'Weekend warrior' and regularly active physical activity patterns confer similar cardiovascular and mortality benefits: a systematic meta-analysis

It is well documented that physical activity (PA) is associated with a lower risk of non-communicable diseases including cardiovascular disease (CVD) as well as mortality.1–3 Previous PA guidelines as well as recent guidelines by the World Health Organization have recommended that all adults should aim for 150–300 min of moderate intensity PA per week or 75–150 min of vigorous intensity PA per week or an equivalent combination of moderate-intensity and vigorous-intensity PA per week.4 Evidence suggests these levels provide substantial health benefits in most people.2 Despite guideline recommendations and population-wide strategies to promote PA levels, most populations do not adhere to PA recommendations. A major reason for the low levels of adherence is the lack of time. The balance between frequency, duration, and intensity, which are components of PA, plays an important part in the protective effects of PA. To derive maximal benefits from PA, an appropriate intensity, frequency, and duration, which comprise the volume is essential. However, emerging evidence suggests that the intensity of PA may be more important than the quantity (frequency or duration).5 It is uncertain if the majority of PA concentrated into a few days confers similar cardiovascular benefits as that spread over more days. Following the seminal study by Lee et al.,6 a few recent reports have evaluated whether guideline recommended PA patterns concentrated in one or two sessions per week (commonly called the ‘weekend warrior’ pattern) or patterns spread over multiple sessions per week (i.e. regularly active pattern) may differ with respect to cardiovascular outcomes and mortality. Some studies have reported similar benefits,7 whereas other reports suggest that regularly active PA patterns confer more benefits than weekend warrior PA patterns.6,8 Given the sparseness and inconsistency of the data, there is a need to systematically synthesize the existing evidence. Furthermore, given the relatively low sample size of some of these previous studies, pooling the overall evidence will provide adequate power to reveal any true associations. In this context, we aimed to assess and compare the associations of weekend warrior and regularly active PA patterns vs. inactive PA patterns with the risk of adverse cardiovascular outcomes using a systematic review and meta-analysis of all published observational cohort studies conducted on the topic.