Giovanni Grazzi1,2, Gianni Mazzoni1,2, Jonathan Myers3,4, Luciano Codecà2,5, Giovanni Pasanisi6, Nicola Napoli7, Franco Guerzoni7, Stefano Volpato8, Francesco Conconi2, Giorgio Chiaranda9. 1. Public Health Department, AUSL Ferrara, Ferrara, Italy. 2. Center of Biomedical Studies Applied to Sport, University of Ferrara, Ferrara, Italy. 3. Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA. 4. Stanford University School of Medicine, Stanford, California, USA. 5. Cardiovascular Secondary Prevention Program, Public Health Department, AUSL Ferrara, Ferrara, Italy. 6. Division of Cardiology, Department of Medicine, 'Delta' Hospital, AUSL Ferrara, Ferrara, Italy. 7. Health Statistics Unit, University Hospital, Ferrara, Italy. 8. Department of Medical Science, University of Ferrara, Ferrara, Italy. 9. General Directorship for Public Health and Integration Policy, Emilia-Romagna Region, Bologna, Italy.
Abstract
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. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
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. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
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