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Strength Training by Children and Adolescents Council on Sports Medicine and Fitness Pediatrics 2008;121;835-840 DOI: 10.

1542/peds.2007-3790

The online version of this article, along with updated information and services, is located on the World Wide Web at: http://www.pediatrics.org/cgi/content/full/121/4/835

PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly publication, it has been published continuously since 1948. PEDIATRICS is owned, published, and trademarked by the American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village, Illinois, 60007. Copyright © 2008 by the American Academy of Pediatrics. All rights reserved. Print ISSN: 0031-4005. Online ISSN: 1098-4275.

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2 Recent studies have shown some benefit to increased strength. and gluteal muscles) are also appropriate for children and theoretically benefit sports-specific skill acquisition and postural control. strength training augments the muscle growth that normally occurs with puberty in boys and girls by actual muscle hypertrophy. The amount and form of resistance used and the frequency of resistance exercises are determined by specific program goals.pediatrics. resistance training.1. Table 1 defines common terms used in strength training. strength-training programs may be undertaken to try to improve sports performance and prevent injuries.2007-3790 All policy statements from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed. overall function. 1098-4275). strength training.12.7. or retired at or before that time. muscle size. April 2008 835 Downloaded from www.1542/peds. defines relevant terminology and provides current information on risks and benefits of strength training for children and adolescents. Copyright © 2008 by the American Academy of Pediatrics S TRENGTH TRAINING (ALSO known as resistance training) is a common component of sports and physical fitness programs for young people. Similar to the geriatric population. such as providing rotator cuff and scapular stabilization exercises preventively to reduce overuse injuries of the shoulder in overhead sports.21.3. Increases in strength occur with virtually all modes of strength training of at least 8 weeks’ duration and can occur with training as little as once a week. mode (type of resistance). the abdominal. Strength-training programs may include the use of free weights. rehabilitate injuries. results are inconsistent regarding the translation of increased strength to enhanced youth athletic performance. such as cardiovascular fitness. This statement. although some adolescents may use strength training as a means to enhance muscle size for improving appearance.13 In preadolescents. with proper technique and strict supervision. including female individuals and preadolescent boys.17.14. blood lipid profiles. body composition.4 Resistance training is being incorporated into weight-control programs for overweight children as an activity to increase the metabolic rate without high impact. but it is unclear whether it has the same benefit in preadolescent athletes. Key Words children. proper resistance training can enhance strength without concomitant muscle hypertrophy. revised. Number 4.14–16 This mechanism accounts for the increase in strength in populations with low androgen concentrations. can increase strength in preadolescents and adolescents. gains in strength.1.7–12 Appropriately supervised programs emphasizing strengthening of the core (focusing on the trunk muscles. and duration all contribute to a properly structured program. adolescents.8 Frequency. elastic tubing. Similar to other physical activity.1.6 Multiple studies have shown that strength training.14.1. Unfortunately.18 Strength training is a common practice in sports in which size and strength are desirable. and mental well-being in children with cerebral palsy. 2009 . Unfortunately. There is limited evidence to suggest that prehabilitation may help decrease injuries in adolescents. intensity.pediatrics. 0031-4005. and/or enhance long-term health. strength training in youth may stimulate bone mineralization and have a positive effect on bone density. Recent research suggested a possible reduction in sports-related anterior cruciate ligament injuries in adolescent girls PEDIATRICS Volume 121. Such gains in strength can be attributed to a neurologic mechanism whereby training increases the number of motor neurons that are “recruited” to fire with each muscle contraction.22 and there is no evidence that strength training will reduce the incidence of catastrophic sports-related injuries in youth. or power are lost 6 weeks after resistance training is discontinued. eg.5. Online.20 Preventive exercise (prehabilitation) refers to strength-training programs that address areas commonly subjected to overuse injuries.1542/ peds. In contrast.19. low back. which is a revision of a previous American Academy of Pediatrics policy statement. BENEFITS OF STRENGTH TRAINING In addition to the obvious goal of getting stronger.org by on June 28.11. strength training has been shown to have a beneficial effect on several measurable health indices. bone mineral density. or an athlete’s own body weight. Olympic weightlifting PEDIATRICS (ISSN Numbers: Print.org/cgi/doi/10. weight machines. www. although training twice a week may be more beneficial. and mental health.2007-3790 doi:10.POLICY STATEMENT Strength Training by Children and Adolescents Council on Sports Medicine and Fitness Organizational Principles to Guide and Define the Child Health Care System and/or Improve the Health of All Children ABSTRACT Pediatricians are often asked to give advice on the safety and efficacy of strengthtraining programs for children and adolescents.

who are at risk for worsening ventricular hypertrophy and restrictive cardiomyopathy or hemodynamic decompensation secondary to an acute increase in pulmonary hypertension.1.24.29 although caution should be used for young athletes with preexisting hypertension. the greater the strength development. Focusing a strengthening program to the muscles that stabilize the trunk of the body. the individual’s own body weight. symmetry. and resistance training in this population should be approached with caution. A group of repetitions separated by scheduled rest periods (eg. The training may include use of free weights. and/or other resistance devices to attain this goal.pediatrics. because they may require medical clearance to reduce the potential for additional elevation of blood pressure with strength training if they exhibit poorly controlled blood pressure. An exercise regimen in which the athlete progressively increases the amount of weight lifted and/or the number of repetitions.24 Injury rates in settings with strict supervision and proper technique are lower than those that occur in other sports or general recess play at school.10. leg press). Youth with other forms of cardiomyopathy (particularly hypertrophic cardiomyopathy).26. and gluteal muscles as well as flexibility of muscular attachments to the pelvis. The speed of muscle contraction is fixed through the range of motion.31 Young people with Marfan syndrome with a dilated aortic root also are counseled against participation in strength-training programs.24 which has estimated the number of injuries connected to strength-training equipment. such as jumping up onto and down from a platform. A competition in which muscle size. More patient-friendly information on performance-enhancing substances is available at www.30 Specific anthracyclines that have been associated with acute congestive heart failure include doxorubicin. lowering a weight). The data from the National Electronic Injury Surveillance System neither specify the cause of injury nor separate recreational from 836 AMERICAN ACADEMY OF PEDIATRICS Downloaded from www. and upper trunk being commonly injured areas. Young athletes with seizure disorders should be withheld from strength-training programs until clearance is obtained from a physician. GUIDELINES FOR STRENGTH TRAINING A medical evaluation of the child before beginning a formal strength-training program can identify risk factors for injury and provide an opportunity to discuss previous injuries. The American Academy of Body building when strength training was combined with specific plyometric exercises. training goals. 3 sets of 20 reps). Core strengthening Set Reps One-rep max (1RM) Concentric contraction Eccentric contraction Isometric contraction Isokinetic contraction Progressive resistive exercises Plyometric exercises Weightlifting Power lifting competitive injuries that result from lifting weights. idarubicin. low-back pain. the squat. machines. daunomycin/daunorubicin. and the bench press. because they are at risk for acute decompensation with a sudden change in hemodynamics. techniques. RISKS OF STRENGTH TRAINING Much of the concern over injuries associated with strength training come from data from the US Consumer Product Safety Commission’s National Electronic Injury Surveillance System. Power lifting includes the dead lift. Overweight children may appear to be strong because of their size but often are unconditioned with poor strength and would require the same strict supervision and guidance as is necessary with any resistance program. Weightlifting (which is sometimes called Olympic lifting) includes the snatch and the clean and jerk. The training emphasizes strengthening of the abdominal. with the hand. low back.27 Appropriate strength-training programs have no apparent adverse effect on linear growth. wall sits: athlete holds the position of feet planted flat on ground with knees at a 90° angle and back against the wall). Abbreviation for repetitions.TABLE 1 Definition of Terms Term Strength training Definition The use of resistance methods to increase one’s ability to exert or resist force.aap.org/ family/sportsshorts12. Muscle strains account for 40% to 70% of all strength-training injuries. growth plates. Individuals with moderate to severe pulmonary hypertension also should refrain from strenuous weight training.pdf. it is not necessary or appropriate for every child. medical conditions. the greater the work performed and the greater the endurance development. Repeated eccentric and concentric muscle contractions. 2009 . A competitive sport that also involves maximum lifting ability. Although research supports the safety and efficacy of resistance training for children. such as the quadriceps and hamstring muscles. The muscle length is unchanged during contraction (eg. or the cardiovascular system. motives for wanting to begin such a program. low back. A competitive sport that involves maximum lifting ability. Youth who have received chemotherapy with anthracyclines may be at increased risk for cardiac problems because of the cardiotoxic effects of the medications. arm curl.11.25 Most injuries occur on home equipment with unsafe behavior and unsupervised settings.28. Youth who are interested in getting bigger and stronger should be discouraged from considering the use of anabolic steroids and other performance-enhancing substances and should be provided with information regarding the risks and health consequences of using such substances. such as jumping up onto and down from a platform. and possibly mitoxantrone. The more repetitions.org by on June 28. The muscle shortens during contraction (eg. The more weight lifted. and definition are judged. should be counseled against weight training. and expectations from both the child and the parents. Youth should be reminded that strength training is only a small part of an overall fitness or sports program. The maximum amount of weight that can be displaced in a single repetition. The muscle lengthens during contraction (eg.23 Plyometric exercises enable a muscle to reach maximum strength in a relatively short time span through a combination of eccentric and concentric muscle contractions.

pediatrics. the American Orthopaedic Society for Sports Medicine. but philosophies often vary between Western nations and Eastern European nations. If long-term health benefits are the goal. When children or adolescents undertake a strengthtraining program. most strength-training machines and gymnasium equipment are designed for adult sizes and have weight increments that are too large for young children. When indicated. the AAP remains hesitant to support participation by children who are skeletally immature and is opposed to childhood involvement in power lifting. because safe technique may be difficult to maintain and body tissues may be stressed too abruptly. Number 4. Strength training 4 times per week seems to have no additional benefit and may increase the risk for an overuse injury.to 15-minute warm-up and cool-down periods with appropriate stretching techniques also are recommended. Youth with uncontrolled hypertension. For the purposes of this policy statement. Preadolescents and adolescents should avoid power lifting.” Prepubertal youngsters are involved in competitive weightlifting. this is an area in which more research is necessary to substantiate low injury rates as more youngsters continue to be involved with competitive weightlifting. 2. then strength training should be combined with an aerobic training program. body building. Strength gains can be acquired through various types of strength-training methods and equipment. Children with complex congenital cardiac disease (cardiomyopathy. 4.38 and the National Strength and Conditioning Association. As with general strength training. Proper 10. seizure disorders.org by on June 28. This restrictive concept is applied to strength training. however. As the AAP has stated previously. The sport of weightlifting is distinct from common strength training. 2009 .40 Young people who want to improve sports performance generally will benefit more from practicing and perfecting the skills of their sport than from strength training alone. When pediatricians are asked to recommend or evaluate strength-training programs for children and adolescents. which is sometimes referred to as Olympic lifting.35–37 and some programs have low rates of injury because they require stringent learning of techniques before adding any weight. and should be performed through the full range of motion at each joint. Exercises should include all muscle groups. a referral may be made to a pediatric or family physician sports medicine specialist who is familiar with various strength-training methods as well as risks and benefits for preadolescents and adolescents. April 2008 837 Downloaded from www. as discussed in Table 2. as opposed to the competitive sport of weightlifting.35 Limited research on weightlifting as a sport has revealed that children have participated with few injuries. Clearly. workouts need to be at least 20 to 30 minutes long. it is reasonable to add weight in 10% increments. a medical evaluation should be performed by a pediatrician or family physician. Increasing the repetitions of lighter resistance may be performed to improve endurance strength of the muscles in preparation for repetitive-motion sports. strict supervision and adherence to proper technique are mandatory for reducing the risk for injury. Explosive and rapid lifting of weights during routine strength training is not recommended.34 it seems logical that strength programs need not start before achievement of those skills. they should begin with low-resistance exercises until proper technique is perfected. When 8 to 15 repetitions can be performed. although strength training should be part of a multifaceted approach to exercise and fitness. the following issues should be considered: a. and maximal lifts until they reach physical and skeletal maturity. RECOMMENDATIONS 1. b. or a history of childhood cancer and chemotherapy should be withheld from participation until additional treatment or evaluation. such as the “snatch” and the “clean and jerk. Because of the limited research regarding prepubertal injury rates in competitive weightlifting. body building.39. Free weights require better balance control and technique but are small and portable.33 Because balance and postural control skills mature to adult levels by 7 to 8 years of age. and continue to add weight or repetitions as strength improves. take place 2 to 3 times per week. or use of the 1-repetition maximum lift as a way to determine gains in strength. Athletes who participate in strength-training programs should be educated about the risks associated with the use of such substances. Proper technique and strict supervision are mandatory for safety reasons and to reduce the risk for injury. Children also should have advanced to a certain level of skill proficiency in their sport before embarking on a disciplined strength-training program for the strength to have some potential value. Proper supervision is defined as an instructor-to-student ratio no more than 1:10 and an approved strength-training certification.Pediatrics (AAP) strongly condemns the use of performance-enhancing substances and vigorously endorses efforts to eliminate their use among children and adolescents. Proper resistance techniques and safety precautions should be followed so that strength-training programs for preadolescents and adolescents are safe and effective. Whether it is necessary or appropriate to start such a program and which level of proficiency the youngster already has attained in his or her sport activity should be determined before a strength-training program is started. pulmonary artery hypertenPEDIATRICS Volume 121. Before beginning a formal strength-training program. provide small weight increments. For achievement of gains in strength. the research regarding strength gains and the recommendations regarding youth involved in lifting weights apply specifically to the activity of strength training as an adjunct to exercise and sports participation. athletes should not use performance-enhancing substances or anabolic steroids. because it involves specific types of rapid lifts.32. Guidelines have been proposed by the AAP (as follows). and can be used for strengthening sports-specific movements. 3. including the muscles of the core.

multiple choice. proctored examination 120 MC questions.0-hour ACE approved Yes. National Council on Sports & Fitness. proctored examination 105 questions at certification site Home examination.org Scientific 80-question.acsm. continuing education unit. high school diploma or equivalent.issaonline.org www. 12 CEC 2 y. CPR certification 18 y of age. adult CPR certification.ifpa-fitness. proctored examination Written examination. adult CPR certification As of 2006. 3-h proctored examination Yes. CPR certification 18 y of age. 1.org www. 10 CEUs 2.0 NASM CEUs 3 y.acefitness. high school diploma or equivalent AMERICAN ACADEMY OF PEDIATRICS 18 y age. 24 NSPA CEC No 2 CEC per year 3 y. adult CPR certification Downloaded from www.pediatrics. 6 CEUs.com www. 140 MC questions. 5 practicals 2 y. American Council on Exercise.838 Requirements Every 2 y. instructor certifications received by the following groups are certified by the National Committee for Certifying Agencies (NCCA): National Strength and Conditioning Association. 2-h proctored examination 140 questions.ncsf.nsca-lift. proctored examination.0-hour ACE approved 2 y. 2009 18 y of age. CEC 45 h 3 y. written/practical examination. 2005 Yes Yes No No www. 2003 Yes. 2-h proctored examination 150 MC questions. 300 h of work experience.com www. adult CPR certification No requirements National Council on Strength and Fitness Certified Personal Trainer (NCSF-CPT) National Academy of Sports Medicine Certified Personal Trainer (NASM-CPT) National Strength and Conditioning Association Certified Personal Trainer (NSCS-CPT) National Strength and Conditioning Association Certified Strength and Conditioning Specialist (NSCS-CSCS) American Council on Exercise (ACE) Personal Trainer American Council on Exercise (ACE) Clinical Exercise Specialist National Federation of Professional Trainers (NFPT) American College of Sports Medicine (ACSM) Certified Personal Trainer American College of Sports Medicine (ACSM) Health Fitness Instructor International Fitness Professional Association (IFPA) American Fitness Professional Association (AFPA) Personal Trainer International Sports Science Association (ISSA) National Strength Professional Association (NSPA) Personal Trainer 18 y of age.5-hour proctored examination.com www.org www. MC. 1996 www. 2003 Yes.Afpafitness. American College of Sports Medicine.nfpt. adult CPR certification Associate’s or bachelor’s degree in healthrelated field.com www. CPR indicates cardiopulmonary resuscitation. CEC. and the National Federation of Professional Trainers. 90 d to complete Home examination Two 10-h lectures. 16 CEC 2 y.nsca-lift.org 150 MC questions.com TABLE 2 Certification Organizations Certification 18 y of age.acsm. etc) 3 y. 2. 2 different categories (conference. 2 written simulations 150 MC questions.org www.nasm. 2 y of experience High school diploma or equivalent.acefitness.org www. National Academy of Sports Medicine.org www.org by on June 28. practical 110 MC 2. CEC 60 h 2 y. 3-h proctored examination 120 MC questions. current ACE-PT 18 y of age. continuing education credits. 2. 2003 Yes. CEU. 1996 Examination Content Recertification NCCA Web Address www. . 6 CEUs as above Yes Yes. 50 MC questions. high school diploma or equivalent.nspainc. high school diploma or equivalent. research publications.5-hour proctored examination 150 MC questions. adult CPR certification No requirements 18 y of age. CPR certification BA/BS degree or chiropractor degree.

Effects of two different strength training modes on motor performance in children. 2006 –2007 CONSULTANT Michael F. Chairperson *Teri M. MS. and exercise through the complete range of motion. 3rd ed. Functional strength training in cerebral palsy: a pilot study of a group circuit training class for children aged 4 – 8 years.org by on June 28. Resistance training in children and youth: a meta-analysis. ¨ sprint. Res Q Exerc Sport. Strength training for children and adolescents. incremental loads can be added using either body weight or other forms of resistance. Micheli LJ. Gomez. Cappetta. d.9(1):29 –36 17. Aerobic conditioning should be coupled with resistance training if general health benefits are the goal. MD Canadian Paediatric Society James Raynor. April 2008 839 . Strength training effects in prepubescent boys. Gibbs JL. Loud RL. Rice. Morris FL. McCambridge. MD *Paul R. 1997. Ozmun JC. Number 4. Once the exercise technique has been mastered. Resistance training and youth.22(5):605– 614 12. Griesemer BA. Tenenbaum G.1(4): 336 –350 15. Blimkie CJ. MD.17(1):48 –57 4. Pediatr Clin North Am. Pediatr Clin North Am. 2001.74(9):1025–1033 7. Garner S. MPH Charles T. The effects of strength training and detraining on children.73(3):340 –344 20. Flanagan SP. McBurney H. Adams RD. Bernhardt. Cahill BM. MD. Laubach LL. et al. Griesemer. Conroy B. Dean CM. Sports Med.49(4):793– 802 3. Dev Med Child Neurol. Clin Sports Med.26(4):510 –514 16. et al. Fleck SJ. DeMarco GM Jr.sion. Mero A. Hoffman J. Champaign. 2002. 1996. Prospective ten month exercise intervention in premenarchal girls: positive effects on bone and lean mass. Surburg PR. 1996.19(4):593– 619 2.15(6):389 – 407 13. MD Stephen G. Payne VG. Faigenbaum AD. MD Bernard A. The effectiveness of resistance training in children: a meta-analysis.22(3):176 –186 8. 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pediatrics. appears in the following collection(s): Office Practice http://www.1542/peds.pediatrics. 9 of which you can access for free at: http://www.2007-3790 Updated Information & Services References including high-resolution figures. along with others on similar topics.121.org by on June 28.org/cgi/content/full/121/4/835#otherarticle s This article.835-840 DOI: 10.pediatrics.shtml Information about ordering reprints can be found online: http://www. tables) or in its entirety can be found online at: http://www.org/cgi/content/full/121/4/835 This article cites 34 articles. can be found at: http://www.org/misc/Permissions.pediatrics.Strength Training by Children and Adolescents Council on Sports Medicine and Fitness Pediatrics 2008.pediatrics.shtml Citations Subspecialty Collections Permissions & Licensing Reprints Downloaded from www.org/cgi/content/full/121/4/835#BIBL This article has been cited by 3 HighWire-hosted articles: http://www.pediatrics.org/cgi/collection/office_practice Information about reproducing this article in parts (figures. 2009 .org/misc/reprints.pediatrics.