Predictors of sustained walking among diabetes patients in managed care: The Translating Research into Action for Diabetes (TRIAD) study

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. © 2008 Society of General Internal Medicine.