'Weekend Warriors' Have Lower Risk for All-Cause Death

Ricki Lewis, PhD

January 09, 2017

Exercising in "weekend warrior" mode for just one or two sessions a week lowers the risk for all-cause mortality and death from cardiovascular disease (CVD) or cancer compared with no exercise, according to results of a study published online January 9 in JAMA Internal Medicine.

The minimal weekly level of leisure time exercise for those aged 18 to 64 years, according to the World Health Organization, is 150 minutes of moderate-intensity aerobic activity or 75 minutes of vigorous-intensity aerobic activity. Such activity, spread over several days during the week, is known to reduce the risk for CVD, cancer, and all-cause mortality.

However, it has not been clear whether concentrating that amount of exercise into one or two sessions, as "weekend warriors" often do, provides the same benefits.

To find out, Gary O'Donovan, PhD, from Loughborough University, England, and colleagues analyzed data from 63,591 respondents to the Health Survey for England and the Scottish Health Survey between 1994 and 2012. The surveys selected households based on geography, and the British National Health Service Central Registry identified participants who died. The researchers probed associations between exercise patterns and the risk for death from all causes, CVD, and cancer.

Participants were at least 40 years of age to exclude cardiac deaths resulting from congenital conditions. Interviewers collected information, which included sports, exercise, and domestic activities that had occurred during the previous 4 weeks.

Participants were divided into four groups according to exercise habits: inactive (no reported moderate or vigorous activity or exercise), insufficiently active (<150 minutes per week of moderate activity or <75 minutes of vigorous activity), regularly active (≥150 minutes per week of moderate activity or 75 minutes of vigorous activity from 3 or more sessions), or weekend warrior (≥150 minutes per week of moderate activity or 75 minutes of vigorous activity in one or two sessions).

Mean age of participants was 58.6; 45.9% were men and 44.1% were women. At the start, 39,947 (62.8%) were inactive, 14,224 (22.4%) were insufficiently active, 2341 (3.7%) were weekend warriors, and 7079 (11.1%) were regularly active. Mean body mass index was similar among the groups.

The weekend warriors were about evenly split over whether they crammed their workouts or activities into one or two sessions: 45.0% in one and 55.0% in two.

Men comprised more of the weekend warrior classification. Sports were more popular among the weekend warriors (2201 [94.0%]) compared with among the participants reporting regular activity (5309 [75.0%]. Walking briskly or fast was also popular, reported from 726 (31.0%) of weekend warriors and 5168 (73.0%) of the regularly active participants.

Inactive participants were older and more likely to smoke, have chronic illness, and perform unskilled work.

Although weekend warriors spent on average 300 minutes per week in moderate or vigorous activity compared with 450 minutes per week for participants reporting regular activity, the weekend warriors spent a greater proportion of their workout time at the vigorous level.

The results indicate that any exercise is better than none.

Among the 63,591 participants, 8802 died from all causes, 2780 from CVD, and 2526 from cancer.

In fully adjusted models, risk for all-cause death was 30% lower among weekend warriors compared with inactive participants (hazard ratio [HR], 0.70; 95% confidence interval [CI], 0.60 - 0.82); risk for CVD death was 40% lower (HR, 0.60; 95% CI, 0.45 - 0.82), and risk for cancer death was 18% lower ( HR, 0.82; 95% CI, 0.63 - 1.06).

Similar risk reductions emerged for the insufficiently active group compared with inactive participants: for all-cause mortality, risk reduction was 31% (HR, 0.69; 95% CI, 0.65 - 0.74), it was 37% for CVD death (HR, 0.63; 95% CI, 0.55 - 0.72), and 14% for cancer death (HR, 0.86; 95% CI, 0.77 - 0.96).

Reductions among those who regularly exercise compared with the inactive group were 35% (HR, 0.65; 95% CI, 0.58 - 0.73) for all-cause mortality, 41% (HR, 0.59; 95% CI, 0.48 - 0.73) for CVD death, and 21% (HR, 0.79;95% CI, 0.66 - 0.94) for cancer death.

"One of the most striking findings in the present study was that 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 adherence to prevailing physical activity guidelines," the researchers conclude. The investigation also showed that weekend warriorhood is similarly beneficial in women and men.

"The encouraging news emerging from this new report is that for those who exercise less frequently, meeting the guidelines minimum in only 1 to 2 sessions per week yields some mortality benefit," write Hannah Arem, PhD, and Loretta DiPietro, PhD, from the Milken Institute School of Public Health at George Washington University, Washington, DC, in an invited commentary.

"The authors should be commended for this important contribution to the literature on the importance of frequency of physical activity, and we hope that future studies will continue to explore these questions to better inform national and international guidelines," they conclude.

Limitations of the study include the self-reporting of activity, lack of generalizability from the 90% white respondents, and demonstrating association, not causation.

The investigators and the commentators have disclosed no relevant financial relationships.

JAMA Intern Med. Published online January 9, 2017. Article full text, Commentary full text

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