AAP: A weighty matter: Strength training in youth

In April 2008, the American Academy of Pediatrics (AAP) came out with a newpolicy statement on strength training by children and adolescents. The statementconsiders weight training or resistance training safe, with the proper supervisionand technique. However, longer-term injury data is needed, and weight trainingis not recommended for the general population. The AAP policy also states thatit is against competitive power lifting and body building.

To illustrate the guidelines,two physicians, Teri McCambridge, MD, and Paul Stricker, MD, presented severalcase studies at the AAP’s National Convention and Exhibition, including preadolescents, adolescents, and special patient populationswho ask their pediatrician about strength training.

Preadolescent
When working with preadolescents who want to begin a strength training program,they recommend that the pediatrician make four checks of the patient. Verify thatthe child can achieve balance, is proficient in a sport, is disciplined, and canfollow directions. Although preadolescent children can gain significant strengthwith strength training, you do not want to encourage any child below the age of7 or 8. For developmental reasons, children under that age will not gain anythingfrom strength training.

Recent research has shown that preadolescents, both boys and girls, can gain strengthwith weight training. It appears that there is a neurological mechanism at work,since these children lack androgenic hormones.

In addition, McCambridge and Stricker recommend that pediatricians ask both thechild and parent several questions: Whose idea is this? Patient, parent, coach?Is this activity necessary? And will this child be appropriately supervised?

Studies have shown that good supervision and technique prevent injury. It is importantthat children learn proper form, use the appropriate equipment for their size,and are properly supervised by certified or trained individuals. They should attenda program that has a ratio of one adult to ten children.

Adolescent
Strength training in adolescents is of a bigger concern, because of the availabilityof equipment and techniques for the older child. Data suggests that safety existsin well-supervised settings. Two-thirds of injuries are due to free weights beingused in an unsupervised fashion.

Competitive weightlifting has a significant injury risk, because of the potentialfor it being done improperly. Examples of improper lifting injuries are bilateraldistal radial ulnar fractures, disc herniation, spondylolsis and spondylolisthesis,ASIS (anterior superior iliac spine) pelvic avulsion fracture, and even death, in the case of a child who dropped aweight on his chest. In power lifting, adolescents force themselves to do maximumlifts, squats, bench press, and dead lifts.

It is important that there be a distinction between strength training and competitiveweightlifting, when young children and adolescents are involved. The risk is toohigh for injury in competitive weightlifting. However, strength training is notthe end-all or be-all for sports. It should be looked at as one component of varioustraining methods. There is no performance benefit noted at this time.

Adolescent with a chronic condition
Any adolescent who wants to participate in strength training but who has a concerning pastmedical history must be cleared by his specialist. Often, children with cardiacconditions or who are cancer survivors need to have their request reviewed bytheir specialist.

This child will need to be well controlled, and have guidance on the proper strengthtraining program. This guidance should include how the parents can evaluate apersonal trainer’s credentials, and a list of sports training facilitiesin their area. Both the trainers and facilities should have strengthtraining credentials that show they are certified by associations such as NationalStrength and Conditioning Association, American Council on Exercise, or the AmericanCollege of Sports Medicine.

In other special patient populations such as overweight, cerebral palsy, osteoporosisor osteopenia, children can benefit from a prescribed strength-training exerciseprogram. Research has shown increases in cardiovascular fitness, increased strength,improved overall function, and improved overall mental well being.

General recommendations can be found in the AAP guidelines.