Abstract
Purpose
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.
Methods
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.
Results
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.
Conclusions
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.
Similar content being viewed by others
References
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Boreham, C., & Riddoch, C. (2001). The physical activity, fitness and health of children. Journal of Sports Sciences, 19, 915–929.
Kohl, H. W. R., & Murray, T. (2012). Foundations of physical activity and public health. Champaign: Human Kinetics.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Pühse, U., & Gerber, M. (2005). International comparison of physical education. Concepts, problems, prospects. Aachen: Meyer & Meyer.
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.
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.
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 Town
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.
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.
United States Department of Health and Human Services. (2008). 2008 physical activity guidelines for Americans. Washington, DC: U.S. Government Printing Office.
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.
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.
The Kidscreen Group Europe (2006). The KIDSCREEN questionnaires: Quality of life questionnaires for children and adolescents. Lengerich: Pabst Science.
WHO. (2007). Growth reference 5–19 years. Geneva: World Health Organization.
Hair, J. F., Black, W. C., Babin, B. J., & Anderson, R. E. (2010). Multivariate data analysis. Upper Saddle River: Pearson Education.
Cohen, J. (1988). Statistical power analysis for the behavioral sciences. Mahwah: Erlbaum.
Nunnally, J., & Bernstein, B. (1994). Psychometric theory. New York: McGraw-Hill.
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.
WHO (2016). WHO fact sheet: Physical activity in adolescents (15 March 2016). Geneva: World Health Organization.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Bouchard, C., Malina, R. M., & Perusse, L. (1997). Genetics of fitness and physical activity (p. 408). Champaign: Human Kinetics.
Byrne, B. M. (2010). Structural equation modeling with AMOS. Basic concepts, applications, and programming. New York: Taylor & Francis.
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.
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.
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.
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.
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.
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.
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.
DoBE (2014). National School Nutrition Programme. Report 2013/2014. Pretoria: Department of Basic Education.
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.
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.
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.
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.
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.
Acknowledgements
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.
Funding
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.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
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.
Appendix
Appendix
Rights and permissions
About this article
Cite this article
Salvini, M., Gall, S., Müller, I. et al. Physical activity and health-related quality of life among schoolchildren from disadvantaged neighbourhoods in Port Elizabeth, South Africa. Qual Life Res 27, 205–216 (2018). https://doi.org/10.1007/s11136-017-1707-1
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11136-017-1707-1