"Weekend Warriors" Have Similar Heart Health Benefits Compared With Those Who Exercise Daily

In this video, Shaan Khurshid, MD, MPH, talks about his team's study that analyzed a database of nearly 90,000 people and found that concentrated physical activity (1-2 days per week) offers similar heart health benefits compared with physical activity that is distributed more evenly throughout the week.

Additional Resource: 

• Khurshid S, Al-Alusi MA, Churchill TW, Guseh JS, Ellinor PT. Accelerometer-Derived "Weekend Warrior" Physical Activity and Incident Cardiovascular Disease. JAMA. 2023;330(3):247-252. doi:10.1001/jama.2023.10875

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TRANSCRIPTION:

Shaan Khurshid, MD, MPH: My name is Dr. Shaan Khurshid and I am a staff electrophysiologist at Massachusetts General Hospital.

Consultant360:  What was the impetus for this study? Why now?

Dr. Khurshid: Yeah, so the Weekend Warrior pattern or concentrated physical activity pattern has been studied before, but prior studies have been smaller in scope and limited by the fact that they rely primarily on self-reported or questionnaire responses, which we know that people tend to overestimate their own activity when you ask them. And so we leveraged a relatively recently available unique resource of nearly 90,000 people who wore a wrist-worn accelerometer for measured activity over the course of one week. And we saw the opportunity to assess the Weekend Warrior pattern versus more regular activity versus inactivity, in that larger group of individuals who had measured activity, which allowed us to look at specific outcomes that we were interested in, including heart failure, heart attack, stroke, and atrial fibrillation.

C360: How does this study fill a current gap in our knowledge?

Dr. Khurshid: Well, as I mentioned, those previous studies looked at the Weekend Warrior pattern, and because they were smaller, they really could only look at overall mortality. We were specifically interested in specific cardiovascular outcomes like those ones I mentioned. And given the sample size of the data set, we were able to assess for those with high statistical power. And again, I think the fact that the activity was measured just makes it a more robust analysis and it really was still an unanswered question, whether concentrated activity is better or worse or the same, as more regularly distributed physical activity.

C360: What were the key takeaways from this study?

Dr. Khurshid: So when we compare those three activity patterns, and again just to summarize, inactive, where individuals did not meet physical activity guideline recommended levels, active regular, where people did meet guidelines, but their activity was more distributed, and then the Weekend Warrior pattern, which was people meeting guideline activity levels, but most of their activity was concentrated in one or two days of the week. When we compared across those three groups, we saw 20 to 40% reductions in risk of each of those four outcomes, atrial fibrillation, heart attack, heart failure, stroke. And those benefits were very similar between the Weekend Warrior group and the active regular group.

C360: How do these findings add to the patient-provider conversation on the ideal amount of physical activity per week?

Dr. Khurshid: I think there's a couple of ways. I think one, patients can I think be discouraged if they feel like they can't get to that 150 and regularly space it out throughout the week. They might feel that if I can only exercise on Sunday, then I might not be getting all of the benefit or as much benefit. And so I think that the ability to be more flexible in our recommendations and say, "Really, the key is to acquire the levels that we recommend", which is 150 minutes per week, and it doesn't necessarily matter how you do that within the context of your life and your schedule, I think that can be empowering to patients.

Another thing that I think is more of a research way to look at that question is I think there have been lots of physical activity interventions that we've studied as a medical field over the course of the last few years and decades. And we know that physical activity is useful, but one of the issues with getting effective interventions is that it's hard to get people to engage with them consistently and over time. And so our study suggests that it might be worth looking at more concentrated interventions, where maybe we ask patients to engage in a physical activity program on top of what they usually do, but just once a week. And maybe that's easier for patients to engage with. We may still see the same kind of benefit we'd expect.

C360: What gaps in our knowledge still remain, and what kinds of studies are necessary to fill those gaps?

Dr. Khurshid: There's a few. So one is we focused specifically on cardiovascular disease, as I mentioned, because that's near and dear to our hearts, literally. But it remains an open question as to whether the Weekend Warrior pattern provides similar benefits to more regular activity across the spectrum of human diseases. So exercise affects respiratory disease, mental health, basically diseases across the whole human spectrum. And we want to know whether we see that same benefit for both activity patterns across all of those potential diseases. So that's a natural follow-up to our findings.

Another thing is our study is observational and retrospective. So we analyzed people who provided their physical activity data in the past. And because it's observational, we try to adjust for what we call confounders or things that can affect both physical activity and disease risk. And so the way to really establish causal effects is to do a trial. And so one of the things that one can do is, as I was alluding to, do an intervention trial where we actually try to get people to engage in concentrated physical activity, maybe that's easier for them to do, and see whether we see those reductions in cardiovascular disease prospectively.

C360: What's next for your group regarding studying this topic further?

Dr. Khurshid: Yeah, I think our immediate next steps would be to do that analysis where we look across the human spectrum of human diseases and see how the Weekend Warrior pattern compares to regular activity across the whole span of diseases. Because the UK Biobank, which is the analysis that we ... Or the population where we did the analysis, has linked electronic health record data for the whole span of conditions. So that's something we're very interested in actively working on. Another thing we're potentially looking into is a lot of these patients in this study also have imaging. So do we see different patterns of heart structure and function across Weekend Warriors, versus people who engage in more regular activity?

C360: Beyond cardiologists, what types of specialists would be interested in the results of your study?

Dr. Khurshid: Yes. I think that physical, it's hard to find a condition where physical activity is not relevant. And so I think by that nature, I think our findings are should be of interest to all specialties and generalists. And specifically, because you mentioned orthopedist, I think that there is this question of whether more concentrated activity leads to an increased injury risk. And we did look at that in the UK Biobank. We did not see any signal for increased musculoskeletal injuries or conditions.

In fact, we saw both Weekend Warrior and regular activity have a lower risk of musculoskeletal issues, which is consistent with what we've seen before from other data. So I think that was encouraging. At the same time, I do think that anytime somebody decides to engage in a new exercise program, it makes sense for them to discuss it with their doctor to use common sense. I don't want people to interpret our findings and saying that they should go from zero to 60 and cram 300 minutes on Saturday, when they haven't exercises in a long time. I think it makes sense to ramp things up gradually and like I said, use common sense and listening to your body.

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