Guidelines on Strength Training for Children Revised

Pediatrics. 2008;121:835-840.

Clinical Context

Many young people become involved in strength training, also known as resistance training, in the context of sports and physical fitness programs. However, some adolescents use strength training to enhance muscle size and appearance. Free weights, weight machines, elastic tubing, or an athlete's own body weight may all provide resistance required for strength training. The type and amount of resistance used and the frequency of repetitions vary depending on specific program goals.

Because pediatricians are often asked to counsel young people on the safety and efficacy of strength-training programs, the AAP issued this revision of a previous policy statement. These revised guidelines define relevant terminology and provide updated evidence regarding the risks and benefits of strength training for children and adolescents.

Study Highlights

• Muscle strains account for 40% to 70% of all strength-training injuries and usually involve the hand, low back, and upper trunk.
• Appropriate strength-training programs do not appear to adversely affect growth or cardiovascular health.
• Strength-training programs for young people should follow proper resistance techniques and safety precautions.
• Preadolescents and adolescents should avoid power lifting, body building, and maximal lifts until they reach physical and skeletal maturity.
• Athletes should not use performance-enhancing substances or anabolic steroids, and young people involved in strength training should be educated about the risks of using these substances.
• A pediatrician or family clinician should perform a medical evaluation before the young person begins formal strength training.
• Youth with uncontrolled hypertension, seizure disorders, or a history of childhood cancer and chemotherapy should not participate in strength training until they undergo additional treatment or evaluation.
• In some cases, referral to a pediatric or family clinician sports medicine specialist familiar with various strength-training methods as well as risks and benefits may be indicated.
• Before beginning a strength-training program, children with complex congenital cardiac disease (cardiomyopathy, pulmonary artery hypertension, or Marfan's syndrome) should be evaluated by a pediatric cardiologist.
• Aerobic conditioning should be coupled with resistance training to optimize general health.
• Strength-training programs should include 10 to 15 minutes of warm-up and cool-down.
• Adequate fluid intake and proper nutrition are needed to maintain muscle energy stores and improve recovery and performance.
• To master the proper technique, specific strength-training exercises should first be learned with no load (no resistance), with incremental loads and then added with either body weight or other forms of resistance.
• Strength training should include 2 to 3 sets of 8 to 15 repetitions 2 to 3 times weekly and should continue for 8 weeks or longer.
• A general strengthening program should target the core and all major muscle groups, with exercise through the complete range of motion. More sports-specific areas may be addressed subsequently.
• Illness or injury from strength training should be fully evaluated before resumption of the exercise program.
• Instructors or personal trainers for young people should be certified and specifically qualified in pediatric strength training.
• To ensure safety, any strength-training program for young people must include proper technique and strict supervision by a qualified instructor.

Pearls for Practice

• To ensure safety and efficacy, strength-training programs for young people should follow proper resistance techniques and safety precautions. Preadolescents and adolescents should avoid power lifting, body building, and maximal lifts until they reach physical and skeletal maturity.
• A pediatrician or family clinician should perform a medical evaluation before the young person begins formal strength training to identify risk factors for injury and to discuss previous injuries and other possible medical conditions that may prevent a young person from participating in strength-training programs.