Background The role of physical activity (PA) patterns in gout prevention remains unclear. This prospective study investigated associations between accelerometer-derived PA patterns, specifically “regularly active” (RA) and “weekend warrior” (WW), and incident gout.

Methods Among 97,474 gout-free UK Biobank participants with valid 7-day accelerometer data obtained using Axivity AX3 wrist-based triaxial devices, we categorized PA patterns as Inactive (<150 min/week moderate-to-vigorous physical activity [MVPA]), WW (≥150 min MVPA with ≥50% concentrated in 1–2 days) and RA (≥150 min MVPA, not meeting WW criteria). Multivariable Cox models were used to estimate hazard ratios (HRs) for incident gout.

Results Over a median follow-up of 8.0 years, 905 incident gout cases occurred. Compared to the Inactive group (n=36,785), both RA (n=20,298; HR 0.75, 95% CI 0.62–0.91, P=0.004) and WW (n=40,391; HR 0.84, 95% CI 0.73–0.98, P=0.024) showed significantly reduced gout risk in fully adjusted models. Crucially, after additional adjustment for total MVPA volume, no significant difference in gout risk was observed between RA and WW across models (all P>0.3). Inverse probability of treatment weighting analyses confirmed these associations (RA vs. Inactive: HR 0.76, 95% CI 0.62–0.93, P=0.007; WW vs. Inactive: HR 0.85, 95% CI 0.72–0.99, P=0.039). Stratification by gout polygenic risk score tertiles showed consistent protective effects for both RA and WW patterns across all genetic risk strata (all P-interaction >0.1). Sensitivity analyses (varying MVPA thresholds, stricter WW definitions [≥75% MVPA in 1-2 days], excluding early gout cases) supported the robustness of the findings.

Conclusion Physical activity, including both regularly active and weekend warrior patterns, was associated with significantly reduced gout risk. Physical activity volume, rather than its temporal pattern, drives the reduction in gout risk. When achieving equivalent MVPA volume, no significant difference exists between regularly active and weekend warrior patterns. The protective role of physical activity was consistent under different subgroups and genetic risk profiles, supporting its potential as a broadly applicable strategy for gout prevention.

The authors have declared no competing interest.

The work was supported by the General Project of the Medical and Health of Zhejiang Province (2024KY037), the State Administration of Traditional Chinese Medicine and Zhejiang Province Co-Construction Project (GZY-ZJ-KJ-23002), the Postdoctoral Research Start-up Fund of Zhejiang Provincial People's Hospital (C-2024-BSH15) and the Talent Recruitment Fund for Outstanding Doctoral Graduates of Zhejiang Provincial People's Hospital (C-2024-BS20).

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