascular events, including incident atrial fibrillation (AF), myocardial infarction (MI), heart failure (HF), and stroke.

A “weekend warrior” was defined as a person who was getting at least 150 minutes per week of physical activity, with 50% or more of it occurring during 1–2 days.

A total of 89,573 adults between 40 and 69 years old who were part of the UK Biobank prospective cohort study.

The participants wore an accelerometer (a wrist-worn device that measures physical activity volume and intensity) for 1 week. They were then characterized based on their levels of moderate-to-vigorous physical activity (MVPA) into the following categories:

• Active weekend warriors (at or above 150 minutes per week of MVPA with at least 50% of their activity occurring over 1–2 days)
• Active regular (at or above 150 minutes per week of MVPA, but not meeting weekend warrior criteria)
• Less active (less than 150 minutes of MVPA per week)

The participants were followed for a median of 6.3 years. The analyses were adjusted for age, sex, racial and ethnic background, tobacco use, Townsend Deprivation Index (socioeconomic status), alcohol intake, educational attainment, employment status, self-reported health, and diet quality.

The weekend warrior activity pattern and the active regular activity pattern were both associated with a lower risk of AF, MI, HF, and stroke, with no differences between groups. Specifically, the following findings were noted:

• The active weekend warriors had a 22% lower risk of AF, a 27% lower risk of MI, a 38% lower risk of HF, and a 21% lower risk of stroke compared to the less active group.
• The active regular group had a 19% lower risk of AF, a 35% lower risk of MI, a 36% lower risk of HF, and a 17% lower risk of stroke compared to the less active group.

“Weekend warrior” vs. regular activity patterns and cardiovascular event risk reduction

Most exercise guidelines recommend a minimum of 150 minutes of MVPA per week for adults with no health conditions. However, what’s less well defined is how this amount of activity should be distributed throughout the week. In other words, what is the optimal exercise frequency for improving health and reducing the risk for disease? Often, exercise is prescribed on 4–5 days or more per week. Working out daily or almost daily is seen as beneficial. On the other hand, concentrating most or all physical activity into 1–2 days per week — the “weekend warrior” activity pattern — is often viewed as an inferior way to accumulate physical activity.

However, a meta-analysis published in 2023^[1] synthesized all of the evidence from observational cohort studies about the “weekend warrior” activity pattern and cardiovascular disease and all-cause mortality risk. Four studies with a total of 426,428 participants were analyzed. Compared to the less active group, the “weekend warrior” activity pattern was associated with a 27% lower risk of cardiovascular disease mortality and a 17% lower risk of all-cause mortality. The regular activity pattern was associated with a 27% and 18% lower risk for cardiovascular disease and all-cause mortality, respectively, compared to the less active group.

The above findings complement those of the summarized study and suggest that “weekend warriors” experience the same benefits of exercise for cardiovascular and all-cause mortality compared to people who follow a “regular” activity pattern, as long as overall exercise levels are equal.

In addition to the risk reduction observed for at least 150 minutes per week, in the summarized study, both the “weekend warrior” and regular activity patterns reduced cardiovascular disease risk at other activity cut-off points: 115 minutes per week or more, 230 minutes per week or more, and 403 minutes per week or more were all associated with benefits.

One concern about “weekend warriors” is that they might increase their risk for injury. However, in a secondary analysis, participants with a “weekend warrior” activity pattern and those with a regular pattern had lower risks of musculoskeletal conditions compared to the less active group.

The message gleaned from these results seems to be that getting active — no matter how often — is good for your health. If you can only make time on 1–2 days per week to exercise, that’s much better than nothing and might be as good as exercising for a similar amount of time on 4–7 days per week.

A major limitation of this study is that even though physical activity was objectively measured using accelerometers, it was only assessed for a period of 1 week. This might not be enough time to reliably assess participants’ habitual patterns of physical activity and may reduce confidence in these findings.

The term “weekend warrior” as used in this study is technically a misnomer because the period of focused activity could occur on either weekends or weekdays.