Physical Activity Project

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Physical Activity ProjectDANCE DANCE REVOLUTION

• Ann E. Maloney, MD
• 2-2-05
• Department of Psychiatry, Child and Adolescent
  Division

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THANKS to

• Dr. Bishop
• Dr. Bethea
• Team DANCER
• Kids and families
• Gatorade, Get Kids in Action

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COMPUTER SCIENTISTS

• Society is facing an epidemic of pediatric
  obesity
• Labor saving devices do just that
• How to measure activity and inactivity

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Underwear?
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How much really helps?

• From NPR last weekThose findings suggest that
  making small changes to daily activities -- by
  tapping your toes, wiggling or otherwise
  expending more restless energy -- could be
  critical to weight loss

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Kids age 6-12

• If you're active less than 30 minutes a day/5
  days a week (or 60 minutes a day for youths under
  18), this program is for you.
• Various web sites try to get kids moving
• TV like Boo Bah and Wiggles try

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LOGO purpose Identify with the Project and Feel
like a Team

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DEMO
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Can DANCING help?
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Scope of Problem

• 17-18 Prepubertal youth now overweight
• Diseases Attributable DM, Ca, HTN, OA, CAD, OSA,
  Infertility, ortho, etc
• Sikich et al (2004) reported in an 8 week study
  an average of 2.3 increase in BMI with
  antipsychotic agents widely used in child
  psychiatry

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Toxic Environment

• The rapid rise in the prevalence of overweight
  can be attributed largely to an environment that
  supports the intake of high-fat, highly palatable
  foods while doing little to foster moderate or
  vigorous physical activity (Hill and Peters,
  1998).

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Overweight Psychiatric Aspects

• Equally impairing are obesity-related
  psychological problems, including low
  self-esteem, depression, poor body image, and
  eating disorders. (French et al., 1995 Pesa et
  al., 2000)

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Thought Leaders assert that

• solutions may include permanent modification of
  activity levels and food choices before trying to
  assume reduced-calorie regimens integrating
  behavioral therapy with pharmacological
  interventions and the identification of genetic
  predispositions (Epstein et al., 2001)

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The Problems Families Face

• Significant societal changes that have
  contributed to fewer family meals eaten together,
  decreased opportunities for children to be
  physically active because of safety concerns, and
  increased television, computer, and video use
  play a potential part in the epidemic of obesity
  and may also be particularly evident in children
  who experience neglect and chronic stress at home
  (Johnson et al., 2002 Lissau and Sorensen, 1994)

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Why a kiddie shrink?

• We can most accurately assess the role of family
  members in both the onset and maintenance of
  obesity. This may include a consideration of the
  role of mothers' restricting food and fathers'
  opinions of child obesity-both of which are
  significantly associated with the child's
  negative self-image (Davison and Birch, 2001). In
  addition, other familial factors such as physical
  and sexual abuse, neglect, and stressful home
  environments (Strauss, 1999) may need to be
  identified...

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NHANES

• Andersen RE, Crespo CJ, Bartlett SJ, Cheskin LJ,
  Pratt M (1998), Relationship of physical activity
  and television watching with body weight and
  level of fatness among children results from the
  Third National Health and Nutrition Examination
  Survey. JAMA 279938-942

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Dance Dance Revolution

• Why was this chosen? It is fun. This is a
  serious problem.

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Design
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Measures

• CSA baseline and endpoint and at follow-up
• (Time 1, 12, 28 week)
• Dennison Sedentary Screen Times baseline/end
• Pedometer Logs for 12 weeks
• DDR sticker sheets to track use 2hr/wk
• Photos top scores and grades for motivation
• Parent report of PA on logs, encouraged to play
• GEMS from Robinson
• Self-Esteem from Harter
• Home Environment from Paez
• Satisfaction survey for youth and adult at
  endpoint

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GEMS from Robinson

Yesterday , I . But usually, I
Activity
1. Bicycling None Less than 15 minutes 15minutesor more None A little A lot
1. Bicycling ? ? ? ? ? ?
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DANCER Experience Thus Far

• Children and families taking this seriously
• One girl elbow walked to her bathroom to put on
  her CSA, so she would not miss steps and counts
  on her CSA
• Families purchasing/replacing pedometers and
  competing for steps
• One child played for 6 hours, one Mom lost 16
  pounds
• Nobel Nomination for Peace in Sibs

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Major findings

• Activity that is moderate or vigorous increased
  more in the intervention that controls
• Sedentary time decreased 4 hrs a week in the
  intervention
• Families are invested, idea is feasible
• Will replicate and disseminate

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Determinants of Adherence to Exercise Prescription

• MD-driven prescription of defined amounts of
  exercise have been shown to increase compliance
• BMI, BP and anthropomorphics were measures, as
  this will show the family that what is measured
  is important

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Why DDR?
Dr. Richard Adler, of the University of Tennessee
Health Science Center in Memphis, said he likes
the game because it "gets the kids off their
butts and they lose weight." "Just like the
kids are addicted to regular video games where
they use their hands and thumbs, they just don't
want to stop," said Adler. DDR has been so
effective in getting teens off the couch that
some schools have incorporated it into their
physical education programs. USA Today 5/23/04
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Internal Life of Youth

• Youth very involved in IM, Chat, Blogs and
  websites like www.ddrfreak.com
• Future studies can use real-time games, compete
  against schools, accumulate total points, add new
  songs. This is fully customizable for the U01
  grant using broadband in homes for LINC data
  capture.

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Case Reports on the Non-Peer Reviewed Web

• Matt Keene's StoryLost 140-150lbs playing Dance
  Dance Revolution, and I lost a good 100 pounds of
  it in under a year

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Gender and Gaming?

• BOY BEAT
• Dancing is not really what you expect teenage
  boys to do at a video arcade. There are no
  machine guns, no explosions, no blood and guts on
  the screen. Just a steady beat, and on the screen
  during some songs, teenaged girls dancing or pink
  hearts popping. But ask any of these kids what
  they like about DDR, and most say they are drawn
  in by the challenge. In that way, it is like
  other video games.

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What is the Hook?

• Like other DDR fanaticsI can't really explain
  the game's draw. It's just fun.
• Unlocking songs, the next level
• "Once you get good at it," he said, wiping his
  brow, "it's really addictive."

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Need more HOOKS

• What does this generation like? People and fads
  vs classics and retro
• What has the most interaction and feedback?
• Ideas like heart rate, smart games that keep
  giving feedback
• What ideas do you have?

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Lasting Impact of PA changes?

• With DDR, Ive lost 95 lbs and kept it off over
  FOUR and a half years. I continue to lose weight
  and feel motivated about myself
• We will test the group at 12 weeks and 28 weeks
  to look for maintenance of the behavior

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Sikichs Lab/Maloney co-PI studyingGhrelin ,
Insulin, C-reactive Protein, V-CAM 1, PAI-1 ,
Fibrinogen, Leptin, Interleukin 6, Adiponectin,
small LDL particles, serum Homocysteine, serum
Lipoprotein A, I-CAM-1, E-selectin in a cohort
treated with atypical antipsychotic agents which
confer some insulin resistance by an unknown
mechanism of action.
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Thank You

• Team DANCER is a wonderful team from both sides
  of the street, in keeping with the roadmap from
  NIH (nutrition, physical therapy, medicine,
  neurodevelopment research, etc)
• Gratitude is expressed to our team for home
  visits, evening hours and commitment to the
  families who ask excellent questions
• Thanks to you for thinking about how we can
  improve this