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

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Abstract

BACKGROUND

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

OBJECTIVE

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

DESIGN

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

PARTICIPANTS

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

MEASUREMENTS

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.

RESULTS

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.

CONCLUSIONS

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.

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Acknowledgements

This study was jointly funded by Program Announcement number 04005 from the Centers for Disease Control and Prevention (Division of Diabetes Translation) and the National Institute of Diabetes and Digestive and Kidney Diseases. The findings and conclusions of this study are those of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the National Institute of Diabetes and Digestive and Kidney Diseases.

Dr. Mangione received support from the University of California, Los Angeles, Center for Health Improvement of Minority Elderly/Resource Centers for Minority Aging Research, NIH/NIA, under grant P30AG021684.

Drs. Mangione and Duru received support from UCLA/Drew Project EXPORT, National Institutes of Health, National Center on Minority Health & Health Disparities (P20MD000148/P20MD000182).

Significant contributions to this study were made by members of the Translating Research into Action for Diabetes (TRIAD) Study Group.

The authors acknowledge the participation of our health plan partners.

Conflict of Interest

None disclosed.

Author information

Authors and Affiliations

  1. David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA

    O. Kenrik Duru MD, Arleen F. Brown MD, PhD & Carol M. Mangione MD

  2. U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA

    Robert B. Gerzoff MS & K. M. Venkat Narayan MD

  3. The Division of Research, Kaiser Permanente, Oakland, CA, USA

    Andrew J. Karter PhD

  4. Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA

    Catherine Kim MD

  5. Division of Primary Care, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ, USA

    David Kountz MD

  6. Rollins School of Public Health, Emory University, Atlanta, GA, USA

    K. M. Venkat Narayan MD

  7. Division of Endocrinology and Metabolism, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ, USA

    Stephen H. Schneider MD

  8. Pacific Health Research Institute, Honolulu, HI, USA

    Chien-Wen Tseng MD & Beth Waitzfelder PhD

  9. School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA

    Carol M. Mangione MD

  10. Department of Family Medicine and Community Health, University of Hawaii, Honolulu, HI, USA

    Chien-Wen Tseng MD

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  1. O. Kenrik Duru MD
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  2. Robert B. Gerzoff MS
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Correspondence to O. Kenrik Duru MD.

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Duru, O.K., Gerzoff, R.B., Brown, A.F. et al. Predictors of Sustained Walking among Diabetes Patients in Managed Care: The Translating Research into Action for Diabetes (TRIAD) Study. J GEN INTERN MED 23, 1194–1199 (2008). https://doi.org/10.1007/s11606-008-0629-6

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  • DOI: https://doi.org/10.1007/s11606-008-0629-6

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