Physical inactivity among adults is a major contributor to the escalating global burden of neurodegenerative diseases and mental disorders. The “Weekend Warrior” (WW) pattern—characterized by condensing the recommended volume of physical activity (PA) into one or two days—has emerged as a potential strategy for time-constrained adults. However, a systematic synthesis comparing the potential association of the WW pattern on neuropsychological outcomes (e.g., neurodegenerative diseases, mental health conditions and cognitive function) with those of inactive (IA) and regular exercise (RE) patterns remains limited. This systematic review aimed to assess the associations of the WW pattern with neurodegenerative diseases (e.g., dementia, Parkinson’s disease), mental health conditions (e.g., depression, anxiety, psychological distress), and cognitive function (CF), and to compare these neuropsychological outcomes with those associated with IA and RE patterns. A systematic search of PubMed, Web of Science, ScienceDirect, and Chinese databases (CNKI, Wanfang) was conducted for observational studies published from inception to October 2025. Thirteen studies (5 cohort and 8 cross-sectional studies) involving adults were included. The assessment of methodological quality was conducted using the Agency for Healthcare Research and Quality (AHRQ) methodology and the Newcastle–Ottawa Scale (NOS). The majority of included studies indicated that the WW pattern was inversely associated with the risks of neurodegenerative diseases and mental health conditions and enhanced CF, exhibiting associations of a similar magnitude to those of RE. Furthermore, the synthesis highlighted prevailing gaps in the extant literature, particularly regarding the lack of randomized controlled trials, insufficient control for confounding variables such as social context, and the limited investigation into the neurobiological mechanisms underlying these associations. This systematic review emphasizes the WW pattern as a viable and time-efficient strategy that promotes positive neuropsychological outcomes, exhibiting associations of a similar magnitude to those observed with RE. The findings substantiate the flexibility inherent in PA guidelines, underscoring that adhering to recommended PA volumes is highly beneficial, even when accumulated within a condensed timeframe. Future research should prioritize randomized controlled trials and investigations into neurobiological mechanisms to further validate causal relationships and elucidate the underlying mechanisms driving these associations.

Background: Musculoskeletal conditions impose an increasing health burden, particularly in ageing populations. For adults who find it difficult to exercise throughout the week, completing the recommended amount of moderate-to-vigorous physical activity (MVPA) over only 1–2 days, commonly described as the “weekend warrior” (WW) pattern, may offer a more practical approach. Whether this concentrated pattern is associated with musculoskeletal outcomes comparable to those observed with regularly distributed activity remains uncertain. This systematic review synthesized current evidence concerning the relationships of the WW pattern with musculoskeletal outcomes and examined how these associations compared with those observed in inactive (IA) and regularly active (RA) adults. Methods: PubMed, Web of Science, and Scopus were searched from database inception through 30 June 2026, following PRISMA recommendations. Ten observational investigations, including four cohort and six cross-sectional studies, were eligible, with individual sample sizes ranging from 3539 to 83,376 adults. Cohort studies were evaluated using the Newcastle–Ottawa Scale, whereas cross-sectional studies were appraised with the Agency for Healthcare Research and Quality checklist. Results: Across the included studies, adults following a WW pattern generally had more favorable estimates for low bone mineral density (BMD), osteoporosis, osteoarthritis, spinal degenerative changes, inflammatory arthritis, and sarcopenia than inactive adults. Where WW and RA patterns were directly contrasted, their associations with most musculoskeletal outcomes were broadly similar, although WW was associated with a higher hazard of osteoarthritis in one study, a lower hazard of fractures in another, and lower odds of sarcopenia among WW participants. Subgroup analyses further suggested that these associations may vary across population characteristics, although the patterns were not uniform. Associations with BMD tended to be more pronounced in men and in participants with body mass index (BMI) < 25 kg/m². Findings for osteoporosis varied according to age and genetic susceptibility, while age- and sex-specific associations with sarcopenia differed across studies. One exploratory analysis also suggested that the association with osteoporosis may vary according to the timing of MVPA across the day. Conclusions: Meeting the recommended weekly amount of MVPA over 1–2 days was generally associated with more favorable musculoskeletal outcomes than inactivity, while the observed estimates were often close to those reported for regularly distributed activity. These findings support the possibility that achieving sufficient weekly activity may remain relevant even when exercise is concentrated into fewer days. Nevertheless, the evidence is entirely observational and is limited by heterogeneous definitions of WW, differences in physical activity assessment, residual confounding, overlapping study populations, and insufficient investigation of injury outcomes. Current findings therefore cannot establish causality or demonstrate equivalence or non-inferiority between WW and RA patterns.