A 9-year-old boy is brought to the office by his parents for a well-child visit. The father is a certified personal trainer and has created a detailed strength training plan for the child; however, the mother is concerned about safety due to the child's age. The plan includes direct supervision of the child during warm-up as well as individualized exercises with light, free weights and weight machines using low resistance every other day. The child is eager to begin strength training. He is performing well in 5th grade and participates in soccer and lacrosse. The child has no chronic medical conditions and takes no medication. Vital signs are normal. BMI is above the 85th percentile for age. Sexual maturity rating (Tanner stage) is 1. Examination is otherwise unremarkable. Which of the following is recommended regarding exercise in this patient?

Question

A 9-year-old boy is brought to the office by his parents for a well-child visit.  The father is a certified personal trainer and has created a detailed strength training plan for the child; however, the mother is concerned about safety due to the child's age.  The plan includes direct supervision of the child during warm-up as well as individualized exercises with light, free weights and weight machines using low resistance every other day.  The child is eager to begin strength training.  He is performing well in 5th grade and participates in soccer and lacrosse.  The child has no chronic medical conditions and takes no medication.  Vital signs are normal.  BMI is above the 85th percentile for age.  Sexual maturity rating (Tanner stage) is 1.  Examination is otherwise unremarkable.  Which of the following is recommended regarding exercise in this patient?

Quizplus · Accepted Answer

Explanation: 11ec25c8_d60c_e9a0_bc81_1da192649305_MD0003_00 Regular physical activity is associated with decreased risk of chronic, adult-onset disease (eg, cardiovascular disease, diabetes) as well as improvements in blood pressure, cholesterol, emotional well-being, and cognitive performance. Children should engage in ≥1 hour of daily moderate to vigorous physical activity, which typically consists of aerobic exercise, such as hiking, running, jumping, or swimming. Strength training (or resistance training) is a complementary exercise that uses free weights and weight machines as resistance to increase a patient's ability to exert force. Benefits include increased muscle strength, joint stability, endurance, and coordination. In addition, adolescents can increase muscle mass and athletic performance. Strength training is considered a safe supplement to aerobic exercise in children with the following conditions: Child readiness: typically age ≥8, cognitive maturity (eg, ability to follow directions), interest in participation Adequate supervision: qualified, responsible, adult professional providing strict oversight Proper techniques: individualized plan with slow progression, education regarding controlled movements and well-fitting equipment, avoidance of excessive load This overweight (BMI ≥85th to 95th percentile), otherwise healthy boy who shows interest in strength training has shown cognitive maturity through his successful participation in organized sports (Choice A). In addition, his father is a trained professional who has created an individualized plan that includes direct supervision. Therefore, strength training should be safe for this patient. (Choice B) Patients who are skeletally immature should not participate in competitive weight lifting (eg, bodybuilding) due to risk of growth plate injury. In contrast, strength training with proper supervision and individualized exercises with low resistance do not increase risk of injury. (Choice C) Strength training is an effective method of increasing muscle strength and decreasing body fat. It can be combined with aerobic exercise to manage weight. (Choice D) A preparticipation physical examination focusing on cardiac and musculoskeletal systems should be performed prior to initiating strength training. Poorly controlled hypertension, pulmonary hypertension, or signs of hypertrophic cardiomyopathy (eg, chest pain, murmur) are contraindications. This patient's examination and vital signs are normal. Educational objective: School-age children should participate in ≥1 hour of daily activity, such as aerobic exercise with or without strength (or resistance) training. Strength training is safe and effective when performed properly, such as with direct supervision and use of proper techniques in a cognitively mature child. References: Resistance training for children and adolescents. (http://www.ncbi.nlm.nih.gov/pubmed/28795003)

A 9-Year-Old Boy Is Brought to the Office by His