Guidance for Strength Training in the Pre-adolescent A Case Based approach in the pediatrician - PowerPoint PPT Presentation

Loading...

PPT – Guidance for Strength Training in the Pre-adolescent A Case Based approach in the pediatrician PowerPoint presentation | free to download - id: 7d93cd-YjE2M



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Guidance for Strength Training in the Pre-adolescent A Case Based approach in the pediatrician

Description:

Title: Resistance Training in Children: Where do we stand? Author: Teri Last modified by: LifeBridge Health Created Date: 1/11/2007 4:15:15 AM Document presentation ... – PowerPoint PPT presentation

Number of Views:175
Avg rating:3.0/5.0
Slides: 62
Provided by: Teri167
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Guidance for Strength Training in the Pre-adolescent A Case Based approach in the pediatrician


1
Guidance for Strength Training in the
Pre-adolescentA Case Based approach in the
pediatricians office
  • Teri McCambridge, MD, FAAP
  • Assistant Professor of Pediatrics
  • Johns Hopkins School of Medicine

2
Teri Metcalf McCambridge
  • A. I have no relevant financial relationships
    with the manufacturer's) of any commercial
    product(s) and/or provider of commercial services
    discussed in this CME activity.
  • B. I do not intend to discuss an
    unapproved/investigative use of a commercial
    product/device in my presentation.

3
Case I
  • 9 year old male football player wants to begin a
    strength training program, but his mom has heard
    he will not demonstrate increases in strength
    until puberty and that it is dangerous.
  • What do you advise?

4
Appropriate age to begin strength training?
  • Attained the ability to follow rules
  • Achieve balance and
  • postural control (age 7-8)
  • Proficiency in their sport
  • Common sense
  • Lack of androgenic hormones?
  • Whose idea?
  • Whats the motive?

Richard Santrak
5
Is it efficacious?Why the controversy?
  • Initial Studies revealed
  • No increase in muscle strength
  • No increase in muscle cross-sectional area
  • 1983 AAP Statement
  • Committee on Sports Medicine
  • Pre-pubescent boys (tanner stage 1-2)
    demonstrate no significant increase in strength
    or muscle mass because of lack of androgens

Vrijens J Med Sport 1978 11152-158
6
Deficiencies of early research
  • Children naturally increase strength as they grow
    and mature, must have adequate controls
  • Studies were short duration
  • Studies evaluated low intensity training volumes
  • (Sets x repetitions x load)
  • Overall inadequate studies

7
Recent Research Demonstrates Significant Gains
  • Sewall, L, Micheli LJ J Pediatric Orthop
    19866143-146
  • Weltman A, et al. Med Sci Sports Exerc 1986
    18629-638
  • Faigenbaum, AD, et al. Pediatr Exerc Sci. 1993
    5339-46.
  • Faigenbaum, AD,. et al. J Strength and Cond Res
    1996 10(2)109-114
  • Falk B, et al. Sports Med.199622(3)176-186
  • Faigenbaum AD J Strength Cond Res
    200115459-465.
  • Strength gains between 36-74.3
  • No effect on flexibility
  • No effect on vertical jump

8
Mechanism of Strength Gains?
  • Not Muscle Hypertrophy
  • As measured by CT scanning
  • Occurs in boys and girls equally
  • Strength gains dependent
  • on increased motor unit
  • Activation/recruitment
  • Coordination
  • Firing
  • 8 weeks required

Ozmun, J Mikesky A. Med Sci Sports Exerc
199426510-514
9
Current AAP Policy Statement
  • 2001-Studies have shown that strength training,
    when properly structured with regard to freq,
    mode, intensity, and duration increases in
    strength in pre-adolescents without muscle
    hypertrophy
  • 2008-Agree with above and Olympic weight lifting
    may be safe in closely supervised settings but
    more research is needed to recommend.

10
Is it Safe?Why the concern?
  • Initial NEISS reports
  • 1979 half of 35, 512 weight lifting injuries
    involved 10-19 year olds
  • 1987 report revealed 8590 children 14 and under
    were treated in emergency department with weight
    lifting injuries
  • 1991-1996 20k-26k equipment associated injuries
    occurring annually

11
Problems with using this data to determine safety
  • Does not distinguish between resistance training
    and competitive weight lifting
  • Information is based on patient report of injury
  • Does not distinguish between supervised and
    unsupervised injuries
  • Does not report if weights were utilized properly

12
Is it Safer than some Sports?
  • Study by Hamill suggests strength training is
    safer than participation in
  • Soccer
  • Basketball
  • Football
  • General play

Hamill B. J Strength Cond Res 1994853-57
13
Recent literature CPSC NEISSAccidental weight
training Injuries
Myer GD. J Strength Cond Res 2009 23(7) 20542060
14
Considered Safe
  • Proper Equipment
  • Proper Form
  • Proper Supervision
  • Certified or Trained individual
  • Ratio of Adult to Student (110)

15
Health Risks--Stunted Growth?
  • Concerns
  • Arouse out of studies in Japan
  • Children performing heavy labor
  • Resulted in stunted growth
  • Nutritional deficiencies or labor?
  • Data of well controlled/designed studies no
    effect on growth or epiphyseal plates

16
CASE 1
  • Can the 9 year old begin a strength training
    program?
  • Whats the reason?
  • Is there supervision?
  • Is it necessary?
  • Is it appropriate?

17
Case 2
  • 14 year old tanner Stage 3 male basketball player
    wants to begin the clean and jerk and snatch
  • What is your opinion of these lifts?
  • Should this be a bigger concern?

18
Strength Training/ Resistance training
  • Specialized method of physical conditioning that
    is used to increase ones ability to exert or
    resist force

19
Methods?
  • Free weights
  • Weight Machines
  • Weight plates
  • Hydraulics
  • Bands/Balls
  • Body weight
  • Kettle balls

20
Other Forms
  • Brief Discussion
  • Competitive Weightlifting (Olympic)
  • Competitive sport that involves maximum lifting
    ability
  • Lifts Snatch and Clean and Jerk
  • Minimal Discussion
  • Power Lifting
  • Competitive sport involving maximum lifts
  • Dead lift, squats, and bench press
  • Body Building
  • Competition that judges muscle size definition,
    and symmetry

21
Plyometrics (Stretch-Shortening Cycle)
  • Safe and worthwhile method of conditioning
  • Typically includes hops or jumps
  • Cautious of too many repetitions

22
The Power Clean
23
Clean and Jerk
24
The Snatch
25
Dead Lift
26
Is Olympic Weightlifting Safe?
  • Data suggests safety in well supervised settings
  • Study at the USA Weightlifting Development Center

Byrd R, Pierce K, et al. Sports Biomech 2003Jan
2(1) 133-40
27
The AAPS Policy (2008)
  • Safe in Well controlled studies, emphasizing
    proper technique
  • Do not yet recommend for general population
  • Concerns regarding improper technique and injury
    risk
  • Impetus for childhood involvement?

28
Whats Really Happening
  • Survey of HS SC coaches
  • 38 of 128 Responded
  • 37 of 38 use Olympic Style lifting

Duehring MD, J Strength Cond Res 2009
23(8)2188-2203
29
Severe Injuries associated with improper Olympic
lifting
  • Bilateral Distal Radial and Ulnar Fractures
  • Disc Herniation
  • Spondylolysis and Spondylolisthesis
  • ASIS pelvic avulsion fracture
  • Scaphoid fracture
  • Death

30
CASE 2
  • Whats the difference between strength training
    and competitive weightlifting?
  • Why the distinction when recommending childrens
    participation?

31
Case 3
  • A 12 year old female soccer players parents
    wants to know if strength training can
  • Prevent an ACL tear?
  • Improve sports performance in the pre-adolescent?
  • Provide permanent strength gains once a program
    is completed?

32
Injury Prevention with Strength Training?
  • Less Shoulder pain in Adolescent Swimmers
  • Dominquez, Swimming Medicine IV 1978 105-109
  • Decreased incidence and severity of knee injury
    with preseason training
  • Cahill B, Griffith E. Am J Sport Med 1978
    6180-184
  • ACL prevention with Plyometric jump training
    program
  • Hewett, TE, et al. Am J Sport Med 1999 27699

More Evidence to follow?
33
Benefits? Anaerobic Power?
  • 30 Prepubescent male athletes
  • 12 week strength training with free weights and
    machines. 3x/week
  • Outcome variables vertical jump, 40 yd dash, and
    Wingate test
  • Results Vertical jump improved, but no other
    measures of anaerobic power

Hetzler, RK, Coop D, et al. J Strength Cond. Res.
1997 11(3)174-181
34
Sports Performance?
  • Inconclusive evidence
  • Evidence for improved
  • vertical jump
  • long jump
  • sprint speed
  • Medicine ball toss
  • Translation into improved performance is
    inconclusive
  • Limited evidence improvement

Hoffman JR (football) J strength Cond Res 2005
19(4)810-815
Faigenbaum A. Phys Edu 2006 63 160-67.
Christou M. (soccer) J Strength Cond Res 2006
20(4), 783-791
35
Strength Training and Detraining
  • Recommend Frequency in children
  • 2x/week training
  • Detraining
  • Loss of strength about 3 week
  • Despite athletic participation

Faigenbaum AD, et al. Res Quarterly Exercise
Sport, 2002 73(4) 416-424.
Faigenbaum, AD, et al. J Strength and Cond Res
1996 10(2)109-114
36
CASE 3
  • Strength training is not the end-all-be-all for
    sports
  • Just one component of various training methods
  • Prehabilitation strengthening may have some
    promise
  • Performance benefit lacking at this time

37
Case 4
  • A 15 year old, with a past medical history of
    Childhood leukemia, wants to begin a strength
    training programIs there any evaluation required
    prior to participation?

38
Athletes requiring clearance prior to
participation
  • Uncontrolled severe hypertension
  • Previous treatment with anthracycline
    chemotherapeutic agents
  • Uncontrolled seizure disorder
  • Underlying neuromuscular disorder (Cerebral
    Palsy, etc.)

39
Cardiology consultation recommended if history of
  • Hypertrophic Cardiomyopathy
  • Moderate-Severe pulmonary hypertension
  • Uncontrolled Hypertension
  • Marfans Syndrome with a dilated aorta

40
Aortic Root dilatation in Elite Strength Trained
athletes
  • 100 Elite Strength trained athletes
  • Age mean 22.1 3.6 years
  • 128 healthy age and height matched control
  • Results Aortic root diameters were significantly
    greater in all 4 locations of measurement, with
    progressive enlargement noted based on duration
    of high intensity lifting.

Am J Cardiology 2007 100528-530
41
Past Medical HistoryChildhood Leukemia/Oncology
  • Patients treated with high dose (500
    mg/M2)anthracycline therapy are at risk for acute
    cardiac decompensation with initiation of weight
    training
  • Cardiology/Oncology input required prior to
    program initiation

Steinherz, Laurel, et al. Cardiac Toxicity 4 to
20 years after completing anthracycline
therapy Jama 1991 266 (12) 1672-1677.
42
CASE 4
  • Usual preparticipation guidelines exist
  • Be aware of new recommendations, such as for
    young cancer survivors

43
Case 5.
  • The parents of a 14 year old want to enroll
    their child in a strength training program. They
    bring in a list of questions including
  • Guidance on a proper strength training program
  • How to evaluate a personal trainers credentials
  • List of respected sports training facility in
    your area

44
Initiating a Weight Training Program
  • What
  • you
  • need
  • to
  • know!

Guidelines have been established by The AAP,
AOSSM, and NSCA
45
General Recommendations(program)
  • 10 minutes dynamic warm-up and cool down
  • Program should include 1-3 sets of 6-15 reps of
    6-8 exercises
  • Include all muscle groups and a full ROM at each
    joint
  • Focus on technique and proper form
  • Recommend 2-3 non-consecutive training
    sessions/wk for 20-30 min
  • Increase resistance gradually
  • Program varied over time

.
Faigenbaum AD. Clinics in Sport Med 19 (4) 2000
46
Examples of exercises to incorporate into a
beginning program
  • Single joint
  • Leg extension
  • Multi-joint
  • Squats
  • Plyometrics
  • Squat jumps, medicine ball chest passes
  • Core strengthening
  • Sit-ups, back extensions

47
Means of progressing a program
  • Increase the resistance
  • Generally 5-10 increase in training load
  • Increase repetitions
  • Increase number of sets

48
Recommendations for Parents evaluating a program
  • Qualifications of Instructor
  • Student Teacher ratio
  • Modes of strength training that will be utilized
  • Evaluate weight stack increments (1-5 pounds in
    children)
  • Weight machine sizes
  • Will 1 weight rep max be used
  • Performance of Olympic or power lifts

49
Special Recommendations forYouth Strength
training
  • Consider decreasing training volume and intensity
    during rapid growth
  • Emphasize flexibility
  • Stress importance of proper lifting techniques
    not amount of weight lifted
  • Controlled movements
  • Proper breathing
  • Recommend against competitive weight lifting,
    power lifting, and body building until skeletally
    mature

50
Evaluating Strength Training Credentials
  • Is the program NCCA certified?
  • Do they require re-certification and CEUS?
  • Are there minimum requirements?
  • Is the exam proctored and does it have a
    practicum?
  • How long have they been certified?

51
What Credentials are recommended for Strength and
Conditioning Specialists?
  • National Strength and Conditioning Association
  • CSCS
  • NSCA-CPT
  • American Council on Exercise
  • American College of Sports Medicine (ACSM)
  • ACSM Health Fitness Instructor
  • ACSM Exercise Specialist

52
National programs for youth strength training?
  • Velocity sports performance
  • http//www.velocitysp.com/
  • Competitive Athletic Training Zone (CATZ)
  • http//www.catzsports.com/

53
Case 6
  • Are there special patient populations in your
    practice that could benefit from a strength
    training exercise prescription?
  • Overweight or At Risk for overweight patients
  • Cerebral Palsy
  • Osteoporosis or Osteopenia

54
Benefits Particular benefit for the overweight
child?
  • Cardiovascular fitness
  • Body composition
  • Bone mineral density
  • Blood lipid profile
  • Mental Health
  • Anxiety
  • Self-concept

55
Benefits Cerebral Palsy
  • Increased strength
  • Improved overall function
  • Improved Mental Well-being

Blundell S. Clin Rehab 200317 48-57
McBurney H. Dev Med Child Neuro 2003 45658-663
56
Benefits Bone mineral densityPrevention of
Osteoporosis
  • Adolescent bone is responsive to the osteogenic
    stimulus of heavy resistance training
  • Bone density of junior Olympic weight lifters was
    greater than age matched controls and normal
    adult bone density

Conroy BP. Med Sci Sport Exerc. 1993251103-9
57
Why Are Kids Strength Training?
  • Fun?
  • Improve Performance?
  • Parental Pressures?
  • Will they burn out?
  • Should they be spending more time playing
    sports?

58
AAP RecommendationsPrevention Overuse and
Burnout
  • Limit activity to 1 sporting activity a maximum
    of 5 days a week.
  • One day off from any organized physical activity
    per week
  • 2 to 3 months off per year from their sport

59
Food for Thought!
  • 0.2-0.5 of high school athletes ever make it
    to the professionals.
  • Variety is the spice of life

60
References
  • AAP COSMF Policy Statement. Strength training by
    Children and Adolescents Pediatrics 2008
    121(4)835-40.
  • AAP Overuse Injuries, Overtraining, and burnout
    in Child and Adolescent Athletes. Pediatrics
    2007 119(6)1242-1245.
  • Youth Resistance Training Position Statement
    Paper and Literature Review. J Strength Cond Res
    2009 23(4)1-20.

61
Thank you!
About PowerShow.com