Accelerometer-Derived "Weekend Warrior" Physical Activity and Incident Cardiovascular Disease

Abstract

Importance: Guidelines recommend 150 minutes or more of moderate to vigorous physical activity (MVPA) per week for overall health benefit, but the relative effects of concentrated vs more evenly distributed activity are unclear.

Objective: To examine associations between an accelerometer-derived "weekend warrior" pattern (ie, most MVPA achieved over 1-2 days) vs MVPA spread more evenly with risk of incident cardiovascular events.

Design, setting, and participants: Retrospective analysis of UK Biobank cohort study participants providing a full week of accelerometer-based physical activity data between June 8, 2013, and December 30, 2015.

Exposures: Three MVPA patterns were compared: active weekend warrior (active WW, ≥150 minutes with ≥50% of total MVPA achieved in 1-2 days), active regular (≥150 minutes and not meeting active WW status), and inactive (<150 minutes). The same patterns were assessed using the sample median threshold of 230.4 minutes or more of MVPA per week.

Main outcomes and measures: Associations between activity pattern and incident atrial fibrillation, myocardial infarction, heart failure, and stroke were assessed using Cox proportional hazards regression, adjusted for age, sex, racial and ethnic background, tobacco use, alcohol intake, Townsend Deprivation Index, employment status, self-reported health, and diet quality.

Results: A total of 89 573 individuals (mean [SD] age, 62 [7.8] years; 56% women) who underwent accelerometry were included. When stratified at the threshold of 150 minutes or more of MVPA per week, a total of 37 872 were in the active WW group (42.2%), 21 473 were in the active regular group (24.0%), and 30 228 were in the inactive group (33.7%). In multivariable-adjusted models, both activity patterns were associated with similarly lower risks of incident atrial fibrillation (active WW: hazard ratio [HR], 0.78 [95% CI, 0.74-0.83]; active regular: 0.81 [95% CI, 0.74-0.88; inactive: HR, 1.00 [95% CI, 0.94-1.07]), myocardial infarction (active WW: 0.73 [95% CI, 0.67-0.80]; active regular: 0.65 [95% CI, 0.57-0.74]; and inactive: 1.00 [95% CI, 0.91-1.10]), heart failure (active WW: 0.62 [95% CI, 0.56-0.68]; active regular: 0.64 [95% CI, 0.56-0.73]; and inactive: 1.00 [95% CI, 0.92-1.09]), and stroke (active WW: 0.79 [95% CI, 0.71-0.88]; active regular: 0.83 [95% CI, 0.72-0.97]; and inactive: 1.00 [95% CI, 0.90-1.11]). Findings were consistent at the median threshold of 230.4 minutes or more of MVPA per week, although associations with stroke were no longer significant (active WW: 0.89 [95% CI, 0.79-1.02]; active regular: 0.87 [95% CI, 0.74-1.02]; and inactive: 1.00 [95% CI, 0.90-1.11]).

Conclusions and relevance: Physical activity concentrated within 1 to 2 days was associated with similarly lower risk of cardiovascular outcomes to more evenly distributed activity.

Figure 1.. Distribution of Moderate to Vigorous Physical Activity (MVPA) on Top 2 Days vs Remaining 5 Days Among Active Individuals Using Guideline-Based Activity Threshold of 150 Minutes or More of MVPA Per Week

Depicted is the distribution of daily MVPA on the 2 most active days of the week (blue), vs the remaining 5 days (yellow), among individuals with activity above the guideline-based threshold (ie, ≥150 minutes MVPA over the week,^,, n = 59 345). A, Individuals meeting criteria for weekend warrior activity (ie, ≥50% of total MVPA achieved in 1-2 days) are shown. B, Active individuals not meeting criteria for weekend warrior activity (regular) are shown. A total of 431 individuals in the weekend warrior group (1.1%) with a value of zero for the remaining 5 days were attributed 1 minute of MVPA to accommodate logarithmic x-axis scale.

Figure 2.. Associations Between Physical Activity Pattern and Incident Cardiovascular Disease

Depicted are plots of multivariable-adjusted associations between activity pattern and incident atrial fibrillation, myocardial infarction, heart failure, and stroke. Three activity groups are compared: active weekend warrior (active WW), active regular, and inactive (reference). Each plot depicts a different activity threshold used to define the inactive group (see title above each plot). Bars depict 95% CIs.