Transcript — Physical Activity Project DANCE DANCE REVOLUTION

Physical Activity Project—
DANCE DANCE
REVOLUTION
Ann E. Maloney, MD
2-2-05
Department of Psychiatry, Child and
Adolescent Division
THANKS to:
 Dr.
Bishop
 Dr. Bethea
 Team DANCER
 Kids and families
 Gatorade, Get Kids in Action
COMPUTER SCIENTISTS
 Society
is facing an epidemic of pediatric
obesity
 Labor saving devices do just that
 How to measure activity and inactivity
Underwear?
How much really helps?
 From
NPR last week…”Those 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 “…
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
LOGO purpose: Identify with the
Project and Feel like a Team

DEMO
Can DANCING help?
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
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).
Overweight: Psychiatric Aspects
 Equally
impairing are obesity-related
psychological problems, including low selfesteem, depression, poor body image, and
eating disorders. (French et al., 1995;
Pesa et al., 2000)
Thought Leaders assert that:
 …solutions
may include permanent
modification of activity levels and food
choices before trying to assume reducedcalorie regimens; integrating behavioral
therapy with pharmacological interventions
and the identification of genetic
predispositions (Epstein et al., 2001)
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)
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...
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 279:938-942
Dance Dance Revolution
 Why
was this chosen? It is fun. This is a
serious problem.
Design
61 youth randomized
Basic Group 19 kids
Enhanced Group 22
Control Group 20
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
GEMS from Robinson
Yesterday , I
….
But usually, I……
Activity
None
Less than 15
minutes
15minutes
or
more


1.Bicycling

None

A little
A lot


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
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
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
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 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.
Case Reports on the Non-Peer
Reviewed Web
 Matt
Keene's Story
Lost 140-150lbs playing Dance Dance Revolution, and I lost a good
100 pounds of it in under a year…
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.

What is the Hook?
 Like
other DDR fanatics…I can't really
explain the game's draw. It's just fun.
 Unlocking
 "Once
songs, the next level
you get good at it," he said, wiping
his brow, "it's really addictive."
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?
Lasting Impact of PA changes?
 With
DDR, I’ve 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
Sikich’s Lab/Maloney co-PI studying:
Ghrelin , 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.
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