“Weekend Warrior” Exercise Pattern Protects Against MASLD and Mortality Comparable to Regular Exercise: National Cohort Study

ABSTRACT Background and Aims Metabolic dysfunction‐associated steatotic liver disease (MASLD) guidelines recommend > 150 min per week of moderate‐to‐vigorous physical activity (MVPA). It is unclear if concentrating MVPA into 1–2 days per week [“weekend warrior” (WW) pattern] offers similar benefits to spreading activity throughout the week. We aimed to assess the association of WW activity pattern with MASLD prevalence, mortality, and atherosclerotic cardiovascular disease (ASCVD) risk among individuals with MASLD. Methods Data from the National Health and Nutrition Examination Survey 2003–2006 were linked to mortality records through 2019. Using accelerometer measurements, participants were categorised as WW (> 150 min of MVPA with ≥ 50% of total MVPA accomplished over 1–2 days), active (> 150 min of MVPA, not meeting WW criteria) and inactive (≤ 150 min of MVPA per week). MASLD was defined as a United States Fatty Liver Index (US FLI) ≥ 30 with at least one cardiometabolic risk factor, excluding other liver diseases. Results Among 2490 participants (mean age: 48.5 years; 47.4% male), both WW and active groups had lower odds of MASLD compared to the inactive group [WW; OR: 0.36 (95% CI 0.24–0.53); active; OR: 0.47 (0.36–0.62)], adjusting for sociodemographic variables. Among 859 MASLD, over 14.3 of years median follow‐up, multivariable Cox regression showed lower all‐cause mortality in the WW [HR: 0.35 (0.13–0.94)] and active [HR: 0.48 (0.24–0.98)] groups. Both WW [OR: 0.27 (0.09–0.75)] and active [OR: 0.39 (0.20–0.78)] groups had lower odds of high ASCVD risk. Conclusions WW physical activity patterns protect from MASLD and all‐cause mortality comparable to regular exercise.