Emily Murphy

Effects of an exercise intervention using Dance Dance Revolution on endothelial function and other risk factors in overweight children.

OBJECTIVE To determine whether an exercise intervention using an active video game (Dance Dance Revolution [DDR]) is effective in improving endothelial dysfunction (EDF) and other risk factors in overweight children. DESIGN Thirty-five children (Body mass index > or = 85(th) percentile, mean age 10.21+/-1.67 years, 17 females) with EDF were assessed for flow-mediated dilation (FMD), lipids, insulin, glucose, NO(2)+NO(3), asymmetric dimethylarginine, symmetric dimethylarginine, l-arginine, height, weight, aerobic fitness, and blood pressure. In a subsample, tumor necrosis factor alpha, interleukin-6, C-reactive protein, and adiponectin were also assessed. Subjects were randomly assigned to 12-weeks of aerobic exercise (EX) using DDR or to a non-exercising delayed-treatment control group (DTC). RESULTS EX had significant improvements in FMD ( 5.56+/-5.04% compared with 0.263+/-4.54%, p=0.008), exercise time on the graded exercise test (53.59+/-91.54 compared with -12.83+/-68.10 seconds, p=0.025), mean arterial pressure (MAP) (-5.62+/-7.03 compared with -1.44+/-2.16 mmHg, p=0.05), weight (0.91+/-1.53 compared with 2.43+/-1.80 kg, p=0.017) and peak VO(2) (2.38+/-3.91 compared with -1.23+/-3.18 mg/kg/min, p=0.005) compared with the DTC. Thirteen EX subjects achieved normal EDF while ten did not. These groups differed at baseline with regard to total cholesterol (TC) and low-density lipoprotein (LDL). CONCLUSION Twelve weeks of DDR-use improved FMD, aerobic fitness, and MAP in overweight children. Improvements occurred without changes in inflammatory markers or nitric oxide production. The results document the need to explore relationships between obesity, endothelial function, inflammation, lipids, exercise intensity, and gender in a larger sample of overweight children.

Universal versus targeted blood cholesterol screening among youth: The CARDIAC project.

OBJECTIVES: The goal was to determine the sensitivity and specificity of family history in identifying children with severe or genetic hyperlipidemias in a rural, predominantly white population. METHODS: A total of 20266 fifth-grade children in West Virginia, from the Coronary Artery Risk Detection in Appalachian Communities (CARDIAC) Project, who completed a family history and fasting lipid profile were used in analyses. The relationship between hyperlipidemia and family history was determined, and the use of family history to predict the need for pharmacologic treatment among children with dyslipidemia was evaluated. RESULTS: A total of 71.4% of children met the National Cholesterol Education Program (NCEP) guidelines for cholesterol screening on the basis of positive family history. Of those, 1204 (8.3%) were considered to have dyslipidemia (low-density lipoprotein ≥130 mg/dL), and 1.2% of these children with dyslipidemia warranted possible pharmacologic treatment (low-density lipoprotein ≥160 mg/dL). Of the 28.6% who did not have a positive family history (did not meet NCEP guidelines), 548 (9.5%) had dyslipidemia, 1.7% of whom warranted pharmacologic treatment. Sensitivity and specificity data demonstrated that family history does not provide a strong indication as to whether pharmacologic treatment may be warranted. CONCLUSIONS: Results indicate that the use of family history to determine the need for cholesterol screening in children would have (1) missed many with moderate dyslipidemia and (2) failed to detect a substantial number with likely genetic dyslipidemias that would require pharmacologic treatment. The use of universal cholesterol screening would identify all children with severe dyslipidemia, allowing for proper intervention and follow-up and leading to the prevention of future atherosclerotic disease.

Metabolic syndrome in fifth grade children with acanthosis nigricans: results from the CARDIAC project

BackgroundA number of cardiovascular disease (CVD) risk factors have been linked to obesity and associated negative health outcomes in children. However, no consistent definition of metabolic syndrome exists for children. In addition, research is needed to systematically examine the prevalence of metabolic syndrome in high-risk children, including those with insulin resistance. This study explores several definitions of metabolic syndrome and determines the prevalence of metabolic syndrome in a large sample of children with acanthosis nigricans (AN).MethodsThe study used results from a large-scale screening of fifth-grade students in West Virginia to explore the prevalence of metabolic syndrome among 676 male and female participants who had mild to severe AN.ResultsIn this high-risk sample of students who had AN, 49% met the criteria, i.e., three risk factors including insulin resistance, high body-mass index, and elevated blood pressure or dyslipidemia, when tested for metabolic syndrome. Children with AN who were classified as obese or morbidly obese were at significantly increased odds of having metabolic syndrome.ConclusionsResults are discussed in terms of systematically defining metabolic syndrome for high-risk children, as well as public health and clinical interventions targeting children who are overweight or obese. The presence of AN and morbid obesity might be easily observed markers for metabolic syndrome.

Individual-, Family-, Community-, and Policy-Level Impact of a School-Based Cardiovascular Risk Detection Screening Program for Children in Underserved, Rural Areas: The CARDIAC Project

The Coronary Artery Risk Detection In Appalachian Communities (CARDIAC) Project has screened more than 80,000 children (10–12 years) for cardiovascular and diabetes risk factors over the past 15 years. Simultaneous referral and intervention efforts have also contributed to the overall program impact. In this study, we examined evidence of programmatic impact in the past decade at the individual, family, community, and policy levels from child screening outcomes, referral rates, participation in subsequent services, and policies that embed the activities of the project as a significant element. Within this period of time, fifth-grade overweight and obesity rates were maintained at a time when rates elsewhere increased. 107 children were referred for additional screening and treatment for probable familial hypercholesterolemia (FH); 82 family members were subsequently screened in family-based screening efforts. 58 grants were distributed throughout the state for community-appropriate obesity intervention. A state wellness policy embedded CARDIAC as the method of assessment and national child cholesterol screening guidelines were impacted by CARDIAC findings. The sustainability and successful impact of this school-based program within a largely underserved, rural Appalachian state are also discussed.

The Coronary Artery Risk Detection in Appalachian Communities (CARDIAC) Project: An 18 Year Review

BACKGROUND The Coronary Artery Risk Detection in Appalachian Communities (CARDIAC) Project is a chronic disease risk factor surveillance, intervention, and research initiative aimed at combating the unacceptably high prevalence of heart disease, diabetes, and other chronic illnesses in West Virginia. OBJECTIVES AND METHODS The school-based public health project identifies health risk factors in children, educates families, informs primary care physicians, and provides resources to schools to help improve population health, beginning with children. RESULTS AND CONCLUSION Details regarding methodology, results, and conclusions derived from this unique public health initiative that has screened over 200,000 children are the subject of this 18- year review.

An Evaluability Assessment of the West Virginia Physical Activity Plan, 2015: Lessons Learned for Other State Physical Activity Plans

Background The US National Physical Activity Plan (NPAP) was released in 2009 as a national strategic plan to increase physical activity (PA). The NPAP emphasized implementing state and local PA programs. Dissemination of information about NPAP has been limited, however. Community Context West Virginia is a predominantly rural state with high rates of chronic diseases associated with physical inactivity. In 2015 an evaluability assessment (EA) of the West Virginia Physical Activity Plan (WVPAP) was conducted, and community stakeholders were invited to participate in updating the plan. Methods A good EA seeks stakeholder input, assists in identifying program areas that need improvement, and ensures that a full evaluation will produce useful information. Data for this EA were collected via national stakeholder interviews, document reviews, discussions among workgroups consisting of state and local stakeholders, and surveys to determine how well the WVPAP had been implemented. Outcome The EA highlighted the need for WVPAP leaders to 1) establish a specific entity to implement local PA plans, 2) create sector-specific logic models to simplify the WVPAP for local stakeholders, 3) evaluate the PA plan’s implementation frequently from the outset, 4) use quick and efficient engagement techniques with stakeholders when working with them to select strategies, tactics, and measurable outcomes, and 5) understand the elements necessary to implement, manage, and evaluate a good PA plan. Interpretation An EA process is recommended for other leaders of PA plans. Our project highlights the stakeholders’ desire to simplify the WVPAP so that it can be set up as a locally driven process that engages communities in implementation.

The relationship between children's physical activity and family income in rural settings: A cross-sectional study

Objective To examine potential differences in childrens physical activity and parent support of their childrens physical activity based on family income within the rural setting. Methods A cross-sectional survey of 566 parents of children (5–15 years-old; mean = 7.7 years; standard deviation = 2.4) living in rural West Virginia from 2010 to 2011 was conducted. Children were recruited and had participated in a school-based health screening program. Results Overall, parents from a rural setting reported that their children engaged in an average of five days of physical activity for at least 60 min. Upon closer examination, children from lower-income families engaged in more physical activity, on average, than children from higher income families per parent report (mean = 6.6 days, confidence interval 95% = 4.9–6.0 vs. middle-income mean = 5.0, confidence interval 95% = 4.4–5.3 and highest-income mean = 4.5, confidence interval 95% = 4.1–4.7; p = .01). Rural parents supported their childrens physical activity in numerous ways. Parents with the lowest incomes were more likely than parents from higher income families to encourage their children to be active and use their immediate environment for play and to be directly involved in physical activity with their children. More affluent parents were more likely to transport their children to other activity opportunities than parents from the lower income brackets. Conclusions Lower income families may utilize their immediate environment and encourage activity among their children whereas more affluent families focus on organized opportunity more often than lower income families. These findings emphasize the need to conceptualize the role family income plays in physical activity patterns and the potential benefit it provides to some families.