Quality of Life Research

, Volume 27, Issue 1, pp 205–216 | Cite as

Physical activity and health-related quality of life among schoolchildren from disadvantaged neighbourhoods in Port Elizabeth, South Africa

  • Marina Salvini
  • Stefanie Gall
  • Ivan Müller
  • Cheryl Walter
  • Rosa du Randt
  • Peter Steinmann
  • Jürg Utzinger
  • Uwe Pühse
  • Markus GerberEmail author



The relationship between health-related quality of life (HRQoL), physical activity (PA), and cardiorespiratory fitness (CRF) among disadvantaged communities in low- and middle-income countries is poorly understood. In South Africa, children from socioeconomically deprived households are at an elevated risk of sedentary lifestyles and poor HRQoL. We examined whether higher self-reported PA and higher CRF levels are associated with better HRQoL in South African schoolchildren from disadvantaged neighbourhoods.


Overall, 832 children aged 8–12 years participated in this cross-sectional study. HRQoL was assessed through five dimensions of the KIDSCREEN-27 tool. Self-reported PA was measured using a single item of the Health-Behaviour of School-Aged Children test, and CRF with the 20-m shuttle run test.


Higher self-reported PA was significantly and positively related to HRQoL. Significant, but small group differences existed across all dimensions of HRQoL between low and high self-reported PA. No significant associations were observed between CRF levels and HRQoL.


Schoolchildren reporting PA of at least 60 min on at least 6 days a week (the recommended minimum) report higher HRQoL than their peers with lower PA levels.


Health-related quality of life Physical activity Cardiorespiratory fitness Schoolchildren South Africa 



We are grateful to Ms. Siphesihle Nqweniso, Ms. Larissa Adams, Ms. Danielle Smith, Ms. Dominique Bänninger, Mr. Thomas Hager, and Ms. Nandi Joubert for their contribution to data collection. We also thank Mr. Bruce Damons and Ms. Mariandah Gerwel for enabling contacts to schools and their contribution to data collection.


This study was financially supported by the Swiss-South African Joint Research Programme (SSAJRP), jointly funded by the Swiss National Science Foundation (SNSF; project no. IZLSZ3 149015) and the National Research Foundation (NRF) in South Africa (project no. 87397). The funders played no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Compliance with ethical standards

Conflict of interest

None of the authors have any conflict of interest.

Ethical approval

The study was approved by the ethical review board of North-western and Central Switzerland (reference no. EKNZ 2014-179), the Nelson Mandela University Human Ethics Committee (reference no. H14-HEA-HMS-002), the Eastern Cape Department of Education, and the Eastern Cape Department of Health in Port Elizabeth, South Africa. All procedures performed in the study were in accordance with the ethical standards described in the institutional research committees and with the 1964 Helsinki declaration and its later amendments.

Informed consent

Each child provided oral assent and written informed consent was obtained from parents/guardians.


  1. 1.
    Ortega, F. B., Ruiz, J. R., Castillo, M. J., & Sjöström, M. (2008). Physical fitness in childhood and adolescence: A powerful marker of health. International Journal of Obesity, 32, 1–11.CrossRefPubMedGoogle Scholar
  2. 2.
    Ravens-Sieberer, U., Erhart, M., Wille, N., Wetzel, R., Nickel, J., & Bullinger, M. (2006). Generic health-related quality-of-life assessment in children and adolescents: Methodological considerations. Pharmacoeconomics, 24, 1199–1220.CrossRefPubMedGoogle Scholar
  3. 3.
    Haraldstad, K., Christophersen, K. A., Eide, H., Nativg, G. K., & Helseth, S. (2011). Predictors of health-related quality of life in a sample of children and adolescents: A school survey. Journal of Clinical Nursing, 20, 3048–3056.CrossRefPubMedGoogle Scholar
  4. 4.
    Ravens-Sieberer, U., Gosch, A., Abel, T., Auquier, P., Bellach, B.-M., Bruil, J., et al. (2001). Quality of life in children and adolescents: A European public health perspective. Sozial- und Präventivmedizin, 46, 294–302.CrossRefPubMedGoogle Scholar
  5. 5.
    Seid, M., Varni, J. W., Segall, D., & Kurtin, P. S. (2004). Health-related quality of life as a predictor of pediatric healthcare costs: A two-year prospective cohort analysis. Health and Quality of Life Outcomes, 2, 48–48.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Meade, T., & Downswell, E. (2016). Adolescents’ health-related quality of life (HRQoL) changes over time: a three year longitudinal study. Health and Quality of Life Outcomes, 14, 14. doi: 10.1186/s12955-12016-10415-12959.PubMedPubMedCentralGoogle Scholar
  7. 7.
    von Rueden, U., Gosch, A., Ramjl, L., Bisegger, C., Ravens-Sieberer, U., & the European Kidscreen Group (2006). Socioeconomic determinants of health related quality of life in childhood and adolescence: Results from a European study. Journal of Epidemiology and Community Health, 60, 130–135.CrossRefGoogle Scholar
  8. 8.
    Chen, G., Ratcliffe, J., Olds, T., Magarey, A., Jones, M., & Leslie, E. (2014). BMI, health behaviors, and quality of life in children and adolescents: A school-based study. Pediatrics, 133, 1–7.CrossRefGoogle Scholar
  9. 9.
    Michel, G., Bisegger, C., Fuhr, D. C., & Abel, T. (2009). Age and gender differences in health-related quality of life of children and adolescents in Europe: A multilevel analysis. Quality of Life Research, 18, 1147–1157.CrossRefPubMedGoogle Scholar
  10. 10.
    Bisegger, C., Cloetta, B., von Rueden, U., Abel, T., Ravens-Sieberer, U., Duer, W., et al. (2005). Health-related quality of life: Gender differences in childhood and adolescence. Sozial- und Präventivmedizin, 50, 281–291.CrossRefPubMedGoogle Scholar
  11. 11.
    Helseth, S., Haraldstad, K., & Christophersen, K. A. (2015). A cross-sectional study of health related quality of life and body mass index in a Norwegian school sample (8–18 years): A comparison of child and parent perspectives. Health and Quality of Life Outcomes, 13, 47. doi: 10.1186/s12955-12015-10239-z.Google Scholar
  12. 12.
    Ataguba, J. E., Akazili, J., & McIntyre, D. (2011). Socioeconomic-related health inequality in South Africa: Evidence from General Household Surveys. International Journal for Equity in Health, 10, 48. doi: 10.1186/1475-9276-1110-1148.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Boreham, C., & Riddoch, C. (2001). The physical activity, fitness and health of children. Journal of Sports Sciences, 19, 915–929.CrossRefPubMedGoogle Scholar
  14. 14.
    Kohl, H. W. R., & Murray, T. (2012). Foundations of physical activity and public health. Champaign: Human Kinetics.Google Scholar
  15. 15.
    Penedo, F., & Dahn, J. R. (2005). Exercise and well-being: A review of mental and physical health benefits associated with physical activity. Current Opinion in Psychiatry, 18, 189–193.CrossRefPubMedGoogle Scholar
  16. 16.
    Wafa, S., Rhahril, M., Ahmad, A., Zainuddin, L., Simail, K., Aung, M., et al. (2016). Association between physical activity and health-related quality of life in children: A cross-sectional study. Health and Quality of Life Outcomes, 14, 71. doi: 10.1186/s12955-12016-10474-y.PubMedPubMedCentralGoogle Scholar
  17. 17.
    Shoup, J. A., Gattshall, M., Dandamudi, P., & Estabrooks, P. (2008). Physical activity, quality of life, and weight status in overweight children. Quality of Life Research, 17, 407–412.CrossRefPubMedGoogle Scholar
  18. 18.
    Gopinath, B., Hardy, L. L., Baur, L. A., Burlutsky, G., & Mitchell, P. (2012). Physical activity and sedentary behaviors and health-related quality of life in adolescents. Pediatrics, 130, 167–174.CrossRefGoogle Scholar
  19. 19.
    Gu, X., Chang, M., & Solmon, M. A. (2016). Physical activity, physical fitness, and health-related quality of life in school-aged children. Journal of Teaching in Physical Education, 35, 117–126.CrossRefGoogle Scholar
  20. 20.
    Kantor, R. M., Grimes, G. R., & Limbers, C. A. (2015). Physical activity, sedentary behaviors, and health-related quality of life in rural Hispanic youth. Translational Issues in Psychological Science, 1, 239–249.CrossRefGoogle Scholar
  21. 21.
    Petersen, S., Mavoa, H., Swinburn, B., Waqa, G., Goundar, R., & Moodie, M. (2012). Health-related quality of life is low in secondary school children in Fiji. International Journal of Pediatrics, 2012. doi: 10.1155/2012/294530.PubMedPubMedCentralGoogle Scholar
  22. 22.
    Crews, D. J., Lochbaum, M. R., & Landers, D. M. (2004). Aerobic physical activity effects on psychological well-being in low-income Hispanic children. Perceptual and Motor Skills, 98, 319–324.CrossRefPubMedGoogle Scholar
  23. 23.
    Van Hout, R., Young, M., Bassett, S., & Hooft, T. (2013). Participation in sport and the perceptions of quality of life of high school learners in the Theewaterskloof Municipality, South Africa. African Journal for Physical Activity and Health Sciences, 19, 612–622.Google Scholar
  24. 24.
    Pühse, U., & Gerber, M. (2005). International comparison of physical education. Concepts, problems, prospects. Aachen: Meyer & Meyer.Google Scholar
  25. 25.
    Strong, W. B., Malina, R. M., Blimkie, C. J. R., Daniels, S. R., Dishman, R. K., Gutin, B., et al. (2005). Evidence based physical activity for school-age youth. Journal of Pediatrics, 146, 732–737.CrossRefPubMedGoogle Scholar
  26. 26.
    Walter, C. M. (2011). In-school physical activity patterns of primary school learners from disadvantaged schools in South Africa. African Journal of Physical and Health Education, Recreation and Dance, 17, 780–789.Google Scholar
  27. 27.
    Hall, K., & Giese, S. (2009). Addressing quality through school fees and school funding. In S. Pendlebury, L. Lake, & C. Smith (Eds.), South African child gauge (pp. 35–40). Cape Town: Children’s Institute, University of Cape TownGoogle Scholar
  28. 28.
    Yap, P., Müller, I., Walter, C., Seelig, H., Gerber, M., Steinmann, P., et al. (2015). Disease, activity and schoolchildren’s health (DASH) in Port Elizabeth, South Africa: A study protocol. BMC Public Health, 15, 1285. doi: 10.1186/s12889-12015-12636-y.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Inchley, J., Currie, D., Young, T., Samdal, O., Torsheim, T., Auguston, L., et al. (2016). Growing up unequal: Gender and socioeconomic differences in young people’s health and well-being. Health Behaviour in School-aged Children (HBSC) study: International report from the 2013/2014 survey. Health Policy for Children and Adolescents, 7, 276–276.Google Scholar
  30. 30.
    United States Department of Health and Human Services. (2008). 2008 physical activity guidelines for Americans. Washington, DC: U.S. Government Printing Office.Google Scholar
  31. 31.
    Biddle, S. J., Cavill, N., & Sallis, J. F. (1998). Policy framework for young people and health-enhancing physical activity. In S. J. Biddle, J. F. Sallis & N. Cavill (Eds.), Young and active? Young people and health-enhancing physical activity – Evidence and implications (pp. 3–16). London: Health Education Authority.Google Scholar
  32. 32.
    Léger, L. A., Mercier, D., Gadoury, C., & Lambert, J. (1988). The multistage 20 m shuttle run test for aerobic fitness. Journal of Sports Sciences, 6, 93–101.CrossRefPubMedGoogle Scholar
  33. 33.
    The Kidscreen Group Europe (2006). The KIDSCREEN questionnaires: Quality of life questionnaires for children and adolescents. Lengerich: Pabst Science.Google Scholar
  34. 34.
    WHO. (2007). Growth reference 5–19 years. Geneva: World Health Organization.Google Scholar
  35. 35.
    Hair, J. F., Black, W. C., Babin, B. J., & Anderson, R. E. (2010). Multivariate data analysis. Upper Saddle River: Pearson Education.Google Scholar
  36. 36.
    Cohen, J. (1988). Statistical power analysis for the behavioral sciences. Mahwah: Erlbaum.Google Scholar
  37. 37.
    Nunnally, J., & Bernstein, B. (1994). Psychometric theory. New York: McGraw-Hill.Google Scholar
  38. 38.
    Kalman, M., Inchley, J., Sigmundova, D., Iannotti, R. J., Tynjälä, J. A., Hamrik, Z., et al. (2015). Secular trends in moderate-to-vigorous physical activity in 32 countries from 2002 to 2010: A cross-national perspective. European Journal of Public Health, 25, 37–40.CrossRefPubMedGoogle Scholar
  39. 39.
    WHO (2016). WHO fact sheet: Physical activity in adolescents (15 March 2016). Geneva: World Health Organization.Google Scholar
  40. 40.
    Breslin, G., Gossrau-breen, D., McCay, N., Gilmore, G., Macdonald, L., & Hanna, D. (2012). Physical activity, gender, weight status, and wellbeing in 9- to 11-year-old children : A cross-sectional survey. Journal of Physical Activity and Health, 9, 394–401.CrossRefPubMedGoogle Scholar
  41. 41.
    Anokye, N. K., Trueman, P., Green, C., Pavey, T. G., & Taylor, R. S. (2012). Physical activity and health related quality of life. BMC Public Health, 12, 624. doi: 10.1186/1471-2458-1112-1624.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Lindwall, M., & Lindgren, E.-C. (2005). The effects of a 6-month exercise intervention programme on physical self-perceptions and social physique anxiety in non-physically active adolescent Swedish girls. Psychology of Sport and Exercise, 6, 643–658.CrossRefGoogle Scholar
  43. 43.
    Brand, S., Kalak, N., Gerber, M., Clough, P. J., Lemola, S., Pühse, U., et al. (2016). During early and mid-adolescence, greater mental toughness is related to increased sleep quality and quality of life. Journal of Health Psychology, 21, 905–915.CrossRefPubMedGoogle Scholar
  44. 44.
    Brand, S., Kalak, N., Gerber, M., Clough, P. J., Lemola, S., Bahmani, S. D., et al (2017). During early to mid adolescence, moderate to vigorous physical activity is associated with restoring sleep, psychological functioning, mental toughness and male gender. Journal of Sport Sciences, 35, 426–434.CrossRefGoogle Scholar
  45. 45.
    Gerber, M., Endes, K., Brand, S., Herrmann, C., Colledge, F., Donath, L., et al. (2017). In 6- to 8-year-old children, cardiorespiratory fitness moderates the relationship between severity of life events and health-related quality of life. Quality of Life Research, 26, 695–706.CrossRefPubMedGoogle Scholar
  46. 46.
    Gerber, M., Endes, K., Herrmann, C., Colledge, F., Brand, S., Donath, L., et al. (2017). Fitness, stress and body composition in primary schoolchildren. Medicine and Science in Sports and Exercise, 49, 581–587.CrossRefPubMedGoogle Scholar
  47. 47.
    Martikainen, S., Pesonen, A. K., Lahti, J., Heinonen, K., Feldt, K., Pyhälä, R., et al. (2013). Higher levels of physical activity are associated with lower hypothalamic-pituitary-adrenocortical axis reactivity to psychosocial stress. Journal of Clincal Endocrinology and Metabolism, 98, 619–627.CrossRefGoogle Scholar
  48. 48.
    Lang, C., Kalak, N., Brand, S., Holsboer-Trachsler, E., Pühse, U., & Gerber, M. (2016). The relationship between physical activity and sleep from mid adolescence to early adulthood. A systematic review of methodological approaches and meta-analysis. Sleep Medicine Reviews, 58, 32–45.CrossRefGoogle Scholar
  49. 49.
    Hatzinger, M., Brand, S., Perren, S., Stadelmann, S., von Wyl, A., von Klitzing, K., et al. (2010). Sleep actigraphy pattern and behavioral/emotional difficulties in kindergarten children: Association with hypothalamic-pituitary-adrenocortical (HPA) activity. Journal of Psychiatric Research, 44, 253–261.CrossRefPubMedGoogle Scholar
  50. 50.
    Korczak, D. J., Madigan, S., & Colasanto, M. (2017). Children’s physical activity and depression: A meta-analysis. Pediatrics, 139(4). doi: 10.1542/peds.2016-2266.
  51. 51.
    Tomson, L. M., Pangrazi, R. P., Friedman, G., & Hutchinson, N. (2003). Childhood depressive symptoms, physical activity and health related fitness. Journal of Sport and Exercise Psychology, 25, 419–439.CrossRefGoogle Scholar
  52. 52.
    Zahl, T., Steinsbekk, S., & Wichstrøm, L. (2017). Physical activity, sedentary behavior, and symptoms of major depression in middle childhood. Pediatrics, 139(2). doi: 10.1542/peds.2016-1711.
  53. 53.
    Ekelund, U., Anderssen, S. A., Froberg, K., Sardinha, L. B., Andersen, L. B., Brage, S., et al. (2007). Independent associations of physical activity and cardiorespiratory fitness with metabolic risk factors in children: The European Youth Heart Study. Diabetologia, 50, 1832–1840.CrossRefPubMedGoogle Scholar
  54. 54.
    Silva, G., Aires, L., Mota, J., Oliveira, J., & Ribeiro, J. C. (2012). Normative and criterion-related standards for shuttle run performance in youth. Pediatric Exercise Science, 24, 157–169.CrossRefPubMedGoogle Scholar
  55. 55.
    Bouchard, C., Malina, R. M., & Perusse, L. (1997). Genetics of fitness and physical activity (p. 408). Champaign: Human Kinetics.Google Scholar
  56. 56.
    Byrne, B. M. (2010). Structural equation modeling with AMOS. Basic concepts, applications, and programming. New York: Taylor & Francis.Google Scholar
  57. 57.
    Gerber, M., Brand, S., Holsboer-Trachsler, E., & Pühse, U. (2010). Fitness and exercise as correlates of sleep complaints. Is it all in our minds? Medicine and Science in Sports and Exercise, 43, 893–901.CrossRefGoogle Scholar
  58. 58.
    Lindwall, M., Ljung, T., Hadzibajramovic, E., & Jonsdottir, I. (2012). Self-reported physical activity and aerobic fitness are differently related to mental health. Mental Health and Physical Activity, 5, 28–34.CrossRefGoogle Scholar
  59. 59.
    Gall, S., Müller, I., Walter, C., Seelig, H., Steenkamp, L., Pühse, U., et al. (2017). Associations between selective attention and soil-transmitted helminth infections, socioeconomic status and physical fitness in disadvantaged children in Port Elizabeth, South Africa: An observational study. PLoS Neglected Tropical Diseases. doi: 10.1371/journal.pntd.0005573.PubMedPubMedCentralGoogle Scholar
  60. 60.
    Reed, K. E., Warburton, D. E. R., Macdonald, H. M., Naylor, P. J., & McKay, H. A. (2008). Action Schools! BC: A school-based physical activity intervention designed to decrease cardiovascular disease risk factors in children. Preventive Medicine, 46, 525–531.CrossRefPubMedGoogle Scholar
  61. 61.
    Ruggero, C. J., Petrie, T., Sheinbein, S., Greenleaf, C., & Martin, S. (2015). Cardiorespiratory fitness may help in protecting against depression among middle school adolescents. Journal of Adolescent Health, 57, 60–65.CrossRefPubMedGoogle Scholar
  62. 62.
    Ravens-Sieberer, U., Auquier, P., Erhart, M., Gosch, A., Rajmil, L., Bruil, J., et al. (2007). The KIDSCREEN-27 quality of life measures for children and adolescents: Psychometric results from a cross-cultural survey in 13 European countries. Quality of Life Research, 16, 1347–1356.CrossRefPubMedGoogle Scholar
  63. 63.
    Hall, K., Sambu, W. L. B., Giese, S., Almeleh, C., & Rosa, S. (2016). South African early childhood review 2016. Cape Town: Children’s Institute, University of Cape Town and Ilifa Labantwana.Google Scholar
  64. 64.
    DoBE (2014). National School Nutrition Programme. Report 2013/2014. Pretoria: Department of Basic Education.Google Scholar
  65. 65.
    Aaltoonen, S., Latvala, A., Rose, R. J., Kujala, U. M., Kaprio, J., & Silventoinen, K. (2016). Leisure-time physical activity and academic performance: Cross-lagged associations from adolescence to young adulthood. Scientific Reports, 6, 39215. doi: 10.1038/srep39215.CrossRefGoogle Scholar
  66. 66.
    Stavrakakis, N., de Jonge, P., Ormel, J., & Oldehinkel, A. J. (2012). Bidirectional prospective associations between physical activity and depressive symptoms. The TRAILS Study. Journal of Adolescent Health, 50, 503–508.CrossRefPubMedGoogle Scholar
  67. 67.
    Achenbach, T. M., Dumenci, L., & Rescorla, L. A. (2002). Ten-year comparisons of problems and competencies for national samples of youth: Self, parent and teacher reports. Journal of Emotional and Behavioral Disorders, 10, 194–203.CrossRefGoogle Scholar
  68. 68.
    Scott, J. J., Morgan, P. J., Plotnikoff, R. C., & Lubans, D. R. (2015). Reliability and validity of a single-item physical activity measure for adolescents. Journal of Paediatrics and Child Health, 51, 787–793.CrossRefPubMedGoogle Scholar
  69. 69.
    Milton, K., Clemes, S., & Bull, F. (2013). Can a single question provide an accurate measure of physical activity? British Journal of Sports Medicine, 47, 44–48.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Department of Sport, Exercise and HealthUniversity of BaselBaselSwitzerland
  2. 2.Swiss Tropical and Public Health InstituteBaselSwitzerland
  3. 3.University of BaselBaselSwitzerland
  4. 4.Department of Human Movement ScienceNelson Mandela Metropolitan UniversityPort ElizabethSouth Africa

Personalised recommendations