Journal of General Internal Medicine

, 23:1194

Predictors of Sustained Walking among Diabetes Patients in Managed Care: The Translating Research into Action for Diabetes (TRIAD) Study


    • David Geffen School of MedicineUniversity of California, Los Angeles
  • Robert B. Gerzoff
    • U.S. Centers for Disease Control and Prevention
  • Arleen F. Brown
    • David Geffen School of MedicineUniversity of California, Los Angeles
  • Andrew J. Karter
    • The Division of ResearchKaiser Permanente
  • Catherine Kim
    • Department of Internal MedicineUniversity of Michigan
  • David Kountz
    • Division of Primary CareUMDNJ-Robert Wood Johnson Medical School
  • K. M. Venkat Narayan
    • U.S. Centers for Disease Control and Prevention
    • Rollins School of Public HealthEmory University
  • Stephen H. Schneider
    • Division of Endocrinology and MetabolismUMDNJ-Robert Wood Johnson Medical School
  • Chien-Wen Tseng
    • Pacific Health Research Institute
    • Department of Family Medicine and Community HealthUniversity of Hawaii
  • Beth Waitzfelder
    • Pacific Health Research Institute
  • Carol M. Mangione
    • David Geffen School of MedicineUniversity of California, Los Angeles
    • School of Public HealthUniversity of California, Los Angeles
Original Article

DOI: 10.1007/s11606-008-0629-6

Cite this article as:
Duru, O.K., Gerzoff, R.B., Brown, A.F. et al. J GEN INTERN MED (2008) 23: 1194. doi:10.1007/s11606-008-0629-6



Although patients with diabetes may benefit from physical activity, few studies have examined sustained walking in this population.


To examine the factors associated with sustained walking among managed care patients with diabetes.


Longitudinal, observational cohort study with questionnaires administered 2.5 years apart.


Five thousand nine hundred thirty-five patients with diabetes walking at least 20 minutes/day at baseline.


The primary outcome was the likelihood of sustained walking, defined as walking at least 20 minutes/day at follow-up. We evaluated a logistic regression model that included demographic, clinical, and neighborhood variables as independent predictors of sustained walking, and expressed the results as predicted percentages.


The absence of pain was linked to walking behavior, as 62% of patients with new pain, 67% with ongoing pain, and 70% without pain were still walking at follow-up (p = .03). Obese patients were less likely (65%) to sustain walking than overweight (71%) or normal weight (70%) patients (p = .03). Patients ≥65 years (63%) were less likely to sustain walking than patients between 45 and 64 (70%) or ≤44 (73%) years (p = .04). Only 62% of patients with a new comorbidity sustained walking compared with 68% of those who did not (p < .001). We found no association between any neighborhood variables and sustained walking in this cohort of active walkers.


Pain, obesity, and new comorbidities were moderately associated with decreases in sustained walking. Whereas controlled intervention studies are needed, prevention, or treatment of these adverse conditions may help patients with diabetes sustain walking behavior.


sustained walkingdiabetes patientsmanaged careTRIAD studypainobesitycomorbidities

Copyright information

© Society of General Internal Medicine 2008