Accelerometer‐Derived ‘Weekend Warrior’ Physical Activity Pattern and Microvascular Risk in Individuals With Type 2 Diabetes and Prediabetes

OBJECTIVE: To investigate the associations between accelerometer-derived physical activity patterns-specifically the "weekend warrior" (WW) pattern versus regularly distributed activity-and the risk of incident microvascular complications among individuals with type 2 diabetes (T2D) and prediabetes. METHODS: This prospective cohort study utilized data from the UK Biobank, analysing 12 923 adults with T2D and prediabetes who had accelerometer-measured data. Participants were classified into three groups: active WW (≥ 150 min/week; ≥ 50% of moderate-to-vigorous physical activity [MVPA] accumulated on 1-2 days), active regular (≥ 150 min/week but not meeting WW criteria), and inactive (< 150 min/week). Hazard ratio (HR) and 95% confidence interval (CI) for incident microvascular complications and their subtypes (diabetic kidney disease [DKD], neuropathy [DN], and retinopathy [DR]) were estimated using Cox proportional hazards models. RESULTS: Over a median follow-up of 7.88 years, 1235 incident microvascular complications were documented. Compared with the inactive group, both active patterns were associated with similarly reduced risks of microvascular complications (WW: HR 0.71 [95% CI 0.61-0.82]; regularly active: HR 0.63 [95% CI 0.52-0.77]). These protective associations extended consistently to DKD, DN and DR, with no statistically significant differences between WW and regularly active groups (all p > 0.05). Findings were robust across alternative MVPA thresholds, subgroup analyses, and sensitivity analyses. CONCLUSIONS: Concentrating recommended weekly MVPA within 1-2 days offers similar microvascular protection as regularly distributed activity among individuals with T2D and prediabetes, supporting flexible approaches for this high-risk population to achieve weekly activity goals.