Movement programmes to enhance motor competence and physical fitness among high school girls in a low-income community of Cape Town, South Africa

Although motor skills, physical fitness and self-efficacy are considered important agents in promoting health and well-being, there is limited research on how exercise can be used to enhance these factors in children within the South African context, particularly among those living in low socio-economic environments. Accumulating evidence worldwide and in South Africa has shown decreased levels of physical activity (PA) among the youth. It is now known that the greatest decline in PA occurs in adolescent girls as compared to boys. Given that insufficient PA and the lack of opportunities to engage in PA is linked to poor motor skills, obesity and harmful health outcomes, it is important to identify effective methods to address PA among high school girls with motor problems and among those who are overweight and obese. International and local data suggest that adolescent girls are “a high-risk” population who have greater risks for obesity and chronic diseases compared to children and adolescent boys. Research has found that adolescent girls are more likely to exhibit poor motor skills and become overweight or obese. Within the South African context, it is believed that adolescent girls in low-income settings are even more prone to becoming physically inactive and obese because they have fewer opportunities to participate in regular PA. Compared to boys, girls have a higher prevalence of overweight and obesity, and perform poorly on motor performance tests. However, the healthcare community has been challenged to provide effective health promotion solutions to these physical health problems encountered in this demographic group due to the lack of empirical evidence on the efficacy of motor interventions. In recognition of this gap, this study was designed to develop and evaluate the efficacy of exercise programmes among high school girls. The study had four aims. The first aim was to examine the relationship between body mass index (BMI), motor competence, physical fitness and self-efficacy in adolescent girls attending high school in a low-income community of Cape Town, South Africa. The second aim was to determine the effects of different motor interventions in a subsample of girls with low motor abilities. The third aim was to compare intervention effects of two different exercises in a separate sample of girls who are overweight and obese. The fourth aim was to determine if participation in a task-oriented functional training would elicit different changes in fitness performance between girls with varying weight status. To achieve these aims, six separate but interrelated studies were conducted in two phases. In phase 1, eligible participants completed various tests aimed to assess their levels of motor competence, physical fitness, self-efficacy and body composition. Phase 2 involved four other intervention studies which examined the effectiveness of two movement programmes in specified populations. In each of these studies, participants were exposed to either a novel Wii Fit protocol (specifically developed for this research) or task-oriented functional training. Both interventions were scheduled 45 minutes per week for 14 weeks. Pre- and posttesting were performed using selected measures of motor coordination, physical fitness and self-efficacy. In this thesis, aim 1 was assessed by Studies 1 and 2, and aim 2 was evaluated by Studies 3 and 4. Similarly, aims 3 and 4 were assessed by Studies 5 and 6. Inclusively, six papers presented in this thesis provided answers to all the aims formulated. With regards to aim 1, the findings indicated that BMI was negatively and independently associated with cardiorespiratory fitness, musculoskeletal fitness, motor competence and self-efficacy. Adolescent girls with increased BMI had decreased cardiorespiratory levels, low musculoskeletal fitness, poor motor competence and reduced self-efficacy compared to peers with a healthy weight. The results highlight the need to develop interventions to target these health markers to optimise health and well-being. To address aim 2, preliminary data were collected to quantify the effects of the newly developed Wii Fit intervention, called the graded Wii Fit protocol among a sample of adolescent girls with low motor ability (probable developmental coordination disorder). Results demonstrated that graded Wii Fit training may be capable of increasing aerobic and anaerobic fitness without decreasing participants’ perception of enjoyment. Following this pilot study, the Wii Fit intervention was compared to task-oriented functional training in a relatively large sample of adolescent girls (who were not included in the preliminary study) with developmental coordination disorder. Significant improvements in motor coordination, aspects of physical fitness and overall self-efficacy emerged for both groups. However, no between group differences were observed on any of the outcomes. These findings indicate that activity-based interventions may elicit positive physical and psychological health benefits in girls with movement difficulties. Either of these interventions could be prescribed to treat motor impairments in female adolescents. The choice of interventions may be influenced by available resources (such as equipment, instructors, electricity etc.) or individual preferences. In relation to aim 3, seeking to compare intervention effects of the two programmes in female adolescents who are overweight and obese, girls who received either the Wii Fit protocol or task-oriented functional training demonstrated improved motor competence and physical fitness without any significant changes in self-efficacy for the two groups. However, no significant differences were observed between the groups on any of the outcomes. This finding indicates that activity-based motor interventions may be useful tools for addressing obesity-related impairments. People working with high school girls who have excess weight could adapt these strategies to promote health, particularly in resource-limited environments. With regards to aim 4, looking at the changes in fitness performance between female adolescents with low and high BMI following the intervention, the results showed significant gains in fitness performance for all participants regardless of weight status. In contrast to girls with high BMI, participants with low BMI demonstrated greater changes in performance on balance and agility tasks. This finding suggests that individuals with excess weight may need adapted programmes to improve their balance and agility performance. In conclusion, the findings of this thesis provide first-hand empirical data explaining the relationship between BMI, motor competence and physical fitness among high school girls in low-income settings. More importantly, results have demonstrated that activity-based motor interventions are capable of improving motor performance in girls with motor difficulties as well as those with excess weight. Further, this thesis makes a significant contribution to the paediatric exercise science literature by showing how ecological theories can be used to develop cost-efficient exercise interventions for the adolescent girls in low-income settings. It is envisaged that people working in low-income schools would apply these ideas to promote optimal physical health. Moreover, the findings may serve as an important resource to inform policy frameworks aimed at promoting physical and psychological health among high school girls within the South African lowincome contexts or other populations with similar characteristics. It is hoped that future studies will evaluate these interventions in heterogeneous samples (e.g. boys and girls) and diverse contexts. Lastly, the sustainability of the changes associated with these interventions needs to be further investigated.