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MULTISPECIALTY

Guidelines on Strength Training for Children Revised

News Author: Laurie Barclay, MD

CME Author: Laurie Barclay, MD Faculty and Disclosures CME Released: 04/11/2008 ; Valid for credit through 04/11/2009

Edition: <a href=English Deutsch Español Français Português MULTISPECIALTY From Medscape Medical News Guidelines on Strength Training for Children Revised News Author: Laurie Barclay, MD CME Author: Laurie Barclay, MD Faculty and Disclosures CME Released: 04/11/2008 ; Valid for credit through 04/11/2009 CME Information April 11, 2008 — The American Academy of Pediatrics (AAP) has revised its policy statement on strength training for children and provides recommendations for strength­training programs for children and teens, according to the results of a study reported in the April issue of Pediatrics . "Pediatricians are often asked to give advice on the safety and efficacy of strength­training programs for children and adolescents," write Eric W. Small, MD, and colleagues from the Council on Sports Medicine and Fitness. "This statement, which is a revision of a previous American Academy of Pediatrics policy statement, defines relevant terminology and provides current information on risks and benefits of strength training for children and adolescents." Strength training, or resistance training, is often incorporated in sports and physical fitness programs for children and adolescents. Some adolescents use strength training to improve their appearance by increasing muscle bulk. Depending on specific program goals, strength­training programs may use free weights, weight machines, elastic tubing, or the participant's own body weight. The risks for strength training include those specific to young people with preexisting medical conditions as well as muscle strains, which account for 40% to 70% of all strength­training injuries. The most frequently injured areas are the hand, low back, and upper trunk. Most injuries occur on home equipment with unsafe behavior and in unsupervised settings. Appropriate strength­training programs do not appear to adversely affect linear growth, growth plates, or the cardiovascular system. General recommendations concerning strength­training in preadolescents and adolescents are as follows: To ensure safety and efficacy, strength­training programs for young people should follow proper resistance techniques and safety precautions. Before the young person embarks on a strength­training program, the clinician should help determine whether it is necessary or appropriate to start such a program and what level of proficiency the young person has already attained in his or her chosen sport activity. Until they reach physical and skeletal maturity, preadolescents and adolescents should avoid power lifting, body building, and maximal lifts. Overweight children may appear to be strong because of their size, but they are often unconditioned with poor strength, and they require the same strict supervision and guidance as do other young people undertaking a resistance program. The AAP reiterates that athletes should not use performance­enhancing substances or anabolic steroids. Athletes who take part in strength­training programs should be educated about the risks associated with these substances. Issues that pediatricians should consider when asked to recommend or evaluate strength­training programs for children and adolescents include the following: A pediatrician or family clinician should perform a medical evaluation before the young person begins a formal strength­training program. This evaluation can identify risk factors for injury and offer an opportunity to discuss previous injuries, low­back pain, medical conditions, training goals, motives for wanting to begin physical training, appropriate techniques, and expectations of both the child and the parents. Youth with uncontrolled hypertension, seizure disorders, or a history of childhood cancer and chemotherapy should not participate in these programs until they receive additional appropriate treatment or evaluation. Print Like Tweet Google+ " id="pdf-obj-0-27" src="pdf-obj-0-27.jpg">

April 11, 2008 — The American Academy of Pediatrics (AAP) has revised its policy statement on strength training for children and provides recommendations for strength­training programs for children and teens, according to the results of a study reported in the April issue of Pediatrics.

"Pediatricians are often asked to give advice on the safety and efficacy of strength­training programs for children and adolescents," write Eric W. Small, MD, and colleagues from the Council on Sports Medicine and Fitness. "This statement, which is a revision of a previous American Academy of Pediatrics policy statement, defines relevant terminology and provides current information on risks and benefits of strength training for children and adolescents."

Strength training, or resistance training, is often incorporated in sports and physical fitness programs for children and adolescents. Some adolescents use strength training to improve their appearance by increasing muscle bulk. Depending on specific program goals, strength­training programs may use free weights, weight machines, elastic tubing, or the participant's own body weight.

The risks for strength training include those specific to young people with preexisting medical conditions as well as muscle strains, which account for 40% to 70% of all strength­training injuries. The most frequently injured areas are the hand, low back, and upper trunk. Most injuries occur on home equipment with unsafe behavior and in unsupervised settings.

Appropriate strength­training programs do not appear to adversely affect linear growth, growth plates, or the cardiovascular system.

General recommendations concerning strength­training in preadolescents and adolescents are as follows:

  • To ensure safety and efficacy, strength­training programs for young people should follow proper resistance techniques and safety precautions. Before the young person embarks on a strength­training program, the clinician should help determine whether it is necessary or appropriate to start such a program and what level of proficiency the young person has already attained in his or her chosen sport activity.

  • Until they reach physical and skeletal maturity, preadolescents and adolescents should avoid power lifting, body building, and maximal lifts. Overweight children may appear to be strong because of their size, but they are often unconditioned with poor strength, and they require the same strict supervision and guidance as do other young people undertaking a resistance program.

  • The AAP reiterates that athletes should not use performance­enhancing substances or anabolic steroids. Athletes who take part in strength­training programs should be educated about the risks associated with these substances.

Issues that pediatricians should consider when asked to recommend or evaluate strength­training programs for children and adolescents include the following:

  • A pediatrician or family clinician should perform a medical evaluation before the young person begins a formal strength­training program. This evaluation can identify risk factors for injury and offer an opportunity to discuss previous injuries, low­back pain, medical conditions, training goals, motives for wanting to begin physical training, appropriate techniques, and expectations of both the child and the parents.

  • Youth with uncontrolled hypertension, seizure disorders, or a history of childhood cancer and chemotherapy should not participate in these programs until they receive additional appropriate treatment or evaluation.

  • For certain youth, referral may be indicated to a pediatric or family clinician sports medicine specialist who is familiar with various strength­training methods as well as risks and benefits for preadolescents and adolescents.

  • Before beginning a strength­training program, children with complex congenital cardiac disease (cardiomyopathy, pulmonary artery hypertension, or Marfan's syndrome) should undergo consultation with a pediatric cardiologist.

  • To optimize general health benefits, aerobic conditioning should be coupled with resistance training.

  • A 10­ to 15­minute warm­up and cool­down should be included in strength­training programs.

  • Adequate intake of fluids and proper nutrition are essential to maintain muscle energy stores and enhance recovery as well as performance.

  • Specific strength­training exercises should first be learned with no load (no resistance) to master the proper technique. Incremental loads can then be added with either body weight or other forms of resistance.

  • Strength training should include 2 to 3 sets of higher repetitions (8 ­ 15) twice to 3 times weekly and should continue for at least 8 weeks.

  • A general strengthening program should involve the core and all major muscle groups, with exercise through the complete range of motion. More sports­specific areas may be addressed subsequently.

  • When there is any evidence of illness or injury from strength training, this should be fully evaluated before the exercise program is resumed.

  • Instructors or personal trainers for young people should be certified with specific qualifications in pediatric strength training.

  • To ensure safety, any strength­training program involving preadolescents and adolescents must include proper technique and strict supervision by a qualified instructor.

"In addition to the obvious goal of getting stronger, strength­training programs may be undertaken to try to improve sports performance and prevent injuries, rehabilitate injuries, and/or enhance long­term health," the guidelines authors write. "Similar to other physical activity, strength training has been shown to have a beneficial effect on several measurable health indices, such as cardiovascular fitness, body composition, bone mineral density, blood

lipid profiles, and mental

health. . . .

Resistance training is being incorporated into weight­control programs for

overweight children as an activity to increase the metabolic rate without high impact."

Pediatrics. 2008;121:835­840.

CLINICAL CONTEXT

Many young people become involved in strength training, also known as resistance training, in the context of sports and physical fitness programs. However, some adolescents use strength training to enhance muscle size and appearance. Free weights, weight machines, elastic tubing, or an athlete's own body weight may all provide resistance required for strength training. The type and amount of resistance used and the frequency of repetitions vary depending on specific program goals.

Because pediatricians are often asked to counsel young people on the safety and efficacy of strength­training

programs, the AAP issued this revision of a previous policy statement. These revised guidelines define relevant terminology and provide updated evidence regarding the risks and benefits of strength training for children and adolescents.

STUDY HIGHLIGHTS

  • Muscle strains account for 40% to 70% of all strength­training injuries and usually involve the hand, low back, and upper trunk.

  • Appropriate strength­training programs do not appear to adversely affect growth or cardiovascular health.

  • Strength­training programs for young people should follow proper resistance techniques and safety precautions.

  • Preadolescents and adolescents should avoid power lifting, body building, and maximal lifts until they reach physical and skeletal maturity.

  • Athletes should not use performance­enhancing substances or anabolic steroids, and young people involved in strength training should be educated about the risks of using these substances.

  • A pediatrician or family clinician should perform a medical evaluation before the young person begins formal strength training.

  • Youth with uncontrolled hypertension, seizure disorders, or a history of childhood cancer and chemotherapy should not participate in strength training until they undergo additional treatment or evaluation.

  • In some cases, referral to a pediatric or family clinician sports medicine specialist familiar with various strength­ training methods as well as risks and benefits may be indicated.

  • Before beginning a strength­training program, children with complex congenital cardiac disease (cardiomyopathy, pulmonary artery hypertension, or Marfan's syndrome) should be evaluated by a pediatric cardiologist.

  • Aerobic conditioning should be coupled with resistance training to optimize general health.

  • Strength­training programs should include 10 to 15 minutes of warm­up and cool­down.

  • Adequate fluid intake and proper nutrition are needed to maintain muscle energy stores and improve recovery and performance.

  • To master the proper technique, specific strength­training exercises should first be learned with no load (no resistance), with incremental loads and then added with either body weight or other forms of resistance.

  • Strength training should include 2 to 3 sets of 8 to 15 repetitions 2 to 3 times weekly and should continue for 8 weeks or longer.

  • A general strengthening program should target the core and all major muscle groups, with exercise through the complete range of motion. More sports­specific areas may be addressed subsequently.

  • Illness or injury from strength training should be fully evaluated before resumption of the exercise program.

  • Instructors or personal trainers for young people should be certified and specifically qualified in pediatric strength training.

  • To ensure safety, any strength­training program for young people must include proper technique and strict supervision by a qualified instructor.

PEARLS FOR PRACTICE

  • To ensure safety and efficacy, strength­training programs for young people should follow proper resistance techniques and safety precautions. Preadolescents and adolescents should avoid power lifting, body building, and maximal lifts until they reach physical and skeletal maturity.

  • A pediatrician or family clinician should perform a medical evaluation before the young person begins formal strength training to identify risk factors for injury and to discuss previous injuries and other possible medical conditions that may prevent a young person from participating in strength­training programs.

CME TEST

Based on the current AAP guidelines, which of the following statements about general recommendations concerning strength training in preadolescents and adolescents is correct?

  • Preadolescents and adolescents can begin a strength­training program at any level of proficiency, particularly if they are healthy, without consulting their clinician

    • Strength­training programs typically stunt growth

  • Preadolescents and adolescents should avoid power lifting, body building, and maximal lifts until they reach physical and skeletal maturity

    • Performance­enhancing substances may be indicated in certain circumstances for limited duration

Based on the current AAP guidelines, which of the following statements about specific issues that pediatricians should consider when recommending strength­training programs for children and adolescents is not correct?

  • A pediatrician or family clinician should perform a medical evaluation before the young person begins formal strength training

    • Warm­up and cool­down are not needed for adolescent strength­training programs

  • Before beginning a strength­training program, children with complex congenital cardiac disease should be evaluated by a pediatric cardiologist

  • Youth with seizure disorders should not participate in strength training until they undergo additional treatment or evaluation

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Medscape Medical News © 2008 The material presented here does not necessarily reflect the views of Medscape or companies that support educational programming on www.medscape.com. These materials may discuss therapeutic products that have not been approved by the US Food and Drug Administration and off­label uses of approved products. A qualified healthcare professional should be consulted before using any therapeutic product discussed. Readers should verify all information and data before treating patients or employing any therapies described in this educational activity.

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