CLINICAL REPORT Guidance for the Clinician in Rendering Pediatric Care

Resistance Training for Children

and Adolescents
Paul R. Stricker, MD, FAAP,a Avery D. Faigenbaum, EdD, FACSM, FNSCA,b Teri M. McCambridge, MD, FAAP,c COUNCIL ON SPORTS
MEDICINE AND FITNESS

Resistance training is becoming more important as an integral part of abstract

comprehensive sport training regimens, school physical education classes,
and after-school fitness programs. The increasing number of youth who
are involved in sport activities, coupled with the health problems of inactivity a
Department of Orthopedics, Pediatric & Adolescent Sports Medicine,
and being overweight, have resulted in increased interest in resistance Scripps Clinic, San Diego, California; bDepartment of Health and
Exercise Science, The College of New Jersey, Ewing, New Jersey; and
training. Secular declines in measures of muscular fitness in modern-day c
Department of Orthopedics, University of Maryland, College Park,
youth highlight the need for participation in youth resistance training Maryland

for nonathletes as well as athletes. Parents often ask pediatricians to offer Drs Stricker, Faigenbaum, and McCambridge served as authors of the
advice regarding the safety, benefits, and implementation of an effective manuscript with substantial input into the content and revision; and
all authors approved the final manuscript as submitted.
resistance-training program. This report is a revision of the 2008 American
Clinical reports from the American Academy of Pediatrics benefit from
Academy of Pediatrics policy statement and reviews current information and expertise and resources of liaisons and internal (AAP) and external
research on the benefits and risks of resistance training for children and reviewers. However, clinical reports from the American Academy of
Pediatrics may not reflect the views of the liaisons or the
adolescents. organizations or government agencies that they represent.

The guidance in this report does not indicate an exclusive course of

treatment or serve as a standard of medical care. Variations, taking
into account individual circumstances, may be appropriate.

All clinical reports from the American Academy of Pediatrics

KEY POINTS automatically expire 5 years after publication unless reaffirmed,
revised, or retired at or before that time.
1. Positive outcomes of improved strength in youth continue to
be acknowledged, including improvements in health, fitness, This document is copyrighted and is property of the American
Academy of Pediatrics and its Board of Directors. All authors have filed
rehabilitation of injuries, injury reduction, and physical literacy. conflict of interest statements with the American Academy of
Pediatrics. Any conflicts have been resolved through a process
2. Resistance training is not limited to lifting weights but includes a wide approved by the Board of Directors. The American Academy of
array of body weight movements that can be implemented at young Pediatrics has neither solicited nor accepted any commercial
involvement in the development of the content of this publication.
ages to improve declining measures of muscular fitness among children
DOI: https://doi.org/10.1542/peds.2020-1011
and adolescents.
Address correspondence to Paul R. Stricker, MD, FAAP. E-mail: drpaul@
3. Scientific research supports a wide acceptance that children and drpaulstricker.com
adolescents can gain strength with resistance training with low injury
PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275).
rates if the activities are performed with an emphasis on proper
technique and are well supervised. Copyright © 2020 by the American Academy of Pediatrics

4. Gains in childhood strength are primarily attributed to the

neurologic mechanism of increases in motor neuron recruitment, To cite: Stricker PR, Faigenbaum AD, McCambridge TM, AAP
allowing for increases in strength without resultant muscle COUNCIL ON SPORTS MEDICINE AND FITNESS. Resistance Training
for Children and Adolescents. Pediatrics. 2020;145(6):e20201011
hypertrophy.

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 5. It is important to incorporate kettlebells, elastic tubing, or alphabetical list of common terms
resistance training into physical a person’s own body weight to used in resistance training.
education classes and youth sport provide the resistance needed to
programs to increase muscular increase strength.
strength, reduce the risk of RESISTANCE-TRAINING BENEFITS
overuse injuries, and spark an Along with the extremes of inactivity
ongoing interest in this type of and/or being overweight and the Performance Benefits
exercise. evolution of youth sports into more The many benefits of resistance
6. Certain health situations require intense training at younger ages, training have been increasingly
consultation with a medical there is also a change in the documented in the pediatric sports
professional before starting landscape of “strength” among arena. Although building strength is
a program of resistance training. children and adolescents. Evidence of often a primary goal, the positive
decreasing measures of muscular sequelae of strength gains in youth
fitness in youth over the years adds continue to be recognized, including
BACKGROUND importance for involving youth in improvements in motor skill
Resistance training and strength some form of resistance exercise performance, gains in speed and
training are synonymous terms used regardless of whether they are power, developing physical literacy,
to denote a component of sport and involved in sports.1–3 On the other reducing the risk of injury, and injury
exercise training that is designed to hand, some adolescents are rehabilitation. Children and youth are
enhance muscular strength, muscular increasingly using resistance training entering competitive sports at
power, and local muscular endurance in pursuit of muscularity without younger ages, and their training
for general exercise or competitive even being involved in sports.4 The programs are becoming more
sports. Resistance training is type, amount, and frequency of complex and can involve the use of
a specialized method of conditioning resistance exercises are dictated by private coaching, personal trainers,
that involves the use of different the specific and unique goals of the and sports psychologists in addition
modes of training with a wide range sport and training program as well as to their routine coaches and teams.
of resistive loads, from body weight the individual child’s resistance Possessing adequate strength to keep
to barbells. Resistance-training training skill competency (RTSC) up with these increased demands on
programs may include the use of free and accumulated time of formal the body is valuable to help reduce
weights (barbells and dumbbells), resistance training (also referred to the risk of injury and optimize gains
weight machines, medicine balls, as “training age”). Table 1 defines an in performance.

TABLE 1 Definitions
Term Definition
Bodybuilding Lifting weights with the specific goal of increasing muscle size, symmetry, and definition with the possible goal of entering
competitive events that are judged
Concentric muscle action The muscle shortens during contraction (ie, lifting phase of bicep curl)
Core strengthening Focusing a strength-building program on the muscles that stabilize the trunk and pelvis of the body; this training emphasizes
strengthening the abdominal, low back, and gluteal muscles as well as flexibility of muscular attachments to the pelvis, such
as the quadriceps and hamstring muscles
Eccentric muscle action The muscle lengthens during contraction (ie, lowering phase of bicep curl)
Integrative neuromuscular Multimodal exercise program using different types of resistance training to target deficits in strength and motor control by
training improving both health- and skill-related components of physical fitness
Isokinetic muscle action This exercise requires special equipment that maintains a fixed speed of muscle contraction throughout the range of motion
Muscular fitness A global term that includes muscular strength, muscular power, and local muscular endurance
Physical literacy Moving with confidence and competence in various activities and environments to benefit overall health
Plyometric exercises Repeated, rapid, eccentric, and concentric muscle actions, such as side-to-side hops or squat jumps
Powerlifting A competitive sport that involves maximum lifting ability; powerlifting includes the dead lift, back squat, and bench press
Prehabilitation Strength, flexibility, and functional training aimed at preventing injuries before they happen or reducing the risk of a recurrent
injury
Repetition (rep) One complete movement of an exercise that typically involves lifting and lowering a load
Repetition maximum (RM) The maximum amount of weight that can be lifted with proper exercise technique using a given resistance; a 1 RM is the
maximum resistance that can be used for 1 complete repetition of an exercise, whereas a 10 RM is the maximum resistance
that can be used for 10 complete repetitions of an exercise
Set A group of repetitions performed continuously
Weightlifting A sport that involves the performance of the snatch and clean-and-jerk exercises in competition
Weightlifting training The use of weightlifting exercises, movements, and derivatives of these exercises incorporated into a training program

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 Health Benefits With a preponderance of studies supervision may be variable
Healthy lifestyles incorporate regular showing positive gains from youth depending on the goals of the
exercise that provides a balance of resistance training, perspectives are resistance-training program, RTSC of
activities, including participating in shifting regarding integrating the participants, and experience of
strength-building programs. In resistance training into physical the teacher, instructor, or coach. An
addition to increasing muscular education, youth fitness, and injury- experienced professional may be able
strength, muscular power, and local reduction programs. to effectively guide a larger number of
muscular endurance, resistance youth, whereas more individualized
Previous concerns regarding instruction may be appropriate for
training has been shown to produce resistance training focused on what
many health benefits, including more advanced-level techniques.
would happen if a child lifts weights, There are many different variables
improvements in cardiovascular but more recent focus has turned
fitness, body composition, bone that contribute to a well-designed
toward what will happen if a child youth resistance-training program,
mineral density, blood lipid does not lift weights, especially in
profiles, insulin sensitivity in youth including quality of instruction,
light of the secular declines in training environment, training
who are overweight, increased measures of muscular fitness over the
resistance to injury, and mental frequency, training age, type of
years. Targeting strength deficits and resistance used, intensity of effort,
health.5–14 building strength reserves will number of sets and repetitions, rest
Programs involving resistance continue to be a valuable concept to interval between sets and exercises,
training provide positive options to address.24,25 The available research and duration of training.26
engage children and adolescents with supports resistance training in youth
overweight or obesity in physical with a new perspective of acquiring
activity and may be more likely to and maintaining high strength Training and Detraining
create a positive and successful reserves to enhance performance Recent studies suggest that
experience for these participants, across a wide range of general and resistance-training programs lasting
who may have lower levels of specific skills while reducing injury .23 weeks are most effective in
physical fitness, poor exercise risk. There is a shift from the primary attaining maximal strength gains.30
compliance, and reduced tolerance concern of injuries associated with Strength gains occur with different
for aerobic training.15–17 Evidence resistance training to the concern of types of resistance training for
does show that participation in injury and other adverse events a minimum duration of 8 weeks with
a resistance-training program helps because of a lack of adequate strength a frequency of 2 to 3 times a week.
increase daily levels of spontaneous to keep up with training In general, detraining effects can
activity in school-aged boys,18,19 demands.14,26,27 occur after 8 to 12 weeks without
which suggests that resistance resistance training,5,7,11,15,31,32 but
Resistance training is applicable to
training may be a good place to start detraining is a more complex process
virtually all children and adolescents
when trying to get inactive kids to be in youth because of developmental
for contributions to muscular fitness,
more active. Progressing into improvements in performance, which
resistance to injury, and improved
a combined program of resistance allows some skills to be retained
performance. Enhancing muscular
and aerobic training may generate better than others.32 Children recover
strength is an important concept to
added benefit because combined more quickly than adults from
embrace fully beyond the association
programs have shown favorable resistance-training fatigue; therefore,
with only lifting progressively heavier
effects on the reduction of total body experts recommend 1 minute of rest
weights. This clarification may
fat in youth.20–22 between sets for beginners,
encourage girls and boys to engage in
year-round resistance training to increasing to 2 to 3 minutes of rest as
Additional Benefits the intensity of training increases
increase their strength reserves
After years of research, it is now without fear of getting too muscular (ie, incorporation of weightlifting
accepted that children and or impairing sports performance. movements or plyometric
adolescents can increase strength exercises).33 Training exercises
with low injury rates if resistance Numerous studies have shown that involving the core (abdominals, low
training is well supervised with an children and adolescents can gain back, and gluteal muscles) are
emphasis on correct technique. Early strength with resistance-training foundationally important for
studies successfully demonstrated programs involving technique- sports participation and can
significant strength gains in children driven progression along with provide benefit for sport-specific
and a lack of injury with proper qualified supervision and skill acquisition and postural
technique and supervision.5,7,12,23 instruction.5,7,12,23,28–30 Adequate control.7,34,35

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 One-Repetition Maximum strength improvements with biomechanics that increase injury
The one-repetition maximum (1 RM) resistance training programs in young risk.54–56
(see Table 1 for definition) test athletes and the effect on the Various prehabilitation studies are
can be administered by qualified neurologic mechanism of motor unit finding positive results in the
professionals to assess maximal recruitment. reduction of anterior cruciate
strength, determine an appropriate Performance Enhancement and ligament injuries, especially when
resistance-training intensity, and Other Uses of Resistance Training resistance training exercises are
evaluate the effectiveness of combined with plyometric
Increases in strength with resistance
a resistance-training program.36 exercises.5–7,45,52,57 Plyometric
programs have shown improvement
Previous American Academy of training involves the use of rapid
Pediatrics (AAP) policy statements in some performance measures, such
concentric and eccentric muscle
have not recommended 1 RM testing as vertical jump, countermovement
actions to enhance muscle strength
in skeletally immature individuals. jumps, and sprint time6,45–47 as well
and power in a relatively short
However, 1 RM testing that is as improved maximal oxygen uptake
amount of time, such as squat jumps.
properly administered has been with combined resistance and aerobic
Plyometric exercises may benefit
training programs.48 Resistance
found to be a valid and reliable performance58–60 and reduce the risk
training combined with aerobic
measure of strength and power in of injury. When combined with
training does not appear to impair
children and adolescents.36,37 proprioceptive training (ie, balance
Although 1 RM testing is used in strength gains in youth and may be
exercises), these programs have also
pediatric research settings and youth more beneficial than single-mode
been shown to be beneficial in
sport facilities, alternative measures training.32,49 Translation of those
rehabilitation and reduction of
(handgrip strength, long jump, and improvements to overall athletic
certain injuries, such as ankle
performance on the field or court may
vertical jump) correlate with 1 RM sprains.61
be more difficult because so many
strength and may be used to evaluate
variables are involved with actual
muscular fitness in youth.38 Research RESISTANCE TRAINING RISKS
performance, making it challenging to
indicates that 1 RM testing in children
and adolescents can be safe and separate the contribution from Injury rates in youth resistance
efficacious when established testing resistance training alone. However, training settings that adhere to
protocols are followed by qualified positive results in the area of qualified supervision and proper
professionals.36,37,39,40 performance measures, along with technique are lower than those
other aspects of sport, such as injury occurring in other sports or general
rehabilitation and injury reduction, recess play at school.4 On the basis of
Mechanisms of Strength Gains make resistance training a valuable years of research in this area, there is
Proper resistance training in children piece of the training landscape and less concern for injury from
can enhance strength without foundational to long-term athletic supervised, well-designed, and
resultant muscle hypertrophy. These development.50,51 technique-driven resistance training
strength gains are attributed and more concern for injuries that
primarily to a neurologic mechanism Prehabilitation occur because of poor supervision, an
whereby training increases the Preventive exercise (prehabilitation) inappropriate progression of training
number of motor neurons that are uses resistance training to address loads, or low strength reserves in
“recruited” to fire with each muscle and focus on joints that are youth who are not prepared for the
contraction.41,42 This mechanism commonly at risk for overuse injuries demands of sports practice and
accounts for the increase in strength (ie, enhancing rotator cuff and competition.
in populations with low androgen scapular stabilization strength
concentrations, including girls and preventively to reduce shoulder Overtraining Risks
preadolescent boys. In contrast, injury in athletes who are involved in Resistance training has more of
resistance training during and after overhead sports, such as baseball, a place in injury reduction than in the
puberty augments muscle growth by softball, tennis, volleyball, swimming, cause of injury. However, prolonged
actual muscle hypertrophy.11 Early and water polo). Research in training with heavy loads and
studies regarding resistance training adolescent athletes has shown resistance training without adequate
involved nonathletic children, but an resistance training to contribute to rest and recovery between sessions
increasing number of studies are decreased injuries.5–7,14,52,53 Injury have been correlated with increased
being conducted with competitive prevention programs may have injuries and illness,62–64 thus
young athletes.43,44 Further research greater effectiveness when started requiring similar attention as with
is needed in the area of long-term before the period of altered other sources of overtraining and

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 sensible incorporation into the yearly injuries from the use of weights and adult metabolic conditioning
training schedule. It is important to resistance training. The NEISS collects programs, the shoulder, knee, and low
account for time spent in resistance data on injuries related to strength back are most commonly injured,78
training as part of total training training equipment but does not but safety in the pediatric population
time to reduce the risk of overuse provide information on supervision, is undetermined because of a lack of
injuries. Resistance training can be program design, or training current data. As with any type of
incorporated into a year-round plan experience. This system warrants resistance training, it is important to
that varies in volume and intensity mentioning in this report to reduce have proper exercise technique,
depending on the sport season (eg, conflicting information among the qualified supervision, and adequate
preseason, in season, or off season). general public who read NEISS recovery between intense training
information. Careful interpretation of sessions.
The AAP recommends rest from
NEISS data is needed because most
competitive athletics, sport-specific
injuries reported from resistance Medical Conditions
training, and practice by taking at
training occur on home gym
least 1 to 2 days off per week to allow Certain health situations require
equipment with unsafe behavior in
for physical and psychological special attention before beginning
unsupervised settings.72 These data
recovery.65 Adequate fluid and caloric a resistance training regimen.
are in stark contrast to data from
intake is necessary to provide the fuel Athletes with poorly controlled,
well-designed studies with
to exercise, compete, recover, and preexisting hypertension require
appropriate supervision and
grow.66,67 Athletes participating in consultation with a medical
technique, making education of
high levels of training volume professional because of the risk of
parents necessary to reduce
who are underrecovered and marked elevation of blood pressure
confusion about the risks associated
undernourished are at risk for during resistance training with
with resistance training in the youth
overtraining, injury, and illness.68,69 weights. Using one’s own body weight
population.12,73–75
is an acceptable alternative until
Skeletal Risks NEISS data suggest that muscle a consultation can be obtained.79,80
Appropriately designed resistance strains account for many of the Consultation with a medical
training programs have no apparent reported injuries, and areas that are professional regarding resistance
negative effect on linear growth, most commonly injured are the hand, training is also required for young
physeal health, or the cardiovascular low back, and upper trunk; recent athletes with uncontrolled seizure
system.7,22 Explosive contractions of NEISS data also suggest that hand disorders,81 although resistance
the muscle-tendon attachment at injuries are particularly common in training has been determined to be
apophyseal areas during active play, children ,12 years old.76,77 NEISS safe in children with underlying
sports, or lifting weights may increase data neither specify the cause of the seizures that are well controlled on
the risk of avulsion fracture until injury (ie, attempting to lift a heavy medication.81,82
closer to skeletal maturity.70,71 load with poor technique) nor
Some children and adolescents
Resistance training safety is enhanced separate recreational from
may be disqualified from
when teachers, coaches, and competitive weightlifting or
participation in resistance training
instructors ensure a safe powerlifting injuries, but the data
because of certain medical conditions.
training environment and use support the need for qualified
Counseling against resistance
developmentally appropriate supervision and equipment that are
training is necessary for youngsters
teaching strategies, focus on appropriate for the size and skill level
with hypertrophic cardiomyopathy
enhancing RTSC, and have an of youth involved in resistance
who are at risk for worsening
appropriate instructor/participant training.
ventricular hypertrophy and
ratio. This ratio can vary on the basis Various intense metabolic restrictive cardiomyopathy or
of the expertise of the instructor, conditioning programs incorporate hemodynamic decompensation
program design, and training age different types of resistance training, secondary to an acute increase in
and RTSC of participants. running intervals, and repetitive body pulmonary hypertension.83
weight exercises, such as plyometrics, Resistance training should be avoided
National Electronic Injury into training sessions. This type of in individuals with pulmonary
Surveillance System high-intensity circuit training is hypertension because of a risk of
Results of the US Consumer Product typically characterized by the acute decompensation during
Safety Commission’s National performance of a maximum number a sudden change in hemodynamics
Electronic Injury Surveillance System of repetitions of selected exercises for as well as those with Marfan
(NEISS) have raised concerns about a predetermined time interval. In syndrome.83

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 Although exercise interventions that Performance-Enhancing Substances performance, and decrease sports
include resistance training may be The AAP strongly opposes the use of injury risk.12,87
beneficial for youth with cancer,84 performance-enhancing substances It is difficult to say at what age a child
certain chemotherapeutic agents and vigorously endorses efforts to can begin resistance training because
require caution. Youth with eliminate their use among children of developmental differences. If
a previous history of cancer treated and adolescents.86 Information is a child is able to begin participating in
with anthracycline chemotherapy are available for health care providers to sports activities at 5 years of age,
at increased risk for cardiotoxicity provide regarding the risks and being able to begin some type of
and acute congestive heart failure health consequences of anabolic resistance training with body weight
during resistance training, as steroids and other performance- movements at that age is acceptable
evidenced by case reports associated enhancing drugs as well as to because strength gains can be made
with doxorubicin, daunomycin or discourage youth from considering in ways other than lifting external
daunorubicin, idarubicin, and their use. For instance, the AAP has loads. An age range of 5 to 7 years is
possibly mitoxantrone.85 a training simulation on addressing when many children are often
the use of performance-enhancing involved in sports participation, and
Misconceptions and Evidence substances (available at www.aap. it is reasonable that they can also
kognito.com). benefit from the strength-building
The health supervision visit is a good
process with exercises such as frog
opportunity to explore the topic of
Integrative Neuromuscular Training jumps, bear crawls, crab walks,
resistance training, dispel the myths
kangaroo hops, and one-leg hops.88
associated with this type of exercise In this era of sedentary pursuits of
The one-leg hop is a skill most 5-year-
(Table 2), and discuss the importance technology and social media, keeping
olds should be able to perform,89
of staying physically active and children and adolescents active and
although the ability to perform more
strong. These visits can allow for the optimally developing motor skills,
complex movements will be
identification of risk factors for muscular fitness, and physical literacy
influenced by the amount of time
injury; discussion of family history, is challenging. No longer can it be
youth have practiced basic skills
medical conditions, medications, assumed that children innately know
and reinforced desired movement
previous injuries, as well as training how to run, hop, jump, and throw.
patterns. The combination of
goals; motivation for resistance Integrative neuromuscular training is
qualified instruction with technique-
training; discussion of experience; a multimodal form of training that
driven progression is likely to yield
and discussion of expectations from uses resistance exercises, dynamic
the greatest benefits for youth at
both the child and parents. It is stability, core exercises, and
any age.
valuable for pediatricians to counsel plyometric and agility training
families about the multiple health and performed in short intervals with
fitness benefits of resistance training, intermittent periods of rest.26,87 Training Age
including improvements in muscular Integrative neuromuscular training The more recent concepts of “training
strength, muscular power, sports can improve muscular fitness in age” and RTSC can be used in the
performance, injury resistance, and youth, enhance motor skill design of a resistance training
long-term athletic development. development, improve sports program. Training age refers to the

TABLE 2 Misconceptions Versus Evidence

Misconceptions Evidence
A child is unable to increase strength before Prepubertal children are able to gain strength by an increase in neurologic recruitment of muscle fibers,
puberty. and gains in strength can be made with low injury rates if resistance training programs are well
supervised with an emphasis on proper technique.
Young boys and girls may get “muscle bound” if Prepubertal strength gains occur by neurologic mechanisms, and pubertal gains may augment muscle
they resistance train. growth by actual muscle hypertrophy enhanced by pubertal hormones.
Resistance training may decrease aerobic Improvements in aerobic performance have been shown with combined aerobic and resistance training
performance in youth. programs, and combined aerobic and resistance programs do not appear to impair strength gains in
children.
Resistance training may stunt growth. Well-designed resistance training programs have not been shown to have a negative effect on physeal
(growth plate) health, linear growth, and cardiovascular health in youth.
Children are stronger now than ever before. There is a need to target strength deficits and build strength reserves due to declining measures of
muscular fitness in modern-day youth.
1 RM testing is unsafe for youth. 1 RM testing may be a safe method for assessing muscular strength in youth provided that qualified
supervision is present and appropriate testing guidelines are followed.

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 cumulative amount of time spent in superior in improving appearance-related purposes of
formalized training, and RTSC countermovement jumps, horizontal maximizing muscle mass, symmetry,
incorporates the quantity of weight jumps, and 5- and 20-m sprints over and body definition. Endogenous
lifted, the quality of the lifting traditional resistance training.47,91 anabolic hormones are necessary for
movement, and the emotional Research has demonstrated that if the increased muscle mass that is the
maturity of the athlete.26,90 As the light loads are used to learn these primary goal of bodybuilding. “Late
athlete’s RTSC advances, higher loads complex movements, and ongoing bloomers” are often tempted to try to
may be used in a technique-driven quality instruction is available for build muscle mass by increasing the
process, and a gradual progression of technique-driven progression, then intensity and volume of training;
incorporating skills requiring higher weightlifting exercises and their however, there is no substitute for the
degrees of technical ability may be derivatives can be incorporated into onset of puberty, and increased
included (ie, more advanced youth training programs safely.7 training does not hasten the
weightlifting movements and Learning how to perform these biological clock. Concerns about
plyometric exercises).7 multijoint lifts correctly requires abnormal eating behaviors, excessive
Understanding training age and the considerable time and coaching focus on body image, or use of
importance of RTSC allows for expertise. Performing these multijoint anabolic agents and other
developmentally appropriate, movements in childhood can help performance-enhancing substances
progressive training rather than youth gain competence and warrant careful screening for these
relying on previous recommendations confidence in performing these skills. behaviors in any adolescent who
based solely on chronological age. If weightlifting movements are going pursues competitive bodybuilding.
With earlier participation in well- to be incorporated into a youth
designed and properly supervised training program, the following Resistance Training Roadmap
resistance training, a 10-year-old girl guidelines are to be considered.
may already have 3 years of Suggestions for youth who are
resistance-training experience versus
 Advance in a gradual fashion, engaged in a resistance training
learning the lifts with a wooden program are as follows.
a 14-year-old boy who is a beginner
dowel then progressing to an
and has a resistance training age of 0.
unloaded, light barbell and finally
 Qualified instructors with
appropriate certifications who
Ways and Means of Improving to a weighted barbell, focusing on
understand youth resistance-
Strength proper form throughout the
training principles and the
technique-driven progression.
Gains in strength can be acquired via physical and psychosocial
These weightlifting movements
various types of resistance training uniqueness of youth should
can be incorporated into beginner
methods and equipment, including provide real-time feedback to
programs but will depend on the
body weight, free weights, resistance ensure safe and correct movement
bands, kettlebells, medicine balls, and goal of the program and quality of
development.
child-size machines. Most fitness instruction available.
 Begin with 1 to 2 sets of 8 to 12
centers use equipment made for adult  Consider training age and RTSC
repetitions using a low resistance
bodies and greater weight level, which will vary individually
training intensity (ie, #60% 1 RM)
increments, but child-appropriate on the basis of cumulative training
as proper technique is developed.
machines are available in some youth and level of instruction.
A low resistance training intensity
centers across the country.  Perform under the guidance of allows for the completion of 8 to
Dumbbells, kettlebells, and medicine a professional with requisite 12 repetitions of a variety of
balls require good balance control coaching certifications, such as exercises without undue fatigue.
and technique while being small in
size, portable, and allowing for sport-
a certified strength and  As RTSC improves and can be
conditioning specialist (National demonstrated consistently, it is
specific motions. Strength and Conditioning reasonable to increase weight in
Association), accredited strength 5% to 10% increments and reduce
The Use of Weightlifting Movements
and conditioning coach (UK the number of repetitions.
The competitive sport of weightlifting Strength and Conditioning
includes the snatch and the clean- Association), or USA weightlifting
 The program can be progressed to
and-jerk exercises, whereas 2 to 4 sets of 6 to 12 repetitions
coach (USA Weightlifting).
weightlifting movements include with a low to moderate training
derivatives of these exercises. Competitive bodybuilding is the intensity (#80% 1 RM).
Research has demonstrated that this application of resistance training  Young athletes can be introduced
type of weightlifting training is principles specifically for the to periodic phases of lower

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 repetition ranges (,6) at a higher statement on youth resistance beginning a resistance training
training intensity (.80% 1 RM) training.7 program in youth with
provided that RTSC is high.30 uncontrolled hypertension,
Resistance training is highly
 When performing more complex, encouraged as part of a multifaceted
uncontrolled seizure disorders,
multijoint exercises, such as specific cardiovascular
approach to physical literacy, exercise,
weightlifting, the importance of conditions, or a history of
strength building, fitness, and athletic
completing all repetitions with treatment with an anthracycline
performance in youth. It is valuable to
proper technique is vital to chemotherapeutic agent.
emphasize that combining aerobic
achieve proper motor control training with resistance training also 2. Seek consultation with
development. During this type of offers long-term benefits for general a pediatric cardiologist for
resistance training, fewer health and fitness. Important factors children with complex congenital
repetitions (eg, 1–3) may be concerning child health are fueling cardiac diseases for guidance on
productive to aid in motor control the need for resistance training for all safety and possible modification
development. youth. Trends of decreasing muscular of participation.
 Include all muscle groups, fitness in youth and the requirement 3. Integrate aerobic and resistance
including core muscles, in of strength for competency in training along with other skill-
a resistance training program. movement skill development are related fitness components into
 Perform the various exercises important and make it meaningful for developmentally appropriate
through the full range of motion families to be aware of the benefits of exercise training (ie, integrative
with proper technique. integrating strength-building neuromuscular training) to
activities into a well-rounded exercise create a comprehensive fitness
 Perform exercises in a particular
program for general physical fitness, program.
sequence during training. In
sports participation, and lifelong 4. In youth with overweight or
general, work large muscle groups
health and wellbeing. It is also obesity, start with basic
before small muscle groups and
important for youth who are involved resistance exercises over a more
complex, multijoint exercises
in resistance training to be able to aerobically based program to
before single-joint exercises.
participate in a safe, supportive, and support and encourage
 Achieving strength gains require nonabusive environment. Health care successful physical activity both
sessions to be at least 20 to providers, parents, and coaches who short- and long-term.
30 minutes long and performed are interested in learning more are
2 to 3 times per week on 5. Include dynamic warm-up
referred to the US Center for
nonconsecutive days while exercises in the training session
SafeSport (www.safesport.org) and
gradually increasing resistance and cool down with less intense
the AAP clinical report on organized
training intensity and volume as stretching.
sports.92
strength and RTSC improve. 6. Encourage participants to have
 Keep the resistance training an adequate intake of fluids and
stimulus effective and enjoyable RECOMMENDATIONS proper nutrition because both
by periodically varying the The necessity and appropriateness of are important for energy storage,
exercises, sets, and repetitions. a youth resistance training program recuperation, and competition.
Proper fuel is beneficial for the
 Use dynamic warm-up exercises are determined on the basis of the
caloric demands of exercise,
integrated into the training program goals and RTSC of
participants. Proper exercise performance, recovery, and
session followed by cool-down
technique and qualified supervision growth.
periods with appropriate
stretching techniques. are necessary for youth resistance- 7. Assess RTSC and provide real-
training programs to be safe, time feedback on exercise
 Youth resistance training
effective, and enjoyable. With technique to minimize risk and
programs should be technique
enthusiastic instruction, constructive maximize benefit from resistance
driven and consistent with the
feedback, and program variation, training. This can be achieved by
needs, abilities, and maturity level
resistance training can become the following.
of the participants.
a lifetime activity. Recommendations  Exercises should be
Guidelines have been proposed by the for a youth resistance training performed initially with little
National Strength and Conditioning program are as follows. or no load until RTSC
Association5 and the 2014 1. Obtain consultation with improves and proper
International Consensus position a medical professional before technique has been mastered.

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  Incremental loads may then participation before allowing the LEAD AUTHORS
be added by using either body exercise program to resume. Paul R. Stricker, MD, FAAP
weight or other forms of 11. Incorporate weightlifting Avery D. Faigenbaum, EdD, FACSM, FNSCA
Teri M. McCambridge, MD, FAAP
resistance as long as proper exercises and their derivatives
form can be maintained. into an exercise program under
 In youth with more advanced the direction of a qualified COUNCIL ON SPORTS MEDICINE AND
training age, higher loads and professional. Progress from FITNESS EXECUTIVE COMMITTEE,
a wooden dowel to an unloaded 2017–2018
intensities will be necessary
to increase muscular strength barbell as RTSC improves. Cynthia R. LaBella, MD, FAAP, Chairperson
M. Alison Brooks, MD, FAAP, Chairperson-
and power in preparation for 12. Educate athletes about the risks Elect
sports.30,43,44 associated with the use of Greg Canty, MD, FAAP
 1 RM testing may be performance-enhancing Alex B. Diamond, DO, FAAP
substances and/or drugs and William Hennrikus, MD, FAAP
appropriate to develop an
Kelsey Logan, MD, FAAP
individualized resistance anabolic steroids to discourage
Kody Moffatt, MD, FAAP
training program and monitor the use of such substances. Blaise A. Nemeth, MD, MS, FAAP
progress. 13. Enhance resistance training K. Brooke Pengel MD, FAAP
Andrew R. Peterson MD, MSPH, FAAP
8. Address all major muscle groups safety by using professionals who
Paul R. Stricker, MD, FAAP
of the upper and lower body are qualified, trained, and aware
along with the core and include of the unique aspects of youth
multijoint activities, such as and possess a recognized LIAISONS
squats and weightlifting strength and conditioning Donald W. Bagnall – National Athletic
exercises, for a comprehensive certification. Instructor/ Trainers Association
Mark E. Halstead, MD, FAAP – American
program for building muscular participant ratio is important and
Medical Society for Sports Medicine
strength and power. These depends on the experience of the
exercises may be complemented instructor as well as the training
by adding more focused age and RTSC of participants. CONSULTANTS
exercises to address sport- Licensed physical education Michele LaBotz, MD, FAAP
specific goals. teachers and certified fitness Andrea Stracciolini, MD, FAAP

9. Sensibly incorporate resistance professionals with understanding

training and account for time and experience in training youth STAFF
spent in resistance training as may provide safe and effective Anjie Emanuel, MPH
part of the total training plan to programs for children and
reduce the risk of overuse adolescents, and young athletes
injuries. Monitoring time spent may receive qualified instruction
resistance training in school- from their high school coaches or ABBREVIATIONS
and community-based programs strength and conditioning 1 RM: 1-repetition maximum
in addition to other types specialists.94 AAP: American Academy of
of training is important to 14. Use proper technique and Pediatrics
account for true total training supervision by a qualified NEISS: National Electronic Injury
volume.93 professional as necessary safety Surveillance System
10. Evaluate any symptom of illness components in any resistance RTSC: resistance training skill
or sign of injury or overuse from training program involving competency
resistance training or sport children and adolescents.

FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.
FUNDING: No external funding.
POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

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