'Weekend warrior' and regularly active physical activity patterns confer similar cardiovascular and mortality benefits: a systematic meta-analysis

It is well documented that physical activity (PA) is associated with a lower risk of non-communicable diseases including cardiovascular disease (CVD) as well as mortality.1–3 Previous PA guidelines as well as recent guidelines by the World Health Organization have recommended that all adults should aim for 150–300 min of moderate intensity PA per week or 75–150 min of vigorous intensity PA per week or an equivalent combination of moderate-intensity and vigorous-intensity PA per week.4 Evidence suggests these levels provide substantial health benefits in most people.2 Despite guideline recommendations and population-wide strategies to promote PA levels, most populations do not adhere to PA recommendations. A major reason for the low levels of adherence is the lack of time. The balance between frequency, duration, and intensity, which are components of PA, plays an important part in the protective effects of PA. To derive maximal benefits from PA, an appropriate intensity, frequency, and duration, which comprise the volume is essential. However, emerging evidence suggests that the intensity of PA may be more important than the quantity (frequency or duration).5 It is uncertain if the majority of PA concentrated into a few days confers similar cardiovascular benefits as that spread over more days. Following the seminal study by Lee et al.,6 a few recent reports have evaluated whether guideline recommended PA patterns concentrated in one or two sessions per week (commonly called the ‘weekend warrior’ pattern) or patterns spread over multiple sessions per week (i.e. regularly active pattern) may differ with respect to cardiovascular outcomes and mortality. Some studies have reported similar benefits,7 whereas other reports suggest that regularly active PA patterns confer more benefits than weekend warrior PA patterns.6,8 Given the sparseness and inconsistency of the data, there is a need to systematically synthesize the existing evidence. Furthermore, given the relatively low sample size of some of these previous studies, pooling the overall evidence will provide adequate power to reveal any true associations. In this context, we aimed to assess and compare the associations of weekend warrior and regularly active PA patterns vs. inactive PA patterns with the risk of adverse cardiovascular outcomes using a systematic review and meta-analysis of all published observational cohort studies conducted on the topic.</p

'Weekend warrior' and regularly active physical activity patterns confer similar cardiovascular and mortality benefits: a systematic meta-analysis

It is well documented that physical activity (PA) is associated with a lower risk of non-communicable diseases including cardiovascular disease (CVD) as well as mortality.1–3 Previous PA guidelines as well as recent guidelines by the World Health Organization have recommended that all adults should aim for 150–300 min of moderate intensity PA per week or 75–150 min of vigorous intensity PA per week or an equivalent combination of moderate-intensity and vigorous-intensity PA per week.4 Evidence suggests these levels provide substantial health benefits in most people.2 Despite guideline recommendations and population-wide strategies to promote PA levels, most populations do not adhere to PA recommendations. A major reason for the low levels of adherence is the lack of time. The balance between frequency, duration, and intensity, which are components of PA, plays an important part in the protective effects of PA. To derive maximal benefits from PA, an appropriate intensity, frequency, and duration, which comprise the volume is essential. However, emerging evidence suggests that the intensity of PA may be more important than the quantity (frequency or duration).5 It is uncertain if the majority of PA concentrated into a few days confers similar cardiovascular benefits as that spread over more days. Following the seminal study by Lee et al.,6 a few recent reports have evaluated whether guideline recommended PA patterns concentrated in one or two sessions per week (commonly called the ‘weekend warrior’ pattern) or patterns spread over multiple sessions per week (i.e. regularly active pattern) may differ with respect to cardiovascular outcomes and mortality. Some studies have reported similar benefits,7 whereas other reports suggest that regularly active PA patterns confer more benefits than weekend warrior PA patterns.6,8 Given the sparseness and inconsistency of the data, there is a need to systematically synthesize the existing evidence. Furthermore, given the relatively low sample size of some of these previous studies, pooling the overall evidence will provide adequate power to reveal any true associations. In this context, we aimed to assess and compare the associations of weekend warrior and regularly active PA patterns vs. inactive PA patterns with the risk of adverse cardiovascular outcomes using a systematic review and meta-analysis of all published observational cohort studies conducted on the topic.</p

Sauna bathing and mortality risk: unraveling the interaction with systolic blood pressure in a cohort of Finnish men

Objectives: This cohort study aimed to investigate the potential interplay between systolic blood pressure (SBP), frequency of sauna bathing (FSB), and all-cause mortality risk among Caucasian men. Design: A prospective study was conducted, involving 2575 men aged 42 to 61 years. Baseline assessments included resting blood pressure measurements and self-reported sauna bathing habits. SBP levels were categorized as normal (Results: Over a median follow-up of 27.8 years, 1,618 deaths were recorded. In the adjusted analysis, individuals with high SBP versus low SBP showed a 29% increased all-cause mortality risk (HR 1.29, 95% CI 1.16–1.43). Similarly, those with low FSB versus high FSB exhibited a 16% elevated mortality risk (HR 1.16, 95% CI 1.02–1.31). When considering combined effects, participants with high SBP-low FSB had a 47% higher mortality risk (HR 1.47, 95% CI 1.24–1.74) compared to those with normal SBP-high FSB. However, no significant association was observed between individuals with high SBP-high FSB and mortality risk (HR 1.24, 95% CI 0.98–1.57). There were potential additive and multiplicative interactions between SBP and sauna bathing concerning mortality risk. Conclusions: This study reveals a potential interplay between SBP, sauna bathing, and mortality risk in Finnish men. Frequent sauna bathing may mitigate the increased mortality risk associated with elevated SBP.</p

Hemodynamic gain index and risk of ventricular arrhythmias: a prospective cohort study

Objectives: Hemodynamic gain index (HGI), a novel hemodynamic index obtained from cardiopulmonary exercise testing (CPX), is associated with adverse cardiovascular outcomes. However, its specific relationship with ventricular arrhythmias (VAs) is unknown. We aimed to assess the association of HGI with risk of VAs in a prospective study. Design: Hemodynamic gain index was estimated using heart rate and systolic blood pressure (SBP) responses ascertained in 1945 men aged 42–61 years during CPX from rest to maximum exercise, using the formula: [(Heart ratemax x SBPmax) – (Heart raterest x SBPrest)]/(Heart raterest x SBPrest). Cardiorespiratory fitness (CRF) was measured using respiratory gas exchange analysis. Hazard ratios (HRs) (95% confidence intervals, CIs) were estimated for VAs. Results: Over a median follow-up duration of 28.2 years, 75 cases of VA were recorded. In analysis adjusted for established risk factors, a unit (bpm/mmHg) higher HGI was associated with a decreased risk of VA (HR 0.72, 95% CI: 0.55–0.95). The results remained consistent on adjustment for lifestyle factors and comorbidities (HR 0.72, 95% CI: 0.55–0.93). Comparing the top versus bottom tertiles of HGI, the corresponding adjusted HRs (95% CIs) were 0.51 (0.27–0.96) and 0.52 (0.28–0.94), respectively. The associations were attenuated on addition of CRF to the model. HGI improved risk discrimination beyond established risk factors but not CRF. Conclusions: Higher HGI is associated with a reduced risk of VAs in middle-aged and older Caucasian men, but dependent on CRF levels. Furthermore, HGI improves the prediction of the long-term risk for VAs beyond established risk factors but not CRF.</p

Inflammation, sauna bathing, and all-cause mortality in middle-aged and older Finnish men: a cohort study

Inflammation and sauna bathing are each related to the risk of all-cause mortality. The interplay between inflammation, sauna bathing and all-cause mortality is not well understood. We aimed to evaluate the separate and joint associations of inflammation (high sensitivity C-reactive protein, hsCRP) and frequency of sauna bathing (FSB) with all-cause mortality in a cohort of Caucasian men. We used the Kuopio Ischaemic Heart Disease Study cohort comprising 2575 men aged 42–61 years at baseline. Serum hsCRP was measured using an immunometric assay and sauna bathing habits were assessed by a self-administered questionnaire. High sensitivity CRP was categorized as normal and high (≤ 3 and > 3 mg/L, respectively) and FSB as low and high (defined as ≤ 2 and 3–7 sessions/week respectively). A total of 1618 deaths occurred during a median follow-up of 27.8 years. Comparing high vs normal hsCRP levels, the multivariable-adjusted HR (95% CI) for all-cause mortality was 1.27 (1.13–1.44). Comparing high vs low FSB, the multivariable-adjusted HR (95% CI) for all-cause mortality was 0.86 (0.76–0.97). Compared with normal hsCRP-low FSB, high hsCRP-low FSB was associated with an increased risk of all-cause mortality 1.28 (1.12–1.47), with no evidence of an association for high hsCRP-high FSB and all-cause mortality risk 1.06 (0.81–1.40). Positive additive and multiplicative interactions were found between hsCRP and FSB in relation to mortality. In a general Finnish male population, both hsCRP and FSB are each independently associated with all-cause mortality. However, frequent sauna baths appear to offset the increased all-cause mortality risk related to high hsCRP levels

Inflammation, sauna bathing, and all-cause mortality in middle-aged and older Finnish men: a cohort study

Inflammation and sauna bathing are each related to the risk of all-cause mortality. The interplay between inflammation, sauna bathing and all-cause mortality is not well understood. We aimed to evaluate the separate and joint associations of inflammation (high sensitivity C-reactive protein, hsCRP) and frequency of sauna bathing (FSB) with all-cause mortality in a cohort of Caucasian men. We used the Kuopio Ischaemic Heart Disease Study cohort comprising 2575 men aged 42–61 years at baseline. Serum hsCRP was measured using an immunometric assay and sauna bathing habits were assessed by a self-administered questionnaire. High sensitivity CRP was categorized as normal and high (≤ 3 and > 3 mg/L, respectively) and FSB as low and high (defined as ≤ 2 and 3–7 sessions/week respectively). A total of 1618 deaths occurred during a median follow-up of 27.8 years. Comparing high vs normal hsCRP levels, the multivariable-adjusted HR (95% CI) for all-cause mortality was 1.27 (1.13–1.44). Comparing high vs low FSB, the multivariable-adjusted HR (95% CI) for all-cause mortality was 0.86 (0.76–0.97). Compared with normal hsCRP-low FSB, high hsCRP-low FSB was associated with an increased risk of all-cause mortality 1.28 (1.12–1.47), with no evidence of an association for high hsCRP-high FSB and all-cause mortality risk 1.06 (0.81–1.40). Positive additive and multiplicative interactions were found between hsCRP and FSB in relation to mortality. In a general Finnish male population, both hsCRP and FSB are each independently associated with all-cause mortality. However, frequent sauna baths appear to offset the increased all-cause mortality risk related to high hsCRP levels

Handgrip strength is inversely associated with fatal cardiovascular and all-cause mortality events

Purpose: We aimed to assess the associations of handgrip strength (HS) with cardiovascular and all-cause mortality and whether adding data on HS to cardiovascular disease (CVD) risk factors is associated with improvement in CVD mortality prediction. Design: Handgrip strength was assessed in a population-based sample of 861 participants aged 61–74 years at baseline. Relative HS was obtained by dividing the absolute value by body weight. Results: During a median (interquartile range) follow-up of 17.3 (12.6–18.4) years, 116 fatal coronary heart diseases (CHDs), 195 fatal CVDs and 412 all-cause mortality events occurred. On adjustment for several risk factors, the hazard ratios (95% confidence intervals (CIs)) for fatal CHD, fatal CVD and all-cause mortality were 0.59 (0.37–0.95), 0.59 (0.41–0.86) and 0.66 (0.51–0.84), respectively, comparing extreme tertiles of relative HS. Adding relative HS to a CVD mortality risk prediction model containing established risk factors did not improve discrimination or reclassification using Harrell’s C-index (C-index change: 0.0034; p = .65), integrated-discrimination–improvement (0.0059; p = .20) and net-reclassification-improvement (–1.31%; p = .74); however, there was a significant difference in –2 log likelihood (p Conclusions: Relative HS is inversely associated with CHD, CVD and all-cause mortality events. Adding relative HS to conventional risk factors improves CVD risk assessment using sensitive measures of discrimination.KEY MESSAGESHandgrip strength (HS) assessment is simple, inexpensive and it takes only a few minutes to measure in clinical practice; however, its prognostic role for fatal cardiovascular outcomes on top of traditional risk factors in apparently healthy populations is uncertain.In a population-based prospective cohort study, good HS adjusted for body weight was associated with lower risk of fatal cardiovascular outcomes and the associations remained consistent across several clinically relevant subgroups.Handgrip strength may be a useful prognostic tool for fatal CHD and CVD events, in the general population. Handgrip strength (HS) assessment is simple, inexpensive and it takes only a few minutes to measure in clinical practice; however, its prognostic role for fatal cardiovascular outcomes on top of traditional risk factors in apparently healthy populations is uncertain. In a population-based prospective cohort study, good HS adjusted for body weight was associated with lower risk of fatal cardiovascular outcomes and the associations remained consistent across several clinically relevant subgroups. Handgrip strength may be a useful prognostic tool for fatal CHD and CVD events, in the general population.</p