Weekend warriors vs. daily gym rats: cardiovascular benefits are similar, new study finds.
I basically need to exercise for a little over an hour per day. If I don’t, I get antsy. Ask anyone who knows me. More than that, though, my mild but annoying low-grade chronic back pain always improves after I’ve exercised. The kicker? I do some of my best thinking on the stationary bike. I’ve had significant breakthroughs in my research right in my basement’s mini-gym.
Once in a while, I don’t have time to exercise, or my workout gets cut short. When that happens, my instinct is always to “make up for it” the next day with a longer session. The overall goal is to have my heart rate in the 135-155 beats per minute range for 55-60 minutes per day, plus some strength and core work mixed in.
Is your workout okay? (Spoiler: yes, as long as it’s challenging you).
Now there’s evidence to support that the frequency/pattern of your exercise does not matter. You can exercise every day or you can do so less frequently but for longer (“weekend warriors”). What matters is the total time and that you exercise at all (more on this below). What matters is that you get your heart rate up a few times per week. If you don’t have time for a daily workout, you can just pile on the minutes on the weekend (and my daily routine is fine too). Participants who exercised moderately or vigorously as little as 2 hours per week had lower rates of atrial fibrillation (a heart rhythm which can be dangerous), heart attacks, heart failure, and strokes. The study followed nearly 90,000 volunteers (with an average age of just north of 60) for around 6 years, on average.
A few interesting points that caught my eye.
This study got published in the prestigious Journal of the American Medical Association because all of the volunteers wore wrist bands that tracked their activity. The “Fitbit” approach to medical and health research is having its day, now that enough time has passed since they became inexpensive and omnipresent that longer-term studies are now being analyzed. In the past, researchers had to ask volunteers to keep track of their habits—and that led to mixed results. Now volunteers consent to being tracked in real time.
The rate of bad outcomes was always better for people who exercised compared to those who were inactive. At the most extreme, 7%-9% of inactive people had any of the bad cardiovascular events compared to 5%-6% of those who reached moderate or vigorous effort levels. But the return on investment for moderately or vigorously exercising 6-7 hours per week instead of 2-4 hours per week really was not apparent in this study. The authors kind of buried this finding—especially on the lower end. It surprised me that people who reached moderate to vigorous levels of effort for just under 2 hours per week basically got all of the cardiovascular benefit. Does that mean that 2 hours is enough to get the cardiovascular upsides? Or does that mean that people who made any time for exercise during their week are already a healthier group than those who are inactive. If it’s the latter, the whole study falls apart. So here’s my lingering question: how little moderate or vigorous exercise can one do and still get the measured health benefits?
Lower effort exercise didn’t count. So, don’t take the above to mean you can expect lower rates of cardiovascular events if you lightly pedal or go for a walk for 115 minutes per week. This study only “counted” exercise that was fairly intense.
Injury rates didn’t differ across groups. There was concern that piling all the exercise into two sessions might lead to more injuries. It didn’t. Meanwhile, the inactive folks had fewer injuries. So, at least there’s that upside to not crushing it in the gym.
There were lots of little findings that should not surprise anyone, but whose overall meanings and implications are not clear. Active folks had lower rates of obesity, diabetes, and lower rates of needing to take medication for high blood pressure. To what extent any of that was significant to improve quality of life or lifespan, we don’t know.
Final thoughts
People exercise for many reasons. I do it for my health, my mental sanity, my bad back, and to justify desserts and alcoholic beverages. Over the years, there have been studies saying just about everything you can imagine about exercise; a certain kind is better than others, certain frequencies are better, certain times of the day are best, yadda yadda yadda. I’m telling you, I’d be shocked if any of those studies are meaningful enough that they should override your own preferences. As long as your exercise is genuinely challenging (if it’s too easy, you may not be getting your heart rate up enough), do what works for you. Do you like hitting it hard on weekend afternoons only? Do it! Do you prefer daily morning workouts? More power to you. As for me, I love finishing a hard day of work by hopping onto my stationary bike.
What’s your routine? Have you found that getting set in your ways is actually a good thing? Comment below!
Morning Dr. Faust, This was interesting. Thank you. Are you familiar with the book BODY BY SCIENCE by Dr. Doug McGuff and John Little? If not, you might want to spend a few minutes searching about Dr. McGuff online. Like you, he is an emergency medicine physician. I was introduced to him by my body builder, personal trainer brother because Dr. McGuff uses the high intensity, "super slow" protocol as the core of his exercise philosophy. He owns a state-of-the-art personal training facility Ultimate-Exercise in SC. He focuses that facility on helping his elderly medical patients. He is an impressive public speaker with a very interesting personal story.
I use his super-slow weight training method once every seven days - he explains why he lets one’s body recover for seven days between intense weight training sessions. My McGuff weight training method requires thirty minutes to move through eight exercises slowly while concentrating on form until I can no longer perform a repetition at the designated weight load. I will have reached my muscle failure point.
Dr. McGuff explains that his patients reliably double their personal strength using this training method within twelve weeks. An impressive illustration of this successful program is that behind his training facility there is a pile of discarded walkers left there by his elderly patients following his twelve week exercise program. I have been doing this weight training program on the machines at the local senior center since 2017, and when combined with a cardiovascular brisk walk daily, this protocol works well for my seventy-six year old body. FYI, I have advanced PCa, CAD, CHF, have had a RARP, CABG5 and SRT for the PCa. I am cared for at MGB, DFCI and UPenn, and most importantly - I am still alive!
Thank you so much for taking the time to provide an audio version. I couldn't get the audio version to take my comment but, alas, I have dry eyes syndrome+ osteoporosis (which I'm resisting with dedicated strength training!). So hearing this column on exercise in audio is greatly appreciated. And it's nice to hear your voice from time to time.