Children and Adolescents

In this topic, we focus on the effects exercise and sport can have on children and adolescents. You will learn about:

• Physical exercise for children and adolescents
• Physiological effects in children and adolescents
• Health limitations
• Sporting considerations and guidelines
• Resistance training considerations and guidelines

Terminology and vocabulary reference guide

As an allied health professional, you need to be familiar with terms associated with basic exercise principles and use the terms correctly (and confidently) with clients, your colleagues, and other allied health professionals. You will be introduced to many terms and definitions. Add any unfamiliar terms to your own vocabulary reference guide.

Activities

There are activities throughout the topic and an end of the topic automated quiz. These are not part of your assessment but will provide practical experience that will help you in your work and help you prepare for your formal assessment.

Children and adolescents typically require a greater level of fitness supervision and a different training approach compared to adults because their bodies are experiencing many changes in development. As an exercise professional, it is important to be mindful of these as they will impact their ability to perform the exercises, therefore there is a need to be both considerate and cautious when developing training programs. The following terms depict the physiological changes for children and adolescents that may affect their performance in physical activity.

Pre-puberty

These changes occur during middle childhood at the approximate age of 6-11 years for girls and 6-13 for boys.

Adolescence

This refers to the period between puberty and the completion of physical growth (becoming an adult). During this growth transition, children are now defined as adolescents. Adolescence occurs at the approximate age of 11-19 years.

As the child’s body matures through each of these stages of growth, they may experience the following changes:

• An increase of strength due to the growth of their muscles mass
• Improved motor skills such as coordination and strength.

Training children versus training adults

There is a significant difference when training children, as, unlike adults, their bodies are still maturing and developing which can lead to different limitations. Select each of the following headings to find out how each difference can limit children and adolescents during physical activity.

Promoting health through exercise

A growing issue amongst youth which is led by the increasing use of technology, such as televisions, smartphones, tablets and other devices, has encouraged a sedentary lifestyle where children are becoming less enticed to be active. It is essential to encourage physical activity for growing children and adolescents to help increase their strength, flexibility, and endurance that subsequently, will assist in their overall health, lifestyle, and other general healthy habits. Promoting health through exercise in the lives of young growing children can improve their fitness and physiological function​, that in turn, helps in developing physical and social skills. These experiences can and should be introduced in a fun, exciting and challenging way.

Studies have shown that exposing children at young ages to a wide range of quality sporting experiences​ can assist in developing excellent physical, social and psychological skills by promoting fair play and positive sporting behaviour. These habits, if instilled at the correct tie, can induce a lifetime of healthy habits.

There are a variety of factors which need to be considered for children and adolescents when concerning their growth and development. They each play a key role in how the body functions or how it may be restricted during exercise. Some of these factors include:

• Age and physical development stage
• Cognitive growth and intellectual development stage
• Gender
• Hormones.

Let’s learn further on the growth and development of children, paying close attention to how it influences their training and exercise.

Pre-puberty stage

Pre-pubescent children are continuously growing at a steady pace throughout their development. The following table demonstrates the approximate growth rates per year.

Children’s age	Approximate growth rate (height) per year
0-12 months	25 cm
1-2 years	13 cm
2-3 years	8-9 cm
3 years to puberty	5 cm

Fun fact

Did you know that children will often double their birth height by the time they turn 3-4 years old? During these years, children will begin to fine-tune their motor skills. As the skeletal system matures in years leading up to puberty, motor coordination will progress. These skills will gradually improve with age and repetition and will be useful to adopt through a wide range of activities from simple child’s play, through to competitive sports.

Strength, coordination and flexibility

The first 6-7 years are an intense period for developing  physical and motor control​. The co-ordination skills of contralateral and visual tracking develop in unison and allow a child to avoid an object​. A good example of this occurs in the early stages of development when a child learns to crawl and walk while avoiding obstacles on the ground through balance. After mastering certain skills through repetition, strength development will follow. Be mindful that this skill development is important for physical safety. The same sequence of development will follow for more technical coordinating skills for children at pre-puberty and adolescence stages.

Physiological effects of muscles and ligaments

Several changes in the development of muscle growth and strength occur in children aged 6-11-years as well as physiological differences in their ligaments. Between the ages of 6-8, the larger muscles of the body tend to be more developed than the smaller muscles, with the smaller muscles continuing to develop in both size and functionality. Within the physiological development of human muscles, growth in size occurs first, followed by strengthening which creates a strong foundation for effective functioning but the time adolescence approaches. Within their skeletal development, bones growth occurs at the ends of the bones, within the epiphyseal region. Whilst this bone growth continues, the ligament structures become firm and strong with the muscle lengthen after the bone lengthens.

Training

While the height and lean body mass (LBM​) growth ratio stay relatively stable between the ages of 6-10 years (mid-childhood), this presents the opportunity to focus on children’s physical activities that will enhance their skills development, rather than concentrating on their fitness. When implementing training for the age groups six years old and above, more than just their physical abilities should be considered. The way they develop both cognitively and intellectually can also influence their ability, skill, and participation in sports. Let us look more at these to learn more about considerations when implementing training for children of these ages.

Cognitive growth​

A child’s cognitive development will gradually develop skills in comprehension, application and building on past knowledge to improve memory and recall and is associated with both maturation and increased learning experiences​. Evidence shows that an increase in logical thinking, reasoning, and problem-solving​ will assist children to further improve their technical skills during physical activities. These activities may be as basic as throwing a ball back and forth between peers or more complex such as competitive team sports.

Intellectual growth

Young children generally forget technical material in approximately 3 days​, therefore, a key element for children to obtain and improve on their technical skills in physical activities is to learn through play and repetition. Repetition of activities is generally enjoyed as there is instant gratification as they improve each time the activity is performed, thus also building their confidence. Additionally, younger children who tend to have a shorter attention span would benefit from enjoyable sporting activities, having clear instructions or structure and that requires focus and attention to body movements, for example, gymnastics or swimming.

Team sports are highly recommended for children to develop social interactions as they develop social and psychological skills by promoting fair play and positive sporting behaviour. Up to the age of 8 years old, children should enjoy a variety of  stimulating activities to develop a general base of physical and movement aptitudes. See the following video that shows a great way to introduce small amounts of exercise that is suitable from approximately 2-5 years of age before getting into technical skills that come with more developed motor skills.

Adolescence stage

Between the approximate ages of 11-19, children will go through a growth spurt. This growth spurt occurs at roughly the same time however, it can vary between individuals and also between regions of the body, for example, the growth rate of arms and legs will reach its peak before the trunk.

During the approximate ages of 11-15 years, the early stages of adolescence, the body can maintain a high level of movement and co-ordination only when maximal and submaximal muscle contractions are not required​. It is important to be mindful that movement coordination can be affected by emotional fatigue as the central nervous system (CNS) of this age group is not yet fully developed​.

Motor development

During adolescence, the area of motor development has a strong focus in developing increased coordination, speed and balance. An example of this is reflected in the gross motor skills used in activities such as cycling, ball games and swimming​ but also in the fine motor skills used in activities such as writing and drawing​. Studies have shown that reaction times start off slow with children at the ages of 6-8 years old and gradually increases. It is important to note that very early training may produce learning of a less economical nature, therefore, training programs should be designed with both ability and development in mind in order to ensure timely progression without overtaxing a stimulus.

The following graph illustrates the reaction time for various age groups for their physical reactions.

Please note: The red line reflects the average reaction time and the orange bar reflects the reactions of 25–75% of the participants.

Physiological effects of muscles

During the early stages of adolescence, an increase in strength is developed that is due to the further development of muscle size, this is more noticeable in boys than girls​. The following table shows the sensitive periods for the development of static strength and power in limbs that occur with both genders at different stages.

Gender	Static strength	Leg and arm power
Male	Approximately 13-16 years	Approximately 13-16 years
Female	Approximately 11-13 years	Approximately 10-13 years

Hormones

Adolescence comes with many physiological changes that are driven by hormones. Androgens are a group of sex hormones, the most commonly known is testosterone, which plays a major role in kick-starting puberty and is responsible for many of the physical changes in children’s bodies. With androgens present, not only are bodies maturing and taking shape into adulthood, but androgens also are an essential part of shaping the body through hypertrophy of the skeletal muscular system. The ability for body shaping is limited without androgens. Other beneficial roles of androgen include:

• Providing aid in modulating cardiovascular function
• Increasing the oxygen-carrying capacity of the blood​ that helps improve stamina and endurance
• Increasing the strength and endurance of children when training.

Gender

Whilst there are no physical or psychological reasons as to why girls and boys cannot play sports together, it is important to note, at the onset of puberty, there are significant differences in their development, this is specifically due to differing hormone levels which can give rise to specific changes within male and female physiology. The following are some considerations when implementing training for different genders.

Strength and height

Males are generally stronger and taller than females​. This is attributable to the hormone testosterone which is released at puberty​. It is suggested that post-pubescent girls should not participate against boys in heavy collision sports because of the risk of serious injury due to lesser muscle mass per unit of body weight​.

Development of breasts

With the onset of puberty, the development of breasts in females may affect the ability for vigorous training due to their sensitivity, size, and sportswear. Breast development is not affected by moderate amounts of physical activity.

Posture in females

A female’s posture may be hindered during puberty by the attempt of hiding their growing breasts. This can cause young developing girls to adopt a forward head and rounded shoulders, typically once breasts are developed, the body will return to its usual posture into adulthood. ​It is however important to encourage proper posture through exercise.

Competitive drive

Studies have found that females do not often have the same competitive drive as males. Consequently, this may influence the amount of effort put into any given physical activity, particularly with competitive sports.

Weakening pelvic muscles in females

As females enter puberty, a physiological weakness of the pelvic muscles occurs in preparation for childbearing. Weak pelvic muscles can contribute to various poor body functionality in the pelvic region, for example, dysfunctional bladder and having a prolapse. This generally occurs in adulthood; however, it is important at a young age to consider implementing pelvic floor exercises to help in preventing any future complications.

Widening pelvis in females

The pelvis typically widens during puberty, creating a larger Q-angle, preparing the female for childbearing. This change in pelvic structure is associated with orthopaedic dysfunction at the hip, knee, ankle, and foot which should be observed during training with exercises adapted to support and enhance optimal motor patterns. Sports that require pivoting should be performed with care or avoided and it is suggested to strengthen the quadriceps muscles along with a focus on hip, knee, and ankle stabilisers.

Female menstrual cycle

Young female bodies will begin to express the hormone oestrogen which is responsible for the beginning of their menstrual cycle (menarche). This typically occurs around 2-3 years following their growth spurt at the average age of 12-13 years. Implementing physical activity will have no impact on the reduction in the production of hormones responsible for normal growth​ and development, however, it is important to note that energy levels may decrease along with the willingness to participate in an activity, particularly activity where genders are mixed due to possible embarrassment and the learning of managing their menstrual cycle.

Flexibility

Flexibility is closely linked with age and physical maturity​, with children, have greater mobility in their joint that decreases with age. However, joint laxity is more commonly seen in females than in males giving rise to greater rates of hypermobility in females than males, one reason why it is common to see female gymnasts. It is important to be careful of joints with hypermobility as they can be less protected from physical stresses and prone to injury.

Gender stereotypes

Throughout history, the perception of genders along with their ability in skills, expectations of performance and conduct in both males and females, has impacted their participation in physical activity. Click on each of the following stereotypes to read more about dissolving these assumptions when training children.

After having read some of the stereotypes, it is important to note that these assumptions should not impact training on either gender. Physical activity should always be encouraged to maintain a healthy lifestyle, with the consideration of a few factors within gender differences that can be adjusted to suit the individual child and further improve their fitness levels. Despite any gender difference, the frequency, duration and intensity have similar effects, in other words, comparable physiological and biochemical changes leading to greater working capacity can be produced in both genders following similar training programmes.

The musculoskeletal​ growth and injuries

The musculoskeletal system, composed of both the muscular and skeletal system, is a solid framework that supports the body​ and its structure. It grows at a steady pace and stops growing at a length that is predetermined by genetics. The growth in the length of children’s bones takes place within the ends of the bone, in the region referred to as the growth plate which is also known as the epiphyseal plate. Bones reach their maturity when the plates fuse together with most of the growth occurring from the age of 9-16 years but, this may vary due to the predetermined genetic make-up of the child. Unfortunately, if an injury to the bone occurs during its growth period, it may likely have a permanent effect on the growth​. Musculoskeletal Injuries include:

• Growth plate injury 
• Broken bones 
• Head and neck injuries
•  Overuse injuries.

Injuries to the epiphysis can be very serious. When damage such as cracks or breaks to the growth plate or specialised joint cartilage occur, there could be abnormal growth or degenerative (wear and tear) arthritic changes later in life if not treated correctly.

Bones in children are considerably flexible, however, are not susceptible to fractures. An immature bone that has good blood supply is easily healed through a plaster cast. It is vital that if any bones are suspected to be injured, the children must immediately be referred to a doctor for an x-ray. Have a look at the following training considerations when implementing training on children with growing bones.

Training Considerations​

• Bones of young children are susceptible to injury associated with heavy training​
• Bone-related problems such as stress fractures, epiphyseal plate fractures, and Osgood-Schlatter’s disease (repetitive-use injury which occurs in children which results in a painful lump below the knee cap) frequently arise in response to heavy repetitive loads.

Muscular System​

It is believed that the genetics of an individual is responsible for the composition of muscle type, some change is still possible when implementing the correct training​. Muscle development gets a boost through puberty thanks to an increase in hormone production, which in turn makes it a critical stage of choosing muscle groups to train for athletic adolescents that are aiming to develop and grow muscle tone and strength.

Fun fact

Muscles (and children) have a mixture of both fast and slow-twitch fibres, the ratio of both is typically genetically pre-determined however, the ratio can be somewhat altered through relevant training but a complete fibre type reversal is not possible, training cannot overpower genetics.

Cardiovascular Capacity

Children require daily bouts of exercise such as running, swimming or cycling to promote the development of their heart and lungs through normal muscular activity​. Heart size increases slowly between 4-10 years​. If the cardio-respiratory system does not develop in unison with the musculoskeletal system, a child’s ability to cope with normal daily exercise will reduce, implying, the younger the child, the lower the proportion of anaerobic energy they can generate.​ Physiologically, females are 1-2 years more advanced than males at the end of this phase​.

Children, compared to adults, require more energy in the form of oxygen when performing exercise or physical activity. Oxygen is a key transporter of energy fuels around the body with the main organ responsible for its distribution being the heart. As the internal organs of a child are still developing, the average heart size of a child is smaller than that of an adult, therefore, this results in a limited oxygen distribution, along with lung capacity being smaller which limits their oxygen uptake. Overall, this means that a child’s oxygen consumption and distribution is lesser than that of an adult which in turn means children will have a different (lesser) capacity of intense cardiovascular activity. This implies children require more oxygen to work at the same rate and so, thanks to nature, children have a higher heart rate than adults in order to meet this demand. As a result of this decreased efficiency, children are less effective in short duration, high energy-demanding activities like sprinting in comparison to adults.

Sadly, 5 in 1000 children are born with a form of heart defect, however, only 2-3 of these children have severe conditions that actually limit their physical activity. With this in mind, proper pre-screening is essential along with proficient and qualified supervision when exercising in order to detect signs such as breathlessness which should be further investigated by a doctor.

Children and adolescents may suffer from a variety of medical conditions that can impact their ability to engage in physical activities. The following are three common medical conditions:

• Asthma
• Diabetes
• Epilepsy.

Let’s look at each of these in more detail to be well equipped when designing an exercise session for children and adolescents that suffer from these conditions.

Asthma

Asthma is a medical condition that affects the airways and is characterised by the following three factors.

1. Bronchospasms occurs when the muscular lining of the airways undergoes involuntary muscle contractions (spasms) and results with loud laboured breathing.
2. Swelling of the lining passages that leads to contraction of the bronchioles (airway branches) limiting the airflow travelling in and out of the lungs.
3. Increased production of mucus and phlegm.

The following image illustrates the internal changes which occur within the bronchi and alveoli with asthma. You will note the progression of severity which is demonstrated by the final image where the respiratory tract completely obstructed.

Asthma attacks can be induced either by allergens or by exercise intensity (or both) however, having asthma should not stop a child from participating in physical activity. Instead, actions can be put in place to help manage this condition. For instance, the child should have a management plan from their doctor in case of an adverse reaction. An asthma attack can also be prevented by ensuring the child has a proper warm-up before the exercise activity and cool down afterwards. The following are some other possible triggers for asthma.

• Seasonal pollen from grasses or flowers​
• Animal fur​
• House dust​
• Cigarette smoke​
• Cold air​.

Fun fact

Did you know that in New Zealand over 521,000 people take medication for asthma? Studies have shown that between 7-10% of New Zealand children are affected by asthma. ​Regrettably, the severity of this condition, particularly in children, see large numbers of children admitted to hospital.

Diabetes

Diabetes is a medical condition that affects 10-15% of children and adolescents. There are two types of diabetes. Select each of the following types to find out more.

Managing diabetics through exercise

It is recommended to include regular exercise and follow a healthy diet as these play a significant role in managing both types of diabetes types. It is important to note, however, that excessive exercise and insufficient amounts of food can lead to low blood sugar levels (hypoglycaemia) therefore proper planning and exercise selection should be conducted in order to ensure safety during and after exercise sessions. Therefore, as a fitness instructor, it is important to be aware of any diabetic children so that appropriate precaution can be taken​, being mindful when diabetics exhibit symptoms of sweating, headache and excessive hunger. This may also include flexing the F.I.T.T principles and adapting aspects of the program such as increased rest periods or selecting alternative exercises where appropriate. Should you provide sweets or sugary drinks, ensure this during the period of low blood sugar only (hypoglycemic events) only. The following are simple guidelines for a physically active diabetic to follow:

• Exercise after a meal or snack​
• Follow a regular exercise program​
• Hypoglycaemia is common after exercise, not during exercise, unless low food intake prior to training​
• Avoid exercise before bed to prevent low blood sugar at night​
• Avoid exercise when diabetic control is poor​
• Take regular drinks or food during prolonged sports, for example, cricket, tennis and golf.

Epilepsy

Epilepsy is a common neurological disorder affecting 1%-2% of the population of New Zealand. It disrupts the brain activity by incurring sudden bursts of uncontrolled chemical or electrical activity in the brain that can result in seizures. ​Seizures are one of the symptoms that epilepsy can bring on and can range from dramatic to less dramatic fits along with brief lapses of concentration.

Have a look at the following video that further explains the different types of seizures that can occur with epilepsy.

Managing epilepsy

When implementing any type of training for children and adolescents who suffer from epilepsy, it is essential to discuss how epilepsy present for them and how they manage it along with how you can support them. During exercise, pay close attention to them during certain activities, for instance, sporting activities such as swimming (water-based activities) or scuba diving as an underwater seizure is life-threatening and should involve extreme close supervision.

It is advised that the best way to deal with a child having a seizure is to allow the normal seizure to run its course. It is important to not restrain the child, ensure that they are away from any sharp objects and their head is safe / protected allowing the seizure to run its natural course. Following the seizure, the child will feel tired or sleepy and it is wise to restrict activity during this time.

Training children and adolescents in sporting activities will require to have a well-rounded understanding of their physical and intellectual capabilities that will help to instruct, demonstrate and assist them in performing physical activity both safely and effectively. Some of the following are some basic considerations and guidelines when planning activities for children and adolescents:

Let us take a closer look at each of these in closer detail.

Communication

It is essential to develop a comfortable environment that encourages a positive, two-way conversation to occur when communicating with children and adolescents during training. The following seven handy pointers should be kept in mind.

1. Vocabulary: for any messages conveyed clearly and not to be misinterpreted, vocabulary needs to be adjusted for the different age groups. Young age groups may still be developing their vocabulary and may not always understand an instruction if a foreign word is used
2. The tone of voice: speed, volume, clarity and expression should be kept positive when communicating. Studies have shown that stress impairs learning in girls. This does not mean some boys may not feel the same pressure when hearing a stressful, yelling voice. Remain patient and when yelling out (as there may be a need in some sports to do so), ensure the tone remains positive and the speed of your words are moderate for clarity and calmness when communicating.
3. Listening: communication without listening is not a good exchange of words. Concentrate on listening for the real responses and comments of children and adolescents and help respond to any queries.
4. Body position: when speaking directly to a child or adolescent, it is respectful to communicate at eye level, the body should be facing forward so they feel you are directly communicating with them. For the younger children, this may mean you need to get down on one knee when
5. Observation: when a child or adolescent is showing disinterest, confusions or even signs of illness, many times these can be identified when observing their non-verbal communication. If these cues are picked up, this can assist to adjust the training or attending to their needs appropriately.
6. Verbal feedback: observe children’s actions and use well-framed questions​ to ensure you are gaining feedback on how they are enjoying the training as well as any areas of difficulty or strain.
7. Avoid gender stereotypes: It can be easy to fall into a trap in assuming certain stereotypes due to gender, however, it is important to remember that using gender stereotypes may be offensive but also limit a child’s abilities to progress and further develop in areas of interest and skill.

It is important to obtain information pertaining to any medical conditions prior to implementing and undertaking and training with a child, note that this information will typically be provided by the child’s parent or guardian, or a designated adult such as a caregiver.

Demonstration​

A demonstration is extremely effective as most children will gain more from simple clear demonstration than a verbal delivery alone. It is important to note, however, that when training a large group, some participants might not be able to see or hear the demonstration, therefore, a few modifications in the delivery to children are required. Click on each of the following to view some handy tips to use when performing a demonstration to large groups.

Organisation​

Before any training begins, it is essential to have a plan. See the following tips on how to be organised when training children and adolescents.

• Scope out the best use of time, space and facilities available by employing simple, clear methods for training
• Have a few safety plans for potential physical and psychological issues they have presented themselves.

The following are handy tools when organising a well-structured sporting activity:

• Give everyone responsibilities such as having all the children involved in the process of setting up and/or packing up
• Ensure that there are allocations of simple tasks that promote leadership​. This could be as simple as asking a child to choose their team players, allocating a child to be in charge of a team of children who are setting up or putting away equipment, allowing children to create their own game as a group, or encouraging children to praise each other and give positive feedback.

Safety considerations and guidelines

There will never be a risk-free environment during a sporting activity, however, there are precautions that should be put in place to help provide safety measures for children during training. Prior to beginning a training regime with children, it is of value to obtain health screening information which would enable the safe development of a session or program along with standard assessment information which enables the tracking of progression and development of each of the participants. Having information regarding each of these will give background knowledge that will help make any appropriate adjustments to the training, along with having awareness of any potential adverse reactions which may occur. The following table illustrates some standard information which should be collected prior to commencing a sporting activity that will help create a safer environment for children and adolescents.

Assessment measures	Screening considerations​
Height​	Cardiac health
Weight​	Asthma​
Girth Measurements	Juvenile diabetes​
Skinfolds​	Epilepsy​
Heart rate	Arthritis​
Peak VO2	Cystic fibrosis​
	Obesity​
	Musculoskeletal injury

A session or program design should also consider their general safety and management of potential injuries whilst keeping in mind the stages of development of a child’s body, motor skills and ability to perform certain activities. For instance, a pre-pubescent child will be more skilful in activities involving large movements such as running, than those involving fine co-ordination​. Typically, there is a lack of coordination and reduced flexibility in some children​ due to a delay in muscle lengthening, as this occurs after the lengthening of bones. This can affect the ability to give maximum performance, it is therefore important not to push children to achieve this. An alternative suggestion, to enhance the development of movement and coordination, is to use circuit type exercises, using bodyweight with light weights can be used, however, only if under appropriate supervision. Furthermore, the use of activities that require maximal or submaximal muscle contractions​ is best avoided.

Another area to be mindful of is overuse injuries as a child’s body is susceptible to injury through excessive stress​. These overuse injuries occur when too much stress is applied to the body and normally through repetitive movements that result in injured growth plates and tendon-muscle attachments. These injuries should be taken seriously and require medical attention​. The following list gives an easy guide to preventing overuse injuries.

Preventing overuse injuries​ in sporting activities

• Children should be evaluated by a physician ​before participating in sporting activities
• Parents should be educated about the benefits and risks of competitive sports and should understand the importance of general fitness to their children.
• Children should participate in a year-round conditioning program to enhance flexibility, strength, fitness​
• Nutritional status of active children should be monitored​
• Fitness professionals should participate in educational programs to learn more about conditioning, sports skills, safety, equipment, and the physiology of growth and development​ for children and adolescents.
• Children should not be pressured excessively to perform and should be encouraged to participate in a variety of sports and activities.

Including regular sporting activities in a child’s routine will promote good overall health and help avoid poor sedentary behaviours. Whilst, safety is a good place to start, there are additional suggested guidelines that can further assist in implementing safe and effective sporting activities for children. Let's learn more about the following guidelines.

Daily exercise

Children should be exposed to 20-30 minutes of energetic exercise daily. This will promote a healthy and active lifestyle that can impact a child’s wellbeing.

Warm-up and cool down

A well-structured warm-up and cool-down, which allows sufficient time for the body to be prepared for exercise (and recover from),​ should be a normal part of all sessions as these will help prevent adverse reactions.

Sport with purpose and for fun

Emphasise on the enjoyment and skill development​ of a sport to help the child stay motivated and adhere to the sporting activity. A poor experience during a sporting activity might discourage them from other sporting activities and, in turn, lead them to steer away from an active lifestyle.

Stretch

Emphasise the importance of stretching, ensure it is implemented carefully without forcing or producing pain​. Stretching will improve flexibility and help in releasing tension in the muscles. Include flexibility exercises to develop and maintain muscle elasticity

Safe play

Train and encourage children to play safely in all training practices. This might mean being safe for themselves or when playing as a part of a team, conducting their themselves safely for others.

Overuse injuries

It is suggested to not implement excessive training as excessive stress on muscles and joints​ with repetitive movements and the use of inappropriately heavy weights can impact the growth and development of the child.

Resistance training is becoming more utilised when training children and is commonly used in schools alongside their usual sporting activities. One of the well-known benefits of implementing this training is that it is a safe and effective method of improving the decline of muscular fitness in children and adolescents. This is because this type of training aims at gradually increasing the resistance load to achieve muscle strength, endurance, flexibility and stability. Different types of resistance training may include some of the following equipment:

• Weighted equipment such as barbells, dumbbells, medicine balls or kettle bells
• Body weight exercises
• Machine-based exercises
• Resistant bands.

Let’s look further into resistance training, its benefits, considerations and guidelines when implementing this method on children and adolescents.

Resistant training for children

Though early studies failed to demonstrate an increase in strength in pre-adolescents who participated in resistance training, more recent studies have demonstrated that boys and girls can increase muscular strength above that of normal growth and maturation​. Incredibly, it was identified that children as young as 6 years have been shown to benefit from resistance training​. Statistics showed that children can improve their strength by 30% to 50% after just 8 to 12 weeks of a well-designed strength training program and need to continue to train at least 2 times per week to maintain their strength (Dahab & McCambridge, 2009). Some other potential benefits to resistance training include the maintenance of the quality of the bone density (along with a calcium-rich diet) during adolescence. Additionally, due to an increase in balance, strength and flexibility in children, it has been said that it promotes increased self-esteem and confidence ​in children as these agilities will assist their performance in other physical activities such as specific sports.

Fun fact

Did you know that resistance training may decrease a child's risk of injury? Statistics illustrate an approximate 3 million injuries occur during sporting participation in the United States of America. It has however been estimated that half of these injuries (50%) could have been prevented by a conditioning process.

Program design considerations

The goal for most children is the development of a complete skill set. ​Resistance training can form one part of a well-rounded exercise program for children​. The following are considerations to assist in designing a resistance training program for children. You will note that many of the considerations are standard approaches used among other training sessions with children such as clear communication.

Screening

A pre-training medical history is not mandatory for apparently healthy children, nonetheless, participants should be screened for injury or illness that may help prevent any injuries or adverse reactions during training.

Educating children

​The goal of resistance training should not be limited to only increase the child’s muscular strength, it should also include teaching children about their bodies, promoting an interest in being active and importantly, having fun! This encourages and creates active lifestyle habits that may last a lifetime. Children who enjoy physical activity and sports are more likely to be active in their adult life.

Quality program design

Two important areas of concern when designing resistance training programs for children are the quality of instruction and the rate of progression​. Instructions should include verbal communication along with a clear demonstration that may need to be repeated. At this stage, it is ideal to determine if the instructions have been well interpreted and incorporated to measure the rate of progression during the training, if not, fine-tune and repeat the verbal and visual delivery.

Communication

Speak with children at their level so they will understand​. Use basic language, avoid technical terms or jargon, keep communication clear, concise, positive and ensure clear instructions are clear and easy to understand also.

Competitiveness

It is known that stress can impact children’s abilities to learn and focus during training, it is therefore suggested, more so for younger children, to downplay competition between participants​. This helps to reduce any feelings of pressure and allow the child to perform to their best of ability whilst having fun.

Limit numbers in a training group

Aim to have an exercise professional to participant ratio of at least 1 to 10.​

Mix it up

It is important to have a variety of training programs and to aim to keep the designed training programs ‘fresh’ and challenging.

Technique

​Multi-joint exercises can be incorporated, so long as the focus remains developing a proper technique. When learning new exercises, children should start with lightweight or a with guidance via long wooden stick which provides education on posture and good technique when performing the exercises.

Simple guidelines for resistance training on children must be adhered to for safe and effective implementation. These include the following:

• Each child should understand the benefits and risks associated with resistance training​
• Competent and caring exercise professionals should supervise training sessions​
• The exercise environment should be free of hazards, and equipment should be in good repair and able to be modified to fit the child​’s height comfortably
• Warm-ups/ cool-downs and stretching exercises should be performed before and after resistance training​
• Careful monitoring of each child's exercise tolerance
• Begin with light loads to allow appropriate adjustments to be made​
• Increase weight loads gradually by approximately 5-10% as strength improves​
• Depending on individual needs and goals, 1-3 sets of 6-15 reps on a variety of single and multi-joint exercises can be used for resistance training
• 2-3 non-consecutive training sessions per week are recommended
• Encourage children to drink plenty of water to stay well hydrated
• Adult spotters should be present to ensure form and safety​.

Overall, children and adolescents as a special population will require the support of an exercise professional that can approach the training and sporting activities that are implemented for children in a well-planned, safe, and effective manner. One key element to be mindful of is the importance of educating children in the importance of physical activity, introducing children to an active lifestyle and most importantly, the ability to adhere to regular exercise for long term health benefits.

There are many factors to consider before and during training such as knowing how to adjust the training to child’s age, needs, limitations, goals and so on. As the exercise professional, take the time to get to know the needs of your training group and how to best design a program which encompasses their physiological and psychological development needs, importantly- have fun!

In this topic, we focused on the effects exercise and sport can have on children and adolescents. You learnt about:

• Physical exercise for children and adolescents
• Physiological effects in children and adolescents
• Health limitations
• Sporting considerations and guidelines
• Resistance training considerations and guidelines