Research and knowledge regarding resistance training in children and adolescents have changed in a positive way over the past few decades. Along with that change comes improved guidance and information for child and adolescent health care providers.
A new AAP clinical report, Resistance Training for Children and Adolescents from the Council on Sports Medicine and Fitness, updates evidence and practices. The report, a revision of a 2008 policy statement, is available at https://doi.org/10.1542/peds.2020-1011 and will be published in the June issue of Pediatrics.
Evolving knowledge
For years, resistance training in children was feared or frowned upon due to a lack of information regarding its effectiveness and safety.
Research has shown prepubertal youths can gain strength without significant risk of injury, as long as supervision and technique are emphasized. Neurologic mechanisms of muscle fiber recruitment were found responsible for gains in strength without gains in muscle size prior to puberty.
The focus has changed from what would happen if a child engaged in resistance training to what would happen if a child did not.
As inactivity and overweight have risen among U.S. children and measures of strength have declined, research shows it is valuable to involve youths in resistance training activities and to use the training for sports performance and injury prevention.
Building benefits
Health benefit outcomes of various resistance training programs include improvements in fitness levels and physical literacy, strength, bone density, lipid profiles, body composition, cardiovascular fitness, injury rehabilitation and injury reduction. Including various forms of resistance and motor skill activities — beyond simply lifting weights — can be engaging and fun for youngsters and may help reverse the general decline in overall strength.
Incorporating resistance training for sports participants may help improve certain measures of performance while reducing muscle imbalances and proprioceptive deficits that contribute to injuries and overuse stress. Incorporating weightlifting movements under supervision with little or no resistance until technique is perfected also contributes to strength and motor skill improvements with a low risk of injury. Integrative neuromuscular training combines various forms of training such as resistance and core exercises, dynamic stability, agility and plyometric exercises to enhance motor skills and muscular fitness, sports performance and injury reduction.
‘Training age’
When a child may become involved in a resistance training program also has changed. It is clear that youths should incorporate strength-building activities in their daily lives for general overall health. Using resistance training as an additional resource to improve strength for sports performance is now appropriately guided by resistance training skill competency and the concept of “training age.”
Previous training levels, amount of weight lifted, movement quality and emotional maturity are used to guide the advancement of training loads rather than relying only on chronological age. For instance, with consistent participation in well-designed resistance programs, a 10-year-old girl may have three years of resistance training experience vs. a 14-year-old boy who is just starting and has a resistance training age of 0.
It is hoped that children can experience positive ways to gain strength and improve their health as lifelong activities.
Recommendations for resistance training
- Consult with a medical professional before beginning a resistance training program in youths with uncontrolled hypertension, uncontrolled seizure disorders, specific cardiovascular conditions or history of treatment with an anthracycline chemotherapeutic agent.
- Create a comprehensive fitness program that integrates aerobic and resistance training and other skill-related fitness components.
- In youths with overweight/obesity, start with basic resistance exercises over a more aerobically based program to encourage successful physical activity.
- Include dynamic warm-up exercises and cool-down with stretching in the training session.
- Encourage participants to have an adequate intake of fluids and proper nutrition for energy storage, recuperation and competition.
- Assess resistance training skill competency and provide real-time feedback on exercise.
- Address all major muscle groups of the upper and lower body along with the core, and include multi-joint activities.
- To reduce risk of overuse injuries, incorporate resistance training sensibly and account for time spent as part of the total training plan.
- Incorporate weightlifting exercises and their derivatives into an exercise program, advancing as competency improves.
- Educate athletes about the risks associated with the use of performance-enhancing substances/drugs and anabolic steroids.
- Use qualified and trained professionals who are aware of the unique aspects of youths and have a recognized strength and conditioning certification. Licensed physical education teachers and certified fitness professionals may provide safe and effective youth programs.
- Use proper technique and supervision by a qualified professional in any youth resistance training program.
Dr. Stricker is the lead author of the clinical report and a member of the AAP Council on Sports Medicine and Fitness Executive Committee.
