title: Improved walking speed is associated with lower hospitalisation rates in patients in an exercise-based secondary prevention programme.
abstract: To determine the relationship between walking speed (WS) maintained during a 1 km test and its improvement on hospitalisation in cardiac outpatients who were referred to an exercise-based secondary prevention programme.
  
  
  
  Hospitalisation was assessed in 1791 patients 3 years after enrolment and related to the WS achieved during a 1 km walk at moderate intensity on a treadmill. Hospitalisation was also assessed during the fourth-to-sixth years as function of improvement in WS in 1111 participants who were re-evaluated 3 years after baseline.
  
  
  
  Three-year hospitalisation rate across tertiles of baseline WS was 50% for the slow walkers (2.7±0.6 km/hour), 41% for the moderate (4.1±0.3 km/hour) and 25% for the fast walkers (5.2±0.5 km/hour) (p for trend <0.0001), with adjusted HRs (95% CI) of 0.93 (0.74 to 1.17, p=0.53) for intermediate and 0.58 (0.43 to 0.78, p=0.0003) for fast. Every 1 km/hour increase in WS was associated with a 21% reduction in hospitalisation (p<0.0001). Hospitalisation from the fourth-to-sixth years was lower across tertiles of improved WS, with 44% for the low (0.2±0.4 km/hour), 34% for the intermediate (0.8±0.2 km/hour) and 30% for the high tertile (1.6±0.4 km/hour) (p for trend <0.0001). Adjusted HRs were 0.68 (p=0.002) for the intermediate and 0.58 (p<0.0001) for the high tertile. Every 1 km/hour increase in WS was associated with a 35% reduction in hospitalisation (p<0.0001).
  
  
  
  Improvement in WS is associated with a significant, dose-dependent lower rate of all-cause hospitalisation in cardiac outpatients. WS is a simple, easily applied and clinically useful tool for cardiac patients undergoing secondary prevention.
authors.affiliation: Public Health Department, AUSL Ferrara, Ferrara, Italy.|Center of Biomedical Studies Applied to Sport, University of Ferrara, Ferrara, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Grazzi
authors.affiliation: Public Health Department, AUSL Ferrara, Ferrara, Italy.|Center of Biomedical Studies Applied to Sport, University of Ferrara, Ferrara, Italy.
authors.forename: Gianni
authors.initials: G
authors.lastname: Mazzoni
authors.affiliation: Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA.|Stanford University School of Medicine, Stanford, California, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Myers
authors.affiliation: Center of Biomedical Studies Applied to Sport, University of Ferrara, Ferrara, Italy.|Cardiovascular Secondary Prevention Program, Public Health Department, AUSL Ferrara, Ferrara, Italy.
authors.forename: Luciano
authors.initials: L
authors.lastname: Codecà
authors.affiliation: Division of Cardiology, Department of Medicine, 'Delta' Hospital, AUSL Ferrara, Ferrara, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Pasanisi
authors.affiliation: Health Statistics Unit, University Hospital, Ferrara, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Napoli
authors.affiliation: Health Statistics Unit, University Hospital, Ferrara, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Guerzoni
authors.affiliation: Department of Medical Science, University of Ferrara, Ferrara, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Volpato
authors.affiliation: Center of Biomedical Studies Applied to Sport, University of Ferrara, Ferrara, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Conconi
authors.affiliation: General Directorship for Public Health and Integration Policy, Emilia-Romagna Region, Bologna, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Chiaranda
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D000072038:Cardiac Rehabilitation / Q000379:methods*; D005080:Exercise Test; D005081:Exercise Therapy; D017079:Exercise Tolerance; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis / Q000503:physiopathology / Q000534:rehabilitation*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission; D020127:Recovery of Function; D012307:Risk Factors; D055502:Secondary Prevention / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D016138:Walking