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BACKGROUND: Attaining guideline-recommended levels of physical activity is associated with substantially lower risk of cardiometabolic diseases.OBJECTIVES: Although physical activity commonly follows a weekend warrior pattern, in which most moderate-to-vigorous physical activity is concentrated in 1 to 2 days rather than spread more evenly across the week (regular), the effects of activity pattern on imaging-based biomarkers of cardiometabolic health are unknown.METHODS: We analyzed 17,146 UK Biobank participants who wore accelerometers for 1 week, and later underwent cardiac magnetic resonance imaging. Activity was categorized as inactive, regular, or "weekend warrior". Associations between activity pattern and magnetic resonance imaging-derived visceral adipose tissue (VAT) and epicardial and pericardial adipose tissue (EPAT) were assessed using multiple linear regression adjusted for confounding factors.RESULTS: Compared to inactive, VAT was progressively lower with weekend warrior (-0.71 L, 95% CI -0.78 to -0.64, P < 0.001) followed by regular activity (-0.96 L, 95% CI -1.04 to -0.88, P < 0.001). Observations were similar for EPAT (weekend warrior activity -2.84 cm, 95% CI -3.20 to -2.49, P < 0.001; regular activity -3.62 cm, 95% CI -4.03 to -3.20, P < 0.001). When compared directly, weekend warriors had modestly higher adipose tissue than regular activity (VAT difference 0.25 L, 95% CI 0.17-0.32, P < 0.001; EPAT 0.78 cm, 95% CI 0.40-1.15, P < 0.001). No differences were observed after adjustment for total moderate-to-vigorous physical activity minutes (VAT 0.07 L, 95% CI -0.01 to 0.14, P = 0.09; EPAT 0.04 cm, 95% CI -0.35 to 0.43, P = 0.84).CONCLUSIONS: Guideline-adherent physical activity is associated with favorable quantitative measures of cardiometabolic health, with no differences based on activity pattern for a given activity volume.