Weekend Warriors vs Regular Exercisers: Some Insights, More Questions

Routinely cramming the recommended week’s worth of physical activity into a couple of days may lead to the same life-extending benefits as spacing out workouts, according to new prospective data.

Prior studies have also shown health and cardiovascular benefits achieved by so-called “weekend warriors”—those who meet physical activity guidelines in only one or two sessions per week—compared with those not meeting physical activity guidelines at all. For adults, both the US Department of Health and Human Services and the World Health Organization currently recommend 150-300 minutes of moderate-intensity or 75-150 minutes of vigorous-intensity physical activity per week.

“The foremost findings of this study, based on three mortality outcomes, reinforce the importance of reaching the recommended levels of physical activity for health,” write the authors, led by Mauricio dos Santos, MSc (Universidade Federal de São Paulo, Brazil).

This should help physicians counselling individual patients, as well as health policy makers, while also lending support to the idea that activities don’t need to be daily, so long as the recommended duration and intensity are met. “This is good news considering that the weekend warrior physical activity pattern may be a more convenient option for many people striving to achieve the recommended levels of physical activity,” the researchers say.

No Differences in Mortality Risk

For the study, published online today in JAMA Internal Medicine, dos Santos and colleagues included 350,978 adults (mean age 41.4 years; 50.8% women) from the US National Health Interview Survey without chronic illness at baseline then divided them according to whether they did the recommended amount of weekly physical activity or not. Those meeting recommendations were further divided according to whether they were active just one or two days per week or active three days or more.

Compared with physically inactive participants, regularly active participants were younger and more likely to be men, leaner, never or former smokers, and current drinkers and to have a higher education level and income, fewer comorbidities, and better self-rated health. Their median physical activity was 420 minutes per week. By contrast, those in the weekend warrior group had median weekly physical activity levels of 240 minutes and compared to the regularly active patients were more likely to be younger, male, Hispanic, current smokers, overweight or obese, less educated, and have lower incomes.

Over a median 10.4 years of follow-up, 21,898 participants died (6.2%), including 4,130 (18.8%) from CVD and 6,034 (27.6%) from cancer. Compared with those who were physically inactive, weekend warriors had similar adjusted risks of all-cause (HR 0.92; 95% CI 0.83-1.02), cardiovascular (HR 0.87; 95% CI 0.66-1.15), and cancer mortality (HR 0.94; 95% CI 0.77-1.15). Physically active participants, by contrast, had significantly lower adjusted risks for all three mortality endpoints.

A different pattern emerged in an analysis comparing the two groups of physically active adults. Here, weekend warriors had similar risks of all-cause (HR 1.08; 95% CI 0.97-1.20), cardiovascular (HR 1.14; 95% CI 0.85-1.53), and cancer mortality (HR 1.07; 95% CI 0.87-1.31) as the regularly active adults.

According to the authors, those findings suggest “that when performing the same amount of physical activity, spreading it over more days or concentrating it into fewer days may not influence mortality outcomes.”

They acknowledge some degree of bias given that physical activity was all self-reported, and comment that the low number of deaths in the weekend warrior group “may explain part of the nonsignificant associations with mortality.” Also, dos Santos and colleagues say their study was limited given that it only obtained physical activity status at baseline, meaning that some participants may not have kept up with their weekend warrior status over time.

Keith Diaz, PhD (Columbia University Irving Medical Center, New York, NY), however, told TCTMD he’s not convinced. While the message that “all exercise counts” is important, “they had conflicting results that don't really add up to a consistent message,” he said. In fact, “their hazard ratios trend in the direction that would suggest that weekend warrior actually is more harmful than helpful.”

Although the study helps fill a gap in that it looks at exercise patterns and outcomes in a group of healthy adults without preexisting disease, “what would have been really helpful for me is [if they showed] the weekend warriors have lower risk compared to the any activity group,” Diaz said. “I wish there was a clearer message to walk away from here with this, but it wasn't there.”

His hesitation with promoting the weekend warrior lifestyle is that previous work has shown this behavior can increase the risk of musculoskeletal injury given that these people tend to not exercise at all during week “and then go extreme during the weekend.

“That's where the concern about the weekend warrior is that it may not be the best thing for somebody to do, especially if they're just starting out,” Diaz added. “It's not something that you'd have a doctor recommend off the bat.”

However, if a physician is faced with a patient who says they can only exercise for 2 days at the most, that’s where “you have to have an honest conversation about yes, that's beneficial, it's helpful, it's going to lower your risk of chronic disease,” he said. “But acknowledge that there likely is some higher risk of musculoskeletal complications or injury. And you live with that because you're not guaranteed you're going get an injury and the benefits outweigh the risk. . . . It's better than nothing. The worst is not to do anything.”

In the future, Diaz called for clinical trials comparing weekend warrior patterns of physical activity with those more spaced out. He would also like to see more studies incorporate wearable devices into tracking physical activity so the results are less likely to be confounded by self-reporting, as well as research looking at patterns of physical activity over time.