# Exercise as it relates to Disease/Is dancing video game (DDR) an effective way to increase physical activity and to decrease sedentary time?

This is an analysis of the journal article "A pilot of a Video Game (DDR) to Promote Physical Activity and Decrease Sedentary Screen Time (2008). This paper was written by Ann E. Maloney, T. Carter Bethea, Kristine S. Kelsey, Julie T. Marks, Sadye Paez, Angela M. Rosenberg, Daiane J. Catellier, Robert M. Hamer and Linamarie Sikich. It was published online in 2008 at "The Obesity Society".

## Keywords of the study

Full Text in Short Form
Moderate and/or Vigorous Physical Activity ＝ MVPA
Dance Dance Revolution ＝DDR
Sedentary Screen Time ＝ SST
Physical Activity ＝ PA
Minutes Per Week ＝ MPW
Hours Per Week ＝ HPW

## What is the background to this research?

According to Sedentary Behaviour Research Network (SBRN), sedentary behaviour refers to any waking activity characterized by an energy expenditure ≤ 1.5 metabolic equivalents and a sitting or reclining posture. In general, it means that any time a person is sitting or lying down, they are engaging in sedentary behaviour. Common sedentary behaviours include TV viewing, video game playing, computer use (collective termed “screen time”), driving automobiles, and reading.
Physical activity is defined as any bodily movement produced by skeletal muscles that results in energy expenditure. Physical activity in daily life can be categorised into occupational, sports, conditioning, household, or other activities. Physical fitness is a set of attributes of that are either health or skill related.
The escalating epidemic of childhood overweight stems from multiple factors including decreased moderate and/or vigorous physical activity (MVPA) and increased sedentary behaviours. In a large study of youth, each hour increase of TV watching was associated with an additional energy intake of 167 kcals/day. Among children <8 years of age, the amount of traditional video game play was even more strongly associated with obesity than TV watching.
The DDR series is an interactive video game that combines real physical dancing with energetic music and visuals. DDR also came from a tailored workout mode that allows players to track how many calories they burn as they play. Therefore in this research, researchers would like to take the opportunity to look into the possibility of promoting physical activity by using the video game DDR to look at the practicability of DDR by placing them in participants' home to examine the effect of increasing physical activity (PA) time and attempt to reduce Sedentary Screen Time (SST).

## Where is the research from?

The study was conducted alongside with a variety of institutes listed below:
* Constella Group
* Department of Psychiatry, University of North Carolina
* Department of Nutrition, University of North Carolina
* Department of Allied Health Science, University of North Carolina
* Department of Biostatistics, University of North Carolina

## What kind of research was this?

This research was a field experiment for which an experiment was done in families associated with University of North Carolina. There were DDR intervention (experimental) group and wait-list control group to compare the results of the feasibility of DDR in participants' home, to increase PA and to decrease SST.

## What did the research involve?

This research involved a group of children between the ages of 7 and 8. They were drafted through postings from their community such as schools, libraries, malls and also invitation through email. In this study, children who had health related issues such as broken limbs, unable to control their body properly, diagnosed significant abnormalities on screening physical exam and also those who've played DDR twice or more were excluded. After screening and signed consent alongside with their guardians, participants were randomised into two separate groups, the DDR group (n = 40) and the wait list control group (n = 20). There were a total of 122 prospective participants who were screened and lastly there were 60 children with 30 boys and 30 girls participated in the study and the DDR and control groups were similar in age, sex, race, anthropometric measurements, and family characteristics
The first 10 weeks of study were for the primary component of this trial in order to compare the performance of DDR group and control group's MVPA and SST by accessing or not accessing to the DDR. After that, all participants were given an in-home unlimited access to DDR with follow-up assessment to complete at 28 weeks. The period from week 10 to 28 was to provide factual and realistic information about the sustainability of DDR in this particular age group. At the same time, by gaining data from the control group, it provided extra information regarding to the behavioural changes related to the use of DDR with children.
The study was conducted by playing DDR wth PS2 (Playstation 2), staffs who involved were responsible for the set up in order to ensure everything was operational and to provide participants with their guardians a hand out on how to operate the game and some strategies to improve DDR skills. Besides that, participants were provided a log book to record down their daily minutes on DDR with parents or guardians to verify and signed as an evident. The number of DDR game played in the machine was also recorded on a 8-MB memory PS2 memory cards which will be collected in week 10. Meanwhile, participants who were in the wait list control intervention group were asked not to play any DDR via any approachable sources, they will be provide with DDR resources after week 10. Children and parents co-reported the amount of time the child spent in various sedentary activities during the weekdays and weekends. This self-report measure completed jointly by participants and their parents asks about the time (in 15-min increments) the child spent in sleep, SST, light, moderate and vigorous activity for each of the 7 days of the prior week.
Researchers had also stated out the areas of limitations and improvements for the study. Due to the small sample group, researchers believed that a sample size of 500 would be required to demonstrate statistical differences given the effect size of 0.25 for vigorous PA suggested by this study, or at least 240 to detect BMI changes

## What were the basic results?

In this study, researchers found that for the changes of PA, there were no statistical differences between the DDR and the control groups in vigorous, moderate, light or sedentary PA.
For vigorous PA, it increased in the DDR group through week 28 and remained statistically different from baseline in this group. For moderated PA, there were no within group changes in both of the DDR and control groups during the first 10 weeks, but it increased in the control group over week 10 to week 28. For light PA, it decreased in the DDR persisted through week 28 but it only decreased in the control groups at week 10.
For changes of Sedentary Screen Time (SST), the DDR group has had a significant reduction in the amount of SST from week 0 to 10 from average 10.5 hours per week to average 9.3 hours per week. At the same time, the SST was increased in the control group from an average of 9.3 hours per week to average 12.3 hours per week. Furthermore, the study found that from week 10 to week 28, SST decreased in both of the DDR group and the control group.
As claimed by the study, children from 8-12 found DDR more appealing than dancing to music, bicycling, or playing an interactive bicycle game with 7-point Likert rating of 6.1 for DDR, 5.8 for interactive bicycle game, 4.9 for bicycling, and 3.3 for dancing to music.
The researchers interpreted the results in a positive and encouraging way. First of all, it figured out that DDR could be an innovative way to reduce SST activities for 7–8 years old children without weighty environmental changes to increase their physical activity time. Second of all, since coaching was unnecessary for DDR, children and their parents/guardians were enjoying DDR together, it built a close relationship in a family.
Researchers stated that it is likely to be useful to see whether additional supports can be easily implemented to maintain interest and enthusiasm in the game. Potential contexts might include use of DDR in after-school programming or even during school days (outside of physical education classes), using more varied songs, and using competition as a motivator.

## What are the implications of this research?

From the results of the study, DDR could be an innovative idea to increase physical activity time and to decrease SST in youth without any significant change in their adapted environment. DDR is a game that can involve both children and their guardians/parents to join together to increase physical activity time and to bond a closer relationship together. In order to summarised, DDR is definitely a way to reduce SST and to increase PA. However, with all the DDRs were freely provided to participants and as the study stated that most of the participants were upper middle class, questions could be raised about the totalitarianism of the study with a small study group and the affordability of DDR for non upper middle class family if DDR was not freely provided.
By reading this study in 2016, with the rapid of advancement of technological development, there were more variations of games which can reduce SST and to increase PA, such as Wii, Xbox 360 Kinect and other dance related games in Playstation. For example, the Wii Fit is unique in that it appears to be the first whole-body movement interactive video game for home use to specifically target the traditional components of health-related fitness. It includes separate modules for aerobic fitness, body composition, muscular fitness, flexibility, and balance. New generation computer games stimulated positive activity behaviours with the children were on their feet and they moved in all directions while performing basic motor control and fundamental movement skills that were not evident during seated gaming. Given the current prevalence of childhood overweight and obesity, such positive behaviours should be encouraged.
In recent days, Pokemon Go which can be downloaded from both Android and Apple mobile app store was another innovative game which can reduce SST and to increase PA, it can even bring the participants out from their adapted environment to a new environment. It can foresee that in the future there could be more smart phone games or video games which will take a similar pathway as Pokemon Go to develop in a more convenient and portable manner to decrease SST and increase PA for their customers.

## What conclusions should be taken away from this research?

In conclusion, this study figured out that DDR can significantly reduce SST and it is a successful tool to encourage children from the age of 7 to 8 to have an average of 89 minutes’ reduction per week. The DDR group demonstrated a remarkable decrease of SST between week 0 to 10, while there was an increase of SST time from the control group from the same period of time. During week 10 to 28, the reduction of SST time was remarkably clear for both DDR and control groups. Moreover, there was a significant increase in vigorous physical activity in the DDR group, despite there were not any changes in the control group. There were changes in the systolic blood pressure when both intervention and control groups recorded an increase from week 0 to 10 while there was no difference in diastolic blood pressure. Based on the participant's responds, most of them describe it as an enjoyable and fun to play and learn activity. At the same time, parents/guardians described that while playing DDR with their children it built a closer relationship with their children. Therefore, over 90% of the children and parents/guardians were satisfied with DDR after 28 weeks of playing with parents who even purchased pedometers themselves.

## Practical Advice

Active gaming used less energy than authentic bowling, tennis, and boxing, and the exercise was not intense enough to contribute towards the recommended amount of daily physical activity for children. There are studies indicated that compared with exercising indoors, exercising in natural environments was associated with greater feelings of revitalization and positive engagement, decreases in tension, confusion, anger, and depression, and increased energy. However, the results suggested that feelings of calmness may be decreased following outdoor exercise, yet participants reported greater enjoyment and satisfaction with outdoor activity and declared a greater intent to repeat the activity at a later date. Therefore, exercising outdoor to reduce SST and to increase PA is still the most significant way.

## Further reading

For further information regarding the benefits of the application of active video games such as DDR or using other related mediums to decrease SST and increase PA, please click on the links below.
"Active Video Games to Promote Physical Activity in Children and Youth A Systematic Review" http://archpedi.jamanetwork.com/article.aspx?articleid=383491&resultclick=1
"Video Gaming Increases Physical Activity" https://joe.org/joe/2010april/tt6.php
"Active video games can be a source of physical activity, shows UT study" http://www.news-medical.net/news/20150614/Active-video-games-can-be-a-source-of-physical-activity-shows-UT-study.aspx
“10 Health Benefits of Video Games” http://www.motionfitness.com/v/vspfiles/assets/images/10%20health%20benefits%20of%20video%20games.pdf
“Effects of active video games on body composition: a randomized controlled trial“ http://ajcn.nutrition.org/content/94/1/156.full.pdf+html

## External information about active video games

External information about DDA (DDRA) (in Jpn): http://p.eagate.573.jp/game/ddr/ddra/p/index.html?___REDIRECT=1
Xbox Kinect: http://www.xbox.com/en-AU/xbox-one/accessories/kinect-for-xbox-one
Wii U/Wii: http://www.nintendo.com.au/wii-u
Playstation VR: https://www.playstation.com/en-au/explore/playstation-vr/
"5 Active Video Games That Can Help You Get in Shape" http://www.cheatsheet.com/technology/5-active-video-games-for-better-health.html/?a=viewall

## References

* 1 2 3 4 5 6 7 MALONEY AE, BETHEA TC, KELSEY KS, MARKS JT, PAEZ S, ROSENBERG AM, CATELLIER DJ, HAMER RM, SIKICH L. A Pilot of a Video Game (DDR) to Promote Physical Activity and Decrease Sedentary Screen Time. Obesity Society [Internet].2008 SEPT [cited 2016 Sept 26] 16(9): 2074-2080. Available from: http://onlinelibrary.wiley.com/doi/10.1038/oby.2008.295/full
* 1 2 Sedentary Behaviour Research Network. What is Sedentary Behaviour? [Internet] Ottawa, Canada: Sedentary Behaviour Research Network; [updated 2016, cited 2016 Sept 26]. Available from: http://www.sedentarybehaviour.org/what-is-sedentary-behaviour/
* 1 2 3 CASPERSEN CJ, POWELL KE, CHRISTENSON GM. Physical Activity, Exercise, and Physical Fitness: Definitions and Distinctions for Health-Related Research. Public Health Reports [Internet]. Mar-Apr 1985 [cited 2016 Sept 26]; 100(2): 126-131. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1424733/pdf/pubhealthrep00100-0016.pdf
* ↑ TM McCambridge, D. T. Bernhardt, J. S. Brenner, T. L. Young, et al. Active Healthy Living: prevention of Childhood Obesity Through Increased Physical Activity. AMERICAN ACADEMY OF PEDIATRICS [Internet]. May 2006 [2016 Sept 26]; 117(5):1834-1842. Available from: https://www.researchgate.net/publication/279798790_Active_Healthy_Living_prevention_of_Childhood_Obesity_Through_Increased_Physical_Activity
* ↑ Wiecha JL, Peterson KE, Ludwig DS et al. When children eat what they watch: impact of television viewing on dietary intake in youth. Arch Pediatr Adolesc Med [Internet]. 2006 [Cited 2016 Sept 26] 160(4) 436–442. Available from: http://archpedi.jamanetwork.com/article.aspx?articleid=204763
* ↑ Flynn MA, McNeil DA, Maloff B et al. Reducing obesity and related chronic disease risk in children and youth: a synthesis of evidence with ‘best practice’ recommendations. Obes Rev [Internet]. 2006 Feb [cited 2016 Sept 26] 7-66. Available from: https://www.ncbi.nlm.nih.gov/pubmed/16371076
* ↑ KONAMI. DDR [Internet]. US. KONAMI [Cited 2016 Sept 26] Available from: https://us.konami.com/ddr/
* ↑ Epstein LH, Beecher MD, Graf JL, Roemmich JN. Choice of interactive dance and bicycle games in overweight and nonoverweight youth. Ann Behav Med [Internet]. 2007 Apr [Cited 2016 Sept 26] 33(2):124-131 Available from: https://www.ncbi.nlm.nih.gov/pubmed/17447864
* ↑ Owens SG, Garner J, Loftin M. Changes in Physical Activity and Fitness After 3 Months of Home Wii FitTM Use. The Journal of Strength and Conditioning Research [Internet]. 2011 Nov [Cited 2016 Sept 26]. 25(11): 3191-3197. Available from: https://www.researchgate.net/profile/Scott_Owens/publication/51713477_Changes_in_Physical_Activity_and_Fitness_After_3_Months_of_Home_Wii_Fit_Use/links/53d917860cf2a19eee83bc42.pdf
* 1 2 Graves L, Stratton G, Ridgers, ND, Cable NT. Energy expenditure in adolescents playing new generation computer games. British Medical Journal [Internet] 2007 Dec. [Cited 2016 Sept 26]; 335(7633): 1282-1284 Available from: http://dro.deakin.edu.au/eserv/DU:30029960/ridgers-comparisonofenergy-2007.pdf
* ↑ Thompson Coon J, Boddy K, Stein K, Whear R, Barton J, Depledge MH. Does participating in physical activity in outdoor natural environments have a greater effect on physical and mental wellbeing than physical activity indoors? A systematic review. Environ Sci Technol [Internet]. 2011 Mar [2016 Sept 26];45(5):1761-72.Available from: http://static1.squarespace.com/static/56e9367020c64742fe062659/t/56fd17fe8259b5ed81da67d2/1459427335466/thomson+coon+paper.pdf