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GuidelinesonStrengthTrainingforChildrenRevised
NewsAuthor:LaurieBarclay,MD
CMEAuthor:LaurieBarclay,MD FacultyandDisclosures
CMEReleased:04/11/2008Validforcreditthrough04/11/2009
CMEInformation

April11,2008TheAmericanAcademyofPediatrics(AAP)hasreviseditspolicystatementonstrengthtrainingfor
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childrenandprovidesrecommendationsforstrengthtrainingprogramsforchildrenandteens,accordingtothe
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resultsofastudyreportedintheAprilissueofPediatrics.
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"Pediatriciansareoftenaskedtogiveadviceonthesafetyandefficacyofstrengthtrainingprogramsforchildrenand Google+
adolescents,"writeEricW.Small,MD,andcolleaguesfromtheCouncilonSportsMedicineandFitness."This
statement,whichisarevisionofapreviousAmericanAcademyofPediatricspolicystatement,definesrelevant
terminologyandprovidescurrentinformationonrisksandbenefitsofstrengthtrainingforchildrenandadolescents."

Strengthtraining,orresistancetraining,isoftenincorporatedinsportsandphysicalfitnessprogramsforchildrenand
adolescents.Someadolescentsusestrengthtrainingtoimprovetheirappearancebyincreasingmusclebulk.
Dependingonspecificprogramgoals,strengthtrainingprogramsmayusefreeweights,weightmachines,elastic
tubing,ortheparticipant'sownbodyweight.

Therisksforstrengthtrainingincludethosespecifictoyoungpeoplewithpreexistingmedicalconditionsaswellas
musclestrains,whichaccountfor40%to70%ofallstrengthtraininginjuries.Themostfrequentlyinjuredareasare
thehand,lowback,anduppertrunk.Mostinjuriesoccuronhomeequipmentwithunsafebehaviorandin
unsupervisedsettings.

Appropriatestrengthtrainingprogramsdonotappeartoadverselyaffectlineargrowth,growthplates,orthe
cardiovascularsystem.

Generalrecommendationsconcerningstrengthtraininginpreadolescentsandadolescentsareasfollows:

Toensuresafetyandefficacy,strengthtrainingprogramsforyoungpeopleshouldfollowproperresistance
techniquesandsafetyprecautions.Beforetheyoungpersonembarksonastrengthtrainingprogram,the
clinicianshouldhelpdeterminewhetheritisnecessaryorappropriatetostartsuchaprogramandwhatlevelof
proficiencytheyoungpersonhasalreadyattainedinhisorherchosensportactivity.

Untiltheyreachphysicalandskeletalmaturity,preadolescentsandadolescentsshouldavoidpowerlifting,body
building,andmaximallifts.Overweightchildrenmayappeartobestrongbecauseoftheirsize,buttheyare
oftenunconditionedwithpoorstrength,andtheyrequirethesamestrictsupervisionandguidanceasdoother
youngpeopleundertakingaresistanceprogram.

TheAAPreiteratesthatathletesshouldnotuseperformanceenhancingsubstancesoranabolicsteroids.
Athleteswhotakepartinstrengthtrainingprogramsshouldbeeducatedabouttherisksassociatedwiththese
substances.

Issuesthatpediatriciansshouldconsiderwhenaskedtorecommendorevaluatestrengthtrainingprogramsfor
childrenandadolescentsincludethefollowing:

Apediatricianorfamilyclinicianshouldperformamedicalevaluationbeforetheyoungpersonbeginsaformal
strengthtrainingprogram.Thisevaluationcanidentifyriskfactorsforinjuryandofferanopportunitytodiscuss
previousinjuries,lowbackpain,medicalconditions,traininggoals,motivesforwantingtobeginphysical
training,appropriatetechniques,andexpectationsofboththechildandtheparents.

Youthwithuncontrolledhypertension,seizuredisorders,orahistoryofchildhoodcancerandchemotherapy
shouldnotparticipateintheseprogramsuntiltheyreceiveadditionalappropriatetreatmentorevaluation.
 Forcertainyouth,referralmaybeindicatedtoapediatricorfamilycliniciansportsmedicinespecialistwhois
familiarwithvariousstrengthtrainingmethodsaswellasrisksandbenefitsforpreadolescentsand
adolescents.

Beforebeginningastrengthtrainingprogram,childrenwithcomplexcongenitalcardiacdisease
(cardiomyopathy,pulmonaryarteryhypertension,orMarfan'ssyndrome)shouldundergoconsultationwitha
pediatriccardiologist.

Tooptimizegeneralhealthbenefits,aerobicconditioningshouldbecoupledwithresistancetraining.

A10to15minutewarmupandcooldownshouldbeincludedinstrengthtrainingprograms.

Adequateintakeoffluidsandpropernutritionareessentialtomaintainmuscleenergystoresandenhance
recoveryaswellasperformance.

Specificstrengthtrainingexercisesshouldfirstbelearnedwithnoload(noresistance)tomastertheproper
technique.Incrementalloadscanthenbeaddedwitheitherbodyweightorotherformsofresistance.

Strengthtrainingshouldinclude2to3setsofhigherrepetitions(815)twiceto3timesweeklyandshould
continueforatleast8weeks.

Ageneralstrengtheningprogramshouldinvolvethecoreandallmajormusclegroups,withexercisethrough
thecompleterangeofmotion.Moresportsspecificareasmaybeaddressedsubsequently.

Whenthereisanyevidenceofillnessorinjuryfromstrengthtraining,thisshouldbefullyevaluatedbeforethe
exerciseprogramisresumed.

Instructorsorpersonaltrainersforyoungpeopleshouldbecertifiedwithspecificqualificationsinpediatric
strengthtraining.

Toensuresafety,anystrengthtrainingprograminvolvingpreadolescentsandadolescentsmustincludeproper
techniqueandstrictsupervisionbyaqualifiedinstructor.

"Inadditiontotheobviousgoalofgettingstronger,strengthtrainingprogramsmaybeundertakentotrytoimprove
sportsperformanceandpreventinjuries,rehabilitateinjuries,and/orenhancelongtermhealth,"theguidelines
authorswrite."Similartootherphysicalactivity,strengthtraininghasbeenshowntohaveabeneficialeffecton
severalmeasurablehealthindices,suchascardiovascularfitness,bodycomposition,bonemineraldensity,blood
lipidprofiles,andmentalhealth....Resistancetrainingisbeingincorporatedintoweightcontrolprogramsfor
overweightchildrenasanactivitytoincreasethemetabolicratewithouthighimpact."

Pediatrics.2008121:835840.

CLINICALCONTEXT

Manyyoungpeoplebecomeinvolvedinstrengthtraining,alsoknownasresistancetraining,inthecontextof
sportsandphysicalfitnessprograms.However,someadolescentsusestrengthtrainingtoenhancemusclesize
andappearance.Freeweights,weightmachines,elastictubing,oranathlete'sownbodyweightmayallprovide
resistancerequiredforstrengthtraining.Thetypeandamountofresistanceusedandthefrequencyofrepetitions
varydependingonspecificprogramgoals.

Becausepediatriciansareoftenaskedtocounselyoungpeopleonthesafetyandefficacyofstrengthtraining
programs,theAAPissuedthisrevisionofapreviouspolicystatement.Theserevisedguidelinesdefinerelevant
terminologyandprovideupdatedevidenceregardingtherisksandbenefitsofstrengthtrainingforchildrenand
adolescents.

STUDYHIGHLIGHTS

Musclestrainsaccountfor40%to70%ofallstrengthtraininginjuriesandusuallyinvolvethehand,lowback,
anduppertrunk.

Appropriatestrengthtrainingprogramsdonotappeartoadverselyaffectgrowthorcardiovascularhealth.

Strengthtrainingprogramsforyoungpeopleshouldfollowproperresistancetechniquesandsafety
precautions.

Preadolescentsandadolescentsshouldavoidpowerlifting,bodybuilding,andmaximalliftsuntiltheyreach
physicalandskeletalmaturity.

Athletesshouldnotuseperformanceenhancingsubstancesoranabolicsteroids,andyoungpeopleinvolvedin
strengthtrainingshouldbeeducatedabouttherisksofusingthesesubstances.

Apediatricianorfamilyclinicianshouldperformamedicalevaluationbeforetheyoungpersonbeginsformal
strengthtraining.

Youthwithuncontrolledhypertension,seizuredisorders,orahistoryofchildhoodcancerandchemotherapy
shouldnotparticipateinstrengthtraininguntiltheyundergoadditionaltreatmentorevaluation.

Insomecases,referraltoapediatricorfamilycliniciansportsmedicinespecialistfamiliarwithvariousstrength
trainingmethodsaswellasrisksandbenefitsmaybeindicated.

Beforebeginningastrengthtrainingprogram,childrenwithcomplexcongenitalcardiacdisease
(cardiomyopathy,pulmonaryarteryhypertension,orMarfan'ssyndrome)shouldbeevaluatedbyapediatric
cardiologist.

Aerobicconditioningshouldbecoupledwithresistancetrainingtooptimizegeneralhealth.

Strengthtrainingprogramsshouldinclude10to15minutesofwarmupandcooldown.

Adequatefluidintakeandpropernutritionareneededtomaintainmuscleenergystoresandimproverecovery
andperformance.

Tomasterthepropertechnique,specificstrengthtrainingexercisesshouldfirstbelearnedwithnoload(no
resistance),withincrementalloadsandthenaddedwitheitherbodyweightorotherformsofresistance.

Strengthtrainingshouldinclude2to3setsof8to15repetitions2to3timesweeklyandshouldcontinuefor8
weeksorlonger.

Ageneralstrengtheningprogramshouldtargetthecoreandallmajormusclegroups,withexercisethroughthe
completerangeofmotion.Moresportsspecificareasmaybeaddressedsubsequently.

Illnessorinjuryfromstrengthtrainingshouldbefullyevaluatedbeforeresumptionoftheexerciseprogram.

Instructorsorpersonaltrainersforyoungpeopleshouldbecertifiedandspecificallyqualifiedinpediatric
strengthtraining.

Toensuresafety,anystrengthtrainingprogramforyoungpeoplemustincludepropertechniqueandstrict
supervisionbyaqualifiedinstructor.

PEARLSFORPRACTICE

Toensuresafetyandefficacy,strengthtrainingprogramsforyoungpeopleshouldfollowproperresistance
techniquesandsafetyprecautions.Preadolescentsandadolescentsshouldavoidpowerlifting,bodybuilding,
andmaximalliftsuntiltheyreachphysicalandskeletalmaturity.

Apediatricianorfamilyclinicianshouldperformamedicalevaluationbeforetheyoungpersonbeginsformal
strengthtrainingtoidentifyriskfactorsforinjuryandtodiscusspreviousinjuriesandotherpossiblemedical
conditionsthatmaypreventayoungpersonfromparticipatinginstrengthtrainingprograms.

CMETEST
 BasedonthecurrentAAPguidelines,whichofthefollowingstatementsaboutgeneralrecommendations
concerningstrengthtraininginpreadolescentsandadolescentsiscorrect?
Preadolescentsandadolescentscanbeginastrengthtrainingprogramatanylevelofproficiency,particularlyif
theyarehealthy,withoutconsultingtheirclinician
Strengthtrainingprogramstypicallystuntgrowth
Preadolescentsandadolescentsshouldavoidpowerlifting,bodybuilding,andmaximalliftsuntiltheyreach
physicalandskeletalmaturity
Performanceenhancingsubstancesmaybeindicatedincertaincircumstancesforlimitedduration

BasedonthecurrentAAPguidelines,whichofthefollowingstatementsaboutspecificissuesthat
pediatriciansshouldconsiderwhenrecommendingstrengthtrainingprogramsforchildrenand
adolescentsisnotcorrect?
Apediatricianorfamilyclinicianshouldperformamedicalevaluationbeforetheyoungpersonbeginsformal
strengthtraining
Warmupandcooldownarenotneededforadolescentstrengthtrainingprograms
Beforebeginningastrengthtrainingprogram,childrenwithcomplexcongenitalcardiacdiseaseshouldbe
evaluatedbyapediatriccardiologist
Youthwithseizuredisordersshouldnotparticipateinstrengthtraininguntiltheyundergoadditionaltreatment
orevaluation

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MedscapeMedicalNews2008
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