Promoting Active Futures: Exploring Physical Activity in Youth

Abstract

Physical activity is essential for the healthy development of youth, promoting overall well-being and reducing the risk of various health conditions. This article explores the significance of preparticipation examinations in youth engaging in strength training and the importance of identifying any potential contraindications and precautions. The American Academy of Pediatrics (AAP) guidelines provide valuable insights, suggesting caution for certain medical conditions such as cardiomyopathy and pulmonary hypertension, where weight training may pose risks to young individuals. By conducting thorough evaluations and adhering to appropriate precautions, the risk of injury and adverse health outcomes can be minimized, enabling youth to reap the numerous benefits of physical activity.

Opinion

In-depth scientific evidence supports the various health benefits derived from engaging in physical activity (PA). These advantages encompass enhanced body composition, prevention of overweight and obesity, and improved skeletal, metabolic, and cardiovascular health [1]. Beyond the physiological aspects, PA also exerts positive effects on psychosocial well-being, including reductions in depression, stress, and anxiety, as well as improvements in self-confidence and self-esteem [2]. The cumulative benefits of regular PA hold significant value throughout life, but they assume critical importance during the formative years for fostering healthy growth, optimizing cardiometabolic function, and preventing chronic diseases [1].

Regrettably, recent decades have witnessed a decline in physical activity due to shifts in lifestyle practices and decreased opportunities for active engagement among children and adolescents. Insufficient physical activity coupled with increased sedentary behaviors have contributed to rising rates of overweight and obesity, thereby leading to associated health problems. This alarming trend has resulted in compromised physical and mental health among progressively younger age groups, with children and adolescents now presenting with metabolic and cardiovascular issues that were previously more commonly associated with adults, such as type 2 diabetes mellitus and atherosclerosis [3].

The public’s understanding of the positive impacts linked to regular physical activity has grown due to the rise in publicized reports and recommendations by professional organizations and government agencies [4,5]. The United States Centers for Disease Control and Prevention (CDC) has assembled a committee that proposes a guideline for school-age children to engage in a minimum of 60 minutes per day of moderate to vigorous physical activity (MVPA), primarily consisting of aerobic exercises that are suitable for their age, development, and enjoyment [6,7,8]. To complement the recommended 60 minutes or more of daily physical activity, it is advised for children and adolescents to incorporate muscle-and bone-strengthening exercises into their routine on at least three days per week [7].

Promoting regular physical activity among children is essential for fostering healthy lifestyle habits from a young age. It is important to allocate a portion of children’s leisure time to engage in play, recreational activities, sports, and other physical endeavors that enhance all aspects of physical fitness. Physical activity can take place within various contexts, including physical education, play, sports, games, transportation, work, recreation, or planned exercise [4,8]. Some instances of moderate physical activity involve activities like skateboarding, hiking, and brisk walking. On the other hand, vigorous physical activity encompasses running, jumping rope, and engaging in sports such as ice hockey, basketball, soccer, or field hockey [6]. To fulfill the requirement of 60 minutes of moderate-to-vigorous physical activity per day, it is recommended to engage in muscle-strengthening exercises such as climbing ropes or jungle gyms, bodyweight exercises like push-ups and pull-ups, as well as weightlifting. Additionally, bone-strengthening activities like jumping rope, running, and skipping should be incorporated into the routine three days per week [6].

Multiple systematic reviews have revealed a broad spectrum of advantages resulting from consistent physical activity in children of school age: decreased fat accumulation in overweight young individuals [9,10], lowering of blood pressure in young individuals experiencing mild essential hypertension [11], decrease in cholesterol and/or triglyceride levels observed in youth with obesity or high cholesterol [12], enhanced skeletal well-being [13,14], enhanced cardiometabolic well-being [6], enhanced muscle strength and endurance [15], enhanced psychological and social well-being [16], lowered likelihood of experiencing depression [6], and enhanced cognitive functioning [17]. The development and upkeep of muscle strength and endurance play a crucial role not only in performing daily activities but also in enhancing performance in recreational or competitive endeavors [18]. Besides the immediate advantages, enhancements in aerobic fitness attained during childhood are linked to improved health outcomes in adulthood [19].

According to federal physical activity guidelines, it is recommended to engage in muscle-strengthening activities for a minimum of three days per week or more [7]. Parents may seek clarification regarding the appropriate timing, safety measures, volume, associated risks, and benefits of incorporating strength training into their child’s routine. Despite the recognition of strength training by healthcare and fitness professionals, certain misconceptions persist concerning its safety and advantages. These misconception are listed below.

• Strength training is unsafe and inhibits growth
• Strength training does not enhance performance or mitigate the risk of injury in children and adolescents
• Strength training does not lead to increased strength in children due to insufficient levels of testosterone
• Strength training is exclusively reserved for youth who participate in competitive sports

The reports on weight training during the 1970s and 1980s emphasized the risk of growth plate injuries, contributing to the mistaken belief that strength training was unsafe for young individuals. Nonetheless, it is important to note that the majority of injuries reported in the literature during that period were primarily attributed to inadequate training loads, improper lifting techniques, and insufficient supervision. Based on two reports utilizing injury surveillance systems, one covering the period from 1990 to 2007 [20], and the other from 2003 to 2005 [21,22], it was observed that weight training-related injuries in children predominantly affected the hands and feet, often resulting from accidents like weight dropping. Therefore, with adequate supervision and adherence to safety guidelines, the majority of these injuries can be prevented.

While strength training carries a minor risk of injury to the skeletal system and soft tissues, the primary concern in children has traditionally been the potential harm to the growth plate known as the epiphyseal plate. However, when strength training is performed with the appropriate frequency, utilizing recommended loads, sets, and repetitions, it typically does not exert excessive stress on the growth plates and does not impede growth. On the other hand, prolonged periods of repetitive impact activities, as observed in gymnastics, tumbling in cheerleading, or high volumes of endurance training, pose a higher risk of epiphyseal injury. If children are instructed in the correct principles of strength training and undergo a gradual and suitable progression of load, the risk of growth plate injury becomes minimal, especially when under the supervision of competent adults [23,24].

The readiness to engage in strength training is determined in relation to the requirements of the sport and the physical, cognitive, and social development of the child. It is recommended that children and adolescents commence strength training only if they perceive it to be valuable and continue only if they find it enjoyable, rewarding, meaningful, and challenging [25]. It is essential for both children and parents to have a clear understanding that the goals of strength training are to enhance muscular strength and endurance rather than focusing solely on muscle size increase. While there is no specific age threshold for engaging in strength training, it is important for each participant to possess the maturity to understand and adhere to instructions, typically around the age of seven or eight. If a child is capable of participating in organized youth sports, they are typically ready to take part in a conditioning program aimed at preparing their body for the physical demands of the sport [26].

Some organizations recommend that individuals undergo an evaluation conducted by a sports medicine specialist prior to engaging in strength training [25,27]. Conversely, others propose that while a medical examination is advisable for seemingly healthy young individuals, it may not be an absolute requirement before participating in a strength-training program [24]. Conducting a preparticipation examination plays a vital role in injury prevention, particularly by identifying and treating undiagnosed or incompletely rehabilitated injuries [26]. Additionally, this examination allows the clinician to inquire about the participant’s health habits and offer education to both the participant and their parents. The American Academy of Pediatrics (AAP) recommends that youth with uncontrolled hypertension, seizure disorders, or a history of anthracycline-based chemotherapy for childhood cancer should undergo further evaluation and/or treatment before participating.

As per the AAP guidelines, it is advised that youth with cardiomyopathy, especially hypertrophic cardiomyopathy, should avoid weight training due to the potential risk of exacerbating ventricular hypertrophy and developing restrictive cardiomyopathy or hemodynamic decompensation caused by an acute increase in pulmonary hypertension. Similarly, the AAP recommends that youth with moderate to severe pulmonary hypertension should refrain from engaging in strenuous weight training, as they may be susceptible to acute decompensation with sudden changes in hemodynamics [28].

In conclusion, physical activity plays a pivotal role in the growth and development of youth. However, it is crucial to prioritize safety and injury prevention, especially when considering strength training programs. Preparticipation examinations serve as vital tools to identify any underlying health issues, allowing clinicians to tailor exercise recommendations and provide necessary guidance. The AAP guidelines serve as valuable resources, highlighting specific medical conditions that warrant caution and additional evaluation before participation in strength training. By heeding these recommendations and taking appropriate precautions, we can ensure that young individuals can enjoy the benefits of physical activity while minimizing potential risks, fostering a healthier and more active future generation. As we move forward, ongoing research and education on the topic are essential to refine our understanding and practices regarding physical activity in youth. Embracing a balanced approach that values the well-being of our youth will enable them to lead healthier, happier lives, well into adulthood.