Physical Activity Project—DANCE DANCE REVOLUTION

1. Physical Activity Project—DANCE DANCE REVOLUTION Ann E. Maloney, MD 2-2-05 Department of Psychiatry, Child and Adolescent Division

2. THANKS to: • Dr. Bishop • Dr. Bethea • Team DANCER • Kids and families • Gatorade, Get Kids in Action

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

4. Underwear?

5. 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 “…

6. 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

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

8. DEMO

9. Can DANCING help?

10. 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

11. 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).

12. 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)

13. 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)

14. 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)

15. 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...

16. 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

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

18. Design

19. 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

20. GEMS from Robinson Yesterday , I …. But usually, I……

21. 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

22. 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

23. 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

24. 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

25. 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.

26. 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…

27. 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.

28. What is the Hook? • Like other DDR fanatics…I 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."

29. 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?

30. 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

31. 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.

32. 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