Abstract
BACKGROUND: The guidelines provided by the World Health Organization (WHO) recommend a minimum of 150 min/week of moderate-to-vigorous physical activity (MVPA) for optimal overall health benefits. However, it remains unclear whether there are differential effects on the risk of incident type 2 diabetes (T2D) between concentrated and evenly distributed physical activity (PA) patterns. We aimed to investigate the associations of accelerometer-derived weekend warrior and regularly active pattern with risk of T2D. METHODS: A total of 84,656 general participants from the UK Biobank with validated accelerometry data and free of T2D was included. Data on PA was collected using the Axivity AX3 wrist-based triaxial accelerometer worn for one week. Participants were categorized into three PA patterns: inactive (< 150 min/week of MVPA), weekend warrior (≥ 150 min/week with ≥ 50% of total MVPA occurring within 1-2 days), and regularly active (≥ 150 min/week but not meeting weekend warrior criteria). RESULTS: During a median follow-up of 8.4 years, 2464 cases of T2D were documented. In multivariable-adjusted models, the weekend warrior pattern (hazard ratio [HR] 0.75; 95% confidence interval [CI] 0.67-0.84) and the regularly active pattern (HR 0.80, 95% CI 0.69-0.94) exhibited a comparable lower risk of T2D compared to physically inactive participants. When stratified by genetic risk score (PRS) of T2D, the weekend warrior pattern was associated with T2D in the higher PRS group (HR 0.78, 95% CI 0.67-0.91), intermediate PRS group (HR 0.78, 95% CI 0.62-0.97) and lowest PRS group (HR 0.59, 95% CI 0.43-0.80). CONCLUSIONS: Engaging in the weekend warrior pattern is associated with a similarly lower risk of T2D to the regularly active pattern, even among individuals with high genetic risk. These findings highlight the weekend warrior pattern as a significant and flexible alternative in preventive intervention strategies for T2D, particularly for those unable to maintain daily activity routines.