The weekend warrior phenomenon: comparable mortality reduction to regular exercise with enhanced neuroprotective effects—a systematic review and meta-analysis

Abstract

Background

The “weekend warrior” (WW) physical activity pattern—characterized by low-frequency, high-intensity exercise concentrated in 1–2 sessions per week—has gained popularity, yet its health implications remain controversial. This systematic review and meta-analysis aim to evaluate the benefits and risks of the WW pattern compared to regular or inactive PA regimens, focusing on mortality, cardiometabolic and neurological outcomes.

Methods

Two independent investigators searched PubMed, Embase, Cochrane Library, and Web of Science for studies published from 01/01/1975 to 01/22/2025. Eligible studies compared health outcomes among WW, regularly active (RA), and inactive populations were included. Outcomes included all-cause/cause-specific mortality, cardiovascular disease (CVD), metabolic disorders, and neurological conditions. Pooled hazard ratios (HR) and odds ratios (OR) were calculated by either random-effects model or fixed-effects model, depending on heterogeneity.

Results

Among the 21 included studies (14 cohort, 7 cross-sectional), WW was associated with reduced all-cause mortality risk versus inactive population (HR = 0.77; 95% CI: 0.68–0.87, P < 0.0001), comparable to the benefit observed with RA (HR = 0.70; 95% CI: 0.63–0.78, P < 0.00001). WW was also linked to reduced risks of CVD mortality (HR = 0.80; 95% CI: 0.66–0.97), cancer mortality (HR = 0.85; 95% CI: 0.77–0.95), and incident CVD (HR = 0.73; 95% CI: 0.64–0.82) when compared with inactivity. Notably, WW conferred greater neuroprotective effects than RA (HR = 0.71 vs. 0.76; P < 0.00001), with a substantial risk reduction compared with inactivity (HR = 0.71; 95% CI: 0.65–0.77). Risk of metabolic disease in WW showed a modest decrease (OR = 0.75; 95% CI: 0.65–0.88, P = 0.0004), although no significant improvements were observed in individual metabolic indices.

Conclusion

Compared with inactivity, the WW pattern offers mortality and cardiometabolic benefits comparable to regular activity, along with uniquely enhanced neuroprotective effects, supporting its viability for time-constrained individuals.

Trial registration

PROSPERO: CRD42024583406.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-025-25062-4.

What is already known on this topic

Observational studies indicate that both the “weekend warrior” and regular exercise reduce risks of all-cause mortality, cardiovascular diseases compared to inactivity. However, current evidence lacks meta-analytic results for high-risk populations with chronic diseases, the evidence on metabolic diseases remains inconsistent, and comprehensive reviews on neurological disease risks are lacking.

What this study adds

This systematic review and meta-analysis establishes that the weekend warrior exercise pattern achieves mortality reduction equivalent to regular activity in general population and even in high-risk populations, while demonstrating superior neuroprotective benefits. The analysis confirms modest metabolic disease risk reduction without significant biomarker improvements.

How this study might affect research, practice or policy

The findings highlight the WW approach as a flexible, practical option for time-constrained individuals, particularly those with chronic diseases or at high risk of cardiometabolic and cerebrovascular diseases, while offering notable neuroprotective benefits. These supports integrating weekend-based exercise into clinical and public health strategies to improve accessibility and health outcomes.

Introduction

In recent decades, the fast-paced lifestyle and hectic schedules of urban dwellers have prompted the emergence of the “weekend warrior” (WW) physical activity (PA) pattern. This regimen involves individuals performing low-frequency, high-intensity exercise, typically achieving the recommended ≥ 150 min of weekly PA—with over 50% concentrated into one or two sessions [1]. According to World Health Organization 2020 guidelines, all adults should undertake 150–300 min of moderate intensity PA per week or 75–150 min of vigorous intensity PA per week or an equivalent combination [2]. Theoretically, regular and consistent PA is the most recommended form of physical activity and is also the most crucial means of reducing overall mortality as well as cardiovascular risks [3]. However, as the weekend warrior PA pattern has emerged as a prevalent form of exercise among fast-paced urban populations, it is imperative to comprehensively review the health benefits and risks of the WW PA pattern.

A myriad of studies has explored this issue, suggesting that the weekend warrior pattern may yield mortality benefits comparable to regular physical activity when contrasted with physical inactivity. Preliminary meta-analytic data indicate that WW participation is associated with significant reductions in all-cause mortality [1, 4–10], cardiovascular disease (CVD) - specific mortality [1, 4–6, 8] and cancer-specific mortality [1, 6, 8] in the general population compared with inactivity and the reduction effects are comparable to RA. Subsequently, endeavors have expanded these studies to populations with chronic conditions such as chronic kidney disease (CKD) [4], diabetes mellitus (DM) [4, 7], and osteoarthritis (OA) [5]. Mechanistically, studies have highlighted the WW pattern’s potential to mitigate incident CVD [5, 11], neurological disorders [12–15] and metabolic dysregulation [16–20].

Despite initial evidence supporting the WW pattern’s mortality benefits, its metabolic benefits remain equivocal. Early studies have reported conflicting outcomes concerning the WW exercise pattern’s capacity to diminish the risk of metabolic disorders [16–20]. Furthermore, research has demonstrated that compared to inactive PA, WW PA does not reduce levels of metabolic biomarkers versus inactive counterparts, such as the triglyceride-glucose index (TyG-index) [21], the comprehensive metabolic health index (CMI) [22], and the lipid accumulation product (LAP) [23], to the same extent as regularly active PA. Importantly, systematic reviews evaluating WW’s impact on all-cause mortality across general and chronic disease populations, as well as those assessing neurological protection and metabolic outcomes of WW PA and other patterns, are still lacking.

This systematic review synthesizes evidence from 21 qualified studies to assess the health benefits and risks of the WW PA pattern relative to other PA modalities. We hypothesize that, compared to physical inactivity, the WW regimen may achieve all-cause mortality and specific-cause mortality reductions comparable to regular PA, with sustained adherence attenuating brain disease and cardiometabolic disease incidence. By addressing unresolved questions about neurological and metabolic outcomes, this review aims to inform evidence-based clinical guidelines and public health strategies tailored to modern urban lifestyles.

Methods

This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement (Supplementary material S1) and was registered in the International Prospective Register of Systematic Reviews (PROSPERO: CRD42024583406).

Search strategy

A comprehensive search was conducted by two authors independently in four databases, PubMed, Embase, Web of Science, and The Cochrane library. The literature included in our database search spans from 01/01/1975 to 01/22/2025. The detailed retrieval process can be referred to supplementary material S2.

Eligibility criteria

This systematic review included studies that met the following criteria: (1) participants were adults (aged 18 years or older); (2) the study focused on individuals with “weekend warrior” PA pattern; (3) assessment of physical activity levels was conducted; (4) the study reported outcomes related to mortality or specific diseases; (5) there were no specific restrictions based on ethnicity, sex, or nationality of participants.

This systemic review excluded studies based on the following criteria: (1) Non-English publications; (2) Studies with incomplete data or uninterested outcomes; (3) Studies that do not measure levels of physical activity or do not report health or injury outcome; (4) Studies lack of a control group; (5) Case reports, editorials, and conference abstracts.

Study selection

During the initial search, we removed the duplication of articles from the four databases. Then, the articles were screened independently by two authors. In cases of disagreement, a third author made the final decision. The full texts of the included studies were thoroughly reviewed, and articles that did not meet the inclusion criteria were excluded (Supplementary material S3).

Data extraction and quality assessment

Data from the included studies were extracted independently by two reviewers, with a third reviewer resolving any discrepancies. We collected information on the first author, year of publication, sample size, age, gender, follow-up duration, participants’ health status, research database, methods of physical activity measurement, and study outcomes. Key outcomes included: all-cause mortality, CVD mortality, cancer mortality, incident CVD, brain disease, metabolic disease and metabolic index. The effect measures of the study included: hazard ratios (HR), odds ratios (OR) and 95% confidence intervals (95% CI).

The two authors independently evaluated the quality of the studies by identifying potential factors that could influence the interpretation of the results. Discrepancies were resolved through consultation with a third reviewer. The quality of the included observational studies was evaluated using the Newcastle-Ottawa Scale (NOS) [24] (Supplementary material S4).

Statistical analysis

In this review, we conducted a comprehensive analysis about the potential health benefits of the weekend warrior PA. Quantitative analysis was performed using Review Manager (RevMan 5.4) to assess five key variables: all-cause mortality, CVD-specific mortality, cancer mortality, brain disease, and metabolic disease, with cohort studies and cross-sectional studies assessed separately. Hazard ratios (HR) and odds ratios (OR), along with 95% confidence intervals (CIs), were used as summary measures of association, with statistical significance defined as P < 0.05. Besides, Three studies included in our review reported β values as effect size metrics, which were presented as outcome measures in descriptive analysis in our review.

To evaluate heterogeneity, we calculated the I² statistic and interpreted values of 25%, 50%, and 75% as low, moderate, and high heterogeneity, respectively. We applied a random-effects model for meta-analysis when I² ≥ 50% and P < 0.05, and adopted a fixed-effects model when I² < 50% and P > 0.05 [25]. Additionally, we performed subgroup analysis for all-cause mortality, dividing participants into two groups: a “healthy population” consisting of generally healthy individuals and a “high-risk population” consisting of individuals with chronic disease as diabetes, chronic kidney disease, or osteoarthritis (Supplementary material S5). Leave-one-out sensitivity analyses were conducted when I² ≥ 50% by sequentially excluding individual studies to assess their impact on the pooled results (Supplementary material S6). Publication bias were assessed using a funnel plot [26] (Supplementary Material S7).

Results

Selection of studies

A total of 7009 studies were identified through searches across four databases. Subsequently, 2755 Articles were excluded due to duplication. Following a review of abstracts and titles, 4214 Articles were excluded based on pre-defined inclusion and exclusion criteria. The subsequent full text assessment led to the exclusion of 19 studies due to irrelevant outcome or inappropriate study design. Ultimately, 21 studies met the inclusion criteria and were included in the analysis. The search process is illustrated in Fig. 1.

Fig. 1.

Flow chart of study selection using PRISMA (Preferred Reporting items for Systematic Meta-Analysis) guidelines

Study characteristics

This study included 14 cohort studies and 7 cross-sectional studies (Table 1). Twelve studies categorized participants into weekend warriors, regularly active, and inactive groups [5–8, 11–15, 17–19], while nine additional studies incorporated an “insufficiently active” subgroup [1, 4, 9, 10, 16, 20–23]. The definition of “weekend warrior” varies slightly across the studies. 7 studies required ≥ 150 min/week of moderate-to-vigorous physical activity (MVPA) in 1–2 sessions [4–6, 15, 19, 21, 23]; 7 studies specified >150 min/week with >50% MVPA concentrated in 1–2 days [7, 9, 11–14, 27]; 6 studies accepted either 150 min moderate or 75 min vigorous activity or equivalent combination weekly in 1–2 sessions [1, 8, 16, 18, 20, 22]; with one unique definitions using ≥ 1,000 kcal/week sports expenditure [10]. All groups included in our analysis were derived from fully adjusted models in the original studies. Sample sizes ranged from 351 to 350,978 participants, with baseline ages spanning 33–62 years and balanced gender distribution. Geographically, the included studies cover a wide range of regions, including United states [4, 7–10, 21–23], Europe [1, 5, 11, 13–15, 17], Asia [16, 18–20], and Mexico [6, 12], enhancing the generalizability of the findings across diverse populations. The mean follow-up duration of included cohort studies was 10.77 years, while the highest mean duration reached 19.7 years [6]. Three studies specifically investigated high-risk participants: individuals with DM and CKD [4], OA [5], and type 2 diabetes [7], respectively, whereas the remaining studies focused on general healthy populations. Physical activity assessment methods included using accelerometer [5, 9, 11, 13–15, 27] and self-reported [1, 4, 6–8, 10, 12, 16, 18–20]. Outcome measures encompassed all-cause mortality [1, 4–10] and specific-cause mortality [1, 4, 6–9], incident CVD [5, 11], brain disease [12–15], metabolic diseases [16–20] and metabolic index [21–23].

Table 1.

Baseline characteristics of included studies

Author	Year	Group	Sample size(n)	Age (mean)	Gender ratio(Male)	Follow up(Years)	Participants	Database	Measurement	Outcomes
Q.Yang [4]	2024	WW/IA/ISA/RA	1702	63.9	53.50%	5.7	DM and CKD	NHANES 2007–2020	SR	All-cause mortality, CVD-specific mortality
Q. Xie [5]	2024	WW/IA’/RA	10,210	58.1	56.50%	7	OA	UK-biobank 2013–2016	AM	All-cause mortality, incident CVD
G.O’Donovan [6]	2024	WW/IA’/RA	154,882	52.3	32.76%	17.6 ± 4.6	Healthy	Mexico city 1998–2004	SR	All-cause mortality, CVD-specific mortality, Cancer-specific mortality
G.O’Donovan [6]	2024	WW/IA’/RA	10,026	NA	NA	19.7 ± 1.9	Healthy	Mexico city 2015–2019	SR	All-cause mortality
J.Mahe [7]	2024	WW/IA’/RA	6067	61.4	52.00%	6.1	Type II diabetes	NHANES 2007–2018	SR	All-cause mortality
M. Dos Santos [8]	2022	WW/IA’/RA	350,978	41.4	49.20%	10.4	Healthy	US National Health Interview Survey 1997–2013	SR	All-cause mortality, CVD-specific mortality, Cancer-specific mortality
E. J. Shiroma [9]	2019	WW/IA/ISA/RA	3438	58.5	41.50%	6.5	Healthy	NHANES 2003–2006	AM	All-cause mortality
G. O’Donovan [1]	2017	WW/IA/ISA/RA	63,591	58.6	48.30%	8.8 ± 4.4	Healthy	England and Scottish Health Survey 1994–2012	SR	All-cause mortality, CVD-specific mortality, Cancer-specific mortality
I-Min Lee [10]	2004	WW/IA/ISA/RA	8421	66.0	100.00%	9	Healthy	Harvard Alumni Health Study	SR	All-cause Mortality
S.Khurshid [11]	2023	WW/IA’/RA	89,573	62.0	43.70%	6.3	Healthy	UK biobank 2013–2015	AM	Incident CVD
F.Lin [15]	2024	WW/IA’/RA	89,400	56.0	43.70%	12.32	Healthy	UK biobank 2006–2010	AM	Parkinson Disease
G.O’Donovan [12]	2024	WW/IA’/RA	10,033	44.2	29.98%	16 ± 2	Healthy	Mexico city 2015–2019	SR	Mild dementia
Y.Ning [13]	2024	WW/IA’/RA	92,784	61.9	43.62%	>5	Healthy	UK biobank 2013–2015	AM	Dementia, Parkinsonism
J. Min [14]	2024	WW/IA’/RA	75,629	61.8	44.60%	8.4	Healthy	UK biobank	AM	Dementia, Stroke, Parkinson’s disease, Depressive disorder, Anxiety
S.Kany [17]	2024	WW/IA’/RA	89,573	62.0	44.00%	6.3	Healthy	UK biobank 2013–2015	AM	DM, Incident HTN, Obesity, Sleep apnea
SW Shin [16]	2024	WW/IA’/ISA/RA	26,197	44.1	50.40%	NA	Healthy	KNHAES 2017–2019	SR	MetS, HTN, Obesity
S. Park [18]	2022	WW/IA’/RA	29,543	46.0	76.90%	NA	Healthy	KNHAES 2014–2019	SR	MetS, DM, HTN, Dyslipidemia, Obesity
Y. S. Jang [19]	2022	WW/IA’/RA	27,788	50.6	44.30%	NA	Healthy	KNHANES 2016–2020	SR	MetS
J. Xiao [20]	2018	WW/IA/ISA/RA	20,502	53.8	34.13%	NA	Healthy	Nantong Metabolic Syndrome Study	SR	MetS, DM, HTN
J. Zhang [21]	2025	WW/IA/ISA/RA	16,400	49.0	48.36%	NA	Healthy	NHANES 2007–2018	SR	TyG index
W. Dai [23]	2024	WW/IA/ISA/RA	59,842	≥ 20	53.19%	NA	Healthy	NHANES 2007–2018	SR	LAP reduction
H. Xue [22]	2024	WW/IA/ISA/RA	16,442	49.0	48.35%	NA	Healthy	NHANES 2007–2016	SR	CMI

Group: WW weekend warrior, IA inactive, no activities, IA’ inactive’, total PA duration < 150 min/week, ISA insufficiently active, total PA duration < 150 min/week, RA regular active, total PA duration ≥ 150 min/week for ≥ 3 sessions, DM Diabetes Mellitus, CKD chronic kidney disease, NHANES National Health and Nutrition Examination Survey KNHANES Korean National Health and Nutrition Examination Survey, AM accelerometer, SR self-reported, CVD cardiovascular disease, MetS metabolic syndrome, CMI cardiometabolic index, TyG triglyceride-glucose index, LAP lipid accumulation products, MetS metabolic syndrome, HTN hypertension, NA not available

Quality assessment

Supplementary material S4 describe the results of the bias risk assessment for each study included in the final evidence synthesis. We employed the NOS to assess the quality of cohort studies and cross-sectional studies. Except one study was assessed moderate risk of bias [20], other studies were assessed low risk of bias. Additionally, we assessed publication bias using the funnel plot tool in Revman5.4.1. There was some publication bias for all-cause mortality, CVD mortality, cerebrovascular diseases, and others, no significant publication bias was found for cancer mortality (Supplementary material S7).

Descriptive analysis

All - cause mortality

In eight cohort studies [1, 4–10], we performed a meta-analysis using a random-effects model. All “weekend warrior” groups reported reduce hazard ratios (HRs) compared to the inactive group (HR = 0.77; 95% CI : 0.68–0.87, P<0.0001). The effect estimates, though slightly higher, remained comparable to those observed in the regularly active group (HR = 0.70; 95% CI: 0.63–0.78, P < 0.00001) The pooled overall effect size showed no significant subgroup differences between the weekend warrior group and the regularly active groups, indicating that both active PA pattern have similar effects in reducing all-cause mortality compared to the inactive group (Fig. 2). Leave-one-out sensitivity analysis confirmed robust results despite high heterogeneity. Simultaneous removal of Shiroma et al. [9] and O’Donovan (2017) [1] significantly reduced heterogeneity (HR = 0.86; 95% CI: 0.79–0.93, P < 0.0002; I² = 32%)), possibly due to their older participant cohorts (Supplementary material S6a). To sum up, these findings suggest that the “weekend warrior” pattern confers a robust similar protective effect against all-cause mortality as regular physical activity, especially in middle-aged working populations.

Fig. 2.

Assessments of weekend warrior physical activity pattern and regularly active physical activity pattern on all - cause mortality compared to inactive group

Notably, a subgroup analysis of three cohorts involved chronic disease patients—encompassing patients with preexisting DM [4], CKD [4], and OA [5], and type 2 diabetes [7]—revealed similar trends. Both PA patterns demonstrated protective effects against mortality, though with differing magnitudes: the WW approach showed a reduced mortality risk compared to inactivity (HR = 0.67; 95% CI: 0.52–0.87, P = 0.002), while the RA group achieved a more pronounced reduction in mortality risk compared to inactivity than the WW group (HR = 0.63; 95% CI: 0.49–0.80, P = 0.0003). It suggests that to people with chronic disease, achieving the recommended MVPA provides greater benefits, while condensing activity into shorter periods may have a more limited impact (Supplemental Material S5).

Specific - cause mortality

CVD - specific mortality

Five prospective cohort studies [1, 4–6, 8] demonstrated significant reductions in CVD - specific mortality among physically active populations using random-effects model. Both WW participants (HR = 0.80; 95% CI: 0.66–0.97, P = 0.03, I² = 65%) and RA participants (HR = 0.79; 95% CI: 0.68–0.91, P = 0.001, I² = 83%) exhibited comparable protective advantages over their inactive counterparts, with no significant difference observed between the two active patterns (Fig. 3). Given the heterogeneity observed across the studies, we performed a leave-one-out sensitivity analysis. The sensitivity analysis indicated that the overall result was less robust in the WW group, but was robust in the RA group (Supplementary material S6b). The results suggest that, compared to the inactive group, the weekend warrior pattern can provides some cardiovascular protection, although its effect is not as strong as that of the regularly active group.

Fig. 3.

Assessments of weekend warrior physical activity pattern and regularly active physical activity pattern on CVD-specific mortality compared to inactive group

Cancer-specific mortality

A total of 569,451 participants from 3 cohort studies [1, 6, 8] reported cancer mortality. Given the low heterogeneity observed in this study (WW: I² = 0%, P = 0.004; RA: I² = 42%, P < 0.00001), a fixed-effect model was selected for the meta-analysis. Compared with the inactive participants, the HR for cancer mortality was lower in WW group (HR = 0.85; 95% CI: 0.77–0.95, P = 0.004) and regularly active group (HR = 0.89; 95% CI: 0.85–0.94, P < 0.00001). These results indicate that individuals who engage in the recommended levels of physical activity experience similar benefits in cancer mortality reduction, whether the activity is distributed throughout the week or concentrated into fewer days (Fig. 4), supporting broader promotion of time-concentrated activity patterns as a practical strategy for cancer prevention in public health campaigns.

Fig. 4.

Assessments of weekend warrior physical activity pattern and regularly active physical activity pattern on cancer-specific mortality compared to inactive group

Incident CVD

Incident CVD was reported in two articles. S.Khurshid et al. [11] evaluated the HRs for atrial fibrillation, myocardial infarction and heart failure (WW: atrial fibrillation: HR = 0.72; 95% CI: 0.66–0.78; myocardial infarction: HR = 0.63; 95% CI: 0.58–0.78; heart failure: HR = 0.63; 95% CI: 0.58–0.68). These results indicated that WW groups had lower risks of CVD compared to the inactive group. Q. Xie et al. [5] found that patients with osteoarthritis who engaged in both activity patterns were associated with similarly lower risks of incident CVD and incident coronary heart disease than inactive patients (incident CVD: WW: HR = 0.73; 95% CI: 0.64–0.82; RA: HR = 0.75; 95% CI: 0.65–0.87; incident CHD: WW: HR = 0.78; 95% CI: 0.62–0.99; RA: HR = 0.80; 95% CI: 0.62–1.08). These outcomes confirm that physical activity concentrated within 1 to 2 days is associated with similarly lower risks of cardiovascular outcomes as more evenly distributed activity (Supplementary Material S8).

Brain diseases

The meta-analysis of four cohort studies [12–15], which were assessed by random effects model, revealed that WW physical activity patterns significantly reduce brain disease risk compared to inactive lifestyles (HR = 0.71; 95% CI: 0.65–0.77, P < 0.00001, I² = 46%), with consistent benefits observed across dementia [12–14] (HR = 0.73; 95% CI: 0.65–0.81, P < 0.00001), Parkinson’s disease [13–15] (HR = 0.60; 95% CI: 0.50–0.72, P < 0.00001), and stroke [9, 14] (HR = 0.77; 95% CI: 0.72–0.84; P < 0.00001) (Fig. 5). Notably, WW pattern exhibited slightly greater risk reduction than RA individuals in overall brain diseases (HR = 0.76; 95% CI: 0.66–0.88, P = 0.0002), dementia [12–14] risk reduction (HR = 0.89; 95% CI: 0.80–0.99, P = 0.03, I² = 0%), Parkinson’s disease [13–15] (HR = 0.60; 95% CI: 0.40–0.90, P = 0.01, I² = 85%), and stroke [9, 14] (HR = 0.81; 95% CI: 0.73–0.89, P < 0.0001, I² = 0%) (Supplementary Material S9). Leave-one-out sensitivity analysis did not alter the results, indicating that our findings are robust(Supplementary material S6c). These findings indicate that the weekend warrior pattern may serve as an effective strategy for reducing the risk of multiple brain diseases with effects even better than regularly exercise.

Fig. 5.

Associations of weekend warrior activity patterns with diverse brain diseases compared to inactive group

Metabolic diseases and risk indices

One cohort study [27] and four cross-sectional studies [16, 18–20] investigated the relationship between the WW exercise pattern and metabolic diseases.The cohort study [27] demonstrated that the WW approach is beneficial in lowering metabolic disease risks, with reductions comparable to the regularly active (RA) group (HR = 0.72; 95% CI: 0.64–0.82, P < 0.00001) (Supplementary Material S8).

The meta-analysis of the four cross-sectional studies using random-effect model indicated that the WW pattern effectively reduces the incidence of metabolic diseases compared to the inactive pattern (Odds ratio [OR] = 0.75; 95% CI: 0.65–0.88, P = 0.0004), including metabolic syndrome [16, 18, 20] (OR = 0.73; 95% CI: 0.55–0.97, P = 0.03), hypertension [18, 20] (OR = 0.79; 95% CI: 0.69–0.90, P = 0.0005), and diabetes [18, 20] (OR = 0.61; 95% CI: 0.46–0.82, P = 0.001) (Fig. 6). The RA pattern also demonstrates an effect in reducing the incidence of metabolic diseases compared to physical inactivity (OR = 0.72; 95% CI: 0.64–0.82, P < 0.00001), including metabolic syndrome [16, 18, 20] (OR = 0.66; 95% CI: 0.58–0.76, P < 0.00001), hypertension [18, 20] (OR = 0.79; 95% CI: 0.67–0.94, P = 0.007), and diabetes [18, 20] (OR = 0.63; 95% CI: 0.45–0.89, P = 0.009) (Supplementary material S10). Leave-one-out sensitivity analysis across the four cross-sectional studies confirmed the highly robust association between the WW pattern and hypertension, as well as the consistent protective effect of the RA pattern against metabolic syndrome. Although sensitivity analysis for metabolic syndrome and diabetes (WW pattern) and hypertension and diabetes (RA pattern) showed some variation upon study exclusion, the direction of overall effect demonstrated protection (Supplementary material S6d).

Fig. 6.

Associations of weekend warrior activity patterns with diverse metabolic disorders compared to inactive group

In three cross-sectional studies [21–23] evaluating physical activity patterns and metabolic risk indices—including the triglyceride-glucose index (TyG index) [21], cardiometabolic index (CMI) [22], and lipid accumulation products (LAP) [23]—only the regularly active (RA) group exhibited significant improvements across all indices compared to inactive counterparts (RA: TyG index: β = −0.11; 95% CI: −0.14 to −0.08, P < 0.0001; CMI: β = −0.13; 95% CI: −0.19 to −0.07, P < 0.0001; LAP: β = −8.85; 95% CI: −11.59 to −6.11, P < 0.0001). The WW group showed some reductions in the TyG index, CMI, and LAP, but these changes did not achieve statistical significance (WW: TyG index: β = −0.01; 95% CI: −0.13 to 0.11, P = 0.9129; CMI: β = −0.09; 95% CI: −0.32 to 0.14, P = 0.4204; LAP: β = −4.70; 95% CI: −15.29 to 5.89, P = 0.3841), suggesting that, while both patterns may reduce disease risk, regular activity demonstrates a stronger and more consistent benefit on metabolic risk indices compared to the WW pattern (Supplementary Material S8).

Discussion

This systematic review and meta-analysis show that the weekend warrior physical activity pattern significantly reduces risks of all-cause, cardiovascular, and cancer mortality compared to inactive pattern, with benefits comparable to those of regular exercise. These protective effects extend to high-risk populations with chronic diseases (including CKD [4], DM [4, 7], and OA [5] patients) and demonstrate notable advantages against neurological disorders (such as dementia and Parkinson’s disease, and stroke) and metabolic diseases. However, cross-sectional studies indicate that WW shows limited improvement in metabolic indices (TyG index, CMI, LAP) relative to regular activity and is associate with an elevated risk of exercise-related injuries in specific population cohorts [28].

The results strongly support the conclusion that the WW is comparable to RA in reducing long-term all-cause and cardiovascular mortality, consistent with the findings of K. Kunutsor et al. [29]. Expanding upon the previous meta-analysis, our study integrates data from fourteen cohort studies and eight cross-sectional studies—including previously underrepresented Latin American populations—to evaluate mortality and specific disease outcomes, thereby substantially strengthening previously tentative conclusions. Particularly, we conducted the first subgroup analysis focusing on high-risk populations with chronic diseases, revealing that both WW and RA patterns confer similar protective effects against mortality in patients with CKD, DM, and OA. Furthermore, our systematic evaluation demonstrate that the WW pattern significantly reduces the risk of metabolic diseases compared to physical inactivity, thereby resolving inconsistencies in prior research. Importantly, the WW pattern provides superior neuroprotective benefits against brain diseases—even exceeding those observed with RA—suggesting that exercise intensity may play a more critical role than frequency in mitigating the risk of neurological disorders.

Despite the promising results demonstrating that the WW regimen reduces mortality risk and incidence of brain disease and cardiometabolic disease, our meta-analysis failed to show significant improvement in metabolic indices compared to inactive patterns. These biomarkers are established indicators of metabolic dysregulation, reflecting insulin resistance (TyG) [21, 30], adiposity-related cardiovascular risk (CMI) [22, 31], and pathological lipid accumulation (LAP) [23, 32]. This clinical-biomarker discrepancy may reflect limitations in cross-sectional study design: they cannot capture dynamic responses to intermittent exercise and are vulnerable to confounding by unmeasured lifestyle factors like diet and sleep. Thus, long-term clinical outcomes, rather than short-term biomarker shifts, should be prioritized in evaluating exercise interventions. Importantly, long-term adherence to WW protocols - particularly over extended periods - may represent a pivotal strategy for reducing metabolic disease incidence and consequently mitigating downstream CVD events, neurological disorders, and all-cause mortality.

Notably, WW showed a trend toward superior risk reduction for neurological diseases compared to RA. Potential mechanisms may involve synergistic effects from high-intensity intermittent exercise, such as improved cerebral blood flow [33], anti-inflammatory effects [34], structural brain improvements [35], and psychosocial factors [36]. This also suggests that exercise intensity, rather than frequency, may be a more critical factor in neuroprotection. However, this finding requires further validation through mechanistic studies.

Our study holds significant public health implications. By demonstrating that intermittent, intense physical activity spread over weekends can provide health benefits comparable to regular daily exercise, the weekend warrior approach offers a flexible and practical alternative for individuals with limited time due to work and personal commitments, serving as an accessible entry point for those who might otherwise remain inactive. Furthermore, the study provides exercise incentives for high-risk groups, such as those with diabetes, by emphasizing that significant health improvements can be achieved even with less frequent, but intense physical activity. Additionally, we also highlight the need for weekend warriors to be cautious about musculoskeletal injuries [28, 37, 38]. Inactive adults should gradually increase the duration and frequency of their physical activity before progressing to higher intensities in order to meet the recommended activity levels and reduce the risk of injuries [39].

Despite the strengths of our study, there are several limitations. (1) While our study incorporates diverse populations, the sample sizes for certain subgroups, especially patients with OA and CKD remain limited. Larger cohort studies are needed to validate these findings. (2) A substantial proportion of the studies included in the analysis used self-reported physical activity data, which may introduce classification biases. (3) There is potential publication bias, necessitating confirmation in future larger meta-analyses. (4) The restriction to English language publications may have led to language bias and limited generalizability to non-English-speaking populations. Future multi-region, multi-language meta-analyses are warranted to validate and extend our findings. (5) It remains unclear whether the WW pattern increases sports injury risk or how such risks might be mitigated—future studies should investigate preventive strategies such as warm-ups and gradual intensity progression.

Conclusion

Compared with inactivity, the WW pattern offers mortality and cardiometabolic benefits comparable to regular activity, along with uniquely enhanced neuroprotective effects, supporting its viability for time-constrained individuals.

Abbreviations

WW

Weekend Warrior

RA

Regularly Active

PA

Physical Activity

CKD

Chronic Kidney Disease

DM

Diabetes Mellitus

T2DM

Type Two Diabetes Mellitus

OA

Osteoarthritis

CVD

Cardiovascular Disease

HR

Hazard Ratio

HR

Odds Ratio

95%CI

95% Confidence Interval

TyG-index

Triglyceride-Glucose Index

CMI

Comprehensive Metabolic Index

LAP

Lipid Accumulation Product

MetS

Metabolic Syndrome

CHD

Incident Coronary Heart Disease

CRF

Cardiovascular fitness

Authors’ contributions

XZ, PT and BL designed the study. XZ, PT and BL undertook the literature review and extracted the data; XZ and PT were responsible for the assessment of study quality and data analysis; XZ drafted the manuscript; XZ, PT, YZ, HT, HL, LS, WX, TW, YL, YW, SC and BL participated in critical review of the manuscript. SC and BL performed study supervision. All authors read the manuscript and approved it.

Funding

This work was supported by National Key R&D Program of China (2023YFC3603400), Hunan Provincial Science Fund for Distinguished Young Scholars (2024JJ2089), National Key R&D Program of China (2019YFA0111900), National Natural Science Foundation of China (No.882072506, 92268115, 82272611), National Clinical Research Center for Geriatric Disorders (Xiangya Hospital, Grant No. 2021KFJJ02 and 2021LNJJ05), National Clinical Research Center for Orthopedics, Sports Medicine and Rehabilitation (2021-NCRC-CXJJ-PY-40), Science and Technology Innovation Program of Hunan Province (No.2021JJ31105).

Data availability

No datasets were generated or analysed during the current study.

Declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

All authors approved the final manuscript and the submission to the journal.

Competing interests

The authors declare no competing interests.