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BASES Position Statement on Guidelines for Resistance Exercise in Young

People
G. Stratton a; M. Jones a; KR Fox a; K. Tolfrey a; J. Harris a; N. Maffulli a; M. Lee a; SP Frostick a
a
The REACH Group, Research into Exercise, Activity and Children's Health,

Online Publication Date: 01 April 2004

To cite this Article Stratton, G., Jones, M., Fox, KR, Tolfrey, K., Harris, J., Maffulli, N., Lee, M. and Frostick, SP(2004)'BASES Position
Statement on Guidelines for Resistance Exercise in Young People',Journal of Sports Sciences,22:4,383 — 390
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 Journal of Sports Sciences, 2004, 22, 383–390
BASES Position Statement on Guidelines for Resistance
Exercise in Young People
Introduction
The Health Education Authority (Biddle et al., 1998)
has published primary and secondary guidelines for
physical activity in young people. The primary guideline
recommends an hour of physical activity each day. The
secondary guideline recommends that young people
engage in exercise that promotes muscular strength,
flexibility and bone health twice weekly. Young people
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can meet the secondary guideline by participating in
resistance exercise. The British Association of Exercise
and Sport Sciences (BASES) identified the need for a
series of evidence-based guidelines for resistance
exercise for the range of professionals and volunteers
working with British children and youth. There have
been previous consensus documents on the topic of
resistance exercise and young people (American Acad-
emy of Pediatrics, 1990, 2000; Blimkie, 1995). The
BASES guidelines aim to encapsulate educational,
psycho-sociological and developmental, as well as
physiological and medical, perspectives. In 1999,
BASES convened a group of experts to consider the
scientific literature and expert opinion before producing
‘Guidelines for Resistance Exercise in Young People’.
The expert group consisted of orthopaedic clinicians,
physical educators, sociologists, exercise physiologists,
psychologists and biomechanists. In addition, indivi-
duals and groups from local authorities, disability and
special needs, the commercial sector and public health
were consulted and subsequently reviewed the guide-
lines. These guidelines provide a summary of this work.
The aims of the group were as follows: ‘To provide
sound practical advice based on research evidence and
expert consensus on safe and effective resistance
exercise for young people’.
Defining resistance exercise
For the purpose of these guidelines, resistance exercise
is defined as ‘exercise specifically designed to enhance
muscular strength and endurance’. Resistance exercise
may involve a variety of activities that create work
demands on the muscles such as weight- and load-
bearing exercise (e.g. climbing), specific body weight
exercises (e.g. curl-ups, press-ups, jumping, hopping)
and the use of resistance materials (e.g. stretch bands,
fixed weight machines, free weights).
Journal of Sports Sciences ISSN 0264-0414 print/ISSN 1466-447X online # 2004 Taylor & Francis Ltd
DOI: 10.1080/02640410310001641629
While the potential for children to engage in
resistance exercise during free play was recognized,
these guidelines were mainly written for professionals
involved in designing and leading formal programmes
of resistance exercise for young people.
Evidence base on the risks and benefits of
resistance exercise in young people
Electronic searches using Medline, SportsDiscus,
PubMed and ERIC electronic databases provided
limited literature on the risks and benefits of
resistance exercise in young people. Where the
literature was particularly sparse the group were left
to consider (a) generalizations from sport and physical
activity literature and (b) expert evidence. Many
studies presented are limited due to poor control,
confounding influences and low numbers of partici-
pants; comparisons between the sexes were difficult to
identify.
Guidelines
Two key guidelines informed by reviews of the research
literature in the fields of physiology, psychology, sports
medicine and sociology and by expert opinion in
exercise science have been produced. The first guide-
line supports the premise that resistance exercise that is
developmentally appropriate, well supervised and
taught is positive for the health of youngsters. The
second guideline has been presented with a view to
improving practice and is intentionally educational in
perspective.
1. All young people should be encouraged to
participate in safe and effective resistance
exercise at least twice a week.
2. Resistance exercise should be part of a ba-
lanced exercise and physical education pro-
gramme.
These guidelines are based upon data summarized from
the following areas: muscle function, flexibility, sport
performance, blood pressure, lipids, adiposity, aerobic
fitness, skeletal health, injury prevention, psychosocial
benefits, injury risks and psychosocial risks. Profes-
 384
sional issues were then considered before suggesting
principles of good practice.
Muscle function
There is a large body of evidence identifying positive
increases in muscle function after short-term resistance
exercise programmes using fixed weights machines.
Muscular strength gains have been evident across all
maturity stages, including pre-pubescents (Rians et al.,
1987; Blimkie et al., 1989; Ramsay et al., 1990;
Faigenbaum et al., 1993), pubescents and post-pub-
escents (Pfeiffer and Francis, 1986). The effects of
implementing resistance exercise using other forms of
resistance (e.g. body weight) is less clear, although
benefits have been reported in pre-pubertal children
(Falk and Mor, 1996) and children aged 10–13 years
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(Siegal et al., 1989). The lifting of free weights has not
been widely researched due to safety and ethical
considerations. However, Servedio et al. (1985) re-
ported significant strength enhancement in pre-pubertal
children. Two recent meta-analyses on the effects of
resistance exercise on young people revealed positive
effect sizes. Falk and Tenenbaum (1996) calculated an
effect size of 0.57 for pre-pubertal boys and girls (boys
512 years; girls 513 years), and Payne et al. (1997)
revealed effect sizes between 0.65 and 0.83 for children
aged 6–18 years. Based on the available evidence, it
would appear that children of all maturity stages can
enhance strength through resistance exercise. Pre-
pubertal children demonstrate smaller absolute but
similar relative strength gain to more mature children.
When comparing training details, most effective pro-
grammes are 8 weeks or longer, involve two or three
sets of exercise, lifting 6–15 repetitions at 50–100% of
maximal effort. Faigenbaum and co-workers (1999),
studying the intensity of training, revealed that gains in
strength were greater from high-repetition moderate-
load than low-repetition high-load programmes in pre-
pubertal children. Faigenbaum and colleagues (2002)
further studied the effects of frequency of training and
demonstrated that strength gains could be achieved
with a single resistance training session per week, but
that two sessions a week resulted in the most effective
gains in one-repetition maximum (1-RM) in seated leg
and bench press. Faigenbaum et al. (1996) suggested
that strength gains in pre-pubertal children regress
towards untrained control values after an 8-week
detraining period. The mechanism of strength enhance-
ment is yet to be determined, although our present
understanding points to neuromuscular rather than
physiological adaptation such as muscle hypertrophy
(Weltman et al., 1986; Ramsay et al., 1990; Ozmun et
al., 1994). Little evidence exists of the sustainability of
strength gains.
Stratton et al.
Flexibility
There are some reservations that resistance exercise
may produce muscle-bound individuals with subse-
quent decreases in flexibility. However, findings from
short-term resistance exercise programmes are equivo-
cal. Studies have revealed significant (Weltman et al.,
1986; Rians et al., 1987; Siegal et al., 1989) and non-
significant improvements in flexibility across maturity
stages (Servedio et al., 1985; Faigenbaum et al., 1993;
Falk and Mor, 1996). Small ( 55%; Sewall and
Micheli, 1986) and moderate to large (8–12%; Rians
et al., 1987; Siegal et al., 1989) changes have also been
found in programmes that included specific stretching
exercises and warm-up routines.
Sport performance
Many sports in which children participate have a
substantial strength or power component and training
to enhance these attributes could serve to improve
performance. The link between sports performance and
resistance exercise has not been fully established, since
few investigators have used robust scientific procedures
to address this question. Furthermore, evidence of
muscular development resulting from training in specia-
list sports such as gymnastics, swimming and athletics is
only observational and the effects of this type of resistance
exercise on performance are intuitive. Ainsworth (1970)
found that 6 weeks of supplemental resistance exercise
failed to increase swim speed in male and female
swimmers aged 7–17 years. On the other hand, longer-
term resistance exercise programmes (Blanksby and
Gregor, 1981) revealed significant improvements in
100-yard swim times. Resistance exercise programmes
also stimulate improvements in motor fitness scores
(Nielson et al., 1980; Weltman et al., 1986; Falk and Mor,
1996). However, further detailed research is required
before the effects of resistance exercise on sports
performance can be fully established.
Blood pressure
Acute responses to resistance exercise would appear to
mirror adult responses (Nau et al., 1990) with a risk of
syncope and elevated blood pressure. Chronic blood
pressure responses to resistance exercise programmes
are equivocal. Short-term resistance exercise pro-
grammes would appear to lead to no change (Rians et
al., 1987; Faigenbaum et al., 1993) or a reduction in
systolic and diastolic blood pressure in normotensive,
pre-pubertal children (Servedio et al., 1985). In
hypertensive adolescents, resistance exercise was found
to maintain systolic blood pressure at a reduced level
following an aerobic exercise programme (Hagberg et
 BASES position statement
al., 1984). When training ceased, blood pressure
returned to values non-significantly different from
initial values. Resistance exercise may prove helpful in
controlling hypertension, and does not appear to
adversely affect blood pressure in young people.
Further evidence is needed to fully qualify these
statements.
Lipids
Concentrations of lipids appear to remain unchanged or
become reduced in response to short-term resistance
exercise programmes in young people. Weltman et al.
(1987) identified reduced total cholesterol in pre-
pubertal children in response to 14 weeks of training.
However, these children exhibited initially elevated
concentrations that were more easily reduced by
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exercise. Additionally, there was no dietary control
and a simultaneous increase in cardiorespiratory fitness,
so the change cannot be attributed to resistance exercise
alone. Fripp and Hodgson (1987) found improved
BMI-adjusted cholesterol profiles after a 9-week resis-
tance exercise programme in adolescents aged 14–17
years, although dietary intake was not controlled. There
is little evidence of the effects of resistance exercise on
lipid profiles. It would appear that either no change or
an improvement is the likely outcome, although further
evidence is required.
Adiposity
In adults, it has been suggested that high-volume,
endurance-based resistance exercise programmes can
lead to reduced fat percentages and skinfold thicknesses
and increases or at least maintenance of muscle mass
during weight loss. In children, there is little evidence to
substantiate this. Short-term resistance exercise pro-
grammes have led to either no change (Rians et al.,
1987; Fukunaga et al., 1992; Ozmun et al., 1994) or a
reduction (Faigenbaum et al., 1993; Lillegard et al.,
1997; Southern et al., 1999) in adiposity in non-obese
children and adolescents. Separating growth from the
effects of training is problematic in paediatric exercise
and this may be exacerbated in studies on overweight or
obese children.
Aerobic fitness
Resistance exercise programmes have led to no change
(Fripp and Hodgson, 1987; Blimkie et al., 1989) or an
increase (Weltman et al., 1986; Docherty et al., 1987) in
peak oxygen uptake. The increases observed in aerobic
power have been attributed to the reciprocal concentric
nature of the exercises and high-volume programme.
However, continuation of other sports activities was
385
allowed during these programmes. Further evidence is
needed to establish a link between exercise volume and
the potential for improvement in aerobic power.
Skeletal health
Most researchers agree that efforts to increase bone
density during the early years of bone formation are
important if people are to maintain skeletal integrity and
mobility throughout life. Several studies have suggested
positive links between physical activity and bone
mineral density (Slemenda et al., 1991; Grimston et
al., 1993; Groothausen et al., 1997). The type of
physical activity is not clear, although weight-bearing or
impact loading activities promote bone health, whereas
non-weight-bearing or low-impact activities do not
(Grimston et al., 1993). Unfortunately, the available
literature is not without its limitations, with most study
designs having been cross-sectional in nature, implying
that factors other than physical activity may have
intervened with the findings such as genetic make-up
and nutrition. This approach means that a cause–effect
relationship has not been determined and cannot be
assumed from the current literature. Additionally, site-
specific bone mineral density alone does not provide a
detailed insight into whole-body bone integrity. Macro-
architectural features also need to be considered.
Despite the limits of the present scientific evidence,
the general consensus is that physical activity is
beneficial to bone health. This has led to the inclusion
of weight-bearing activity as part of recommended
guidelines for physical activity in young people (Biddle
et al., 1998; USDHHS, 2000). As yet, there is no clear
evidence for prescribing a particular dose or type of
physical activity. The role of resistance exercise in
promoting bone mineral density would seem clear,
since it provides an obvious mechanical stress to the
skeletal system. Fukunga et al. (1992) suggested that
resistance exercise led to increased bone tissue in some
children when measured by ultrasound. Well-designed
studies have not been conducted to address this specific
issue. Although the role of resistance exercise in
promoting skeletal health is yet to be determined, it is
likely to be beneficial.
Injury prevention
Properly structured resistance exercise programmes
have the potential to provide an injury prevention
mechanism. In adults, the prescription of resistance
exercise is common to help reduce the risk of joint and
soft-tissue injuries and aid recovery following injury.
This is based on the rationale that resistance exercise
has the potential to strengthen specific muscle groups
and muscles, increase joint stability and balance
 386
reciprocal muscle groups acting around a given joint.
The efficacy of such advice in children is unsubstan-
tiated, as only limited evidence is available. A struc-
tured resistance exercise programme was found to
reduce the number and severity of knee injuries in
adolescent male soccer players over a season (Cahill
and Griffith, 1978). Similarly, lower injury rates and
recovery times from injury were reported in adolescent
male and female athletes (Hejna et al., 1982). However,
the scientific rigour of these studies is questionable;
other factors influencing injury occurrence and rehabi-
litation were poorly controlled. Another potential
benefit of resistance exercise is in the prevention and
alleviation of low back pain, which is increasingly
common in children and particularly adolescents
(Kujala et al., 1996; Leboeuf-Yde and Kyvik, 1998).
Recently, Jones (2002) demonstrated that a twice-
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weekly resistance exercise programme lasting 8 weeks
reduced the perception of pain and increased function
in adolescent sufferers of recurrent low back pain. In
summary, the effectiveness of resistance training in the
prevention and rehabilitation from injury in young
people remains largely unsubstantiated. Injury rates are
very low in well-supervised and well-structured resis-
tance exercise programmes that use equipment scaled
to suit the particular needs and sizes of young people.
Psycho-social benefits
There has been limited empirical research on the
specific effects of resistance exercise on the psycholo-
gical well-being of children and adolescents. Biddle et
al. (2000) summarized the evidence for the impact of
exercise in general on anxiety, depression, self-percep-
tions and self-esteem, cognitive function, mood, affect
and subjective well-being. Similarly, Calfas and Taylor
(1994) reviewed the evidence for the effect of exercise
on adolescent psychological well-being. There was
general support for a positive effect and the strongest
evidence was for the effect of fitness-related activities on
children and adolescent physical self-perceptions and
self-esteem (Fox, 2000). Conditioning and aerobics
activities help young people feel better about them-
selves, particularly those who are initially low in self-
esteem. In addition, motivational effects of aerobics
programmes have been shown to be stronger when the
focus is on self-improvement and mastery rather than
competition against others. Some of these programmes
have incorporated elements of resistance exercise.
The characteristics of resistance exercise have posi-
tive aspects that promote psychosocial benefits. These
include:
. Incremental increases in strength lend themselves to
short- and long-term goal setting.
Stratton et al.
. Resistance exercise can be performed in partnerships
or groups that may provide social benefits.
. Resistance exercise can be used to educate about the
body and how it moves.
With its capacity to overtly indicate personal im-
provement, given a child-centred approach to the
setting, there is no reason not to expect psychological
benefits from resistance exercise. There is also the
potential to experience social interaction and support
benefits from working alongside others, although this
has not been researched. Such benefits are only likely if
the experiences match the stage of psychosocial devel-
opment of children. Young children are motivated by
the ‘here and now’ and are unlikely to work for the kind
of delayed gratification that comes with resistance
exercise. The activity needs to produce an immediate
sense of fun and discovery. Very young children are
therefore not likely to respond positively to supervised
resistance exercise or training, but may enjoy partici-
pating in resistance activities such as climbing, dancing,
skipping and jumping. Adolescents are more likely to
resemble adults in their aim for longer-term changes in
the appearance and performance.
Injury risk
Injury is the major concern regarding the participation
of young people in resistance exercise. Retrospective
and case studies are the major source of evidence
regarding the incidence, severity and type of injury
resulting from resistance exercise. It is important to
distinguish between injury due to submaximal resis-
tance exercise and that due to the competitive sports of
weightlifting and powerlifting. Risk of injury through
participation in resistance exercise and weight/power-
lifting in young people is partially determined by the
characteristics of growth of the musculoskeletal system.
Tendons and ligaments are relatively stronger and more
elastic than the epiphyseal plate, and subsequently
growth plate damage is more common than ligament
injuries (Kruger-Franke et al., 1992; Klenerman, 1994;
Maffulli and Baxter-Jones, 1995; Stanish, 1995). In a
study designed to address the rise of injury risk in pre-
pubertal children, a short-term supervised resistance
exercise programme resulted in a low injury rate and
did not adversely affect growth, development, flexibility
or motor performance (Rians et al., 1987). Other
resistance exercise studies have identified that no injury
occurred as a result of the training programme in pre-
pubertal children (Weltman et al., 1986; Ramsay et al.,
1990; Ozmun et al., 1994; Faigenbaum et al., 1993).
Little is known about the long-term effects of resistance
exercise. The longest study involving resistance exercise
was performed by Stahle et al. (1995) over a 9-month
 BASES position statement
period; no injuries were reported as a result of
participation in resistance exercise. Retrospective sur-
veys suggest lower injury rates compared with many
other sports (Blimkie, 1993; Hamill, 1994). Overall,
well-supervised and appropriately prescribed resistance
exercise provides no greater chance of injury than other
sports activities.
Weightlifting and powerlifting, on the other hand,
where frequent maximal lifts are attempted, can cause
severe musculoskeletal injuries. The most common type
of injury reported in powerlifters is muscle strain
(61.2%), with the lower back being the most common
site of injury (50%) (Brown and Kimball, 1983; Risser
et al., 1990). The increased risks of injury of 1.38 and
0.08 for powerlifting (Brown and Kimball, 1983) and
weightlifting (Risser et al., 1990), respectively, are
deemed higher than that associated with American
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football. Recently, Byrd and colleagues (2003) reported
no injuries in competitive young weightlifters who
undertook 543 lifts. A study using the one-repetition-
maximum as a test of maximal strength in 6- to 12-year-
old children also reported no injuries (Faigenbaum et
al., 2003). The potential for injury during resistance
exercise has been identified. Appropriate supervision
should be an integral part of any resistance exercise
programme (Mazur et al., 1993). Rians et al. (1987)
noted that most problems reported by children during
resistance training were all resolved with technique
correction advised by the supervisor. When lifting heavy
weights, the most common cause of injury appears to be
related to loss of form or inadequate supervision
(Mazur et al., 1993). Therefore, adequate supervision
and training of staff is important in reducing risk during
resistance exercise. Lower injury rates have been
reported in more recent studies, suggesting that modern
safety and supervision approaches to youth exercise
programmes may have improved.
Psychosocial risks
The few studies that have been conducted using
exercise have largely shown positive or insignificant
improvements in psychological well-being. There is
therefore little evidence of a negative impact. However,
if leaders do not operate their programmes based on
sound educational and child-centred principles, then
some young people could be at risk for lower
confidence and lower self-esteem. Where volunteer
programmes operate, young people who are experien-
cing negative emotions are likely to drop out and this
may have an impact on future engagement (perhaps
even as an adult) in similar activities. In school
programmes, where youngsters may have no option
about attendance, then even more care needs to be
taken to avoid negative psychological consequences.
387
Professional issues
The application of theory to practice is often the most
difficult step for practitioners to make. The following
section aims to inform practitioners about the over-
arching principles and general guidelines that should
form the basis for the delivery of high-quality resistance
exercise programmes to young people. These principles
and guidelines are primarily aimed at teachers, coaches
and fitness professionals. In the present climate, the
aims of organized sport, health and fitness development
and physical education for young people are similar and
largely developmental and educational. A well-devel-
oped educational approach to health and fitness in the
National Curriculum already provides a good source of
reference for all professionals working in this area
(Kraemer and Fleck, 1993; Harris, 2000; Elbourn,
2004). These principles and guidelines are therefore
equally applicable to professionals working in physical
education, health promotion, local authorities or the
commercial sector.
Principles of good practice
. Performance achievement is of secondary impor-
tance. The positive welfare and health of the young
person is the primary outcome of any resistance
exercise programme.
. The education of the young person is a fundamental
element of any resistance exercise programme. Well-
designed programmes that are led effectively produce
young people with greater knowledge and confidence
about their bodies and safe and effective resistance
exercise. They also encourage young people to have a
responsibility and input into their own learning.
. The physical development of the young person is also
a fundamental element of any resistance exercise
programme. Quality resistance exercise programmes
support natural growth and maturation.
. The emotional and cognitive development of the
young person is a key element of any resistance
exercise programme. Quality programmes are de-
signed appropriately for the developmental stage to
improve understanding and encourage enjoyment
and fulfilment and exercise adherence.
. Principles of inclusion and integrity should be
adhered to throughout all teaching programmes
and activities should be made accessible to all.
. Exercise sessions will emphasize different aspects
depending on the aims of the programme. Aims of
the programme are defined in terms of health or
performance and age and stage: child, adolescent and
young adult. Health goals are inclusive and include
all young people. Performance goals are for young
 388
elite performers who wish to use resistance exercise
to enable them to meet the demands of their sport.
Resistance exercise for performance cannot be
developed without a basic understanding of resis-
tance exercise for health. Age considerations are
based on the principles and guidelines for quality
resistance exercise programmes.
Based on the scientific evidence and expert opinion,
resistance exercise can be positive when part of a
balanced activity programme. Providing that profes-
sionals who understand the key principles of child
growth and development adequately screen and super-
vise participants, then the combination of low risk of
injury and positive physiological, psychological and
sociological benefits can promote health and perfor-
mance in all groups.
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Acknowledgements
Thanks to BASES for supporting this work. Thanks also to
Philip Vickerman (Liverpool John Moores University) for his
input on disability and inclusion, Kieran Murphy (SHOKK)
for feedback from a commercial standpoint, Geoffrey Platt
(BWLA member), Craig Simmons (FA) and the REACH
group for hosting the meeting.
G. STRATTON,* M. JONES, K.R. FOX, K. TOLFREY,
J. HARRIS, N. MAFFULLI, M. LEE AND S.P. FROSTICK
The REACH Group, Research into Exercise, Activity and
Children’s Health
(*Address all correspondence to Gareth Stratton,
Research Institute for Sport and Exercise Sciences,
Liverpool John Moores University,
15–21 Webster Street,
Liverpool L3 2ET, UK);
e-mail: g.stratton@livjm.ac.uk
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