The impact of a 3-month continuous exercise intervention on the cognitive
functioning of African youth
, Samuel A. Danquah2*
Department of Psychology, Methodist University College Ghana.
2 Department of Psychology, University of Ghana Legon and Methodist University College Ghana
Background: Exercise has been identified as vital for the development of young people. The human body is designed for movement
and therefore a lack of exercise produces tremendous negative impact. Moderate to vigorous exercise is protective of health. Studies
have indicated a link between exercise and the cognitive performance of students. There are consistent findings that continuous exercise
improves cognitive skills of attention and concentration. The influence of exercise on executive functioning however is not conclusive.
This study examined the impact of a structured exercise on the executive functioning, an aspect of cognitive functioning, in African
Methods: An experimental design was used with 60 adolescents (27 males, 33 females) aged 13 to 18 years (mean=14.83 years) living
Participants’ exercise and cognitive functioning were assessed both at baseline and at the end of the intervention. Exercise levels were
measured using the Physical Activity Questionnaire for Older Adolescents (PAQ-A) and by pedometer; cognitive functioning was
assessed with the Raven’s Progressive Matrices test, with additional psychological variables of physical self-worth being measured with
a subscale of the Physical Self Perception Profile, and body dissatisfaction using the body image silhouette test. The participants in the
experimental group participated in aerobic exercise, twice a week for 3 continuous months.
Results: Results from the study showed that participants in the experimental school scored significantly higher on cognitive functioning
compared to the control group [44.48(8.88) vs. 34.17(9.82)] [F (1,56)=24.99, p<0.001].
Conclusion: The study found that higher levels of moderate to vigorous exercise improve the reasoning capacity of students. The
findings also indicated that African students do not participate in regular exercises. Increasing the participation of exercises in school can
facilitate the development of executive functioning among young people who are still developing their cognitive functioning. Nutritional
practice was controlled in the study by ensuring that only participants with higher scores on the Food Frequency Inventory were
included. Therefore nutritional practice did not meditate the relationship between the exercise intervention and cognitive functioning.
physical activity, exercise, moderate to vigorous physical activities, cognitive functioning, executive functioning, reasoning,
cognitive skills, self-esteem, mental health, cognitive development, young people, adolescents, students.
Movement is important for the body because it contributes to
good health . Low levels of exercise have reduced physical
activity levels of adolescents . Children are more active during
their early stages of development, around 8 years. After 11 years
however, their participation in structured exercise decline .
Many adolescents do not meet exercise guidelines of 60 minutes
of moderate to vigorous physical activities (MVPA) a day [2, 3].
Low levels of exercise have been associated with health problems
among young people [5, 6]. Findings indicate that adequate
levels of exercise could prevent and protect young people from
mental health problems . Cognitive functioning is an indicator
of well-being among students because students who perform
poorly are likely to experience depression and self-esteem
problems . Mental health problems are issues which distract
the mind and interfere with proper functioning of the brain .
Cognitive functioning refers to the performance of the brain.
Three components of cognitive functioning have been identified:
executive functioning, cognitive skills and academic achievement
. Executive functioning is a complex construct which includes
logical analysis, abstract and flexible thinking [10, 11]. Academic
achievement is performance on tasks taught and cognitive skills
are learning behaviours including concentration and attention .
An association has been found between exercise and cognitive
skills of attention and concentration [12, 13]. The association
between regular exercise and executive functioning however
is inconclusive . Possibly, this is partly because previous
studies have used complex tools with too many subscales to assess
Students’ academic performance is one of the major concerns
for parents in Africa. In Ghana for example, parents and teachers
put pressure on students to perform using punishment. Students
experiencing learning difficulties therefore manifest behavioural
problems which require psychological intervention .
Moreover, it has been established from research that a healthy
diet is associated with cognitive functioning among students .
Studies indicate that adolescents, who skip meals, consume fast
foods and snacks limit the intake of healthy nutrients, especially
vitamins for well-being. The study therefore controlled for
nutritional practice by ensuring that students selected for the study
had similar nutritional practices. Essential nutrients for cognitive
performance are carbohydrates and vitamins. Assessment of food
groups with these nutrients can determine a good nutritional
practice . In Ghana, learning difficulties among children is
a major precipitator of emotional difficulties among parents and
students themselves . It has been recommended however,
that more studies be conducted to assess the impact of decreased
exercise on the wellbeing of African youth .
This experimental study is therefore designed to examine the
impact of a 3-month structured exercise on executive functioningan
aspect of cognitive functioning and mental health among
adolescents in Ghana. Nutritional practice, a possible confounding
variable was controlled by including participants with higher
scores on the nutritional practice scale. The study also examined
the impact of exercise intervention on students’ physical activity
levels. The following predictions were made: H1: There will be a
significant increase in physical activity levels among students in the
experimental group compared with those in the control group. H2:
There will be a significant improvement in cognitive functioning
among students who receive the exercise intervention compared to
those in the control group. H3: There will be a significant increase
in physical self-worth among students in the exercise intervention
compared to those in the control group. H4: There will be a
significant reduction in body image dissatisfaction among students
in the intervention compared to those in the control group. H5: As
nutritional practice was controlled in the study, it was expected that
the impact of the exercise intervention on cognitive functioning
will not be mediated by nutritional practice.
This study is a repeated measures experimental design to examine
the impact of an exercise intervention on the cognitive functioning
of African adolescents. In addition, well-being outcomes examined
were physical self-worth and body dissatisfaction, which were
indicators of self-esteem. The study was conducted in 3 private
junior high schools in Accra, the capital city of Ghana: God’s
Home Academy, Mt. Olivet Methodist Academy and Kings
College International. These schools were private schools and
similar in terms of their ranking in academic performance. The
school chosen to be the experimental school had PE as part of
their curriculum but it was not conducted. The control school
however didn’t have PE in their curriculum. The study was also
repeated in a single school that didn’t have PE in their curriculum.
The average number of junior high school students in each school
was around 200 students. A sample size calculation indicated that
a sample of 30 participants per group was sufficient to detect a
large effect size (d=0.8) for exercise and cognitive functioning,
based on a statistical power of 0.8 with a probability level of
0.05. This calculation supports the practical limitation that was
encountered in the schools whereby only 60 students were likely
to be available. The large effect size may be an overestimate and
it is a limitation. A stratified and simple random sampling method
was used to select participants from each of the chosen schools.
The junior high schools in Ghana comprised three academic levels
of JHS one, two and three. The various classes were put into strata,
and simple random sampling was used to recruit 30 participants
from each stratum. Therefore, 90 participants were recruited from
each school. The recruited participants were given an informed
consent package to be signed by themselves and their parents and
to be returned to the school within one week. The consent form
was such that if the parents did not respond within one week it
was assumed that they had agreed for their child to participate in
Assessment Areas and Tools:
Four kinds of assessment were conducted: Assessment of eligibility
for moderate to vigorous exercise including anthropometric
characteristics; assessment of existing exercise levels and nutrition; assessment of cognitive functioning; and assessment of
self-esteem (Table 1).
Assessment of Eligibility for Moderate to Vigorous
A Seca weighing scale was used as a screening tool to measure
the weight of participants in both the experimental and control
groups. A stadiometer was also used to assess participants’ height
to the nearest centimetre. The anthropometric measures were taken
to identify participants who were underweight and unhealthy to
do moderate to vigorous exercise . The participants were
measured in light clothing and bare-footed. Weight was recorded
to the nearest kilogram. Using the norms of weight-for-age of
Frisancho , participants with weight ≤5th percentile were
classified as underweight. In addition a standardised health
screening questionnaire  was used to assess participants’ health
for exercise. The health screening tool is a questionnaire which has
a list of major health problems including cardiovascular disease,
asthma, injuries, etc. it requires parents to read through the list and
tick then health problems which are applicable to their children.
Participants who experienced any of the health conditions were
screened out of moderate to vigorous physical activity. .
A stadiometer was used to measure the height of the participants.
Participants were measured bare-footed and height was taken
to the nearest centimetre. Using the norms of height-for-age of
Frisancho , participants with height ≤5th percentile were
classified as stunted.
Assessment of Exercise Participation
The Physical Activity Questionnaire for older Adolescents
(PAQ-A), developed by Kowalski, Crocker, and Donen ,
was used to asses participation in physical exercises. It is a self
–administered recall questionnaire designed to measure physical
activity levels among adolescent students aged 13 to 19 years
of age. It consists of 8 items which ask about the frequency of
doing particular games and also physical activities in a variety of
contexts. Respondents read each item and then rate how often they
do specific physical exercises. It is scored by adding up the values
checked and then dividing by number of items. A score of 1 to 2
indicates a low physical exercise, 3 moderate exercise and 4 to
5 high exercise. The PAQ-A has good validity and reliability. It
correlates significantly with scores of the 7-day Physical Activity
Recall interview (PAR, r = 0.60), the Activity Rating questionnaire
(r= 0.73) as well as with the Caltrac motion sensor (r=0.33) .
The PAQ-A was slightly modified to suit the African culture. Only
two specific games ‘floor-hockey and baseball’ were changed to
African games-‘ampe’ and ‘tumatu’. This is not likely to affect the
validity of the tool. A pilot study using 20 random sample of junior
high participants from high socioeconomic group and 20 from low
socioeconomic group yielded a reliability of .87 of the PAQ-A tool.
New lifestyle (NL)-800 Pedometer
A pedometer was used to objectively assess ambulatory physical
activity levels. It is a battery-operated electronic device that
measures steps and distances when walking or running . It
was chosen over other objective mechanical measures of physical
exercise, such as the accelerometer, because the pedometer
measures walking, which is the most popular form of physical
activity, and is cheap to use . Brisk walking, is a form of exercise,
which has been associated with physical health benefits including
a reduced risk for cardiovascular diseases, diabetes and cancer .
The NL-800 electronic pedometer models have been used in a
wide range of research and has been found to have a high validity
and reliability than other pedometers . To use the pedometer,
it is usually put on a waist belt or waistband. It has a horizontal,
spring-suspended lever that moves up and down with each step the
person makes. It only responds to vertical movements of the hip
that occur when walking and running. It shows the accumulated
steps on a digital screen. It has been indicated that accumulating
10,000 steps a day provides substantial health benefits . When
using the pedometer in research, demonstrations are made to
show participants how to wear the device. Research shows that
the use of pedometer motivates people to do physical activity and
exercise. Therefore, in order to control participants’ reactivity to
the pedometer, it has been suggested that participants be told that it is a body posture device .
The Exercise Log
This was used to record the time the pedometer was worn and the
time it was taken off. It is a single sheet which consists of specified
dates in the week, as well as a column for time and exercise
Assessment of Cognitive Functioning
The Standard Progressive Matrices
The Standard Progressive Matrices (SPM), a non-verbal reasoning
test  was used to assess participants’ executive functioning.
Executive functioning was assessed with a non-verbal reasoning
test because tests with verbal items might be influenced by
respondents past learning and are not culture-free. Moreover, tests
with many subscales such as the Wechsler Intelligence Scale for
Children (WISC)  may create difficulties when comparing
respondents’ performances  because of the tendency for some
respondents to score higher on some subscales than others. The
Progressive matrices test was chosen over other tests to measure
non-verbal reasoning because it is a single and culture-free test
which assesses reasoning capabilities irrespective of respondent’
education or nationality . In the present research, executive
functioning was operationally defined in a simpler way of
‘reasoning’ , hence the main reason for choosing the matrices
test over other cognitive tests. The Progressive Matrices test is in a
form of book which consist of 60 problems divided into Sets A, B,
C, D and E. On every page in the book, a figure with a missing part
is presented. Below each figure are response options of the missing
parts. Respondents have to understand the meaningless figures,
consider how the patterns are related in each figure, and select
the appropriate missing part to complete the figure. The problems
appear simpler at beginning and become more difficult. The
Progressive Matrices has been standardised among British young
people  and also Ghanaian young people . The test-retest
reliability of the Progressive Matrices ranges from 0.83 to 0.88,
which indicates a high reliability. It also correlates significantly
with the Mill-Hill Vocabulary test 90.44 to 0.60. . The test
is suitable for comparing people regarding their capabilities for
immediate observation, clear thinking and understanding. It can be
used as an individual or group test. It takes 45 minutes to complete
the test. The score on the matrices is the total number of problems
the person solved correctly on the test. A higher score indicates high reasoning capability. The total score is converted to percentile score using the norms for the Progressive Matrices.
Assessment of Self-esteem; Physical Self-Worth (PSW)
Participants’ physical self-worth was assessed using the subscale
from the Physical Self-Perception Profile (PSPP) . The PSPP
consists of five subscales, each containing 6 items, which measures
the following domains of self-esteem: perceived competence in
sports (Sport), perceived bodily attractiveness (Body), perceived
physical development (Strength), perceived ability to do exercise
(Condition), and overall physical self-worth (PSW). The PSPP has
been widely used in exercise research . The PSW subscale
was chosen instead of using the entire scale because young people
are likely to evaluate their physical self-worth . The Physical
Self-worth subscale assesses feelings of self-respect, satisfaction
and confidence in the physical domain. It consists of 6 items.
Respondents read each item and rate how it describes themselves
using response options ranging from 1 “not at all like me” (lowest
score) to 5 “ very much like me” (highest score). The internal
consistency of the PSW is between 0.6 and 0.7. It also has a high
test-retest reliability . It takes 5-10 minutes to complete this
test. The test is scored by adding up the score circled from each
of the 6 items. Items 2, 4 and 6 are reversed when adding up the
scores. A higher score on this test indicates a high physical selfworth
or related sub-domain. The PSW scale was modified from
two-directional to a one-directional response options such as 1)
“Not at all like me” to 5) “Very much like me”. A pilot study was
conducted to ensure that participants understood the instructions
on the questionnaire.
The Body Image Silhouette test
The Body Image Silhouette test  was used to assess body
image. The test was chosen because among adolescents an
evaluation of their body image is the most important determinant
of their self-esteem and well-being . This test consists of 9
pictures of different human figures, ranging in body size from
thin to obese. Respondents look at the pictures and then rate, on
a 9-point scale, their current perceived body size and also their
ideal body size. Different pictures are designed for boys and girls.
The silhouette rating scales are widely used to assess body image
and body dissatisfaction in exercise research. The silhouette rating
scales have good face validity and also are highly reliable . The
scales consist of visual images and therefore require less verbal
skills to complete compared to other questionnaires. Test-retest
reliability scores range from 0.89 to 0.92 for assessment of current
body image and 0.71 to 0.82 for ideal body image among males
and females . It takes about 3 minutes to complete this test.
When scoring the test, the difference between scores of the current
body image and scores of the ideal image is calculated. A high
score on the Silhouette test indicates greater body dissatisfaction.
Assessment of Nutritional Practice:
Food Frequency Questionnaire
Nutritional practice was assessed using a Food Frequency
Questionnaire (FFQ) developed by Rockett et al. . The FFQ
was chosen over other well established measures of nutritional
practice such as the 24-hour dietary recall because it assesses
dietary intake for a longer period of time. For example, the 24-hour
dietary recall measures food intake only for a single day. The FFQ
use for this study consisted of 28 food items about the intake of
carbohydrates, proteins, vitamins and minerals. Respondents have
to indicate, using the response options, how often each food item
is eaten in the past week. The FFQ has good validity. Correlation
coefficients between the FFQ and the 24-hour dietary recall range
from 0.21 to 0.58 . It takes about 15 minutes to complete the
questionnaire. In scoring the FFQ, a score of 7 is assigned to the
response option which indicates highest consumption of the food
item through to 0 which is assigned to the response option “not eaten”. The score ticked for each of the food items are summed
up in order to provide the total frequency of food consumed daily.
A higher score on the FFQ indicates high food intake, whereas
a lower score indicates less food intake. Only participants with
higher score on the FFQ were selected to participate in the study.
The study procedure consisted of three stages:
1) The Screening process
2) The study assessment (data collection)
3) The 3 month exercise intervention
1. Study Screening Process
Participants in both the experimental and control groups were
screened for health conditions, weight status and their actual activity
participation. Participants who had health problems as indicated on
the health screening questionnaire were excluded from the study.
Both experimental and control group participants were weighed
to the nearest kilogram. With reference to the norms of weightfor-age
, those with weight <5th percentile were classified as
underweight and excluded from the exercise intervention study.
This is because it is not healthy for underweight participants to
do moderate to vigorous physical activity . The participants’
baseline physical activity levels were assessed using the PAQ-A
and the pedometer. Those who scored highly on physical activity
were also excluded from the study. This is because the main
purpose of the intervention was to increase physical exercises
among participants who did not meet the recommended level of
physical exercise. Again, using a simple random sampling method,
additional number of participants were excluded to get the final 60
participants for the experimental and control group in the study.
Figure 1 shows the screening procedure for the study.
Figure 1. Chart illustrating the recruitment of participants and the screening process for the exercise intervention study in one school
Figure 2. Chart illustrating the recruitment of participants and the screening process for the exercise intervention study in two separate
2. Study Assessment (Data Collection)
This experimental study was to determine the impact of an exercise
intervention on participants’ physical activity participation levels,
executive functioning, physical self-worth and body image. First
of all, a pilot study of the experimental study was carried out in one
school in order to find out if there was the need for modification
of the study procedure. In the single school, where the pilot study
was conducted, participants were separated into experimental
and control groups. The actual experimental study, however, was
conducted in two separate schools. In the procedure, first, baseline
assessments were taken on exercise participation, executive
functioning, physical self-worth, body image and nutritional
practice for both the experimental and control groups during the
first week. Secondly, a moderate to vigorous physical exercise
programme was planned for the participants in the experimental
school only. Participants in the control school did not do any
After the physical exercise intervention, both the experimental and
control groups did a post-test on physical exercise participation,
cognitive functioning, physical self-worth and body image in order
to find out the outcome of the exercise intervention on participants’
physical activity levels and well-being.
It is important to note that the baseline and the post-intervention
assessment were conducted in the morning in order to avoid the
possible influence of tiredness on the cognitive performance test.
It has been suggested that cognitive tests should be administered in
the morning time when students seem to have a better concentration
. During the baseline and post-test assessment, participants
were comfortably seated in a classroom. They were given some
brief information about the purpose of the study and what they
were supposed to do. They were told that the questionnaires
they would be completing were not an exam and also assured of
confidentiality. After the introductory guidelines, the participants
were provided with pens. Then the study questionnaires on physical
activity participation, cognitive functioning, and self-esteem were
The researcher read out the instructions of each questionnaire to
the students. Research assistants were also around to assist students
who needed help regarding completion of the questionnaires. The
data collection lasted about 2 hours. After the students finished
responding to the questionnaires, the participants from each school
were guided to wear pedometers for one week. The pedometer
measurement was done in order to confirm the reported physical
exercise levels (via the PAQ-A). Demonstrations were done to
show these participants how to wear the pedometer.
3. The 3-month structured exercise intervention
A moderate to vigorous physical exercise programme was planned
for the experimental school. Participants in the experimental
school engaged in an after-school physical exercise programme
of two times a week for 3 continuous months. The programme
included skipping, jumping, running, dancing and football. These
participants were also given verbal persuasion to engage in
physical activity and exercise in their spare time. The participants
in the control did not do any structured exercise.
Additional Information Based on the Pilot Study
The experimental study was first conducted in a single school
as a pilot study in order to modify the instruments as well as the
methods in the actual research if necessary. The actual study,
however, was conducted in two separate schools, one school was
the experimental school and the other was the control school.
Before the pilot study, the time allocated for the completion of
the questionnaires was 1 hour 45 minutes. After the pilot study
and the comments from the participants, it became necessary to
increase the time for the assessment to 2 hours. Moreover, all the
questionnaires were completed in English. In order to ensure that
participants received similar instructions for the completion of the
questionnaires, the instructions for each questionnaire was printed
out and read aloud to the participants by the principal researcher
only. Research assistants were around to supervise the students
and also attend to participants who needed some assistance in
completing the questionnaires. In each school, participants were
given a 5 minutes break during the questionnaire time.
Process Evaluation of Data Collection
The data collection was successful. The school heads were grateful
for the research to be conducted in their schools and the students
involved were very cooperative. Two of the schools did not have
Physical Education (PE) in their curriculum and one of the schools
had PE on their curriculum but did not utilise the time for PE,
therefore the physical exercise intervention gave opportunity for
the students to do exercise at school. The students enjoyed the
exercise activity programme and they wished that it continued as
part of their curriculum.
Ethical approval for the study was issued by the Ghana Education
Service. Permission letters were sent to the school heads in order to
conduct the study in the schools. Moreover, informed consent was
obtained from the parents and the students before data collection.
To ensure confidentiality, codes were assigned to participants and
these codes were used to identify participant’s responses to the
First, frequency and descriptive analyses were conducted to obtain
descriptive information about participants in the experimental
and control group. In order to provide descriptive statistics for
categorical and continuous variables, frequency and descriptive
analyses were conducted respectively. All differences among
categorical variables were analysed using Chi-square tests, and
differences among continuous variable were analysed using
independent t-tests. (Table 2). Second, the one-way repeated
measures ANOVA was performed to investigate the impact of the
physical exercise intervention on the students’ physical activity
levels (Table 3). Third, the one-way repeated measures ANOVA
was also performed to determine the impact of the physical
activity intervention on executive functioning (Table 4) and self- esteem indicators of physical self-worth and body dissatisfaction
(Table 5). Finally, the one-way repeated measures ANCOVA
was performed to assess whether nutritional practice moderated
the relationship between the exercise intervention and cognitive
functioning. (Table 6).
Table 3. One-way repeated measures ANOVA results for levels of physical activity and exercise on the PAQ-A and the pedometer
Table 6. One-way repeated measures ANCOVA results for exercise intervention, nutritional practice and cognitive functioning
Table 7. One-way repeated measures ANOVA of exercise and well-being indicators of the pilot study
A total of 60 students who met the study’s inclusion criteria
participated in the study. These students were recruited from
two private schools in the city of Accra, Ghana. At baseline, the
mean age of the participants was 14.83 (1.32) years, which ranged
from 13 to 18 years. Of the entire sample 55.0% were females.
With regards to stature, 18.3% of the participants were stunted.
Regarding the weight of the participants, the average BMI (24.19
kg/m2) was within the normal range. However, nearly half of
these participants were overweight (30.0%) or obese (11.7%).
There were no significant differences between participants in the
experimental and control groups at baseline (p>0.05). Most of the
participants (97%) were present for the post-testing.
The Impact of the exercise intervention on physical
activity and exercise levels
This study firstly examined whether the exercise intervention
had an influence on the participants’ physical activity levels. The
one-way repeated measures ANOVA was used to examine the
difference between baseline physical activity levels and postintervention
physical activity levels of both the experimental and
From Table 3, the experimental and control group had similar
levels of physical activity participation at baseline [1.40 (0.43);
1.42 (0.49), respectively]. At post intervention, however the
experimental group scored higher on self-reported physical
activity (PAQ-A) than the control group [4.55 (0.48); 1.55
(0.58)]. The repeated measures ANOVA showed that the observed
difference in exercise participation scores from baseline to post
intervention was significant [F(1, 56) = 417.35, p< 0.001]. In
addition, participants in the experimental group obtained higher
scores on the pedometer at post-testing than participants in the
control group. Participants who participated in the exercise
intervention increased their physical activity participation to
12015.67 steps per day. Again, the observed difference in physical
activity participation levels between participants was statistically
significant [F(1, 28) = 372.95, p< 0.001]. The results indicated that
the exercise intervention had a significant impact on participants’
physical activity participation levels.
The Impact of the 3-month continuous exercise on
executive functioning (an aspect of cognitive functioning)
The second objective of this study was to examine the impact of the
physical exercise intervention on performance on a standardised
cognitive test. In order to avoid the use of complicated tests which
is a major methodological flaw of previous studies , this study
assessed the impact of exercise on cognitive functioning with a
simpler standardised culture free-test (progressive matrices) to
assess reasoning. Results presented in Table 4 below indicates that
the experimental and control group had similar performance on the
matrices test at baseline. However, at post-test, the experimental
group participants obtained increased scores on the cognitive test
compared with those in the control group. Results from the repeated
measures ANOVA showed that the increase in the matrices test
scores of the experimental group participants was significant [F(1,
56) = 24.99, p< 0.001]. The findings indicated that the physical
exercise intervention had an impact on participants’ reasoning
capacity, hence supporting the prediction of the study.
In the exercise literature it has been recommended that experimental
studies be conducted to strengthen the evidence base of the impact
of exercise on mental health variables . It was therefore the
objective of this study to examine the causal relationship between
exercise intervention and mental well-being in African adolescents
(Table 5). From Table 5, the mean scores on self-esteem showed
that the experimental and control group were comparable at
baseline on physical self-worth. The post intervention means
showed that the experimental group scored higher on physical
self-worth than the control group. The repeated measures ANOVA
showed that the difference observed between the two groups at
post intervention was significant [F(1, 56) = 37.31, p< 0.001].
Therefore the physical exercise had a significant positive impact
on physical self-worth, which supported the study prediction.
Regarding results on the body image test, (Table 5), the mean scores
at baseline revealed that the experimental and control group had
similar scores on body dissatisfaction. However, the mean scores
at post intervention showed that participants in the experimental
group had a decrease in scores on the body image scale (which
indicates less body dissatisfaction) than the control group. The
repeated measures analysis of variance showed that the observed
difference between the experimental and control group at post
intervention was significant [F(1, 56) = 17.61, p< 0.001]. Physical
exercise intervention had a significant impact on the reduction of
body dissatisfaction, thus supporting the study prediction.
Assessing a possible moderator of the impact of
the exercise intervention on participants’ cognitive functioning.
From the health literature, nutritional practice is likely to be a
confounder of the relationship between exercise and cognitive
functioning (e.g. Black, 2003; Kim et al., 2010). This study
controlled nutritional practice by including participants with
higher scores on the nutritional practice scale. Results in Table
6 shows that the impact of exercise intervention on cognitive
functioning did not show any interaction with nutritional practice.
As nutritional practice was controlled, participants’ nutritional
practice was not significantly associated with performance on the
executive functioning test [F(1, 55) = 0.20, p> 0.05]. The findings
indicated that when nutritional practice was controlled for, the
exercise intervention had a significant positive impact on cognitive
The Pilot Study Results
The experimental study, which was conducted in two separate
schools (from April ending to July ending and one month followup
to the end of August) was initially conducted in a single school
as a pilot study. The findings of the pilot study were similar to
results obtained from the actual study conducted in two separate
When assessing the impact of the exercise intervention on the
physical activity levels of the participants, the pilot results showed
that both the experimental and the control group participants
had comparable levels of physical activity at baseline. At post
testing however, participants in the experimental group scored
significantly higher on the PAQ-A [F(1, 54) = 590.19, p< 0.001],
and also on the pedometer [F(1, 28) =267.03, p< 0.001]. When
assessing the impact of the exercise intervention on cognitive
functioning, the experimental group had significantly higher
scores on executive functioning than the control [F(1, 54)= 33.89,
p< 0.001]. Moreover, the experimental group participants scored
significantly higher on self-esteem than participants in the control
group (Table 7).
Summary of Findings
• The exercise intervention had a significant impact on physical
activity participation levels.
• The exercise intervention had a significant positive impact on cognitive functioning.
• The exercise intervention had a significant positive impact on aspects of self-esteem.
The present study found that moderate to vigorous exercise had
a significant positive impact on cognitive functioning and mental
health of young people. This finding is consistent with studies
conducted among Western young people, which indicated that
physical activity is associated with good mental health [35, 36,
37, 38]. In this study, participants who took part in the physical
exercise intervention experienced enhancement in cognitive
functioning and self-esteem compared to those who did not do
exercise. This finding indicates that moderate to vigorous physical
exercise improves mental health. Research indicates that selfesteem
problems are strongly associated with depression [39, 40].
Therefore, there is the possibility that students who participated
in the structured exercise experienced a reduction in depression
symptoms which in turn enhanced self-esteem compared to the
students in the control group who did not take part in the exercise.
With regards to cognitive functioning, students who participated
in the exercise intervention significantly improved their reasoning
capabilities compared to those who did not do exercise. This
finding contributes to the physical activity literature by assisting to
make the association between exercise and executive functioning
clearer. This is because there have been inconsistent findings on the
association between physical activity and executive functioning
[13, 14]. This study based on experimental design is supported by
some studies from Western cultures which have also found that
exercise has a significant positive impact on executive functioning
in young people [41, 42, 43]. This finding however, contradicts
with previous studies which have found no association between
physical activity and executive functioning [44, 45]. The reason
for the present finding seems to be that the present study utilised
an experimental design to minimise some of the extraneous factors
which are associated with non-experimental studies. This study
assessed executive functioning simply as reasoning capabilities
and therefore used a simple tool to assess executive functioning.
Moreover, the reason for the present results is possibly due to
the fact that prior to the physical exercise intervention, both the
experimental and control group students might be experiencing
some symptoms of depression which inhibited their cognitive
capacities. Research studies indicate that depression affects
cognitive performance . Goldney et al.  also reported that
even subclinical levels of depression have a significant negative
impact on productivity. After the exercise intervention, the students
who participated in exercise (the experimental group) seem to
have experienced reduction in depressive symptoms, which
manifested in their improvement in cognitive functioning as well
as improvement in their low self-esteem. Probably, the students
in the control group, however, continued to manifest depressive
symptoms which inhibited their cognitive performance as well as
On the contrary, when utilising the results of the present study, it
should be considered that the schools from which participants were
recruited were not randomly selected to the experimental and control
conditions. A specific school was used as the experimental school
as a result of the schools receptiveness to the exercise intervention.
Moreover, the test utilised to assess executive functioning was a
non-verbal cognitive test, which measures spatial skills. Therefore
the improvement observed on the executive functioning can only
be specified to spatial skills but not verbal skills. In summary, the
present findings indicate that participation in exercise is associated
with improved reasoning capabilities. This suggests that physical
activity and exercise is beneficial for young people who are still
developing in executive functioning . More importantly, the
present findings seem to support the evidence and make it clearer
the association between exercise and executive functioning. This
finding is helpful for schools in making decisions about school
physical education programs for students. It has been clearly
demonstrated that participation in exercise improves cognitive
functioning and mental health. The finding however, is mainly
generalizable to students from upper class schools in Ghana.
The main purpose of this study was to strengthen current literature
showing the associations between physical exercise and wellbeing
using an intervention study. It was found that participation in
moderate to vigorous physical activity has an impact on executive
functioning, an aspect of cognitive functioning. The findings
imply that conduction of exercise in schools would help students
to learn better. Ghanaian parents are advised to make children walk to school if the distance is not too long and the environment
is safe. School physical exercises should be conducted consistently
for students and students are encouraged to participate in them as
regular exercises can improve cognitive functioning.
Written informed consent was obtained from parents/guardians of
participants and also the participants themselves.
No competing interests.
Contribution of Authors
First author conducted the assessment and exercise intervention
programme in the schools, data analysis and write up of exercise
and health aspects of the paper. The second author assisted with
data-analysis, proof reading and write-up of the well-being/
mental health aspect of the paper. Both authors approved the final
1Dr. Mavis Asare, Clinical Sport Psychologist, Methodist
University College Ghana
2Prof S.A. Danquah, Professor of Psychology, University of
Ghana Legon and Methodist University College Ghana
The authors acknowledge Mrs. Soni Valecha (Progressive Life
Center), Dr. Ines Varela-Silva (Loughborough University, UK)
and Research Assistants who helped with data collection in the
schools. Sincere gratitude also to the junior high school students
who participated in the study.
- Bouchard, C., Blair, S.N., & Haskell, W.L: Physical activity and
health. Leeds: Human Kinetics; 2012.
- World Health Organisation: Global recommendations on physical activity for health. Geneva: WHO; 2010.
- Pearson, N., Atkin, A.J., Biddle, S.J.H., Gorely, T., & Edwardson,
C: Patterns of adolescent physical activity and dietary behaviours.
Int J of Nutr and Phys Act 2009, 6: 45.
- World Health Organisation: Adolescent health. Geneva: WHO;
- Biddle, S.J.H., & Asare, M: Physical activity and mental health
in children and adolescents: A review of reviews. BJSM 2011,
- Janssen, I., & LeBlanc, A.G: Systematic review of the health
benefits of physical activity and fitness in school-aged children
and youth. Int J of Behav Nutr and Phys Act 2010, 7: 40.
- Emerson, E., Einfeld, S., & Stancliffe, R.J: The mental health
of young children with intellectual disabilities or borderline
intellectual functioning. Soc Psychiat and Psychiatr Epidemiol 2010, 45:579-587.
- Carter, K. & Seifert, C.M: Psychology. Burlington, MA: Jones
and Barlett Learning; 2013.
- Keeley, T.J.H., & Fox, K.R: The impact of physical activity and
fitness on academic achievement and cognitive performance in
children. International Rev Sport and Ex Psych 2009, 2(Suppl 2), 198-214.
- Gregory, R.J: Psychological testing: History, principle and
application (5th Ed.). New York: Pearson Education, Inc; 2007.
- Spearman, C: The abilities of man: Their nature and
measurement. New York: Macmillan; 1927.
- Sibley, B.A., & Etnier, J.L: The relationship between physical
activity and cognition in children: A meta-analysis. Pediatr Ex Sc
2003, 15: 243-256.
- Tomporowski, P.D., Davis, C.L., Miller, P.H., & Naglieri,
J.A. (2008). Exercise and children’s intelligence, cognition, and
academic achievement. Edu Psyc Rev 2008, 20:111-131.
- Best, J.R: Effect of physical activity on children’s executive
functioning: Contributions of experimental research on aerobic
exercise. Dev Rev 2010, 30:331-351.
- Progressive Life Centre: Technical Report. Unpublished
Annual Report. Accra; 2013.
- Thompson, J., & Manore, M: Nutrition: An applied approach
(3rd ed.). New York: Pearson Education, Inc; 2002.
- Bauman, A. E., Reis, R. S, Sallis, J. F., Wells, J, C., loos, R.
J. F., & Martin, B. W., for the Lancet Physical Activity Series
Working Group: Correlates of physical Activity: Why are some
people physically active and others are not? The Lancet 2012, 380
(Suppl 9838): 258-271.
- Martins, V. J. B., Florencio, T. M. M.T., Grillo, L. P., Franco,
M. P., Marins, P. A., Clemente, A. P. G., Santos, C. D. L., Vieira,
M.A., & Sawaya, A.L: Long-lasting effects of undernutrition. Int J
Environ Res and Pub Health 2011, 8: 1817-1846.
- Frisancho, A. R: Anthropometric standards: an interactive
nutritional reference of body size and body composition for
children and adults. Ann Arbor, MI: University of Michigan Press;
- American College of Sports Medicine (ACSM): ACSM’s
resource manual for guidelines for exercise testing and prescription
(6th edition). New York: Human Kinetics; 2010.
- Kowalski, K. C., Crocker, P. R. E., & Donen, R. M: The
Physical Activity Questionnaire for older children (PAQ-C) and
Adolescents (PAQ-A). Saskatoon: University of Saskatchewan;
- Washburn, R., Chin, M.K., & Montoye, H.J: Accuracy of
pedometer in walking and running. Res Quart 1980, 51:695-702.
- Welk, G. J: Physical activity assessments for health-related
research. Leeds: Human Kinetics Publishers, Inc; 2002.
- Clemes, S. A., O’Connell, S., Rogan, L. M., & Griffiths, P. L.
(2011). Evaluation of a commercially available pedometer used to
promote physical activity as part of a national programme. BJSM
2011, 44: 1178-1183.
- Raven, J.C: Guide to the standard Progressive Matrices.
London: H.K Lewis & Co; 1998.
- Wechsler, D: Wechsler Intelligence Scale for Children. London:
Harcourt Brace; 1991.
- Siegler, R., DeLoache, J., & Eisenberg, N: How Children
Develop (3rd ed.). New York: Worth Publishers; 2011.
- Annum, A: Replication of the standardisation of the Progressive
Matrices-Unpublished M.Phil. thesis. University of Ghana, LegonAccra;
- Fox, K. R., & Corbin, C. B: The Physical Self Perception
Profile: Development and preliminary validation. J Sport and Ex
Psyc 1989, 11: 408-430.
- Harter, S: Processes underlying adolescent self-concept
formation. In R. Montemayor, G. R. Adams, & T.P. Gullota (Eds.),
From childhood to adolescence: A transitional period? Newbury
Park, Cal Sage; 1990.
- Stunkard, A. J., Sorensen T, Schulsinger F: Use of the Danish
adoption register for the study of obesity and thinness. In: Kety,
SS, Rowland LP, Sidman RL, Matthysse SW, editors. The genetics
of neurological and psychiatric disorders. New York: Raven; 1983.
- Hart, E. A: Assessing body image. In K. Tritschler (Ed.), Barrow
& McGee’s practical measurement and assessment. Philadelphia:
Lippincott, Williams & Wilkins; 2000. p:409-437.
- Rockett, H. R., Breitenbach, M., & Frazier, A. L., Witschi, J.,
Wolf, A. M., Field, A. E., & Colditz, G. A: Validation of a Youth/
Adolescent Food Frequency Questionnaire. Preventive Medicine
1997, 26 (Suppl 6): 808-816.
- Brucewalsh, W., & Betz, N.E: Tests and assessment. New
Jersey: Prentice Hall Inc; 1995.
- Boyd, K.R., & Hrycaiko, D.W: The effect of a physical activity
intervention package on the self-esteem of pre-adolescent and
adolescent females. Adolescence 1997, 32(Suppl 127):693-709.
- Burgess, G., Grogan, S., & Burwitz, L: Effects of a 6-week
aerobic dance intervention on body image and physical selfperceptions
in adolescent girls. Body Image 2006, 3:57-66.
- Larun, L., Nordheim, L.V., Ekeland, E., Hagen, K. B., & Heian,
F: Exercise in prevention and treatment of anxiety and depression
among children and young people. Cochrane Database of Syst Rev
- Etnier, J.L., Nowell, P.M., Landers, D.M., & Sibley, B.A: A
meta-regression to examine the relationship between aerobic
fitness and cognitive performance. Brain Res Rev 2006, 52:119-
- Battle, J: Relationship between self-esteem and depression
among high school students. Percept Motor Skills 1980, 51:157-
- Comer, R.J: Abnormal Psychology. New York: Worth
- Castelli, D.M., Hillman, C.H., Hirsch, J., Hirsch, A., Drollette,
E: Fit kids: Time in target heart zone and cognitive performance.
Prev Med 2011, 52:S55-S59.
- Roebroeck, M.E., Hempenius, L., Van Baalen, B.,
Hendriksen, J.G.M., Van Den Berg-Emons, H.J.G., & Stam,
H.J: Cognitive functioning of adolescents and young adults
with meningomyelocele and level of everyday physical activity.
Disability and Rehabilitation 2006, 28(Suppl 20): 1237-1242.
- Ruiz, J.R., Ortega, F.B., Castillo, R., Martín-Matillas, M.,
Kwak, L., Vicente-Rodríguez, G., Noriega, J., Tercedor, P.,
Sjöström, M., & Moreno, L.A: Physical activity, fitness, weight
status, and cognitive performance in adolescents. J Pediat 2010,
157(Suppl 6), 917-922.
- Davis, C.L., Tomporowski, P.D., Boyle, C.A., Waller, J.L.,
Miller, P.H., Naglieri, J.A., & Gregoski, M: Effects of aerobic
exercise on overweight children’s cognitive functioning: A
randomised controlled trial. Research Quarterly for Exercise and
Sport 2007, 78(Suppl 5): 510-519.
- Martinez-Gómez, D., Ruiz, J.R., Gómez-Martinez, S., Chillón,
P., Rey-López, J.P., Diaz, L.E., Castillo, R., Veiga, O.L., & Marcos,
A: Active commuting to school and cognitive performance in
adolescents. Arch Pediatr Adoles Med 2011, 165(4), 300-305.
- Goldfield, G.S., Henderson, K., Buchholz, A., Obeid, N.,
Nguyen, H., & Flament, M.F: Physical activity and psychological
adjustment in adolescents. J Phys Act Health 2011, 8:157-163.