14th August 2022, Dr Chee L Khoo
We all know that regular physical activities is associated with lower ill-health and mortality and better quality of life. International guidelines suggest adults perform from 150 to 300 minutes per week (min/wk) of moderate-intensity aerobic physical activity, 75 to 150 min/wk of vigorous-intensity aerobic physical activity, or an equivalent combination of both intensities (1). There is further recommendations of no more 2 days without exercises which means, we should spread out the exercise days. Unfortunately, we all live busy lives and trying to do exercises during the week can be difficult to achieve to some patients. Can we do all the 150-300 mins on the weekend or do we have to spread them out during the week?
There are studies comparing regular physical activity (i.e. physical activity spread out over the week) with inactive people. A meta-analysis of epidemiologic studies of physical activity suggests that both moderate- and vigorous intensity activity may offer similar benefits on all-cause mortality, although vigorous intensity is advocated by exercise professionals to induce larger gains in physical fitness (2) The minimum frequency of weekly physical activity associated with lower all-cause mortality is unknown (1).
There are studies that have investigated whether the same amount of physical activity concentrated in 1 or 2 sessions per week (ie, weekend warrior pattern) or spread over multiple sessions during the week (ie, regularly active pattern). The Harvard Alumni Health Study,6 men who followed a regularly active physical activity pattern had a 36% lower all-cause mortality compared with physically inactive participants (1). In a pooled study of 11 cohorts with more than 60 000 participants, weekend warrior activity patterns were associated with a 30% lower risk of all-cause mortality, a 41% lower risk of cardiovascular disease (CVD) mortality, and a 13% lower risk of cancer mortality compared with participants reporting no moderate to vigorous physical activity (MVPA)(4).
In a National Health and Nutrition Examination Survey, 2003-2005, accelerometer-based study, weekend warrior physical activity pattern was associated with 69% lower all-cause mortality (HR 0.31; 95% CI, 0.17-0.57). (5)
In a study by O’Donovan et al,7 weekend warriors were compared with participants who reported no MVPA, HR for CVD mortality was 0.60 (95% CI, 0.45-0.82) in weekend warrior participants and 0.59 (95% CI, 0.48-0.73) in regularly active participants (4).
However, studies comparing regular physical activity with weekend warriors are limited. dos Santos M et al examined the association of weekend warriors and regularly active leisure-time physical activity patterns with all-cause, CVD and cancer mortality (6). 481 566 adults (18-84 years old) with data from the 1997 to 2013 from the US National Health Interview Survey (NHIS) were linked to the National Death Index records through December 31, 2015.
Participants were classified according to the level and pattern of their physical activity: physically active (moderate to vigorous physical activity (MVPA) ≥150 min/wk) and inactive (MVPA <150 min) per WHO guidelines for physical activity and sedentary behaviors.3 The physically active group was further classified according to the frequency of MVPA sessions per week: weekend warrior (≤2 sessions/wk) or regularly active (≥3 sessions/wk). Intensity and duration of the sessions were also taken into account and adjusted accordingly.
When they compared weekend warriors with physically inactive participants, there was a 15% reduction in all-cause mortality.
Amongst 350 978 participants, the average age was 41.4 years. Weekend warriors were younger, more likely to be men, Hispanic, current smokers, overweight or obesity, and have lower educational attainment and income compared with regularly active participants. Median physical activity was 240 min/wk in the weekend warrior group vs 420 min/wk in the regularly active group. During a median of 10.4 years of follow-up (3.6 million person-years), 21 898 deaths were ascertained, including 4130 from CVD and 6034 from cancer. They excluded the first two years of follow-up.
Compared with physically inactive participants, multivariable-adjusted HRs for all-cause mortality were 0.92 (95% CI, 0.83-1.02) for weekend warrior and 0.85 (95% CI, 0.83-0.88) for regularly active participants. Regarding mortality, there were non-statistically significant associations between weekend warrior vs inactive participants. HRs for CVD mortality were 0.87 (95% CI, 0.66-1.15) for weekend warrior and 0.77 (95% CI, 0.71-0.84) for regularly active participants. HRs for cancer mortality were 0.94 (95% CI, 0.77-1.15) for weekend warrior and 0.88 (95% CI, 0.83-0.94) for regularly active participants.
Regularly active participants with longer durations of sessions and intensity of physical activity had lower all-cause and cause-specific mortality rates compared with inactive participants (Table 3). Longer session duration was associated with lower all-cause mortality.
When comparing weekend warrior with inactive participants, higher frequency (2 vs 1 session/wk) and intensity of physical activity were not associated with lower mortality.
When they compared weekend warriors with regularly active participants, HRs for weekend warrior vs regularly active participants were 1.08 (95% CI, 0.97-1.20) for all-cause mortality, 1.14 (95% CI, 0.85-1.53) for CVD mortality, and 1.07 (95% CI, 0.87-1.31) for cancer mortality. The difference was not statistically significant which means there were essentially no difference whether the exercises you do is spread out during the week or you only do exercises on the weekend.
In summary, it would seem from the study from dos Santos M et al that regularly active participants and weekend warriors have all-cause, cardiovascular and cancer mortality benefits compared with inactive participants. 1 or 2 sessions per week of moderate- or vigorous-intensity leisure time physical activity was sufficient to reduce all-cause, CVD, and cancer mortality risks regardless of whether the exercise sessions were spread over the week or performed only on the weekend.
References:
- Bull FC, Al-Ansari SS, Biddle S, et al.World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med. 2020;54 (24):1451-1462. doi:10.1136/bjsports-2020-102955
- Rey Lopez JP, Sabag A, Martinez Juan M, Rezende LFM, Pastor-Valero M. Do vigorous-intensity and moderate-intensity physical activities reduce mortality to the same extent? a systematic review and meta-analysis. BMJ Open Sport Exerc Med. 2020;6(1):e000775. doi:10.1136/bmjsem-2020-000775
- Lee IM, Sesso HD, Oguma Y, Paffenbarger RS Jr. The “weekend warrior” and risk of mortality. Am J Epidemiol. 2004;160(7):636-641. doi:10.1093/aje/kwh274
- O’Donovan G, Lee IM, Hamer M, Stamatakis E. Association of “weekend warrior” and other leisuretime physical activity patterns with risks for all-cause, cardiovascular disease, and cancer mortality. JAMA Intern Med. 2017;177(3):335-342. doi:10.1001/jamainternmed.2016.8014
- National Center for Health Statistics. Health Care Surveys. Accessed August 3, 2022. https://www.cdc.gov/nchs/ahcd/ahcd_confidentiality.htm
- dos Santos M, Ferrari G, Lee DH, et al. Association of the “Weekend Warrior” and Other Leisure-time Physical Activity Patterns With All-Cause and Cause-Specific Mortality: A Nationwide Cohort Study. JAMA Intern Med. 2022;182(8):840–848. doi:10.1001/jamainternmed.2022.2488