Adherence to guideline-recommended optimal dose (≥150 min/week of moderate-to-vigorous physical activity [MVPA]) has been associated with reduced risk of cardiovascular disease (CVD) in adults with type 2 diabetes mellitus (T2DM) or prediabetes. However, the influence of different PA patterns, such as concentrated versus evenly distributed activity, on this risk remains unclear. We aimed to examine the associations of accelerometer-measured “weekend warrior” (WW) and active regular patterns with incident CVD in adults with T2DM or prediabetes.

Using accelerometer data from 10,989 participants with T2DM or prediabetes (aged 43–78 years) from the UK Biobank, we categorized participants into three PA patterns: active WW pattern (guideline-recommended optimal dose with ≥ 50 % of MVPA concentrated over 1–2 days/week), active regular pattern (guideline-recommended optimal dose with ≥ 50 % of MVPA spread across > 2 days/week), and the inactive pattern (<150 min/week of MVPA). The primary outcomes, including overall CVD, myocardial infarction (MI), atrial fibrillation (AF), heart failure (HF), and stroke, were obtained from hospital and death records. Cox proportional hazards regression was used for the analyses, with results presented as hazard ratios (HRs) with 95 % confidence intervals (CIs).

Over a median follow-up of 7.86 years, 1,128 CVD cases were identified. Compared to inactive individuals, the active WW group had a lower risk of overall CVD, MI, AF, and HF, with HRs and 95 % CIs of 0.72 (0.63–0.83), 0.66 (0.51–0.85), 0.70 (0.58–0.85), and 0.66 (0.51–0.86), respectively. Similar risk reductions were observed in the active regular group (overall CVD: 0.75 [0.64–0.89], MI: 0.58 [0.42–0.80], AF: 0.85 [0.68–1.05], HF: 0.51 [0.36–0.72]).

The active WW pattern, concentrating guideline-recommended MVPA into 1–2 days, was similar to the active regular pattern in reducing the risk of CVD in adults with T2DM or prediabetes.