Accelerometer-Derived "Weekend Warrior" Physical Activity and Cardiovascular Outcomes Across the Stages 0-3 of Cardiovascular-Kidney-Metabolic Syndrome: A Prospective UK Biobank Study

BackgroundCardiovascular-Kidney-Metabolic (CKM) syndrome is a progressive spectrum where patients often struggle with daily exercise. The "Weekend Warrior" (WW) pattern offers a flexible alternative, but its efficacy across CKM stages remains unclear. We evaluated the association of accelerometer-derived WW activity with cardiovascular outcomes across CKM Stages 0-3. MethodsThis prospective study included 88,832 UK Biobank participants (CKM Stages 0-3). Physical activity was objectively measured via 7-day accelerometry and categorized by weekly moderate-to-vigorous physical activity (MVPA) volume and pattern: Inactive (<150 min), WW ([&ge;]150 min; [&ge;]50% volume in 1-2 days), or Regularly Active (RA). The primary outcome was incident cardiovascular disease (CVD), a composite of coronary heart disease (CHD), heart failure (HF), stroke, atrial fibrillation (AF), and peripheral artery disease (PAD). ResultsDuring a median 7.5-year follow-up, 9,125 incident CVD events were recorded. In fully adjusted models, both WW and RA patterns were associated with similar risk reductions for total CVD (WW: HR 0.87, 95% CI 0.83-0.91, P < 0.001; RA: HR 0.88, 95% CI 0.83-0.94, P < 0.001) and CHD (WW: HR 0.86, 95% CI 0.80- 0.93, P < 0.001; RA: HR 0.86, 95% CI 0.79-0.93, P < 0.001). Notably, the WW pattern demonstrated unique benefits for AF (HR 0.91, 95% CI 0.85-0.99, P = 0.024) and PAD (HR 0.85, 95% CI 0.78-0.93, P < 0.001). In CKM Stage 3, the WW pattern showed a 38% reduction in total CVD risk (HR 0.62, 95% CI 0.47-0.83, P = 0.001) and marked reductions in HF (HR 0.47, 95% CI 0.24-0.90, P = 0.022) and PAD (HR 0.52, 95% CI 0.31-0.89, P = 0.019). Dose-response analysis revealed a non-linear L-shaped association, with CVD risk reductions plateauing at 200-300 min/week of MVPA. Furthermore, the WW pattern significantly offset the risk conferred by high genetic susceptibility and elevated inflammation (Stage 3 with hs-CRP > 3 mg/L: HR 0.46, 95% CI 0.25-0.84, P = 0.012). Both patterns conferred substantial survival advantages, with the WW pattern showing a 24% lower risk of all-cause mortality (HR 0.76, 95% CI 0.70-0.81, P < 0.001). ConclusionsThe WW pattern is associated with significant reductions in CVD risk and mortality across the CKM spectrum. Concentrating activity into 1-2 days is a feasible, safe, and effective strategy, offering unique vascular protection in advanced disease. For CKM patients, achieving total MVPA volume--ideally 200-300 min/week--should be prioritized over frequency.