BMJ Open 3:e003446 doi:10.1136/bmjopen-2013-003446
  • Rehabilitation medicine
    • Research

Treadmill walking speed and survival prediction in men with cardiovascular disease: a 10-year follow-up study

  1. Giovanni Grazzi1
  1. 1Center of Biomedical Studies Applied to Sport, University of Ferrara, Ferrara, Italy
  2. 2Cardiology Division, VA Palo Alto Health Care System, Stanford University, Palo Alto, California, USA
  3. 3Department of Internal Medicine, University of Ferrara, Ferrara, Italy
  1. Correspondence to Dr Eva Bernardi; bernardi.eva{at}
  • Received 20 June 2013
  • Revised 5 September 2013
  • Accepted 24 September 2013
  • Published 25 October 2013


Objective To determine whether the walking speed maintained during a 1 km treadmill test at moderate intensity predicts survival in patients with cardiovascular disease.

Design Population-based prospective study.

Setting Outpatient secondary prevention programme in Ferrara, Italy.

Participants 1255 male stable cardiac patients, aged 25–85 years at baseline.

Main outcome measures Walking speed maintained during a 1 km treadmill test, measured at baseline and mortality over a median follow-up of 8.2 years.

Results Among 1255 patients, 141 died, for an average annual mortality of 1.4%. Of the variables considered, the strongest predictor of all-cause mortality was walking speed (95% CI 0.45 to 0.75, p<0.0001). Based on the average speed maintained during the test, participants were subdivided into quartiles and mortality risk adjusted for confounders was calculated. Compared to the slowest quartile (average walking speed 3.4 km/h), the relative mortality risk decreased for the second, third and fourth quartiles (average walking speed 5.5 km/h), with HRs of 0.73 (95% CI 0.46 to 1.18); 0.54 (95% CI 0.31 to 0.95) and 0.20 (95% CI 0.07 to 0.56), respectively (p for trend <0.0001). Receiver operating curve analysis showed an area under the curve of 0.71 (p<0.0001) and the highest Youden index (0.35) for a walking speed of 4.0 km/h.

Conclusions The average speed maintained during a 1 km treadmill walking test is inversely related to survival in patients with cardiovascular disease and is a simple and useful tool for stratifying risk in patients undergoing secondary prevention and cardiac rehabilitation programmes.

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