The "Weekend Warrior" Physical Activity Pattern and Cardiometabolic Health: A Pooled Harmonized Individual Participant Analysis of the ProPASS Consortium

Background While weekend warrior (WW) physical activity (PA) pattern has been associated with cardiovascular benefits, most existing evidence is based on self-reported PA. Evidence using harmonized, thigh-worn accelerometry to examine associations between the weekend warrior phenotype and comprehensive cardiometabolic profiles remains limited. Methods We pooled harmonized individual-participant data from six cohorts in the Prospective Physical Activity, Sitting and Sleep (ProPASS) Consortium. In this cross-sectional analysis, participants were classified as inactive (<150 min/week MVPA), weekend warriors (150 min/week with 50% accumulated on 1-2 days), or regularly active 150 min/week but not meeting the WW criterion). A composite cardiometabolic score averaged eight standardized indicators: triglycerides, HDL cholesterol, total cholesterol, HbA1c, body mass index, waist circumference, systolic blood pressure, and diastolic blood pressure. Generalized linear models were used to estimate associations between PA patterns and both composite and individual cardiometabolic outcomes, adjusted for age, sex, smoking, alcohol intake, self-rated health, CVD history, medication use, blood biomarker fasting status, and cohort. Results Among 13,904 adults (mean age 54.3{+/-}9.5 years; 54.7% women), 61.8% were inactive, 24.5% weekend warriors, and 13.7% regularly active. Compared with inactivity, both active patterns were associated with more favorable composite cardiometabolic scores (WW: = -0.118 (95% CI: -0.142, -0.095); regularly active: = -0.111 (95% CI: -0.141, -0.081)), with negative values indicating better cardiometabolic health. Weekend warriors and regularly active adults showed broadly similar associations across individual markers, including lower adiposity (BMI and waist circumference) and more favorable metabolic biomarkers (higher HDL cholesterol; lower triglycerides and HbA1c), with no meaningful differences between the two active patterns for the composite score or any individual outcome. Associations with total cholesterol and blood pressure were small. Conclusions Both active patterns were associated with more favorable cardiometabolic profiles than inactivity, and profiles were broadly comparable whether MVPA was concentrated on 1-2 most active days (weekend warrior) or accumulated more regularly across the week. Keywords: weekend warrior; physical activity; accelerometry; cardiometabolic health