West Virginia’s Health Revolution

It’s hard not to immediately like Ryan Walker. The cheerful, talkative sixth grader from Martinsburg, West Virginia crackles with prepubescent confidence and easy charm, especially when you get him talking about his favorite pastimes, basketball and videogames. In particular, he has a special fondness for Konami’s Dance Dance Revolution (DDR).

“People give me a lot of compliments on how well I can do it,” he boasts. “I can beat everybody. I hate to say it, but, well, you know.”

Ryan’s confidence, however, is a relatively new development. For years, the 11-year-old boy struggled with his weight; just nine months ago, he was close to 170 lbs (the healthy weight for a 6-foot adult male). He’d even developed activity-induced asthma. “Running, riding his bike, he’d get those red little cheeks,” says his mother, Tammy. “He was out of breath a lot, and he couldn’t run up steps or jog around the neighborhood.” Tammy, whose own father had died at 47 from heart disease, feared her son might soon fall prey to her family’s long history with cardiovascular problems and diabetes.

But then Ryan found DDR. Or, more accurately, DDR found him.

Ryan was one of 50 overweight and obese children recruited for West Virginia University’s (WVU) Games for Health research project, an at-home clinical study designed to assess how Konami’s mega-popular rhythm game could be used to combat childhood obesity.

The preliminary results of the study, released earlier this year, were so compelling the Public Employee’s Insurance Agency (PEIA; who had funded the project) partnered with Konami to deploy the dance game in each of West Virginia’s 765 schools. But the Mountain State isn’t alone in its DDR fervor. School boards in Los Angeles and Hawaii have announced similar plans to roll out the game in their gym classes, too.

DDR in the P.E. classroom is just one weapon in America’s War on Fat, a struggle that, judging by the evidence, we appear to be losing. “We’re this society that’s overfed but undernourished,” says Emily Murphy, doctoral candidate and pediatric exercise physiologist at WVU’s School of Medicine. (The Games for Health project is her doctoral thesis.) According to the American Obesity Association, approximately 127 million Americans are overweight. Another 60 million are clinically obese. And it’s not just adults battling the bulge, either; nationwide, 15 percent of all kids ages 6-19 classify as obese.

“As these kids get older, their problems are only going to get worse,” says PEIA spokesman David Bailey. “This is actually one of the first generations with a shorter life expectancy than their parents. You have kids with coronary heart disease at 10 years old, who are more obese than a lot of adults you see.” Rates of hypertension, asthma and cardiovascular dysfunction have skyrocketed among children in the past 30 years, and cases of Type II diabetes – once known as “adult” diabetes – have more than tripled; these days, one out of every three new Type II diabetics is a kid.

Children are particularly at risk in West Virginia, which was recently ranked by the Center for Disease Control as the number one state in the country for obesity. The Mountain State is like a microcosm of every pediatrician’s worst fears. For example, the Coronary Artery Risk and Detection in Appalachian Communities survey, on which Murphy worked, found that nearly half – 48 percent – of the state’s fifth graders were either overweight or at risk for developing heart disease in the future. Of the 40,832 kids screened, a full 25 percent were clinically obese.

Pundits, politicians and parents alike are quick to blame TV and videogames for their part in making our kids fat, and for good reason: Quality time with the PlayStation generally does not shrink waistlines. But it doesn’t help that schools across the country have had to drop physical education classes due to budget constraints and stricter federal testing mandates. In West Virginia, most elementary school students attend physical education classes only once a week. High schoolers get just one semester of gym in all four years.

Making matters worse, West Virginia is one of the poorest, most rural states in the country, with almost two-thirds of its 1.8 million residents living in communities with fewer than 2,500 people. That remoteness and lack of infrastructure puts West Virginians at a major health disadvantage. “Sometimes exercise isn’t as easy as just walking down your street, because people live in rural areas without sidewalks,” says Bailey. “That lack of access to physical equipment, and the rural nature and topography, can really lend itself to physical inactivity.”

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The Games for Health study came out of that frantic need to address West Virginia’s childhood obesity crisis, but only serendipitously did it include DDR. While shopping at the mall one day, Dr. Linda Carson, director of WVU’s Motor Development Center, had noticed a small crowd of kids playing DDR in an arcade. To her delight, she saw the children dancing, sweating and even drinking water instead of soda. The sight intrigued her, and together with PEIA’s Nidia Henderson, she designed a research project to assess just how much kids could benefit from regularly playing the game.

The first rounds of testing for the Games for Health project opened in April 2004, and initially, the study was only available to the children of PEIA members. When Tammy heard about the study, she knew she wanted Ryan involved. “My son is one of those kids who loves videogames,” she says. “But when they said that he’d actually have to move his feet, and he couldn’t just sit there and play, we really wanted him to do it.”

For Ryan’s initial health assessment, Tammy and her husband drove their son to the university’s campus in Morgantown, over two and a half hours from their home. “We even drove it in a snowstorm,” she says. “That’s how serious we were about him doing this study.”

Once there, Ryan underwent a series of clinical tests to determine his body mass index (BMI), blood pressure, cholesterol, and insulin and glucose levels, as well as his endurance and aerobic capacity. Researchers also examined the arteries in his arms to evaluate his endothelial functioning, or how well his blood vessels expanded in response to increased blood flow (like with exercise). Endothelial dysfunction is thought to be a major initiating cause in both heart disease and diabetes, and of the 35 kids in the study who had theirs tested, every single one exhibited at least some arterial dysfunction at the start.

After the tests, Ryan’s family was given a game console, a dance mat and a copy of DDR Extreme (funded from the initial $50,000 grant from PEIA). Under the study, Ryan played DDR for at least 30 minutes a day, five days a week, while logging which songs he played and when. In addition, he wore a pedometer to keep track of his daily steps, making a note of any other physical and sedentary activities he participated in. “We had to write down pretty much everything he did from the time he woke up to the time he went to bed, and send it in each week,” says Tammy. To help keep Ryan motivated, a clinician from WVU would call Ryan weekly, asking about his progress and giving him plenty of encouragement.

Not that he needed it, at least in the beginning. The first night of the study, after they got home, Ryan says he fired up the game and danced 31 songs in a row. “That was pretty crazy that first night,” he says. “It was fun. Well, until basically I was dying.”

In February 2007, WVU released preliminary results from the study, announcing that in just 12 weeks, the test kids had significantly improved their overall fitness level and endothelial functioning. Better yet, on average the test group hadn’t gained any weight, unlike the control group, which had gained an average of six pounds over the three month period.

Most importantly, however, the study found the test kids’ self-esteem had dramatically increased, making them more likely to try other forms of physical activity. “DDR was kind of a gateway,” says Murphy. “[The kids] mastered something, so they felt good about themselves. And then they’re more willing to go try out for the cross country team or the basketball team or other sports.”

In addition to losing about 10 or 15 pounds on the program, Ryan’s good cholesterol shot up 21 points, and his endurance improved by 25 percent. Plus, he’s only needed to use his inhaler once or twice in nine months since he started the study. But Tammy says the biggest change has been in Ryan’s demeanor. “Before, he didn’t really want to go to kids’ houses and play or spend the night,” she says. “He couldn’t keep up with the other kids. But now, I can’t even keep up with him half the time. He’s spending the night with friends, or passing the football with his dad at night, or riding his bike, or playing basketball. This change, it’s – it’s just amazing.”

So why did the test kids respond so well to DDR, when traditional team-based sports had left them cold? Murphy suspects it had something to do with how mainstream videogames have become. “Kids are so videogame oriented,” she says. “Half the time I don’t think the kids even realize they’re exercising, because they’re having so much fun.”

Word of the study’s preliminary results quickly reached the West Virginia Department of Education, and officials there were so impressed that they started testing out DDR in the gym classes of 20 state schools. That pilot program generated national media attention, garnering mentions by USA Today, The New York Times, Good Morning America and even MTV.

In early 2006, the West Virginia Department of Education decided to expand its pilot program to encompass all of its school systems, starting with the state’s more than 150 middle schools. “That’s the time in a child’s development when they start to make choices for themselves,” explains Bailey. The new DDR crusade, which was an official partnership between PEIA and Konami, received additional financial backing from Acordia National, Mountain State Blue Cross Blue Shield, the Benedum Foundation and the Governor’s Office.

DDR is now in all West Virginia middle schools, and while its use in the curriculum varies from teacher to teacher, the setup itself is generally the same. Two kids at a time can play on the dance mats, hopping to the speeding arrows, while their classmates shadow their movements on either practice pads or the bare floor as they wait for their turn. Some schools with a little more money use a video projector to cast the game screen onto the gymnasium walls.

Far from kids getting bored with the mass arrangement, Ryan says his classmates at Hedgesville Middle School love the game. “When [the gym teacher] has the mats out, the line’s always a mile long,” he says. “We just got two more mats, so you can get four people playing it now. So, like, it was cool before, but now you actually have a line.”

If there’s a kid who doesn’t like DDR, says Bailey, “we haven’t found them yet. Almost all the kids who’ve played it enjoyed it, and wanted to continue to play it.”

Perhaps one of the best benefits of the study, says Bailey, is how the children’s newfound enthusiasm for exercise has brought their families together. “There were quite a few people in the study who said that it’s become a family thing, that instead of watching TV after dinner, they now play DDR,” he says.

Tammy agrees, admitting her entire family has caught the DDR bug. “My husband and I would do the mat with Ryan. Of course, he’s a lot better than we are,” she laughs. “We also have a 6-year-old little girl, and she tries it too, but her legs just aren’t long enough yet.”

Ryan has spoken about his experiences in the study at several national health conferences and expos, and he has helped Carson and Murphy train new P.E. teachers unfamiliar with the DDR equipment. And although he plays DDR less often these days than he once did, he’s still a big fan. “With DDR, I was doing something I liked,” he says. “I worked up a sweat, and I felt really good when I did it. It felt like, you know, since you were sweating, you were actually getting something accomplished. I, well, I – I really liked it. A lot.”

Lara Crigger is a freelance science, tech and gaming journalist and frequent contributor to The Escapist. Her email is lcrigger[at]gmail[dot]com.

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