Weekend Warrior and other physical activity patterns: mortality and life expectancy in individuals with cardiometabolic multimorbidity

Abstract

Objectives This study examined the associations of different physical activity patterns with mortality risk and life expectancy among individuals with cardiometabolic multimorbidity (CMM). Design We analyzed data from adults with CMM in the National Health Interview Survey (1997–2018), linked to mortality records through December 31, 2019. CMM was defined as the coexistence of at least two of heart disease, diabetes, and stroke. Methods Physical activity was categorized as Inactive, Insufficiently Active, Weekend Warrior (≥150 min/week in 1–2 sessions), or Regularly Active (≥150 min/week in ≥3 sessions). Relative mortality risks were estimated using Cox proportional hazards models, absolute mortality rate differences using Poisson regression, and differences in life expectancy at ages 45 and 65 using flexible parametric survival models. Subgroup and sensitivity analyses assessed robustness. Results The analytic sample included 15,079 adults with CMM, of whom 8299 (55.0%) were women. Over a mean follow-up of 10.1 years, 6932 deaths occurred. Compared with Inactive participants, mortality risk was 19% lower among the Insufficiently Active (HR = 0.81, 95% CI: 0.75–0.89), 36% lower among Weekend Warriors (HR = 0.64, 95% CI: 0.49–0.83), and 40% lower among the Regularly Active (HR = 0.60, 95% CI: 0.55–0.65). At age 45, estimated differences in life expectancy were 2.24, 4.60, and 4.94 years across these groups, respectively; corresponding differences at age 65 were 1.46, 3.04, and 3.27 years. Conclusions Among individuals with CMM, recommended levels of physical activity, whether accumulated in 1-2 weekly sessions or more frequent exercise, were associated with lower mortality risk and longer life expectancy. Weekend Warrior and regular activity patterns showed comparable associations with survival-related outcomes.