Accelerometer-derived “Weekend Warrior” physical activity and all-cause and cardiovascular mortality across CKM stages 0–3

The 2023 American Heart Association Presidential Advisory introduced cardiovascular-kidney-metabolic (CKM) syndrome, but the mortality impact of "Weekend-Warrior" (WW) physical activity in this population remains uncertain. Using data from 1,927 adults in the 2003-2006 NHANES with accelerometer-measured activity and CKM stages 0-3, participants were classified as inactive, regularly active (≥150 min/week moderate-to-vigorous activity across ≥3 days), or WW (≥150 min/week concentrated in 1-2 days). Mortality status was tracked through 2019. Over a median 13.2-year follow-up, 306 deaths occurred, including 98 cardiovascular. Compared with inactivity, regular activity was associated with 75% lower all-cause mortality (HR 0.25, 95% CI 0.13-0.48) and 82% lower cardiovascular mortality (HR 0.18, 0.04-0.76). WW activity reduced all-cause mortality by 41% (HR 0.59, 0.37-0.94) but showed no significant effect on cardiovascular mortality (HR 0.76, 0.36-1.64). Subgroup analyses suggested that the survival benefits of physical activity were more evident among older adults (≥60 years), non-smokers, and individuals with early CKM stages (0-1), underscoring the public health importance of early promotion of physical activity along the CKM continuum. These findings suggest that while regular activity confers the greatest longevity advantage in early CKM syndrome, a WW pattern still offers meaningful protection and may be a practical alternative for individuals unable to maintain consistent exercise routines.