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Strength Training and Children's Health

a
Avery D. Faigenbaum
a
Department of Human Performance and Fitness, University of Massachusetts, Boston, MA,
02125
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 Strength Training
and Children’s Health
C
hildren need to participate
regularly in physical activities
that enhance and maintain
cardiovascular and musculoskeletal
health. While children have tradition-
ally been encouraged to participate in
aerobic activities such as swimming
and bicycling, a compelling body of
Downloaded by [Western Kentucky University] at 07:42 24 April 2013
evidence indicates that strength train-
ing can be a safe and effective method
of conditioning for boys and girls,
provided that appropriate training
guidelines are followed (Faigenbaum,
Kraemer, et al., 1996; Falk & Tenen-
baum, 1996; Hamill, 1994). In addi-
tion to enhancing motor skills and
sports performance, regular partici-
pation in a strength-training program
has the potential to positively influ-
ence several measurable indices of
health for children. It helps strengthen
bone, facilitate weight control, en-
hance psychosocial well-being, and
improve one’s cardiovascular risk pro-
file. Furthermore, a stronger muscu-
loskeletal system will enable children
to perform daily activities with more
energy and may increase their resis-
tance to sports-related injuries.
This article will provide an over-
view of the potential health benefits
associated with strength training for
youths, and will highlight design con-
siderations for such programs. The
focus will be on musculoskeletal a d a p
tations to strength training that are
observable in healthy children. This
information is particularly relevant
because of the increasing number of
children who engage in various forms
of strength-training activities and the
current emphasis on making physical
education more engaging, inclusive,
and health-oriented.
For the purposes of this article, the
term “strength training” is defined as
24
A W R Y D. FAICENBAUM
a specialized method of physical con-
ditioning that involves the progres-
sive use of a wide range of resistive
loads to enhance or maintain one’s
ability to exert or resist force. This term
should be distinguished from the
competitive sports of bodybuilding
and powerlifting.
Trainability of Children
For many years, it was believed that
strength training was ineffective or
unsafe for children due to their phy-
sical immaturity. The prevailing atti-
tude among physical educators and
healthcare providers was that strength-
training-induced gains before puberty
were not possible due to inadequate
levels of circulating androgens, and
that such training would be poten-
tially injurious to the growth cartilage
of children. However, research con-
ducted over the past 10 to 15 years
provides convincing evidence that
strength training can be a safe and
effective method of conditioning for
children, as long as appropriate guide-
lines are followed (Blimkie, 1993;Falk
& Tenenbaum, 1996; Hamill, 1994).
The American Orthopaedic Society
for Sports Medicine (1988),the Ameri-
can College of Sports Medicine (2000),
and the National Strength and Condi-
tioning Association (Faigenbaum,
Kraemer, et al., 1996) all support
children’s participation in appropri-
ately designed and competently su-
pervised strength-training programs.
Children as young as six have ben-
efited from strength training using
various combinations of sets and
repetitions, from one set of 10 to 15
repetitions (Faigenbaum, Westcott,
LaRosa Loud, & Long, 1999) to five
sets of 15 repetitions (Isaacs,Pohlman,
& Craig, 1994). While children show
only small to moderate gains in car-
diorespiratory performance following
aerobic training (Payne & Morrow,
1993), gains in muscular strength of
roughly 30 to 50 percent are typically
observed in children following short-
term (i.e., eight-to-12-week)strength-
training programs (Faigenbaum,
Westcott, et al., 1996; Faigenbaum,
Zaichkowsky, Westcott, Micheli, &
Fehlandt, 1993; Pfeiffer & Francis,
1986; Ramsay et al., 1990; Sailors &
Berg, 1987;Weltman et al., 1986).Fac-
tors such as the program design (e.g.,
number of sets and repetitions), qual-
ity of instruction, and training experi-
ence of the subjects may have influ-
enced the degree of strength gain in
past studies. In general, it appears that
these percentage-based strength gains
made by children are similar to or
greater than gains made by older
populations. However, training-in-
duced strength gains during child-
hood are primarily due to neural
adaptations rather than hypertrophy;
in other words, strength training im-
proves the nervous system’s ability to
coordinate the recruitment of muscle
fibers (Ozmun, Mikesky, & Surburg,
1994; Ramsay et al., 1990).
Health Benefits
Again, a growing body of evidence
suggests that the health of a child is
more likely to improve rather than be
adversely affected by participation in
an appropriately designed strength-
training program. Regular participa-
tion in strength-building activities
has been shown to positively influ-
ence children’s bone-mineral density
(BMD) (Morris, Naughton, Gibbs,
Carlson, & Wark, 1997),body compo-
sition (Faigenbaum etal., 1993;Siegal,
Camaione, & Manfredi, 1989),cardio-
Vol. 72 No. 3 JOPERD March 2001
 respiratory fitness (Weltman et al.,
1986),blood lipids (Fripp& Hodgson,
1987;Weltman,Janney, Rians, Strand,
& Katch, 1987), and psychosocial well-
being (Faigenbaum, 1995). Further-
more, since the musculoskeletal sys-
tem of many boys and girls who enter
sports programs may be ill-prepared
to handle the duration and magni-
tude of forces that develop during
practice and game situations, strength-
training programs may be able to de-
crease their risk of sports-related inju-
ries (Smith,Andrish, & Micheli, 1993).
In short, participation in a strength-
training program, along with other
physical activities such as riding a bike,
gives inactive children yet another
Downloaded by [Western Kentucky University] at 07:42 24 April 2013
opportunity to improve their health
and quality of life. A summary of the
potential health benefits associated
with strength training for youths is
presented in table 1.
Old concerns about strength train-
ing for youths include the ideas that it
could result in chronic hypertension
or stunt their statural growth. How-
ever, current findings indicate that
regular participation in such activities
has no adverse effect on the resting
blood pressure of children (Faigen-
baum et al., 1993; Rians et al., 1987).
In fact, strength training may actually
lower the resting blood pressure of
hypertensive teenagers provided that
submaximalloads are used and proper
exercise procedures are followed
(Hagberg et al., 1984).
The concern that strength training
will damage the growth plates of chil-
dren and impede their statural devel-
opment seems to have come from an
old report indicating that children in
remote areas ofJapan who performed
heavy labor were short in stature (Kato
& Ishiko, 1964). In this report, how-
ever, etiologic factors such as poor
nutrition were not controlled, and the
children performed heavy labor in
mountainousvillages for several hours
a day. Current observations indicate
no evidence of a decrease in stature in
children who perform strength train-
ing in a controlled environment (Faig-
enbaum, Kraemer, et al., 1996). Fur-
thermore, growth-plate fractureshave
March 2001 JOPERD * Vol. 72 No. 3
not been reported in any prospective
fouth strength-training study pub-
lished to date. While all children are
susceptible to such fractures, it has
been noted that this type of injury
may be less likely to occur during child-
hood than during adolescence, be-
cause the growth plates of children
may actually be stronger and more
resistant to sheering forces than the
growth plates of adolescents (Micheli,
1988). In view of these data, if chil-
dren are taught how to train properly
and if nutritional recommendations
are followed, then strength training
will likely have a favorable influence
on their growth, but will not affect
their genotypic maximum.
From a public-health perspective,
it is interesting to note that the tradi-
tional fears associated with strength
training for youths have been replaced
by health objectives that aim to in-
crease the number of children age six
and older who regularly participate in
physical activities that enhance and
maintain muscle strength, endurance,
and flexibility (U.S. Department of
Health and Human Services, 1996).
Furthermore, the belief that strength
training is harmful to the immature
skeletons of young weight trainers is
not consistent with current findings
suggestingthat childhood and adoles-
cence may be the period during which
the bone-modeling process responds
best to the mechanical loading of
physical activities such as strength
training (Drinkwater, 1995).
Although genetics strongly influ-
ences peak bone mass, it seems that
the prevention of skeletal frailty in
senior populations may depend not
only on reducing bone loss during
adulthood, but also on maximizing
BMD during childhood and adoles-
cence with exercise and proper nutri-
tion (e.g., consumption of adequate
calcium).A n increase of only three to
five percent in BMD may reduce one’s
fracture risk by 20 to 30 percent
(Johnson, Miller, & Slemenda, 1992).
Clearly, we need to develop and imple-
ment programs that foster childhood
gains in BMD, particularly since the
annual cost of caring for patients with
xteoporosis has reached $13.8 billion
and the incidence of osteoporosis is
expected to triple by the year 2040
(Bachrach, 2000).
In one recent study, 9-to-10-year-
Dld participants in a 10-month “high
impact” physical activity program
(whichincluded strength training and
aerobic exercise three times per week)
showed significant improvements in
BMD as compared to an age-matched
control group (Morris et al., 1997).
Furthermore, it was recently reported
that eccentric strength training may
be more effective than concentric
strength training in enhancing the
BMD of females who are 20 to 23 years
old (Hawkins et al., 1999), and it is
possible that similar benefits could
occur in younger populations. While
it is clear that weight-bearing physical
activity is absolutely essential for nor-
mal bone development, additional
clinical trials are needed to define
more precisely the optimal exercise
prescription for enhancing BMD in
children. This potential benefit may
be particularly important for girls,
who are at greater risk of developing
0steoporosis.
As the prevalence of childhood obe-
sitycontinuesto increase (Flegal,1999),
the positive influence of strength train-
ing on body composition should be
considered as a possible means of re-
versing this trend. Although aerobic
exercise is typically prescribed for de-
creasing body fat, several strength-
training studies involving children
Benefits of Strength
Increased muscle strength
Increased bone-mineraldensity
Increased cardiorespiratoryfitness
Improved blood-lipid profile
Improved body composition
Lowered blood pressure (if
hypertensive)
Increased resistance to injury
Enhanced psychosocial well-being
Improved attitude towards
lifetime physical activity
25
 have reported a decrease in fatness
(asmeasured by skinfolds) among par-
ticipants (Faigenbaum et al., 1993;
Lillegard, Brown, Wilson, Henderson,
& Lewis, 1997; Siegal et al., 1989).
While strength training has been
shown to increase the resting meta-
bolic rate of adults (Pratley et al.,
1994), only limited data are available
regarding children. In one report in-
volving obese children, a five-month
strength-training program (involving
two sets of 12 to 15 repetitions on
seven exercises performed three times
per week) did not significantlyimprove
energy expenditure (Treuth, Hunter,
Pichon, Figueroa-Colon, & Goran,
1998). However, the authors of this
Downloaded by [Western Kentucky University] at 07:42 24 April 2013
report commented that more intense,
higher-volumetraining programs could
have a more favorable influence on
children’s energy expenditure.
Although the treatment of child-
hood obesity is complex, observations
from the youth strength-training cen-
ter at the South Shore YMCA in
Quincy, Massachusetts, suggest that
overweight children enjoy strength
training because it is not aerobically
taxing; it gives all participants the op-
portunity to experience success and
feel good about their performance.
Unpublished data from this center
indicate that children’s training heart
rates (measured with Polar Vantage
XL monitors) during 30 to 40 min-
utes of strength-building activities typi-
cally wax and wane between 130 and
150 beats per minute. Thus it can be
speculated that strength training with
moderate loads (60-to-75%of the one
repetition maximum) and a high num-
ber of repetitions (10-to-15) may fa-
cilitate long-term fat loss and weight
management in overweight children.
Perhaps the most overlooked ben-
efit of strength training is its potential
impact on children’s psychosocial
health. It has been observed that the
socialization and mental discipline
exhibited by children participating in
strength-training programs are similar
to the characteristics of children par-
ticipating in team sports (Rians et al.,
1987).With proper instruction and lead-
ership, strength training may positively
26
nfluence children’s attitudes towards
)hysical education, physical fitness,
md lifelong exercise (Westcott,Tolken,
Ic Wessner, 1995).Also, some evidence
ias suggested that participation in a
trength-training program will favor-
ibly influence selected psychologi-
:a1 measures (e.g., self-efficacy and
elf-esteem) in children and adoles-
:ents (Holloway, Beuter, & Duda,
1988; Westcott, 1992; Westcott et al.,
1995). However, excessive pressure
rom parents, coaches, and teachers
o perform at a level beyond one’s
:apabilities can have adverse psycho-
,ocial consequences.
Prevention of Sports-
Related Injuries
,n the United States, millions of chil-
lren participate in school- and com-
nunity-based sports programs. Along
Nith this staggering number of youth-
;ports participants, however, there has
3een a concomitant increase in the
lumber of sports-related injuries to
11-prepared and improperly trained
Joung athletes (Outerbridge &
Micheli, 1995). While factors such as
improper equipment, hard playing
surfaces, and time periods of rapid
growth (i.e., peak height velocity) are
recognized as risk factors for overuse
injuries in children (Micheli, 1983),
the physical-activity backgrounds of
aspiring young athletes must also be
considered. Many states lack a daily
physical education requirement, and
many children in physical education
classes are not meeting the desired
fitness goals. Further, sedentary pur-
wits such as television viewing and
web “surfing” continue to occupy a
significant amount of children’s free
time (Dietz, 1990).
While there are many mechanisms
to reduce sports-related injuries in
young athletes (e.g., coaching educa-
tion, parent education, proper equip-
ment), the establishment of funda-
mental fitness abilities (including pre-
paratory muscle conditioning) as a
preventative health measure should
not be overlooked. According to the
American College of Sports Medicine,
up to 50 percent of all injuries sus-
ained by children while playing orga-
iized sports are likely preventable
:Smith, Andrish, & Micheli, 1993).
strength training appears to be an
:ffective injury-prevention strategy for
idult athletes, and similar mechanisms
nay help to decrease the prevalence
if injuries in youth sports. By strength-
ming ligaments, tendons, and bones,
mhancing muscle strength and en-
lurance, and developing muscle bal-
ince around joints, strength training
nay decrease the incidence of inju-
ries among young athletes.
A few studies have demonstrated
lecreased injury rates in adolescents
Nho participated in conditioning pro-
grams that included strength training
(Cahill & Griffith, 1978; Dominguez,
1978; Hejna, Rosenberg, Buturusis, &
Krieger, 1982;Hewett, Stroupe, Nance,
& Noyes, 1996), and it seems likely
that children would experience simi-
lar benefits if appropriate training
guidelineswere followed. In one study
involving female high school volley-
ball players, a six-week strength and
conditioning program significantly
decreased peak landing forces, which
in turn decreased forces placed on
the lower extremity joints (Hewett et
al., 1996). Due to the increasing inci-
dence of knee injuries among young
female athletes (Arendt & Dick, 1995),
encouraging participation in such pro-
grams in an attempt to strengthen liga-
ments prior to sports participation
merits consideration. Since it is likely
that many factors (e.g., limb align-
ment, joint laxity, hormonal changes,
shoe-surface interaction) are respon-
sible for this increase in knee injuries,
additional clinical trials are needed to
determine the best method for reduc-
ing such injuries.
While the total elimination of
sports-related injuries is an unrealistic
goal, it seems prudent for children to
participate in at least six weeks of pre-
paratory conditioning (including
strength, aerobic, flexibility, and agil-
ity training) before sports participa-
tion. During this time, correctable risk
factors such as poor physical condi-
tion can be identified and treated by
qualified teachers and coaches. This
Vol. 72 No. 3 JOPERD March 2001
 type of preseason conditioning pro-
gram may better prepare young ath-
letes for the demands of practice and
competition, and may even decrease
the likelihood that they will drop out
of sport due to frustration, embarrass-
ment, failure, or injury. We also need
to encourage children to participate
in a variety of sports and activities in
order to develop a wide range of skills.
According to the American Academy
of Pediatrics (2000), children should
avoid specialization in a single sport
before adolescence.
Designing a Strength-
Training Program
SafetyAlthough there is no minimum
Downloaded by [Western Kentucky University] at 07:42 24 April 2013
age requirement for participation in a
strength-training program, all train-
ees should have the emotional matu-
rity to accept and follow directions
and should understand the benefits
and risks associated with this type of
training. In general, if a child is ready
for participation in sports, then he or
she is ready for some type of strength
training. While children as young as
age six have participated in highly su-
pervised strength-training programs
at the South Shore YMCA,some evi-
March 2001 JOPERD Vol. 72 No.3
lence suggests that children younger
:han age six are more likely than older
;roups to be injured with weight-train-
ing equipment (Jones, Christensen,&
lu‘oung, 2000). Obviously, cautionary
measures need to be taken when chil-
dren of any age want to participate in
z strength-training program.
It is important to remember that
no matter how big or strong a child is,
adult training programs and training
philosophies (e.g.,“No pain, no gain”)
should not be imposed on children.
The volume and intensity of most adult
training programs exceed children’s
abilities, and the prescribed recovery
periods are often inappropriate for
them as well. When designing strength-
training programs for children, it is
always better to underestimate their
physical abilities and gradually in-
crease the volume and intensity of
training than to overestimate their
abilities and risk an injury. Further-
more, all students should participate
in at least five to 10 minutes of warm-
up activities (e.g., low-to-moderate-in-
tensity aerobic exercise and stretch-
ing) before strength training.
Even though some young athletes
may want to play themselves into
;hape, it is unlikely that they will gain
h e specific benefits of strength train-
Lng without actually participating in a
strength-training program. Due to in-
dividual differences in stress tolerance,
however, the volume and intensity of
strength training needs to be carefully
prescribed for each child, particularly
since such training adds to the chronic
repetitive stress placed on the young
skeleton. In short, strength training
should not simply be added to a young
athlete’s training program, but rather
incorporated into a year-round pro-
gram that varies in intensity.
Teachers and coaches who super-
vise children in strength-trainingpro-
grams must have a thorough under-
standing of training guidelines and
safety procedures. All exercises must
be clearly explainedand properly dem-
onstrated on safe equipment, and un-
safe behavior in the weight room
should not be tolerated under any cir-
cumstances. Easy-to-follow explana-
tions and verbal learning cues (e.g.,
back flat, head up) can facilitate the
acquisition of proper form. Posters
that depict children performing
strength-training exercises correctly
may also be helpful. Unsupervised
27
 youth strength-training programs art ise and instruct every exercise ses-
not recommended under any circum ,ion. Some home exercise equipment
stances due to the potential for seri uch as the barbell bench press can
ous injury, and children should no -esultin serious injury or death if used
do strength training at home unless 2 vithout a spotter (George, Stakiw, &
competent adult is willing to super Wright, 1989).
1 Table 2. Guidelines foryouth
Strength-Training Programs
Design. Strength training should be
me part of a total fitness program for
:hildren that also includes aerobic,
lexibility, and agility exercises. Pro-
;rams should be based on individual
ieeds and abilities, and children
ihould be encouraged to ask ques-
lions so that all of their concerns are
rddressed. In addition to traditional
?ree-weight training (barbells and
hmbbells) ,avariety of other strength-
training tools (e.g., one's own body
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weight, elastic tubing, child-sizeweight
machines and medicine balls) are
available for youth programs (see pho-
tos on page 27).
It has been recommended that chil-
dren perform one to three sets of six
to 15 repetitions on a variety of exer-
cises that focus on the upper body,
lower body, and core (abdominal and
lower back) musculature (Faigenbaum
et al., 1996). More recent data, how-
ever, suggest that the use of moderate-
load, high-repetition (i.e., 13-to-15
repetitions to muscular fatigue) train-
ing protocols may be more benefi-
cial than heavy-load, low-repetition
(i.e., 6 to 8 repetitions) protocols for
children participating in an introduc-
tory program (Faigenbaum, Westcott,
LaRosa Loud, & Long, 1999). Begin-
ning a strength-training program with
single sets of about 10 to 15 repeti-
tions per exercise not only allows for
training sessions per week are positive changes in muscular perfor-
recommended. mance, but also provides an opportu-
When necessary, adult spotters nity for children to feel good about
should be nearby to assist the their performance.
children in the event of a failed Only limited data are available re-
repetition.
garding the relationship between rep-
Focus on participation, with etitions and selected percentages of
lots of movement and positive
the one repetition maximum (RM) in
reinforcement.
children. In adults, it appears that the
Strength training should be
number of repetitions that can be per-
systematicallyvaried to optimize
gains. formed at a given percentage of the
one RM are specific for a given exer-
Strength training should be
one part of a well-balancedyouth- cise (Hoeger, Barette, Hale, &
fitness program. Hopkins, 1987), and similar observa-
i I
_I . . I _
tions have been reported in children
_ _ _ _ ^ I " _ - ~
(Faigenbaum,Westcott, LaRosa Loud,
SC Long, 1998).Thus it is possible that
the minimal strength threshold-
when expressed as a percentage of the
m e RM-may vary between muscle
groups, possibly due to the amount of
muscle mass involved with each exer-
cise. When prescribing a strength-
training program for children, your
best approach may be to first establish
the repetition training range (e.g., 10
to 15) and then by trial and error
determine the maximal load that can
be handled for the prescribed range.
In the youth strength-training pro-
gram at the South Shore YMCA, we
begin with activities that are moder-
ately challenging so that the children
can develop fundamental skills and
gain confidence in their abilities be-
fore progressing to more advanced
exercises. We also discuss the value of
strength training and highlight the
risks associated with this form of exer-
cise. Our students learn in a coopera-
tive, non-threatening environment
and are encouraged to help one an-
other. They exercise at self-selected
intensities that are within a prescribed
repetition range; the emphasis on out-
comes is reduced so that they can fo-
cus on the enjoyment of strength train-
ing and physical activity.
Following each class, we reflect on
what the students learned and enjoyed
in order to help us plan future les-
sons. While tangible outcomes such as
increased muscle strength are impor-
tant, they are not the only benefits
associated with youth strength-train-
ing programs. When workingwith chil-
dren, it is important to focus on in-
trinsic factors such as skill improve-
ment, personal success, and having
fun. The use of individualized work-
out logs can serve as an incentive for
children to focus on their own im-
provement. In addition, teachers and
youth coaches can serve as positive
role models for students.
As children get stronger, it is im-
portant to increase the resistance, the
number of repetitions, or the number
of sets so that they can make con-
tinual gains. This fundamental prin-
ciple of strength training is based on
Vol. 72 No. 3 JOPERD March 2001
 the fact that a muscle will respond to
the demands placed on it by getting
stronger. Therefore, more resistance
must be added to ensure further gains.
As such, when a child can perform 15
repetitions with proper technique on
any exercise, you should increase the
weight by 5-to-10 percent (about two-
to-five pounds, depending on the ex-
ercise) and decrease the number of
repetitions to 10.
However, this does not mean that
every exercise session needs to be
more intense or voluminous than the
previous session.While it is important
to keep the program fresh and chal-
lenging, children should be given the
opportunity to develop proper form
Downloaded by [Western Kentucky University] at 07:42 24 April 2013
and technique with minimal (if any)
muscle soreness. Every three or four
weeks in our strength-training pro-
gram, we incorporate an “unloading
week” wherein we decrease the inten-
sity and volume of training to give the
children time to recover fully. During
this unloading week, students are able
to work on their exercise techniques,
reflect on their strength gains, and
avoid overtraining. While detailed in-
formation on the development of
youth strength-training programs is
available elsewhere (Faigenbaum &
Westcott, 2000), a summary of guide-
lines for such programs is presented
in table 2.
Conclusion
Strength training has the potential to
offer observable health benefits to boys
and girls, provided that appropriate
guidelines are followed. Despite tradi-
tional concerns regarding the safety
and efficacy of strength training for
children, scientific evidence and clini-
cal impressions strongly suggest that
such training should be part of a com-
prehensive health-maintenance strat-
egy for young populations. Unlike
some other types of physical activity,
strength-training programs can be
designed to meet the needs of all boy5
and girls, especially those who can ben.
efit from physical activity the most.
Qualsied instructors, appropriate pro
gram design, ample practice, and en.
couragement from teachers, coaches.
March 2001 JOPERD Vol. 72 No. 3
barents, and peers are all important
actors in establishing children’s life-
ong interest in strength training.
The effects of strength training on
elected health measures should be
ecognized by physical and sport edu-
ators. At a time when we need to
mcourage all students to pursue life-
ime physical activities, it is no longer
icceptable to focus solely on activities
or elite young athletes. We now have
he information tojustify the incorpo-
,ation of strength-training activities
nto health-oriented physical educa-
ion curricula. Additional research can
ielp us further explore the health-
mhancing effects of strength training
)n children.
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Vol. 72 No. 3 JOPERD March 2001