General paediatric populations: Children are not small adults

Hello, and welcome to the step on exercise modifications for children and adolescents. In an effort to individualise exercise prescription, we must consider each client separately. However, there are some general considerations or modifications that can be made because of a person’s age. While functionability and exercise preference varies greatly between peers, let us examine common physiological characteristics of children and adolescents, and how exercise prescriptions can be modified to best suit this population. Physiologically, children are not small adults. There are unique differences when a person is growing up which affect their exercise capacity. For example, we would expect maximum oxygen consumption to increase with age. However, this happens at different rates in boys and girls.

Furthermore, as a child becomes an adolescent, their physical activity levels and exercise preferences change and can often be heavily influenced by their community and peers. In recent years there has been a lot of media attention and research on the topic of childhood obesity, overweight, and type 2 diabetes. In 2004, the Surgeon General for the US stated that because of the increased rates of obesity, unhealthy eating habits, and physical inactivity, we may see the first generation that will be less healthy and have a shorter life expectancy than their parents. The idea that lifestyle choices would result in a shortened life expectancy for a generation shocked many people, and drew forward research in this area.

Physical activity guidelines state that children should engage in at least 60 minutes of age appropriate moderate to vigorous intensity physical activity a day. These guidelines have been adopted by many states and organisations around the world. The physical benefits of exercise in children are evident. The majority of the research on exercise and children has focused on aerobic exercise and physical activity levels. However, there are known benefits to resistance training in children, and this can come into play from age six and over. Resistance training in children can result in increased muscular strength, power, improved body composition, and bone health, as well as a reduction in sports related injuries.

Remember that resistance training in young children will likely not take the form of dumbbells and weight machines. Resistance exercise, like all exercise prescription for children, should be age appropriate and fun. Consider throwing brightly coloured bags of sand, pushing and pulling carts, or climbing rope and monkey bars, which use the child’s own body weight as a resistance. By observing a child playing in a playground, you will notice that resistance exercise can actually occur and take many interesting forms.

Let’s look at some general tips on exercise prescription for children. Firstly, variety is key. Children will grow accustomed to tasks quickly, therefore, the same exercise may need to take several forms, and prescription and training method will have to change regularly to encourage continued adherence. For resistance exercise prescription, begin with light weights and simple movements over one joint. For older children and adolescents with good coordination, consider adding multi-joint exercises and review technique regularly. When a child grows, their ability to coordinate may also change. Careful monitoring and reevaluation is therefore required, especially during and immediately after a growth spurt. All exercise should be safe and effective, but it is also a key consideration for it to be fun and age appropriate.

Consideration should be given to individual preferences, and the research seems to suggest that exercise activities which are social are preferred and maintained. Engagement may also be enhanced through choice and independence, which are facilitators of physical activity participation in young people. There is a need to examine whether the exercise environment is suitable, especially for clinical populations who may not be as able-bodied as their peers. Exercise equipment, if used, should be of an appropriate size, and again, variety is key. Most children thrive on a challenging changing task which continues to stimulate. Research is increasing in the area of activity promoting video games, which are highly stimulating.

However, even these games only maintain a child’s interest for a certain period of time before they look for a new alternative. Exercise prescription in paediatric populations will challenge your imagination and keep you on your toes as you create scenarios and quietly manipulate play to achieve exercise goals and enhance health. It is not easy, but when approached with a childlike heart, it is always fun.