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Improved walking speed is associated with lower hospitalisation rates in patients in an exercise-based secondary prevention programme
  1. Giovanni Grazzi1,2,
  2. Gianni Mazzoni1,2,
  3. Jonathan Myers3,4,
  4. Luciano Codecà2,5,
  5. Giovanni Pasanisi6,
  6. Nicola Napoli7,
  7. Franco Guerzoni7,
  8. Stefano Volpato8,
  9. Francesco Conconi2,
  10. Giorgio Chiaranda9
  1. 1Public Health Department, AUSL Ferrara, Ferrara, Italy
  2. 2Center of Biomedical Studies Applied to Sport, University of Ferrara, Ferrara, Italy
  3. 3Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
  4. 4Stanford University School of Medicine, Stanford, California, USA
  5. 5Cardiovascular Secondary Prevention Program, Public Health Department, AUSL Ferrara, Ferrara, Italy
  6. 6Division of Cardiology, Department of Medicine, ‘Delta’ Hospital, AUSL Ferrara, Ferrara, Italy
  7. 7Health Statistics Unit, University Hospital, Ferrara, Italy
  8. 8Department of Medical Science, University of Ferrara, Ferrara, Italy
  9. 9General Directorship for Public Health and Integration Policy, Emilia-Romagna Region, Bologna, Italy
  1. Correspondence to Giovanni Grazzi, Center of Biomedical Studies Applied to Sport, University of Ferrara, Via Gramicia 35 Ferrara 44123, Italy; giovanni.grazzi{at}


Objective 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.

Methods 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.

Results 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).

Conclusion 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.

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  • Contributors GG and GC designed data collection tools, monitored data collection, wrote the statistical analysis plan, cleaned and analysed the data and drafted and revised the paper. GG and GC are guarantors. JM, SV and FC analysed the data and drafted and revised the paper. GM, LC, GP, NN and FG monitored data collection and analysed the data.

  • Competing interests None declared.

  • Ethics approval The study was approved by the Human Studies Committee of the University of Ferrara, no. 22-13 and all subjects gave written informed consent.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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