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

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.