Association of weekend warrior physical activity pattern with all-cause and cardiovascular mortality among US adults with metabolic dysfunction-associated steatotic liver disease: findings from NHANES 2007-2018

Background: Weekend warrior physical activity (PA) pattern has been shown to have similar health benefits to regularly active activity. We aimed to explore the association of weekend warrior PA with all-cause and cardiovascular disease (CVD) mortality in metabolic dysfunction-associated steatotic liver disease (MASLD) through NHANES 2007-2018. Methods: We assessed PA patterns based on the recommended total PA duration (≥150 min/week) and exercise sessions. Weekend warrior PA was defined as completing the recommended amount of PA through 1-2 sessions, whereas the regularly active group ≥3 sessions. MASLD was assessed based on the presence of hepatic steatosis (as assessed by the Fatty Liver Index) and metabolic disturbances. Results: A total of 10,410 MASLD participants were enrolled. Achieving the recommended amount of total PA duration significantly reduced mortality compared with the inactive group. Total PA frequency was inversely associated with mortality risk within limited sessions, whereas excessive sessions had no additional benefit. In the fully adjusted model, weekend warrior PA was associated with significantly lower all-cause (hazard ratio [HR] 0.423, 95% CI 0.233-0.767) and CVD mortality (HR 0.172, 95% CI 0.044-0.677) compared with the inactive group. When the regularly active group was referenced, weekend warrior PA did not increase the risk of all-cause and CVD mortality. The association between weekend warrior PA and all-cause mortality was only present in participants <60 years of age. Conclusions: Weekend warrior PA may serve as a viable PA modality to reduce mortality in patients with MASLD, particularly among those <60 years of age.