CLINICAL REVIEW: Paediatric Resistance Training: Benefits, Concerns, and Program Design Considerations

Paediatric Resistance Training: Benefits, Concerns, and Program Design Considerations.

By Pip Sail

Avery D. Faigenbaum and Gregory D.Myer

Current Sports Medicine Reports Vol.9 No.3, pp.161 -168, 2010

A growing number of young athletes are involved in resistance training in schools, fitness centre and sports-training facilities(13,61). As more children and adolescents get involved it is important to establish safe and effective guidelines by which resistance exercise can improve the health, fitness and sports performance of younger populations. The term resistance training refers to a method of conditioning that involves the progressive use of a wide range of resistive loads, different velocities and a variety of training modalities

Resistance training can offer unique benefits for children when properly supervised and appropriately prescribed: a) enhanced muscle strength/power b) enhanced motor skill performance c) facilitate weight control d) increase bone mineral density e) increase resistance to sports related injury f) increase local muscle endurance g) improve insulin sensitivity h) improve blood lipid profile i) enhance attitude toward lifetime physical activity

Body Composition

Although the treatment of paediatric obesity is complex, exposure to resistance training along with counselling and nutrition advice may provide a safe pathway for obese youth to initiate exercise. Several studies have reported favourable change in body composition in children and adolescents who were obese following participation in a progressive resistance training program (44,65,67).

Bone Health

Childhood and adolescence may be the opportune time to for the bone-modelling and remodelling process to respond to tensile forces associated with weight-bearing activities (3,73). If age-specific resistance training guidelines are followed along with proper nutrition, resistance exercise can play a critical role in bone mass acquisition during the paediatric years (73). The mechanical stress from this type of training may act synergistically with growth-related increases in bone mass (3,73).

Sports-Related Injuries

Owing to the apparent decline in free time physical activities among children and adolescents (57,59), it seems that the musculoskeletal system in some young athletes may not be prepared for the demands of sports practice and competition. Appropriately designed and sensibly progressed resistance training programs may help to reduce the likelihood of sports related injuries in young athletes. While there is not one combination of exercises, sets and repetitions that has proven to optimise training adaptations, these data indicate that multifaceted programs that increase muscle strength, enhance movement mechanics and improve functional abilities appear to be the most effective for reducing sports related injuries in children.

While musculoskeletal growth and development show similar trends between genders, male and female strength and neuromuscular patterns diverge significantly during and after puberty (31). Boys naturally demonstrate power, strength and coordination that correlates to maturational stages whereas untrained girls show very little improvement throughout puberty (31,35,43,62). Multifaceted training that combine resistance training, plyometric training, balance and proprioception have been found to enhance movement biomechanics and lower limb strength in adolescent girls (49-55). Resistance training combined with growth and development may induce a “neuromuscular spurt "which may improve biomechanics related to injury risk (34,54) and may improve sports performance.

Risks and Concerns

Current findings indicate a low risk of injury in children and adolescents who follow age appropriate training guidelines (18,24,42) Potential for injury to the physis or growth plate has been a primary concern associated with youth resistance training. The growth plate can be significantly weaker than the surrounding connective tissue and therefore less resistance to shear or tensile forces (66) and injury to this section of the bone can result in significant discomfort, growth disturbance and loss of training hours. However, these injuries are generally caused by improper lifting techniques, poorly designed training programs and poorly appointed training loads combined with lack of qualified adult supervision. There is no evidence to suggest that resistance training will negatively impact growth and maturation during childhood and adolescence (18,42). While data to date indicates that injury occurrence in paediatric resistance training is very low (18,24,42) professional who prescribe resistance exercise should be mindful of the risk associated with this type of training, cognisant of safety precautions and aware of the potential risk for repetitive use soft tissue injuries. Lower back pain has become a significant health concern among adolescents (37) and a role for preventative intervention to enhance strength, muscular endurance and low back stability has become apparent particularly in young lifters. Injuries to the lower back may be in part due to poor program design, improper technique and inappropriate progression of loads and thus if paediatric resistance trains guidelines are not followed there is potential for serious injury.

Paediatric Resistance Training Guidelines

A prerequisite for the development and administration of safe, effective and enjoyable youth resistance training program is understanding training principles and an appreciation the uniqueness of the physical and psychosocial aspects of training children and adolescents. There is no minimum age requirement at which children can begin resistance training but participants must be mentally and physically ready to comply with coaching instructions and the stress of an organised training program. There does not appear to be one optimal combination of sets, reps and exercises that will promote favourable adaptations in young lifters. Sensible integration of different training and periodic manipulation of program variable will keep the training effective, challenging and pleasurable. Individual effort combined with a well-designed training program will determine the adaptations that take place.

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When designing resistance training programs for young athletes, it is important to consider the total exercise dose, which includes sports practice and competition as well as free play, physical education and possibly private coaching sessions. Because of the interindividual variability of stress tolerance, each young athlete should be treated as an individual. A reduction in sports performance and an increased risk of injury can result if resistance exercises are

simply added onto a young athlete's training schedule.

Acute Program Design Variables

Variables to be considered in designing a paediatric resistance program: a) warm-up and cool-down b) selection and order of exercise c) training intensity and volume d) rest intervals between sets and exercises e) repetition velocity

Warm up procedures should involve the performance of dynamic movement designed to elevate core body temperature, enhance motor-unit excitability , improve kinaesthetic awareness and maximise active range of movement.

Select exercises that are appropriate to the participant's body size, fitness level, exercises technique experience and training goals. Resistance training with free weights, medicine balls and body weight will be particularly beneficial for young athletes who need to enhance motor skill, balance, core strength and muscle power. Most youth will perform total body workouts several times per week which involve multiple exercises stressing all major muscle groups each session. In this type of workout large muscle group exercises should be performed before smaller muscle group exercises and multiple-joint exercises should be performed before single joint exercises. More challenging exercises should be performed earlier in the workout when the neuromuscular system is less fatigued

Training intensity is one of the most important factors in a resistance training program because it is the major stimulus related to muscular fitness. To reduce the risk of injury young lifters need to first learn how to perform the exercise technically with a light load and then gradually progress the intensity or volume without compromising technique. Begin resistance training with two sets of 10-15 repetitions with a light load to develop proper technique then depending on the individual needs, goals and abilities repetition loads can be progressed to include additional sets with heavier loads, for example 6-10rep max., on large muscle groups to maximise strength gains. It is important that the number of repetitions allow the lifter to maintain movement speed and efficiency for all repetitions within a set.

Research suggests that children and adolescents can resist fatigue to a greater extent than adults during several repeated sets of resistance exercise (19). Thus a short rest interval of about a minute may suffice in children. This should be decided as long as technique remains good.

The cadence at which resistance exercise is performed can affect the adaptations to a program. The performance of different training velocities within a program may be the most effective stimulus for young athletes, however as velocity is increased it is critical to retain correct technical performance of each repetition.

CONCLUSION

Scientific evidence and clinical impressions indicate that resistance training has the potential offer health and fitness value to children and adolescents provided that appropriate training guidelines are followed and qualified instruction is available. Comprehensive resistance training programs that integrate different elements of physical fitness are the most likely to enhance sports performance and reduce the risk of injury.

A full list of references is available on request.

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British Journal of Sports Medicine November 2019; Vol. 53, No. 22

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http://bjsm.bmj.com/content/53/23

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