We live in conflicting times. Compared with a decade ago, we now have children specializing in only a single competitive sport and doing it from an earlier age. This contrasts with an ever increasing rate of childhood obesity.

Strength training in children and adolescents has been getting increased attention recently, as it may benefit both of these groups, as well as most children. The American Academy of Pediatrics (AAP) has recently endorsed strength training in childhood as safe and effective if certain safeguards are followed. Children are ready for strength training when they are old enough to participate in organized sports, while younger children can benefit from freeplay activities.

Before a strength training program is undertaken two critical conditions must be met.

The first is the child or adolescent must be medically evaluated and approved by their pediatrician for participation. It is recommended that children in this age group be seen for a general checkup every two years and this is a good opportunity to address any concerns. Re-evaluation may be necessary if any major changes (new injury or medical problem) in health have occurred.

The second condition is that the child and parent have realistic expectations. While strength and flexibility can be increased through training, muscle size will not change until a child reaches physical maturity and so should not be a goal. Power lifting, competitive lifting, body building and maximal lifts should be avoided until physical maturity is reached.

To ensure strength training is fun, safe and effective, all workouts should be supervised by a qualified adult and occur in a safe, uncluttered environment. The greatest risk of injury is with inadequate supervision and not learning or using proper technique. Benefits are more optimal if training is done two to three nonconsecutive days per week, and include a five to ten minute warm up and cool down period that incorporates stretching for the last 20 to 30 minutes.

Pre-teens and beginners should begin with exercises such as sit-ups, push-ups, pull-ups and lunges that use their own body weight as resistance. An advantage of push-ups and sit-ups is they strengthen two areas that are usually weakest and prone to injury. Supervision will allow the safe transition to the use of weights for resistance, as this varies by age, experience, and fitness level.

Light enough weights should be used to allow good control and form, with 10 to 15 repetitions as a goal. When 15 repetitions can be completed with good control, a five percent increase in weight is allowed. Additional sets and aerobic exercises may be added depending on individual goals.

Important elements of form incorporate slow lifting and controlled lowering (i.e.: do not throw and drop). Exhaling with effort and having a spotter minimize the risk of light-headedness and weight dropping.

Adult fitness is being recognized as a protective factor against cardiovascular disease, type 2 diabetes, osteoporosis, low self-esteem and obesity. Strength training is being recognized as a critical component of overall fitness.

While not as well studied, most of these benefits do appear to apply to children as well. Strength training appears also to create an increased willingness to engage in sports. Social connectedness appears to be one of the greater protective factors for children against many risky behaviors and this is often fostered by participation in sports activities.

By encouraging a heart-healthy lifestyle that incorporates strength training in childhood, one is more likely to continue healthy habits into adulthood.

Resources to get you started include your pediatrician, websites such as www.nsca-lift.org., or www.StrongKid. com. Our sports medicine specialist, Dr. Gary Nichols, is an excellent resource, particularly if unique conditions or concerns arise. With proper adult supervision and realistic expectations strength training is a safe and beneficial part of a healthy lifestyle.

—Andrew Larson, MD