Physical Activity Project—Physical Activity Project—DANCE DANCE DANCE DANCE REVOLUTIONREVOLUTION

Ann E. Maloney, MDAnn E. Maloney, MD2-2-052-2-05

Department of Psychiatry, Child and Department of Psychiatry, Child and Adolescent DivisionAdolescent Division

THANKS to:THANKS to:

Dr. BishopDr. Bishop Dr. BetheaDr. Bethea Team DANCERTeam DANCER Kids and familiesKids and families Gatorade, Get Kids in ActionGatorade, Get Kids in Action

COMPUTER SCIENTISTSCOMPUTER SCIENTISTS

Society is facing an epidemic of pediatric Society is facing an epidemic of pediatric obesityobesity

Labor saving devices do just thatLabor saving devices do just that How to measure activity and inactivityHow to measure activity and inactivity

Underwear?Underwear?

How much really helps?How much really helps?

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

Kids age 6-12Kids age 6-12

““If you're active less than 30 minutes a If you're active less than 30 minutes a

day/5 days a week (or 60 minutes a day day/5 days a week (or 60 minutes a day for youths under 18), this program is for for youths under 18), this program is for you.”you.”

Various web sites try to get kids movingVarious web sites try to get kids moving TV like Boo Bah and Wiggles tryTV like Boo Bah and Wiggles try

LOGO purpose: Identify with the LOGO purpose: Identify with the Project and Feel like a TeamProject and Feel like a Team

DEMODEMO

Can DANCING help?Can DANCING help?

Scope of ProblemScope of Problem

17-18% Prepubertal youth now overweight17-18% Prepubertal youth now overweight Diseases Attributable: DM, Ca, HTN, OA, Diseases Attributable: DM, Ca, HTN, OA,

CAD, OSA, Infertility, ortho, etcCAD, OSA, Infertility, ortho, etc Sikich et al (2004) reported in an 8 week Sikich et al (2004) reported in an 8 week

study an average of 2.3 increase in BMI study an average of 2.3 increase in BMI with antipsychotic agents widely used in with antipsychotic agents widely used in child psychiatrychild psychiatry

Toxic EnvironmentToxic Environment

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

Overweight: Psychiatric AspectsOverweight: Psychiatric Aspects

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

Thought Leaders assert that:Thought Leaders assert that:

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

The Problems Families FaceThe Problems Families Face

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

Why a kiddie shrink?Why a kiddie shrink?

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

NHANES NHANES

Andersen RE, Crespo CJ, Bartlett SJ, Andersen RE, Crespo CJ, Bartlett SJ, Cheskin LJ, Pratt M (1998), Relationship Cheskin LJ, Pratt M (1998), Relationship of physical activity and of physical activity and television television watchingwatching with body weight and level of with body weight and level of fatness among children: results from the fatness among children: results from the Third National Health and Nutrition Third National Health and Nutrition Examination Survey. Examination Survey. JAMAJAMA 279:938-942 279:938-942

Dance Dance RevolutionDance Dance Revolution

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

DesignDesign

61 youth randomized

Basic Group 19 kids Enhanced Group 22 Control Group 20

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

GEMS from RobinsonGEMS from Robinson

Activity

1. BicyclingNone

Less than 15 minutes

15minutesor

moreNone A little A lot

Yesterday , I …. But usually, I……

DANCER Experience Thus FarDANCER Experience Thus Far

Children and families taking this seriouslyChildren and families taking this seriously One girl elbow walked to her bathroom to One girl elbow walked to her bathroom to

put on her CSA, so she would not miss put on her CSA, so she would not miss steps and counts on her CSAsteps and counts on her CSA

Families purchasing/replacing pedometers Families purchasing/replacing pedometers and competing for stepsand competing for steps

One child played for 6 hours, one Mom One child played for 6 hours, one Mom lost 16 poundslost 16 pounds

Nobel Nomination for Peace in SibsNobel Nomination for Peace in Sibs

Major findingsMajor findings

Activity that is moderate or vigorous Activity that is moderate or vigorous increased more in the intervention that increased more in the intervention that controlscontrols

Sedentary time decreased 4 hrs a week in Sedentary time decreased 4 hrs a week in the interventionthe intervention

Families are invested, idea is feasibleFamilies are invested, idea is feasible Will replicate and disseminateWill replicate and disseminate

Determinants of Adherence to Determinants of Adherence to Exercise PrescriptionExercise Prescription

MD-driven prescription of defined amounts MD-driven prescription of defined amounts of exercise have been shown to increase of exercise have been shown to increase compliancecompliance

BMI, BP and anthropomorphics were BMI, BP and anthropomorphics were measures, as this will show the family that measures, as this will show the family that what is measured is importantwhat is measured is important

Why DDR?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

Internal Life of YouthInternal Life of Youth

Youth very involved in IM, Chat, Blogs and Youth very involved in IM, Chat, Blogs and websites like www.ddrfreak.comwebsites like www.ddrfreak.com

Future studies can use real-time games, Future studies can use real-time games, compete against schools, accumulate total compete against schools, accumulate total points, add new songs. This is fully points, add new songs. This is fully customizable for the U01 grant using customizable for the U01 grant using broadband in homes for LINC data broadband in homes for LINC data capture.capture.

Case Reports on the Non-Peer Case Reports on the Non-Peer Reviewed WebReviewed Web

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

Gender and Gaming?Gender and Gaming?

““BOY BEAT” BOY BEAT” Dancing is not really what you expect teenage Dancing is not really what you expect teenage

boys to do at a video arcade. There are no boys to do at a video arcade. There are no machine guns, no explosions, no blood and guts machine guns, no explosions, no blood and guts on the screen. Just a steady beat, and on the on the screen. Just a steady beat, and on the screen during some songs, teenaged girls screen during some songs, teenaged girls dancing or pink hearts popping. But ask any of dancing or pink hearts popping. But ask any of these kids what they like about DDR, and most these kids what they like about DDR, and most say they are drawn in by the challenge. In that say they are drawn in by the challenge. In that way, it is like other video games. way, it is like other video games.

What is the Hook?What is the Hook?

Like other DDR fanatics…I can't really Like other DDR fanatics…I can't really explain the game's draw. It's just fun.explain the game's draw. It's just fun.

Unlocking songs, the next levelUnlocking songs, the next level

"Once you get good at it," he said, wiping "Once you get good at it," he said, wiping his brow, "it's really addictive." his brow, "it's really addictive."

Need more HOOKSNeed more HOOKS

What does this generation like? People What does this generation like? People and fads vs classics and retroand fads vs classics and retro

What has the most interaction and What has the most interaction and feedback?feedback?

Ideas like heart rate, smart games that Ideas like heart rate, smart games that keep giving feedbackkeep giving feedback

What ideas do you have?What ideas do you have?

Lasting Impact of PA changes?Lasting Impact of PA changes?

With DDR, I’ve lost 95 lbs and kept it off With DDR, I’ve lost 95 lbs and kept it off over FOUR and a half years. I continue to over FOUR and a half years. I continue to lose weight and feel motivated about lose weight and feel motivated about myself…myself…

We will test the group at 12 weeks and 28 We will test the group at 12 weeks and 28 weeks to look for maintenance of the weeks to look for maintenance of the behaviorbehavior

Sikich’s Lab/Maloney co-PI studying:Sikich’s Lab/Maloney co-PI studying:Ghrelin , Insulin, C-reactive Protein, V-CAM –1, PAI-1 , Fibrinogen, Leptin, Ghrelin , Insulin, C-reactive Protein, V-CAM –1, PAI-1 , Fibrinogen, Leptin, Interleukin 6, Adiponectin, small LDL particles, serum Homocysteine, serum Interleukin 6, Adiponectin, small LDL particles, serum Homocysteine, serum Lipoprotein A, I-CAM-1, E-selectin Lipoprotein A, I-CAM-1, E-selectin

in a cohort treated with atypical antipsychotic agents which confer some insulin in a cohort treated with atypical antipsychotic agents which confer some insulin resistance by an resistance by an unknown mechanism of actionunknown mechanism of action..

Thank YouThank You

Team DANCER is a wonderful team from both Team DANCER is a wonderful team from both sides of the street, in keeping with the roadmap sides of the street, in keeping with the roadmap from NIH (nutrition, physical therapy, medicine, from NIH (nutrition, physical therapy, medicine, neurodevelopment research, etc)neurodevelopment research, etc)

Gratitude is expressed to our team for home Gratitude is expressed to our team for home visits, evening hours and commitment to the visits, evening hours and commitment to the families who ask excellent questionsfamilies who ask excellent questions

Thanks to you for thinking about how we can Thanks to you for thinking about how we can improve thisimprove this