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Exercise Benefits in Children:Exercise Benefits in Children:Preventing Osteoporosis Since YouthPreventing Osteoporosis Since Youth

Lyle J. Micheli, MDLyle J. Micheli, MDChildren’s Hospital BostonChildren’s Hospital Boston

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Why Train Kids?Why Train Kids?

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Organized Children’s Sports:Organized Children’s Sports:North AmericaNorth America

Team SportsTeam Sports•• BaseballBaseball•• Gridiron FootballGridiron Football•• Soccer Soccer •• Ice HockeyIce Hockey•• BasketballBasketball•• Other: Field hockey,Other: Field hockey,

lacrosse, rugby, etc.lacrosse, rugby, etc.

Individual SportsIndividual Sports•• GymnasticsGymnastics•• SwimmingSwimming•• Tennis SkatingTennis Skating•• Distance runningDistance running•• TriathlonTriathlon•• Other: Dance, cycling, Other: Dance, cycling,

riding, rodeo, etc.riding, rodeo, etc.

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Benefits of Training: Benefits of Training: The Child AthleteThe Child Athlete

•Enhance Performance•Prevent Injury•Health & Fitness•Bone Health

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Benefits of Training: Benefits of Training: The Child AthleteThe Child Athlete

•Enhance Performance••Prevent InjuryPrevent Injury•Health & Fitness•Bone Health

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Injury PreventionInjury Prevention

1. ACSM: Smith, A, Andrish, J, Micheli, L, The Prevention of Sports Injuries in Children & Adolescents. Med. Sci Sports Exercise. 25:1-7, 1993

2. Hejna, Rosenberg, A. et al. The Prevention of Sports Injuries in High School Students Through Strength Training. Nat’l. Strength & Conditioning Assoc. J. 4=28-31, 1982

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Benefits of Training: Benefits of Training: The Child AthleteThe Child Athlete

•Enhance Performance•Prevent Injury••Health & FitnessHealth & Fitness•Bone Health

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Childhood HealthChildhood Exercise

Adult Exercise Adult Health

?

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Benefits of Training: Benefits of Training: The Child AthleteThe Child Athlete

•Enhance Performance•Prevent Injury•Health & Fitness••Bone HealthBone Health

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Bone HealthBone Health

Morris, F, Morris, F, NaughtonNaughton, G, et al., G, et al.

Prospective Ten Month Exercise Intervention in Prospective Ten Month Exercise Intervention in PrePre--MenarchalMenarchal Girls: Positive Effects on Bone Girls: Positive Effects on Bone

and Lean Massand Lean Mass

J. Bone Miner Res. 12=1453J. Bone Miner Res. 12=1453--1462, 19971462, 1997

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Childhood Exericise Adult Bone Health?

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GymnasticsGymnastics

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Skeletal Benefits of Pre-MenarchealGymnastics Are Retained After

Activity Cessation

Scerpella, T et al.

Ped. Ex. Sci. 22: 21-23. 2010

3 year long study

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The Female Athlete TriadThe Female Athlete Triad

•• AmenorrheaAmenorrhea•• OsteopeniaOsteopenia•• Disordered EatingDisordered Eating

Overuse Injury: Stress Fracture

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Sports Training: Sports Training: The Child AthleteThe Child Athlete

•• Cardiovascular Cardiovascular •• MusculoskeletalMusculoskeletal

–– StrengthStrength–– FlexibilityFlexibility

•• NutritionNutrition•• SkillsSkills•• PsychologicalPsychological

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Rowland, TW (ed)Rowland, TW (ed)

Developmental ExerciseDevelopmental ExercisePhysiology, Human KineticsPhysiology, Human Kinetics

Champagne, Illinois 1996Champagne, Illinois 1996

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Pediatric RunnersPediatric Runners

VO2 MaxVO2 Max

Pulse RatePulse Rate

But adaptation less than adultsBut adaptation less than adults

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Sports Training: Sports Training: The Child AthleteThe Child Athlete

•• Cardiovascular Cardiovascular

•• MusculoskeletalMusculoskeletal––StrengthStrength–– FlexibilityFlexibility

•• NutritionNutrition•• SkillsSkills•• PsychologicalPsychological

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Strength Training Strength Training For ChildrenFor Children

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StrengthStrength

The ability to exert force against The ability to exert force against an external resistancean external resistance

•• Joint Joint –– Muscle specificMuscle specific•• Technique specificTechnique specific

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Strength Training: ChildrenStrength Training: Children

•• Safe?Safe?•• Increase ? (Mechanism)Increase ? (Mechanism)•• Benefits? Benefits?

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Strength Training: ChildrenStrength Training: Children

•• Safe?Safe?

•• Increase ? (Mechanism)Increase ? (Mechanism)•• Benefits? Benefits?

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Special Considerations: Special Considerations: Child Strength TrainingChild Strength Training

•• Close, qualified supervisionClose, qualified supervision•• VarietyVariety•• Resistance: PreResistance: Pre--OverloadOverload•• Repetitions: 10Repetitions: 10--15 (5015 (50--70% 1RM)70% 1RM)•• Rest (2Rest (2--3 x/week3 x/week

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PrePre--Season Conditioning for the Season Conditioning for the PrePre--Adolescent AthleteAdolescent Athlete

Faigenbaum A, Micheli L, Faigenbaum A, Micheli L, Pediatric Annals Pediatric Annals

29=15629=156--161, 2000161, 2000

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Strength Training: ChildrenStrength Training: Children

•• Safe?Safe?•• Increase ? (Mechanism)Increase ? (Mechanism)

•• Benefits? Benefits?

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Sports Training: Sports Training: The Child AthleteThe Child Athlete

•• Cardiovascular Cardiovascular

•• MusculoskeletalMusculoskeletal–– StrengthStrength

––FlexibilityFlexibility•• NutritionNutrition•• SkillsSkills•• PsychologicalPsychological

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Flexibility Training: Flexibility Training:

Do Kids Really Need It?Do Kids Really Need It?

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Sitting InactivitySitting Inactivity

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FlexibilityFlexibility

•• Ballistic (Sport/Dance Specific)Ballistic (Sport/Dance Specific)•• Slow Stretch (30 sec.)Slow Stretch (30 sec.)•• Facilitative (PNF)Facilitative (PNF)

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Sports Specific: Sports Specific: GymnasticsGymnastics

Enhanced shoulder flexibility in female gymnasts Enhanced shoulder flexibility in female gymnasts decreases low back pain extension stress decreases low back pain extension stress

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The Child Athlete The Child Athlete Sports Training:Sports Training:

•• Cardiovascular Cardiovascular •• MusculoskeletalMusculoskeletal

–– StrengthStrength–– FlexibilityFlexibility

•• NutritionNutrition•• SkillsSkills•• PsychologicalPsychological

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Nutrition: The Young AthleteNutrition: The Young Athlete

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The Young Athlete: The Young Athlete: Nutritional Concerns: Nutritional Concerns:

•• DehydrationDehydration--Increased heat Increased heat succeptabilitysucceptability

•• Junk food/Fast food: Vitamin, mineral deficiencyJunk food/Fast food: Vitamin, mineral deficiency•• ObesityObesity•• Eating disordersEating disorders

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Nutritional Concerns: Nutritional Concerns: The Young AthleteThe Young Athlete

•• DehydrationDehydration--Increased heat susceptibilityIncreased heat susceptibility

•• Junk food/Fast food: Junk food/Fast food: Vitamin, mineral deficiencyVitamin, mineral deficiency

•• ObesityObesity•• Eating disordersEating disorders

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Typical Adolescent Food Habits

•Meal Skipping•Snacking•Consumption of Fast Foods•Dieting*Vulnerable to Nutrition Deficiencies*•Calcium•Vitamin A •Iron, Ascorbic Acid

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Nutritional Concerns: Nutritional Concerns: The Young AthleteThe Young Athlete

•• DehydrationDehydration--Increased heat susceptibilityIncreased heat susceptibility•• Junk food/Fast food: Vitamin, mineral deficiencyJunk food/Fast food: Vitamin, mineral deficiency

•• ObesityObesity•• Eating disordersEating disorders

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Adolescent ObesityAdolescent Obesity

•• Caloric IntakeCaloric Intake•• ExerciseExercise•• ComplianceCompliance•• FamilyFamily

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Nutritional Concerns: Nutritional Concerns: The Young AthleteThe Young Athlete

•• DehydrationDehydration--Increased heat susceptibilityIncreased heat susceptibility•• Junk food/Fast food: Vitamin, mineral deficiencyJunk food/Fast food: Vitamin, mineral deficiency•• ObesityObesity

•• Eating disordersEating disorders

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Female Athlete TriadFemale Athlete Triad

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Female Athlete Triad (ACSM)Female Athlete Triad (ACSM)

•• DisordedDisorded eatingeating•• AmenorrheaAmenorrhea•• Premature osteoporosisPremature osteoporosis•• Overuse injuries: Stress Overuse injuries: Stress FxFx. .

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Body CompositionBody Composition

Female Athlete / DancerFemale Athlete / Dancer> 13% BWF> 13% BWF

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Nutritional SupplementsNutritional Supplements

•• Males More LikelyMales More Likely•• Females: Calcium, IronFemales: Calcium, Iron•• Performance EnhancementPerformance Enhancement•• CreatineCreatine

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Nutritional SupplementsNutritional Supplements

•• Males More LikelyMales More Likely

•• Females: Calcium, IronFemales: Calcium, Iron•• Performance EnhancementPerformance Enhancement•• CreatineCreatine

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Nutritional SupplementsNutritional Supplements

•• Males More LikelyMales More Likely•• Females: Calcium, IronFemales: Calcium, Iron

•• Performance EnhancementPerformance Enhancement•• CreatineCreatine

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Nutritional SupplementsNutritional Supplements

•• Males More LikelyMales More Likely•• Females: Calcium, IronFemales: Calcium, Iron•• Performance EnhancementPerformance Enhancement

•• CreatineCreatine

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Anabolic SteroidsAnabolic Steroids

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Faigenbaum, A., Westcott, W. et al. Faigenbaum, A., Westcott, W. et al.

Anabolic Steroid Use by Male and Anabolic Steroid Use by Male and Female Middle School StudentsFemale Middle School Students

Pediatrics 101: E6, 1998Pediatrics 101: E6, 1998

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Anabolic Steroids: RisksAnabolic Steroids: Risks

•• Liver=Failure, tumorsLiver=Failure, tumors•• Mood Change: ”Mood Change: ”RoidRoid Rage”Rage”•• Heart DiseaseHeart Disease•• Growth ArrestGrowth Arrest•• Female=Female=HursationHursation, , baldlessbaldless•• Acne Acne

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Androgenic = Androgenic = MasculinizingMasculinizing

Anabolic = Tissue buildingAnabolic = Tissue building

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Growth HormoneGrowth Hormone

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Drug TestingDrug Testing

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Nutritional Supplements: Nutritional Supplements: DopingDoping

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Carbohydrate LoadingCarbohydrate Loading

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Strength, Endurance and Body Strength, Endurance and Body Composition are more important than Composition are more important than

body weight.body weight.

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SleepSleep

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Sports Training: Sports Training: The Child AthleteThe Child Athlete

•• Cardiovascular Cardiovascular •• MusculoskeletalMusculoskeletal

–– StrengthStrength–– FlexibilityFlexibility

•• NutritionNutrition

•• SkillsSkills•• PsychologicalPsychological

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Sports Training: Sports Training: The Child AthleteThe Child Athlete

•• Cardiovascular Cardiovascular •• MusculoskeletalMusculoskeletal

–– StrengthStrength–– FlexibilityFlexibility

•• NutritionNutrition•• SkillsSkills

•• PsychologicalPsychological

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Organized SportsOrganized Sports

ConcernsConcerns

•• Emotional StressEmotional Stress•• Endurance/Heat stressEndurance/Heat stress•• InjuryInjury

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Sports PsychologistSports Psychologist

•• FocusFocus•• Competitive StressCompetitive Stress

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Who Does The Training?Who Does The Training?

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IOC Consensus Statement: IOC Consensus Statement: Training the Elite Child AthleteTraining the Elite Child Athlete

REFERENCESREFERENCES

IOC Consensus Statement: Training the Elite Child Athlete. IOC Consensus Statement: Training the Elite Child Athlete. BJSM 2008; 42:3 163BJSM 2008; 42:3 163--164164

IOC Consensus Statement: Training the Elite Child Athlete. IOC Consensus Statement: Training the Elite Child Athlete. ClinClin J of Sp Med. 2008, 18:2; 122J of Sp Med. 2008, 18:2; 122--123123

The Adolescent Athlete: A Practical ApproachThe Adolescent Athlete: A Practical ApproachMicheli L, Purcell L eds. 2007 Springer Micheli L, Purcell L eds. 2007 Springer VerlagVerlag; 410; 410--413413

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Lyle J. Micheli, MD

michelilyle@aol.com