Association Between Walking Speed and Mortality in Cardiac Patients with Type 2 Diabetes Involved in a Secondary Prevention Program

Background: This study aimed to investigate associations between walking speed (WS) and mortality among cardiac patients with type 2 diabetes. Methods: Of the 3328 patients included in the ITER registry between 1998 and 2023, 490 patients diagnosed with type 2 diabetes (mean age 67 ± 9 years) were categorized into tertiles based on WS measured at baseline. Walking speed was measured using the 1 km treadmill walking test (1km-TWT). Cox proportional hazard models were used to examine associations between WS and all-cause and cardiovascular disease mortality, adjusting for demographic and clinical confounders. Results: The results showed a significative inverse association between WS and mortality. A total of 205 patients died over a median follow-up of 11 years. Patients with a higher baseline WS reported a lower mortality risk compared to slow walkers. A similar magnitude was confirmed by the sensitivity analysis excluding people who died in the first three years. Conclusions: The 1km-TWT is an effective predictor of mortality among cardiac patients with type 2 diabetes and a valuable educational tool for exercise-based interventions in secondary prevention. These findings highlight the efficacy of exercise-based programs to improve physical function and reduce mortality risk, underscoring the importance of promoting exercise as part of long-term cardiovascular disease management.