Adding to the growing body of evidence supporting the health benefits of cramming all your weekly exercise into two days, a large new study has found that it can significantly reduce the risk of cardiovascular mortality in adults with diabetes.
Researchers from medical institutions including Harvard T.H. Chan School of Public Health, Boston University School of Public Health and Vanderbilt University Medical Center found that for those living with diabetes – predominantly type 2 – the current recommendation of 150 minutes of exercise a week didn't have to be spread out over seven days to significantly lower the risk of dying from heart disease, and reduce overall disease mortality. Cardiovascular disease is the leading cause of death in adults with diabetes.
Known as the "weekend warrior" approach, this mode of working out has gained a lot of attention in the last five years as researchers look to uncover how you can get the most health "bang for your buck" when it comes to exercise. A 2022 study showed that weekend workouts lower risk of premature death, while in 2023, scientists found that adults cramming all their minutes into Saturday and Sunday bursts of activity reaped the same heart benefits as those who spread things out across the week.
This latest study looked at the exercise habits of 51,650 adults with self-reported diabetes who participated in the National Health Interview Survey (NHIS) between 1997 and 2018. The team categorized people into four groups: Inactive (no weekly exercise), insufficiently active (less than 150 minutes per week), weekend warriors (150-plus minutes per week, in one to two sessions) and regularly active (15-plus minutes spread across three or more sessions).
And, this time, those active over one or two sessions came out on top. Compared to inactive participants, weekend warriors cut their risk of dying from any cause by 21%, and from cardiovascular disease by 33%. The regularly active group also saw significant benefits, with a 17% lower any-cause mortality rate and a 19% drop in cardiovascular risk, compared to the inactive cohort.
Adults with diabetes, especially type 2, have an increased risk of heart attack, stroke and other cardiovascular complications compared to the general population. While regular exercise helps to manage blood sugar and protect heart health, many diabetics face physical challenges when it comes to daily workouts – including fatigue, disability, joint discomfort, neuropathy-related pain and other comorbidities.
While the study itself didn't specify, data from the NHIS suggests the vast majority of the 51,650 participants had self-reported type 2 diabetes.
“This kind of evidence can change how we talk about exercise,” said public health experts in an accompanying editorial. “It opens the door for more people to feel empowered and capable, rather than defeated by rigid guidelines.”
Some study limitations are worth noting, however. In addition to it being likely but unclear that the data focused on adults with type 2 diabetes, the researchers drew from information that was self-reported, so precise workout timing is more ballpark than exact. It also didn't assess non-lethal cardiovascular outcomes, nor did it track the type of exercise the participants engaged in.
However, this last limitation somewhat broadens the flexibility of workouts, as long as it's "moderate-to-vigorous physical activity." This could be in the form of weightlifting, cycling, jogging, playing tennis or other heart-pumping sports, or even brisk walks and aquarobics.
Overall, the study shows there's no strong evidence that spacing out exercise across multiple days provides significantly more protection than doing it all in one or two sessions. It's also worth noting that insufficiently active participants still had 11% lower all-cause mortality when compared to those in the inactive category.
What's more, it challenges traditional beliefs that daily or near-daily activity is necessary for sustained benefit in chronic conditions like diabetes. Knowing that there are significant health gains to be made by squeezing movement into a few hours over the weekend, compared to spreading it out during the week, can also offset the guilt many people feel about a lack of consistency.
While consistency – frequency and distribution – remains the official guideline for getting the most out of physical activity, this study shows that total volume may be more important, as far as mortality-related outcomes are concerned. This could help reshape how clinicians assist patients with diabetes who for many reasons can't sustain daily or frequent exercise sessions.
The study was published in the journal Annals of Internal Medicine.
Source: Harvard T.H. Chan School of Public Health via EurekAlert!
