Promoting physical activity in children with MetaKenkoh.

PURPOSE: Over 15% of children aged 6 to 11 yr are overweight, more than three times as high as a generation earlier. Overweight children are at higher risk for diabetes, high blood pressure, high cholesterol, and orthopedic problems, as well as psychological problems. Overweight children are also more likely to become overweight adults, with higher risks for heart disease, stroke, hypertension, diabetes, and some types of cancers. In response to this epidemic, Health Management Consultants of VA, Inc., funded by the National Institute of Child Health and Human Development, developed MetaKenkoh, an Internet-based, activity-contingent game for children 9-11 yr of age. The game promotes physical activity through the use of pedometers that are used to relate game performance to children's own daily activity. METHODS: We conducted a clinical trial in which children aged 9-11 were randomized to groups that either played the game (Intervention Group - IG) or that monitored only (Control Group - CG). RESULTS: Preliminary data indicate that underweight and normal weight children in the IG (n=22) show an increase in activity at one week, as measured by pedometer, whereas there is a drop in steps reported by children in the CG (n=24). In the overweight and at-risk groups, both the IG (n=16) and the CG (n=15) show a slight increase in activity levels. CONCLUSION: Activity-contingent games may have the potential to facilitate increased physical activity in children. However, more research is needed in order to evaluate the effectiveness of this approach.

Clinical trial of an Internet-based case management system for secondary prevention of heart disease.

PURPOSE: Despite demonstrated benefits of cardiac rehabilitation and risk factor reduction, only 11% to 38% of eligible patients with cardiovascular disease (CVD) participate in cardiac rehabilitation programs. Women and older adults are particularly less likely to participate in cardiac rehabilitation. In an effort to broaden access to cardiac rehabilitation, the authors developed an alternative Internet-based program that allows nurse case managers to provide risk factor management training, risk factor education, and monitoring services to patients with CVD. METHODS: The evaluation consisted of a randomized, clinical trial involving 104 patients with CVD, 53 of whom used the program as a special intervention (SI) for 6 months and 51 of whom received usual care (UC). RESULTS: The results indicate that fewer cardiovascular events occurred among the SI subjects (15.7%) than among the UC subjects (4.1%) (P =.053), resulting in a gross cost savings of $1418 US dollars per patient. With a projected program cost of $453 USD per patient, the return on investment is estimated at 213%. More weight loss occurred in the SI group (-3.68 pounds) than in the UC group (+.47 pounds) (P =.003). The differences between the two groups in terms of blood pressure, lipid levels, depression scores, minutes of exercise, and dietary habits were not statistically significant. CONCLUSION: An Internet-based case management system could be used as a cost-effective intervention for patients with CVD, either independently or in conjunction with traditional cardiac rehabilitation.