Weekend warrior physical activity and its association with all-cause and cause-specific mortality in general and chronic disease populations: a systematic review and meta-analysis

To quantify the associations of the “weekend warrior” (WW) physical activity pattern (i.e., accumulating at least 150 min of moderate-to-vigorous physical activity [MVPA] over 1–2 days per week, or accumulating at least 50% of total weekly MVPA) with all-cause mortality, cardiovascular disease (CVD) mortality, and cancer mortality in the general population and among patients with chronic diseases, and to explore heterogeneity sources. We searched PubMed, Cochrane, Embase, and Web of Science through July 20, 2026, for prospective cohort studies reporting adjusted HRs and 95% CIs. Overlapping cohorts were deduplicated to one estimate per cohort per outcome. Pooled HRs used REML random-effects models with modified Knapp–Hartung CIs; heterogeneity was assessed by I 2 , τ 2 , and Q. Fixed-effects models were used only for diabetes and MASLD model comparison. Subgroup and sensitivity analyses included leave-one-out, alternative-study substitution, three-level, and CR2 approaches. Quality was assessed with NOS; publication bias analyses were exploratory because each outcome included < 10 independent cohorts. Seventeen studies were eventually included. In the main analysis after weight removal, the pooled HR for all-cause death (k = 6), CVD death (k = 5), and cancer death (k = 5) was 0.76 (95% CI: 0.62–0.93), 0.76 (95% CI: 0.59–0.98), and 0.81 (95% CI: 0.73–0.91), respectively. Analysis of chronic diseases showed that HR = 0.68 (95% CI: 0.55–0.84) for all-cause death of hypertension; random effect results for all-cause death of diabetes mellitus and MASLD were not significant, fixed effect was significant but should be interpreted carefully; CVD death and cancer death of CVD, hypertension, diabetes mellitus and MASLD were mostly single studies and not combined. Descriptive funnel plot only for publication bias k < 10. In this de-duplicated independent-cohort meta-analysis, the weekend warrior pattern was observationally associated with lower all-cause, cardiovascular, and cancer mortality in general and chronic disease populations. The findings extend previous meta-analyses by providing disease-specific estimates, particularly for hypertension, while evidence for diabetes and MASLD remains limited. These associations are not causal, given residual confounding, reverse causality, exposure heterogeneity, and high heterogeneity in all-cause mortality. Whether the pattern is a feasible option for time-constrained individuals requires validation in prospective studies with harmonized exposure definitions. Not applicable.