Increased Walking Speed Reduces Hospitalization Rates in Patients with Cardiovascular Disease During Exercise-Based Secondary Prevention

Raisi, Andrea; Piva, Tommaso; Myers, Jonathan; Zerbini, Valentina; Menegatti, Erica; Lembo, Margherita; Michelon, Sofia; Meneghini, Isabella; Grazzi, Giovanni; Mazzoni, Gianni; Mandini, Simona

doi:10.3390/jcm14134583

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Increased Walking Speed Reduces Hospitalization Rates in Patients with Cardiovascular Disease During Exercise-Based Secondary Prevention

by

Andrea Raisi

^1,2

,

Tommaso Piva

¹

,

Jonathan Myers

^2,3,4

,

Valentina Zerbini

^1,*

,

Erica Menegatti

⁵,

Margherita Lembo

¹

,

Sofia Michelon

¹,

Isabella Meneghini

¹,

Giovanni Grazzi

^1,2,6,

Gianni Mazzoni

^1,6 and

Simona Mandini

¹

Center for Exercise Science and Sport, Department of Neuroscience and Rehabilitation, University of Ferrara, Via Gramicia 35, 44121 Ferrara, Italy

²

Healthy Living for Pandemic Event Protection (HL-PIVOT) Network, University of Illinois at Chicago, Chicago, IL 60607, USA

³

Division of Cardiology, VA Palo Alto, Palo Alto, CA 94304, USA

⁴

Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA

⁵

Department of Environmental and Prevention Sciences, University of Ferrara, 44121 Ferrara, Italy

⁶

Public Health Department, AUSL Ferrara, 44121 Ferrara, Italy

^*

Author to whom correspondence should be addressed.

J. Clin. Med. 2025, 14(13), 4583; https://doi.org/10.3390/jcm14134583 (registering DOI)

Submission received: 28 May 2025 / Revised: 25 June 2025 / Accepted: 27 June 2025 / Published: 27 June 2025

(This article belongs to the Special Issue Hypertension and Cardiovascular Disease: Clinical Updates and Perspectives)

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Abstract

Background/Objectives: Walking speed (WS) is associated with morbidity and mortality. This study sought to investigate the associations between WS and hospitalization among patients with stable cardiovascular disease (CVD) and analyze how changes in WS impact all-cause hospitalization during exercise interventions. Methods: Of the 3328 patients in the ITER registry, 2871 (aged 65 ± 11 years) were analyzed. WS was measured using the 1 km treadmill walking test (1 km-TWT). Hospitalization was evaluated after one and three years according to the baseline WS tertiles. Additionally, 1465 patients were re-evaluated three years after the baseline, categorized into SlowWS and FastWS groups, and subsequently associated with changes in WS (worsening or low, moderate, and high improvements), generating six joint categories. Hospitalization was re-assessed during the fourth and sixth years after the baseline. The associations between WS and all-cause and CVD hospitalization were examined using Cox proportional hazard models, adjusting for demographic and clinical confounders. Results: A higher baseline WS was inversely associated with one-year hospitalization, with a 42% lower risk of all-cause hospitalization (95% CI: 0.51, 0.66) and a 38% lower risk of cardiovascular-related events (95% CI: 0.45, 0.86) compared to those in slower patients. Significant but mitigated magnitudes were observed for three-year hospitalization. A similar trend resulted in WS changes over time. Interestingly, the six-year risk in the SlowWS-high group was a 43% (95% CI: 0.45, 0.74) lower risk, which was comparable to that in the FastWS-low patients. Conclusions: The 1 km-TWT effectively predicts hospitalization among cardiac outpatients and is a valuable educational tool for exercise-based interventions in secondary prevention. These findings emphasize the efficacy of exercise-based programs, highlighting the importance of promoting exercise in long-term CVD management.

Keywords: cardiovascular disease; hospitalization; walking speed; exercise; cardiac rehabilitation; secondary prevention

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MDPI and ACS Style

Raisi, A.; Piva, T.; Myers, J.; Zerbini, V.; Menegatti, E.; Lembo, M.; Michelon, S.; Meneghini, I.; Grazzi, G.; Mazzoni, G.; et al. Increased Walking Speed Reduces Hospitalization Rates in Patients with Cardiovascular Disease During Exercise-Based Secondary Prevention. J. Clin. Med. 2025, 14, 4583. https://doi.org/10.3390/jcm14134583

AMA Style

Raisi A, Piva T, Myers J, Zerbini V, Menegatti E, Lembo M, Michelon S, Meneghini I, Grazzi G, Mazzoni G, et al. Increased Walking Speed Reduces Hospitalization Rates in Patients with Cardiovascular Disease During Exercise-Based Secondary Prevention. Journal of Clinical Medicine. 2025; 14(13):4583. https://doi.org/10.3390/jcm14134583

Chicago/Turabian Style

Raisi, Andrea, Tommaso Piva, Jonathan Myers, Valentina Zerbini, Erica Menegatti, Margherita Lembo, Sofia Michelon, Isabella Meneghini, Giovanni Grazzi, Gianni Mazzoni, and et al. 2025. "Increased Walking Speed Reduces Hospitalization Rates in Patients with Cardiovascular Disease During Exercise-Based Secondary Prevention" Journal of Clinical Medicine 14, no. 13: 4583. https://doi.org/10.3390/jcm14134583

APA Style

Raisi, A., Piva, T., Myers, J., Zerbini, V., Menegatti, E., Lembo, M., Michelon, S., Meneghini, I., Grazzi, G., Mazzoni, G., & Mandini, S. (2025). Increased Walking Speed Reduces Hospitalization Rates in Patients with Cardiovascular Disease During Exercise-Based Secondary Prevention. Journal of Clinical Medicine, 14(13), 4583. https://doi.org/10.3390/jcm14134583

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Increased Walking Speed Reduces Hospitalization Rates in Patients with Cardiovascular Disease During Exercise-Based Secondary Prevention

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