Strength gains can be acquired through various types of strength-training methods and equipment; however, most strength-training machines and gymnasium equipment are designed for adult sizes and have weight increments that are too large for young children. Free weights require better balance control and technique but are small and portable, provide small weight increments, and can be used for strengthening sports-specific movements.
When children or adolescents undertake a strength-training program, they should begin with low-resistance exercises until proper technique is perfected. When 8 to 15 repetitions can be performed, it is reasonable to add weight in 10% increments. Increasing the repetitions of lighter resistance may be performed to improve endurance strength of the muscles in preparation for repetitive-motion sports. Exercises should include all muscle groups, including the muscles of the core, and should be performed through the full range of motion at each joint. For achievement of gains in strength, workouts need to be at least 20 to 30 minutes long, take place 2 to 3 times per week, and continue to add weight or repetitions as strength improves. Strength training >4 times per week seems to have no additional benefit and may increase the risk for an overuse injury. Proper technique and strict supervision are mandatory for safety reasons and to reduce the risk for injury.
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.
Preadolescents and adolescents should avoid power lifting, body building, and maximal lifts until they reach physical and skeletal maturity.
As the AAP has stated previously, athletes should not use performance-enhancing substances or anabolic steroids. Athletes who participate in strength-training programs should be educated about the risks associated with the use of such substances.
When pediatricians are asked to recommend or evaluate strength-training programs for children and adolescents, the following issues should be considered:
Before beginning a formal strength-training program, a medical evaluation should be performed by a pediatrician or family physician. Youth with uncontrolled hypertension, seizure disorders, or a history of childhood cancer and chemotherapy should be withheld from participation until additional treatment or evaluation. When indicated, 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. Children with complex congenital cardiac disease (cardiomyopathy, pulmonary artery hypertension, or Marfan syndrome) should have a consultation with a pediatric cardiologist before beginning a strength-training program.
Strength-training programs should include a 10- to 15-minute warm-up and cool-down.
Athletes should have adequate intake of fluids and proper nutrition, because both are vital in maintenance of muscle energy stores, recovery, and performance.
Specific strength-training exercises should be learned initially with no load (no resistance). Once the exercise technique has been mastered, incremental loads can be added using either body weight or other forms of resistance. Strength training should involve 2 to 3 sets of higher repetitions (8 to 15) 2 to 3 times per week and be at least 8 weeks in duration.
A general strengthening program should address all major muscle groups, including the core, and exercise through the complete range of motion. More sports-specific areas may be addressed subsequently.
Any sign of illness or injury from strength training should be evaluated fully before allowing resumption of the exercise program.
Instructors or personal trainers should have certification reflecting specific qualifications in pediatric strength training.
Proper technique and strict supervision by a qualified instructor are critical safety components in any strength-training program involving preadolescents and adolescents.
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