Is strength training safe for children?
Health care and fitness professional groups – including the American Academy of Pediatrics, the American Orthopaedic Society of Sports Medicine, the American College of Sports Medicine, and the National Strength and Conditioning Association – agree that a supervised strength training program that follows the recommended guideline and precautions is safe and effective for children and adolescents (ACSM, 1998; Cahill, 1998; Faigenbaum et al, 2002; Pediatrics, 2008; Schafer, 1991)
Like adults, before starting a program, children should have a pre-participation physical exam by a qualified medical professional. This is necessary because some children should not participate due to medical reasons. Children and adolescents with cardiomyopathy, isolated pulmonary hypertension, stage 2 hypertension, chemotherapy with anthracyclines, and Marfan syndrome patients should not participate (Babaee Bigi and Aslani, 2007; Pediatrics, 2008; Rice, 2008). Consultation with a medical professional regarding resistance training is also required for young athletes with uncontrolled seizure disorders (Epilepsia, 1997, as cited in Stricker et al., 2020).
Always attain medical clearance.
At what age can children start strength training?
There is no minimal age requirement for participation. A child’s physical, cognitive, and social maturity are main factors in determining the age at which a child is ready to begin a strength training program. Children must be able to follow directions and demonstrate sufficient balance and proprioception, with usually occurs by 7 or 8 years of age (Dahab and McCambridge, 2009).
Exercise Prescription
Frequency: 2 to 3 non-consecutive days/ week
Intensity: Begin with 1 to 2 sets of 8 to 15 repetitions at a low resistance training intensity (≤ 60% 1RM). The initial load should be selected so that 10 to 15 repetitions can be completed with some fatigue but no muscle failure (Faigenbaum et al, 1996).
As the child’s resistance training skill competency improves and can be demonstrated consistently, the weight can be increased in 5% to 10% increments with a reduction in the number of repetitions. The program can be progressed to 2 to 4 sets of 6 to 12 reps with a low-moderate intensity (≤80% 1RM) (Stricker et al, 2020). Periodic phases of lower repetition ranges (<6) at a higher intensity (>80% 1RM) can be introduced so long as resistance training skill competency is high (Lesinski et al. 2016).
Timing: 8 to 10 exercises per session. 2 to 3 exercises per muscle group. 1 to 3 minutes rest between sets. Each training sessions should include a 5-10 minute warm-up and a 5-10 minute cool down.
Type: A variation of resistance types: free weights, resistance bands, medicine balls, and weight machines. Be cautious of weight machines as they are usually adult-sized and not meant for kids and the lever arms may not be sized correctly. Also, be careful with free weights since balance and coordination are underdeveloped in preadolescents which increases their susceptibility to injury (Dahab and McCambridge, 2009).
Note that weight training programs should be individualized based on age, maturity, and personal goals and objectives. Programs that incorporate an aerobic component are most beneficial because they stimulate an increase in metabolism and improve cardiovascular fitness (Dahab and McCambridge, 2009).
Benefits?
Appropriately designed strength training programs can benefit children’s health by not only improving their strength, muscular power, and local muscular endurance; but also their balance, bone mineral density, lipid profiles, fat-free mass, and insulin sensitivity. In addition, it contributes to an increased personal self-esteem, resistance to injury, and mental health (Conroy et al. 1993; Faigenbaum et al. 2009; Fripp & Hodgson, 1987).
Is 1RM testing appropriate for kids? Heavy loads? Olympic Style weightlifting?
The American Academy of Pediatrics, 2008 does not support using continuous maximal lifts for youth strength training. Single maximal lifts are not recommended until skeletal maturity is attained. Generally, submaximal loads should be used and when a child or adolescent is learning a new exercise, no-load repetitions can be used to develop form and technique.
However, research conducted by Faigembaum et al., 2003, demonstrates that healthy children can safely perform 1-RM strength tests so long as the appropriate procedures are followed and qualified instruction is present.
Olympic-style weightlifting and powerlifting can also be performed by healthy children so long as proper progression is followed as well as the guidance of a skilled coach (Dahab and McCambridge, 2009).
Skeletal Risks
Resistance training programs that are appropriately designed have no apparent negative effect on linear growth, the cardiovascular system, or physeal health (Lloyd et al. 2014, as cited in Stricker et al. 2020). The rare case reports of epiphyseal plate fractures related to strength training are due to the misuse of equipment, lifting inappropriate amounts of weight, improper technique, or training without qualified adult supervision (Caine et al., 2006). Similarly, soft tissue injuries to the lower back are commonly the result of poor technique, too much weight, or ballistic lifts (Jones et al., as cited in Dahab and McCambridge, 2009). There is no direct relationship between strength training and occurrence or severity of injuries in young athletes. It may even indirectly reduce the risk or severity of sports-related injuries (Dahab and McCambridge, 2009).
References:
American Academy of Pediatrics Committee on Sports Medicine and Fitness. Strength Training for children and adolescents. Pediatrics. 2008; 121:835-840.
American College of Sports Medicine. Current Comment: Youth Strength Training. Indianapolis, IN: American College of Sports Medicine; 1998.
Babaee Bigi MA, Aslani A. Aortic root size and prevalence of aortic regurgitation in elite strength trained athletes. Am J Cardiol. 2007; 100:528-530.
Cahill BR. American Orthopaedic Society for Sports Medicine: Proceedings of the Conference on Strength Training and the Prepubescent. Chicago, IL: American Orthopaedic Society for Sports Medicine; 1998.
Caine D, DiFiori J, Maffulli N. Physeal injuries in children’s and youth sports: reasons for concern? Br J Sports Med. 2006 Sep;40(9):749-60. doi: 10.1136/bjsm.2005.017822. Epub 2006 Jun 28. PMID: 16807307; PMCID: PMC2564388.
Conroy BP, Kraemer WJ, Maresh CM, Fleck SJ, Stone MH, Fry AC, Miller PD, Dalsky GP. Bone mineral density in elite junior Olympic weightlifters. Med Sci Sports Exerc. 1993 Oct;25(10):1103-9. PMID: 8231753.
Dahab KS, McCambridge TM. Strength Training in Children and Adolescents: Raising the Bar for Young Athletes? Sports Health. 2009;1(3):223-226.
Faigenbaum AD, Milliken LA, Westcott WL. Maximal strength testing in healthy children. J Strength Cond Res. 2003;17(1):162-166
Faigenbaum AD, Kramer WJ. Cahill, et al. Youth resistance training: Position Statement paper and literature review. J Strength Cond Res. 1996 l18:62.
Faigenbaum AD, Milliken LA, Loud RL, Burak BT, Doherty CL, Wescott WL. Comparison of 1 and 2 days per week strength training in children. Res Q Exerc Sport. 2002:73:416-424.
Faigenbaum, Avery D1; Kraemer, William J2; Blimkie, Cameron J R3; Jeffreys, Ian4; Micheli, Lyle J5; Nitka, Mike6; Rowland, Thomas W7. Youth Resistance Training: Updated Position Statement Paper From the National Strength and Conditioning Association. Journal of Strength and Conditioning Research 23():p S60-S79, August 2009. | DOI: 10.1519/JSC.0b013e31819df407
Fripp RR, Hodgson JL. Effect of resistive training on plasma lipid and lipoprotein levels in male adolescents. J Pediatr. 1987;111:926-931.
Lesinski M, Prieske O, Granacher U. Effects and dose relationships of resistance training on physical performance in youth athletes: a systematic review and meta-analysis. Br J Sports Med. 2016;50(13):781-795
Paul R. Stricker, Avery D. Faigenbaum, Teri M. McCambridge, COUNCIL ON SPORTS MEDICINE AND FITNESS, Cynthia R. LaBella, M. Alison Brooks, Greg Canty, Alex B. Diamond, William Hennrikus, Kelsey Logan, Kody Moffatt, Blaise A. Nemeth, K. Brooke Pengel, Andrew R. Peterson; Resistance Training for Children and Adolescents. Pediatrics June 2020; 145 (6): e20201011.
Rice SG, American Academy of Pediatrics Concil on Sports Medicine and Fitness. Medical conditions affecting sports participation. Pediatrics. 2008;121:841-848.
Schafer J. Prepubescent and adolescent weight training: is it safe? Is it beneficial? J Strength Cond Res. 1991:13:39.
Paul R. Stricker, Avery D. Faigenbaum, Teri M. McCambridge, COUNCIL ON SPORTS MEDICINE AND FITNESS, Cynthia R. LaBella, M. Alison Brooks, Greg Canty, Alex B. Diamond, William Hennrikus, Kelsey Logan, Kody Moffatt, Blaise A. Nemeth, K. Brooke Pengel, Andrew R. Peterson; Resistance Training for Children and Adolescents. Pediatrics June 2020; 145 (6): e20201011. 10.1542/peds.2020-101
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