As we all know, good things come in threes. This is the third and final post on resistance training in adolescents. If you have not yet read the first two articles, check them out here: Part One and Part Two. As you will now know, we have so far discussed the overall safety of resistance training in children and adolescents and some of the health benefits. This final article will take up where the second let off, and discuss some more benefits, key points for resistance training in adolescents and also my own experience of developing a resistance training program with young athletes .
Childhood obesity is an ever developing epidemic, the percentage of obese children and adolescents almost tripled between 1980’s to 2000 in the US (Ogden et al., 2008). Regrettably the numbers have not significantly lowered since. In fact, at the current rate it is predicted that 65 per cent of young Australians will be overweight or obese by 2020 (Better Health Channel, 2010).
There has been numerous health problems associated with obesity;
- Type 2 diabetes
- Eating disorders such as bulimia and binge eating
- Orthopaedic disorders
- Liver problems including fatty liver
- Respiratory disorders
- Sleep apnoea
- Social impact (obese children are more likely to have low self-esteem)
While there is conflicting evidence, something we should be used to by now, an 8 week resistance training program has been shown to significantly decrease absolute percent body fat and increase lean body mass (McGuigan et al., 2009). Resistance training is also proposed to increase metabolic rates. This suggests that a well designed resistance training program will be beneficial for weight loss. In addition, the enhancement of motor skills has the potential to improve a child’s motivation to participate in sport through improved self-esteem and enjoyment.
However, as a sport physiotherapist you are just as likely to be working with fit and healthy athletes. We know that the body requires a certain percentage of body fat to function. Adipose tissue plays a role as energy storage and protects the internal organs. So it will be important to ensure that a holistic approach is taken. This will include looking at things like appropriate nutritional intake, balancing the training regime and monitoring their measurements (body fat, lean mass etc.).
As a side note, one concept I regularly remind my young athletes (mainly females but certainly not limited to them) about is that overall weight is not a good measurement to monitor closely. This is especially when undertaking a resistance program where one of the aims of the intervention is to gain lean body mass. Weight is something that you would expect to be increasing, as the child or adolescent grows taller, gains muscle and bone density. So it is important to reassure your athletes that it is still important to eat right and be active and that total body weight is only part of the picture. The same would go for the BMI measurement, if you were to go through the ‘stat’s page’ of your favourite football team you would find a lot of them would fall under the over-weight or obese category, yet it would be nonsensical to label them as such.
Mental or ‘Health of Mind’ Gains
Gretchen Reynolds recently posted an article online for The New York Times about the benefits seen with elderly women from resistance training. She discusses the studies that have shown changes in the ways of thinking and blood flow through the brain. For more details read her post here.
Fortunately for our young athletes similar benefits, with varying degrees of evidence have been seen with exercise. Just to list some:
- Reduced depression
- Reduced anxiety
- Improved self-esteem
- Improved cognitive performance and academic achievement (Biddle & Asare, 2011; Ekeland et al., 2005)
Looking specifically at resistance training, we know the benefits are seen in different population groups, both elderly women and adults (Melnick & Mookerjee, 1991; Tucker, 1987). The research suggests that similar benefits could occur in children and adolescents (Faigenbaum, 1995). Resistance training also reduces the overall risk of injury (reducing time away from general exercise).
Therefore, it is not entirely unsubstantiated to conclude that there are health of mind benefits from resistance training in children and adolescents. Further high quality research will be needed to determine the extent of the benefits and if the effects are direct or indirect.
Type One Diabetes or ‘Juvenile Diabetes’
We know that exercise is beneficial for those with type two diabetes mellitus (T2DM). We also know that resistance training has been shown to be beneficial in the management of T2DM. It is unfortunate that the figures suggest both the numbers of T2DM and juvenile diabetes (T1DM) have been increasing, within both children and adolescent populations (White, 2005). In fact, on average there are two new cases of T1DM in Australian children every day (Australian Institute of Health and Welfare Canberra, 2010).
Unlike T2DM, exercise has not been shown definitively to improve glycaemic control in T1DM. However, with appropriate screening and qualified supervision resistance training can be safely undertaken by children and adolescents with T1DM. The American Diabetes Association state that all levels of exercise, from leisure activities to competitive professional performance, can be performed by individuals with T1DM who do not have complications and have good blood glucose control.
There are several things that need to be understood, monitored and managed for individuals with T1DM. For this population group specific knowledge is required and any resistance training program with individuals that have T1DM should only be ran by those with the specific qualifications that cover such knowledge. Appropriate arrangements should also be made prior to the commencement of the program. This would include looking into matters like pre-participation assessment by their GP and insuring that the correct equipment and medications are available. Both the Australian Institute of Sport and American Diabetes Association offer detailed advice on how to manage individuals with T1DM during exercise (click the links to be taken to the relevant pages).
Guidelines for Resistance Training in Adolescents
It is fairly easy to come across quite extensive guidelines for running a resistance program with children and adolescents. I will not try and ‘compress’ them into this already lengthy post. However, I will list some of the key points and add a little bit about my experience with resistance training programs with children and adolescents. If you are interested the sources of some of the below guidelines may be accessed via:
- American Academy of Pediatrics; Strength Training by Children and Adolescents
- Australian Sports Commission; Weight Training for Young Athletes
Key Points for Resistance Training in Adolescents
The following are a few key points for implementing resistance training programs in adolescents:
- Children and adolescents should undergo a medical examination prior to commencing a resistance training program
- Resistance training should not commence before adult levels of balance and postural control skill are achieved (normally by 7 to 8 years of age)
- Participants should have a good level of skill proficiency in their sport before adding resistance training to their training regime
- Warm-up and warm-down should be standard components of the program
- Explosive and rapid lifting/movements should be avoided
- Maximal lifts should be excluded and discouraged
- Initially the focus should be on technique before progresssion
- Adolescents and children should initially perform one to three sets of 6 to 15 sub-maximal repetitions of a variety of exercises
- Exercises can be progressed in the following ways:
- Increase the training volume (more reps/sets, longer session)
- Increase the amount of resistance lifted/moved
- Increase training frequency (more session per week)
- The 10% rule is a reasonable guide here – limiting increases in training frequency, intensity (amount of resistance) and duration to no more than 10% per week.
Rest periods need to be incorporated into the training program. This needs to consider the whole training regime of the athlete. Young athletes will often be associated with a number of teams and clubs even within the one sport, this may include school, club, regional and state teams. As the supervisor or treating physiotherapist of the young athlete it may be required of you to be the liaison between the different teams to ensure that appropriate rest is allowed. This would also be pertinent in situations where the player was injured and required a rest period.
It should be noted that no significant gains were seen with 4 or greater days of resistance training per week (compared to 2-3). To reduce the risk of overuse injuries, sessions should be kept to a maximum of 3 per week and they should be undertaken on non-consecutive days.
My Personal Experience
My most recent experience with a resistance training program with young athletes was a cohort of promising swimmers, aged 14-21 including both male and female athletes. A personal trainer and I ran the program. Each had between six to fourteen athletes. There were three sessions held a week, however, the swimmers were only expected to attend two. I found two main challenges when conducting resistance training programs with children and adolescents.
The first and main challenge when conducting the sessions was maintaining the focus of the athletes. The athletes had a good understanding of the importance of correct technique and the benefits of focusing on the task at hand. Yet they would often take advantage of the fact that their heads were above water and they could actually talk with each other during the session. To reduce this distraction we would regularly change the program (cycling every 4-6 weeks) and we would often change the style of the program (from a set routine to circuit type activities etc.) The circuit programs were very successful. Regrettably the facilities were not available as often as we would have liked, but that’s reality for you
The second challenge was the introduction of new swimmers. We would deliberately focus on the most basic skills first and then build on those. However, with a new swimmer quite often their basic skills would be lacking and require almost one on one training to catch them up to the same level for the rest of the group. We were able to manage this on most sessions, as we always had two instructors and often less than 10 athletes. On the occasions were we had a full group we would often have to get the new athlete to follow a very simple program until we had the time to focus on progressing the basics.
Clinical Implications and Take Home Messages
- Young athletes will demonstrate strength gains with a resistance program
- Some specific populations (e.g. with cerebral palsy or juvenile diabetes) can benefit from a resistance program, either directly or indirectly.
- A resistance training program will facilitate increasing bone mineral density in children and adolescents
- A well organised and structured resistance program will aid in the risk reduction of injuries
- Resistance training can help with improving body composition (total body fat, lean mass)
- There are direct and indirect benefits of resistance training for children and adolescents in terms of mental health. However, this needs more high quality research
What Are Your Experiences?
We would love to know what your experiences have been with adolescents and resistance training? Have you achieved some of these benefits or successfully implemented these interventions in adolescents? What are the challenges that you have faced? Be sure to let me know in the comments or catch me on Facebook orTwitter
About the Author
This is another great guest post from Christopher Snell. Christopher is an Australian physiotherapist who graduated from Monash University (Melbourne). Professionally he has worked with local level swimming and football (both soccer and AFL) clubs as a sports trainer, strength and conditioning coach and physiotherapist. His clinical interests include acute sports injuries, knee rehabilitation and dry needling. He is currently employed at Waverley Park Physiotherapy Centre.
Photo Credit: just.Luc
Australian Institute of Health and Welfare Canberra. (2010, August). Incidene of Type 1 diabetes in Australian children 2000-2008. Diabetes Series no. 13.
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