Family Practice Residency ‘100 Days, Get Moving!’ Teaching fifth-graders how to develop healthier lifestyles Scott Wissink, MD Third-year Resident UPMC St. Margaret Family Practice Residency Pittsburgh, PA

Objectives On completion of this lecture, the participants should be able to: Utilize online resources to encourage healthier lifestyles for children and adolescents Incorporate the use of pedometers to monitor activity among children and adolescents Understand/ Recognize the challenges involved in initiating and maintaining a fitness program in a public elementary school setting

Background More than 15% of children between the ages of 6 and 19 are overweight Studies show that overweight and obese children have up to an 80% chance of becoming overweight and obese adults These children are at risk for many associated negative health and social consequences The epidemic is certainly multi-factorial There is a growing awareness of the need to create neighborhoods which are more pedestrian friendly in order to encourage physical activity

Background Pedometers have been studied to accurately measure activity levels in both adults and children Several on-line websites allow users to log pedometer steps and convert them into mileage toward virtual walking trips Lesson plans tailored to kids are available which incorporate use of pedometers in gym, math, geography, and activities outside of school

Project Format Students in 2 fifth grade classes and their teachers are provided with pedometers Each student logs his or her steps daily using a website which is specifically designed for this age group Using their recorded pedometer steps, a website allows students either individually or collectively to take a “virtual walk” across the United States and children can track their progress as they move from state to state

Project Format To embellish healthy habits, groups of students collaborate to make posters with an assigned topic, which are displayed in the classrooms

Project Format Geography lessons are incorporated by the teachers as each class makes progress from state to state as the website provides information about each new state they reach The students can win playground equipment for their class as an incentive to walk the most mileage The two classes compete with each other for a trophy, which the winning class displays until the competition begins again the following year

Project Format Before and after the 100 days, the students’ blood pressure (BP) is measured and their Body Mass Index (BMI) is calculated Each student also completes a fitness survey both before and after the 100 days

Fitness Survey

Goals Assess baseline fitness levels and BMI of inner-city fifth graders Utilize pedometers and the Log It website designed for children to encourage increased activity levels Use incentives such as playground equipment and competition with another class to increase motivation Encourage implementation of healthy lifestyle choices to prevent obesity

Pittsburgh, Pennsylvania

Pittsburgh Green Spaces

Friendship Neighborhood

Friendship School

Friendship School

Friendship School

Pedometers www.accusplit.com

Online Resources www.pecentral.org www.peclogit.org

Results Average BMI percentiles for age Spring 2005 Fall 2005 Class 1 pre = 75.1 (range 25-99) post = 76.1 (range 22-99) Class 2 pre = 78.0 (range 31-100) post = 75.5 (range 24-100) Fall 2005 Class 1 pre = 66.2 (range 12-99) Class 2 pre = 70.4 (range 2-100)

Results BMI greater than 85th percentile for age (at risk for overweight) Spring 2005 Class 1 pre = 8/17 (47%) post = 9/17 (53%) Class 2 pre = 7/18 (39%) post = 7/18 (39%) Fall 2005 Class 1 pre = 8/20 (40%) Class 2 pre = 9/21 (43%)

Challenges Variable levels of computer proficiency and willingness to use online resources among both students and teachers Getting kids and teachers engaged initially and maintaining their dedication throughout the project Broken or lost pedometers Safe and appropriate walking areas Weather Accuracy of documentation of steps Time allotted during school for activity

Future Directions Partner with urban developers affiliated with Carnegie Mellon University in order to design safer walking environments Partner with similar projects at the middle school and high school level in Pittsburgh Partner with Highmark to implement citywide or statewide program Continue the project during Fellowship focusing on kids’ attitudes toward pedometer use

Important Roles Students Parents Principal Classroom Teachers School Nurse Gym Teacher Keyboarding Teacher Funding Sources

Funding For their contributions to the project Thank you to: St. Margaret Foundation Friendship School Wal-Mart For their contributions to the project

Online Resources www.panaonline.org www.cdc.gov/nccdphp/dnpa/obesity/state_programs/pa.htm www.preventioninstitute.org/nutritionstrat.html www.mchlibrary.info/knowledgepaths/kp_phys_activity.html www.cdc.gov/mmwr/preview/mmwrhtml/00046823.htm www.rense.com/general37/bnewar.htm www.centredaily.com/mld/centredaily/news/6810592.htm http://grants.nih.gov/grants/guide/pa-files/PAR-03-009.html

Online Resources www.reutershealth.com/wellconnected/doc53.html www.fitness.gov/aboutpcpfs/members/members.html www.allstarkidsclub.com/afterschool.html www.canfit.org/ www.presidentschallenge.org www.healthierus.gov/steps www.aahperd.org/naspe www.kellogs.com www.fitness.gov www.fitnessinschools.org/ejournal/2004/july1.htm