Accelerometer-derived “weekend warrior” physical activity pattern and cardiovascular disease in individuals with hypertension: a prospective cohort study

Extensive evidence has demonstrated that physical activity (PA), particularly moderate-to-vigorous intensity PA (MVPA), has protective effects on cardiovascular disease (CVD) in individuals with hypertension. However, the relative effects of different PA patterns in this high-risk population remain unclear. We aimed to evaluate the associations of three PA patterns ("weekend warrior" (WW), regularly active, and inactive) with incident CVD in individuals with hypertension. This large prospective cohort study included 40,283 adults with hypertension from the UK Biobank who had accelerometer-measured PA data between June 2013 and December 2015. Participants were categorized into three groups: the regularly active pattern, the WW pattern, and the inactive group. Outcomes included overall CVD, as well as its four major subtypes: myocardial infarction (MI), atrial fibrillation (AF), heart failure (HF), and stroke. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the associations between PA patterns and outcomes. Over a median follow-up of 7.59 years (interquartile range, 7.33–8.47), 3789 new cases of overall CVD were identified. Compared with the inactive group, both the WW (HR = 0.76, 95% CI = 0.71–0.82) and regularly active (0.78, 0.71–0.85) patterns were associated with a significantly and similarly reduced risk of developing overall CVD. Moreover, both active groups showed reduced risks of incident MI (WW, 0.75, 0.65–0.87; regularly active, 0.72, 0.61–0.86), AF (WW, 0.77, 0.70–0.85; regularly active, 0.80, 0.71–0.90), HF (WW, 0.58, 0.50–0.68; regularly active, 0.67, 0.56–0.80), and stroke (WW, 0.78, 0.65–0.93; regularly active, 0.85, 0.70–1.05). Additional subgroup and sensitivity analyses confirmed the robustness of main findings. The WW pattern was associated with a similarly lower risk of CVD as more evenly distributed activity in individuals with hypertension, offering an effective and flexible strategy for improving cardiovascular health.