Using Technology to Counter the Effects of Sedentary Behavior

1. 65
70
75
80
85
Baseline 6 mo
Low-densitylipoprotein(mg/dL)
LDL CHOLESTEROL
Group x Time Interaction p = .034
5.0
5.2
5.4
5.6
5.8
6.0
Baseline 6 mo
HbA1c(%)
GLYCATED HEMOGLOBIN*
* Measurement adherent:
Group x Time Interaction p = .012
0
1
2
3
Baseline 6 mo
C-REACTIVE PROTEIN
C-ReactiveProtein(mg/L)
ZAMZEE CONTROL
SECONDARY OUTCOMES
USING GAMIFICATION TO INCREASE PHYSICAL ACTIVITY IN CHILDREN
Zamzee Research Study and Pilot Insights
A project of
ZAMZEE RANDOMIZED CONTROLLED
TRIAL AND BIOMARKER STUDY
Nicole Guthrie MS, Fred Dillion BA, Jana Haritatos PhD, and Steve Cole PhD
OBJECTIVE
Assess the impact of Zamzee, an accelerometer-linked online motivational
system, on MVPA in a diverse sample of US middle school-aged children.
Zamzee combines individualized feedback, progress monitoring and goal
setting, tangible incentives, and intrinsic motivation features to promote
long-term increase in physical activity as measured by a 3-axis accelerometer
system with automated upload to a central database.
BACKGROUND
Most US adolescents do not achieve CDC-recommended levels of moderate-to-
vigorous physical activity (MVPA), placing the next generation of Americans at
increased risk for a diverse array of chronic diseases. There is a great need for
new scalable interventions that can persistently increase MVPA in adolescents.
CONCLUSIONS
The Zamzee activity meter/motivational website system can consistently
increase MVPA over 6 months in middle school-aged children, with favorable
effects on blood lipid and metabolic parameters.
PRIMARY OUTCOMES
STUDY DESIGN & DEMOGRAPHICS
THANK YOU TO OUR PARTNERS
The participants, families, physicians and administrators of the pediatric weight
management pilot sites.
INSIGHT 1
Average Weekly Minutes of Physical Activity
SELF-REPORTED MINUTES
571
ZAMZEE MEASURED MINUTES
237
INSIGHT 2
Average Attendance (Completion Rate) at Final Class
Zamzee Pilot Cohort has Increased Program Completion Rates
Compared to Historical Average
HISTORICAL AVERAGE
57%
ZAMZEE PILOT*
87%
*Sub-set of total population n= 31
OBJECTIVE
Assess the impact of Zamzee on children and family members enrolled in
pediatric weight management clinics.
BACKGROUND
Many healthcare providers now offer weight management clinics to children and
families struggling with childhood obesity. As part of promoting healthy behavior
change, there is a great need in these clinics for scalable, low-cost interventions
that increase the physical activity of clinic participants.
ZAMZEE IN PEDIATRIC WEIGHT
MANAGEMENT CLINICS
Findings from Pilot Study
SUMMARY
The use of Zamzee in pediatric weight management clinics in the pilot project
provided physicians with an objective measurement of physical activity which
differed significantly from self-reported data. In addition, use of Zamzee
resulted in an increased percentage (52% at one pilot site) of participants
completing the assigned program. Moreover, we saw higher engagement with
the Zamzee program when it was used as a family (84% versus 17%). These are
promising indicators that Zamzee could be a scalable, low-cost intervention
that increases the physical activity of children enrolled in pediatric weight
management clinics.
STUDY DESIGN & DEMOGRAPHICS
Program Length: 5-20 weeks | February - June 2013
6Pediatric Weight
Management Clinics
148Patients
166Family Members
6-18 YEARS OLD (MEAN AGE:10.95
STANDARD DEVIATION: 2.64)
BMI > 85TH PERCENTILE + CO-MORBIDITY,
OR BMI > 95TH PERCENTILE
AVERAGE MINUTES OF MVPA PER WEEK
over the 6 month study
AVERAGE MINUTES OF MVPA PER STUDY WEEK
20
40
60
80
100
120
140
160
MVPA(minutes/week)
Week
6 12 18 24
ZAMZEE CONTROL
Patient Self-Reported Minutes of Physical Activity Were Significantly
Greater Than Zamzee Measured Minutes
TIME CARRYING ZAMZEE
DURING WAKING HOURS
6mos.
[24 weeks]22.2MEAN BMI
25% OVER 25; 8% OVER 30
(5.2 STANDARD DEVIATION)
12.7 MEAN AGE
(0.8 STANDARD DEVIATION)
11-14years oldPRIMARY
MVPA ASSESSED
CONTINUOUSLY
OVER 6-MONTH
FOLLOW-UP
SECONDARY
LIPID, METABOLIC
& INFLAMMATORY
BIOMARKERS ASSESSED
AT BASELINE AND
6-MONTH FOLLOW-UP
(4 SITES)
RANDOMIZED TO THE ZAMZEE MOTIVATIONAL
WEBSITE OR PASSIVE MONITORING CONTROL1:1
448
MIDDLE-SCHOOL AGE CHILDREN
46% 54%GIRLS (244)BOYS (204)
Highly Engaged Children (8+ weeks participation)
87%
Children Using
Zamzee Without
Family
Children Using
Zamzee With
Highly Engaged
Family Members
83%
17%
84%
16%
HIGHLY ENGAGED
NOT HIGHLY ENGAGED
HIGHLY ENGAGED
NOT HIGHLY ENGAGED
INSIGHT 3
Children More Likely to be Highly Engaged in Zamzee if Family
Participates in Program
RESULTS
Within the biomarker sub-study,
the Zamzee group showed more
favorable pre to post-study changes
in LDL cholesterol, total cholesterol
and, in protocol-adherent
participants, HbA1c.
Non-significant effects were observed
for CRP and BMI.
AVERAGE HIGHER RATE
WITH THE ZAMZEE GROUP
COMPARED TO CONTROL
MVPA RATE
4.5x
MORE DAYS THAT
THE ZAMZEE GROUP MET
THE CDC-RECOMMENDED
60 MINUTES OF MVPA/DAY
MVPA LEVELS
ZAMZEE GROUP 3.1% ± 0.3% OF DAYS
CONTROL GROUP 0.7% ± 0.4% OF DAYS
P < .0001
59%ZAMZEE GROUP MEAN MVPA = 118 MIN/WEEK ± 3
CONTROL GROUP MEAN MVPA = 74 MIN/WEEK ± 5
OVER THE 6-MONTH STUDY, NO DECREMENT IN DIFFERENCE OVER TIME.
GROUP X WEEK INTERACTION, P = .9415
20
40
60
80
100
120
140
MVPA(minutes/week)
CONTROL ZAMZEE
74
118 INCREASE OVER
CONTROLS
p < .0001
59%
PRIMARY OUTCOMES