Accelerometer-Derived “Weekend Warrior” Physical Activity and Cardiovascular Outcomes Across the Stages 0–3 of Cardiovascular-Kidney-Metabolic Syndrome: A Prospective UK Biobank Study

Abstract Background Cardiovascular-Kidney-Metabolic (CKM) syndrome is a progressive spectrum where patients often struggle with daily exercise. The “Weekend Warrior” (WW) pattern offers a flexible alternative, but its efficacy across CKM stages remains unclear. We evaluated the association of accelerometer-derived WW activity with cardiovascular outcomes across CKM Stages 0–3. Methods This prospective study included 88,832 UK Biobank participants (CKM Stages 0–3). Physical activity was objectively measured via 7-day accelerometry and categorized by weekly moderate-to-vigorous physical activity (MVPA) volume and pattern: Inactive ( 3 mg/L: HR 0.46, 95% CI 0.25–0.84, P = 0.012). Both patterns conferred substantial survival advantages, with the WW pattern showing a 24% lower risk of all-cause mortality (HR 0.76, 95% CI 0.70–0.81, P < 0.001). Conclusions The WW pattern is associated with significant reductions in CVD risk and mortality across the CKM spectrum. Concentrating activity into 1–2 days is a feasible, safe, and effective strategy, offering unique vascular protection in advanced disease. For CKM patients, achieving total MVPA volume—ideally 200–300 min/week—should be prioritized over frequency.