Physical Fitness and Resistance Training – PediaCast 212

Dr James MacDonald and Dr Avery Faigenbaum join Dr Mike in the PediaCast Studio to discuss physical fitness and childhood resistance training. At what age should parents start encouraging physical activity? When should formal sports participation start? How much is too much? What can you do to prevent injury and burn out? Is weight lifting safe for kids? And what constitutes a reasonable conditioning program? Answers to these questions and many more… on this week’s PediaCast!

Topics

  • Physical Fitness

  • Resistance Training

  • Weight Lifting

  • Conditioning Programs

Guests

Links

Transcription

Announcer 1: This is PediaCast.

[Music]

Announcer 2: Welcome to PediaCast, a pediatric podcast for parents. And now, direct from the campus of Nationwide Children's, here is your host, Dr. Mike!

Mike Patrick: Hello everyone! And welcome one again to PediaCast, a pediatric podcast for moms and dads. This is Dr. Mike coming to you from the the campus of Nationwide Children's Hospital in Columbus, Ohio.

It is Episode 212, 2-1-2 for May 23rd, 2012. Lot's of two's and 12's there. Physical fitness and resistance training, that's the topic today. But before we get to the show, I wanted to mention a couple of show ago, back it was Episode 210, we had Dr. Sarah Denny and we talked about 'Summer Safety'.

01:03

And I work with her in the emergency department a couple of days ago. And she was appalled that she had forgotten to mention something. And I promised her that as soon as possible, I would mention it.

So in that program we had mentioned bike safety and helmet safety, swimming pool safety, trampolines. And there was something she forgot, and felt it was really important to get out there. And that is, this summer make sure that you don't leave your kids in the car.

So cars heat pretty fast and you want to make sure that you don’t leave your kid, even if just seems like, 'OK, I'm going to be in the store five minutes', don't do it. Just make it a habit, don't leave your kids in the car by themselves. There are other dangers too not just the heat, but that certainly is one of them.

So there you go Sarah, fret no more we got the message out. All right. Let's move on to today's program. Physical fitness is important for all of us, we know it improves health, both physically and mentally.

02:02

We all know we should be doing it even when we don't. And we know it's important spans the ages from encouraging the babies to crawl and cruise, to senior citizens taking long walks and swimming laps, and riding bikes to keep their bodies in shape.

Today we're going to tackle physical fitness on many levels. We'll answer such questions as; at what age should parents start thinking about physical fitness? When should kids start playing organized sports? Is there a maximum number of sports they should play? What is a reasonable amount of training?

And when does athletic conditioning become dangerous? How do I motivate my video game playing teenager to get off the couch? And what about strength or resistance training, is this safe for kids? And should children perform advanced weight lifting maneuvers like snatch, and clean, and Jerk.

And I have to admit this topic is really not my cup of tea, and I have to Google those terms to find out. I actually watched You Tube videos to say what they were. Then I went home and told my wife and she said, "Oh, yeah. I know what those are."

03:03

But fortunately I have two great guest with me in the Pediacast studio today to help answer those questions because if it were just me, we won't get very far on this one. Dr. James MacDonald is a physician with the division of Sports Medicine here at Nationwide Children's Hospital, and Dr. Avery Faigenbaum is a professor of Health and Exercise Science at College of New Jersey.

Before we get to them I want to remind you, if there's a topic you'd like us to talk about or you have a comment up for the show, just go to PediaCast.org, click on the contact link. You can also email PediaCast@gmail.com, or call the voice line at 347-404-KIDS, 347-404-K-I-D-S.

Also the information presented in PediaCast is for general educational purposes only, we do not diagnose medical conditions or formulate treatment plans for specific individuals. So if you have a concern about your child's health, make sure you call your doctor and arrange a face to face interview and hands on physical examination.

Also your use of this audio program is subject to the PediaCast terms of use agreement which you can find over at PediaCast.org.

04:05

All right. So let's jump right through it, Dr. James MacDonald is a physician with the division of Sports Medicine here at Nationwide Children's Hospital, and an Assistant Professor or Pediatrics at the Ohio State University College of Medicine.

Dr. MacDonald attended Harvard Medical School, completed a family practice residency at Maine Dartmouth Sports Medicine Fellowship at Children's Hospital Boston. He spent the next 10 years practicing sports medicine with the University of California.

And he finally escaped the East and West Coast and landed in the Midwest. Of course not just anywhere in the Midwest, but right here at Nationwide Children's, and we're fortunate to have him. So, welcome to PediaCast Dr. MacDonald.

James MacDonald: Thanks for having me. It's good to be here.

Mike Patrick: Yeah. We are happy to have you here. And Dr. Avery Faigenbaum is a professor of Health and Exercise Science at the College of New Jersey. He's co-authored over 150 scholarly publications, 30 book chapters, and eight books including "Youth 3Strength Training", and "Progressive Plyometrics for Kids".

He's a fellow of the American College of Sports Medicine and the National Strength and Conditioning Association.

05:05

And as active researcher and practitioner in the field of Pediatric Exercise Science. Dr. Faigenbaum has addressed more than 250 conferences in 10 countries and he's frequently quoted by national news outlet. He continues to develop successful strength and conditioning programs for children and adolescents. And we're very happy to have him here in the studio today. So welcome to PediaCast, Dr. Faigenbaum.

Avery Faigenbaum: Thank you very much. Great to be here.

Mike Patrick: Great. So I did notice something that are two academic institutions have in common the Ohio State University, and the College of New Jersey.

Avery Faigenbaum: That's right. We'd like to keep the T capitalized.

Mike Patrick: Yeah. There's little pride issue there, right? The..

[Laughter]

Mike Patrick: And everyone else were you know, always make fun of that, you know, The Ohio State University. All right. So Dr. MacDonald, tell us why is physical fitness important?

James MacDonald: Well it's important for so many reason. I think the moist obvious is physical fitness is a way of getting the body stronger.

06:09

There are many, many medical outcomes negative ones that happen when people are not fit ranging from heart disease to osteoporosis. I think an undertold story is the mind, body connection is increasing literature that physical fitness is directly correlates with for instance in kid's academic performance.

So one of the things we're seeing more and more is desire for instance to cut physical education classes in school with a zeal to somehow improve academic performance is actually shooting our kids into fee.

Mike Patrick: Yeah. In our last program, we talked about how with this pay to play kind of thing that's really taking on in the schools because of budget problems that lower income kids are really sort of getting left out and then not being able to participate because of the cost.

James MacDonald: Yeah. Absolutely that's another trend I think is very concerning of pay to play.

07:01

Mike Patrick: Now who should be concerned with physical fitness?

James MacDonald: Everyone. I think the devils in the details, it's a pretty broad answer, I mean, speaking to you as adult and me as adult clearly we need it as well as kids. But it's a lifetime paradigm I think. I was thinking as you were talking like when my physical activity starts. As far as I'm concern it starts in the cradle, and how parents interact with their children. We're physical creatures, we need to always attend to physical issues like fitness, throughout our whole life.

Mike Patrick: Yup. And you talked about the health benefits of it and the mind benefits. And some of those health things I mean, lipid compositions and blood pressure, and your heart health, and the people are always looking for more ways to have more mental alertness. And all of these things come into play and are improved with increased physical activity.

08:01

James MacDonald: Absolutely. I think as well, again I'm spending out something Dr. Faigenbaum has shared with me. Again I think an untold story specifically for kids and adolescents is how important the sense of well being is for their own psychological development.

This idea of programming and for success. Getting them physically active in the appropriate dimensions for their body type and their skill set is hugely important. A lot of our interventions historically are actually programmed for failure. You know, get people into gym, and a lot of times they're really fit. Athletic kids they star and the other one sit on the sidelines, and the vicious cycle of.

Mike Patrick: Yeah. There's no positive reinforcement if you're not doing you know, progressing or doing well with it.

James MacDonald: Absolutely.

Mike Patrick: You know, you said parents should start right from the cradle. What are some things parents can do for young kids? And we're talking all the way down to babies and toddlers. What are some things that they can do to really be intentional about physical fitness for those really young kids?

09:06

James MacDonald: You know, I agree, I want to feel that one and then just give you the heads up. Dr. Faigenbaum has done a lot of work in identifying the best ages to really hit a sort of structure programs especially resistance training. But you know, I'm aware and I see it, and I think the literature is fairly week.

But I think a strong argument could be made for importance as I said even in the cradle. All parents know these days in America about the importance of back to sleep to avoid SIDS. But they don't recognize however that they allow their children just always be on their back, they don't get any tummy time.

We're talking about a kid who by the time they are taller has no arm strength. And when they inevitably fall as a toddler, they're going to have difficulty breaking that fall. I've seen so many times in my practice, I don't know if you see this in urgent care.

Toddlers with lacerations on their face, where again I think that literature is weak, but I think at least I could say anecdotally I've seen the kids who did spend tummy time, they're able to break that fall.

10:05

I think the other thing that immediately comes to my mind is we see lots of parents this days very active, very interested in fitness themselves, they're on their bike, their kids in the trailer behind the bike.

Mike Patrick: Yeah.

James MacDonald: I think somehow as kids starts to develop their motor skills, we parents have to scale back our needs, and our goals and incorporate age appropriate stuff for our kids.

Mike Patrick: Yeah.

James MacDonald: If you're going on a hike with your kid, you're going to expect to maybe get about 200 yards if you're dealing with a two year old. And that's OK because for them they're going to explore the worms in the ground, they're going to get activity appropriate for their development level. And as a parent I think you just have to figure out some other time to get your aerobic activity because you won't get a hike with a kid, but you got to take that kid on.

Mike Patrick: Because it's important and not just from a physical activity standpoint, but also just doing some fun stuff with your kids and really be involved with them which we talked about quite a bit on this show. So, yeah all points well, well taken.

11:02

You know too, and Dr. Faigenbaum, one of the things that I've noticed from your writings is the fundamentals with these young kids and just getting out there and running, jumping, hopping, skipping. You could speak to that that a little bit.

Avery Faigenbaum: No exactly. As we talk about physical activity for children, I think parents need to realize that we're looking at at least 60 minutes per day. And physical activity is absolutely essential for normal growth and development. It's abnormal for your child to be inactive and watch two to three, to four hours or television everyday, it's abnormal.

So years ago, two to three hours of physical activity after school was common. But nowadays from a public health perspective, we're encouraging moms and dads to shoot for at least 60 minutes. And that can be accumulated throughout the whole day.

Walking to school, a recess break, physical education during the day, and of course after school activities. But as we talk about the benefits, let's not overlook the link between physical fitness and academic performance.

12:02

Mike Patrick: Yeah.

Avery Faigenbaum: You know we can talk about lowering cholesterol and blood pressure, and improving body composition. But when talking about school children, the date seems to show that as children become fitter, they become better learners. And that's an important message for moms and dads.

Mike Patrick: Yeah. Absolutely. What do you think -what kind of physical activities then should parent –OK. We talked a little bit about babies and young toddlers and the importance of getting them out and active even if it slows you down. But as we get to the older kids, what sort of things. They're not quite to the age of organized sports yet, but what sort of that middle range, what sort of activities should parents should be encouraging them to do?

Avery Faigenbaum: That's a good question because children are active like you and I. But they are active in different ways and for differently reasons. Now taking that adult exercise prescription that you and I might do. For example 30 minutes on a treadmill or a stepping machine, that just doesn't work for children. Watch children on a playground, and you'll never see a child running for 30 minutes without stopping.

13:00

They are active in short burst of physical activity. So what's the best kind of activity? It's short burst physical activity that enhances motor skills. That is jumping, hopping, skipping, balancing. Those are the skills that we need to develop during childhood, during the so called 'skill hungry years'.

So rather than go out for a 30 minute run for a child which I think most children won't do anyway. We need to have short bouts of physical activities. Think of the stuff that you and I did on a playground many years ago. That's the kind of activity that builds their muscle strength and motor skill. And that's the activity that predicts a more active lifestyle later in life.

Mike Patrick: Great. And there's so many opportunities for parents to get creative with those kinds of things. I mean, there are still playgrounds around, there's you know, in the neighborhood. They are safer and lower to to the ground that we were kids. But there's community rec centers in YMCA's, and they have programs that kids can get involved in and then parents can take advantage of those as well.

14:00

James MacDonald: Absolutely. The one thought I had on those lines, I mean there's playgrounds, many of us, not all of us are fortunate enough to have say like a tree inn our backyard. Again I think it gets to the issues of summer safety, but I think we tend to over estimate injuries for instance climbing tree and fall. And in our zeal to protect people from that acute injury.

Again kids are not developing sort of standard normal motor skills like we all probably shares as kids like climbing up trees. Even if you don't feel comfortable letting your child climb up a tree, it's pretty easy to string a rope up, have a little piece of wood at the bottom, the pre-fabricated stuff you get at Target, and have a swing for your child to play around with.

Mike Patrick: Yeah. Your points are well taken. And in fact we just kind of got off, a couple of shows ago we did a two show series on pre-hospital emergency care and summer safety. And we talked about the safety stuff.

15:03

And you can really try to wrap your kids in bubble wrap at one extreme. And then the other extreme is pure negligence and to not thinking ahead and what the dangers could be. And really it's probably the best to live somewhere in between those two extremes. OK. So as we get into a little older kids, and now we're not just talking about running and playing, but really more of a structured type, more intentional program for kids.

And one of the things that comes up is strength training or resistance training. And I've actually heard both of those terms. So, Dr. Faigenbaum, when we're talking about really weights and building up muscles, is it better to use strength training or resistance training?

Avery Faigenbaum: Well, that's a good question. I think both those terms can used synonymously. Strength training or resistance training refers to the method of conditioning or a method of exercise using ones own body weight, or medicine balls, or barbells, or dumbbells, that's all a form of resistance exercise or strength exercise.

16:01

We need to distinguish those terms from the competitive sports that you see in television that is weightlifting which we'll see in the Olympics or power lifting which we see in magazines. And of course body building which we see in the magazine where the goal is not muscle strength, but muscle size and symmetry. So today we're talking about strength training or resistance training as a method of conditioning or a method of exercise.

Mike Patrick: Sure. And where does this fit in? Why is resistant training compared to aerobic activities, you know, running, treadmills, elliptical. Where does resistance training sort of fit in and why is that important?

Avery Faigenbaum: Well I think they're both synergistic. I think children should participate in program that enhance their aerobic fitness and their muscle strength, and their motor skill development. But the benefits of strength training are unique, we can increase muscle strength, we can increase bone strength, we can increase the metabolic health of muscle that is it uses sugar better.

That's just what we want, and in many cases when a child gets stronger, they move better, that is they become better jumpers, hoppers, skippers, and runners. And they tend to engage in more physical activity.

17:03

So I think strength training is really fundamental to a lifetime of physical activity.

Mike Patrick: Sure.

James MacDonald: Could I chime in on that?

Mike Patrick: Yeah. Yeah. Absolutely.

James MacDonald: Because I actually think another thing that you know, and this is something I've shared with Dr. Faigenbaum and really just got off listening to a talk of his. There are different strokes, for different folks, you know different body types. Some of our children already overweight, and asking that child to get out and run, maybe just get on your bike free play.

Sometimes it's harder, they can go from what would be for us an aerobic effort to anaerobic levels pretty soon. Whereas they oftentimes will be more skilled, and actually have greater strength of then their peers and be able to participate in resistance training in a way they couldn't more aerobically.

Mike Patrick:Yeah.

James MacDonald: So that idea of different strokes for different folks I think is really important.

Avery Faigenbaum: And to follow up on what Dr. MacDonald said, it's important because for really interested in changing behavior. If moms and dads want their boys and girls to be active for a lifetime, and that's the business we're in, we need to enhance their confidence and their abilities to be physically active.

18:10

Mike Patrick: Yeah.

Avery Faigenbaum: So for an overweight child for example we can talk about aerobic exercise all day, the child won't do it, but they will do strength training because they are strong. So sometimes we need to look from the head, from the neck up. And we need to change behavior first, get that child excited about physical activity and then introduce other modes of training. But for a child who weighs 200 pounds or 300 pounds, and these are the children we see up today, maybe strength training needs to be on the list of activities they can perform.

Mike Patrick: Yeah.

James MacDonald: And again in the literature one of the phrases I see and it just resonates, 'programs for success'. You again ask that 200 pound child to run a half mile like their peers, you just programmed them for failure. On the other hand Dr. Faigenbaum shared some data this morning in his talk, you get that same overweight child into a resistance program, you're not aerobically training them, six weeks down the road, their half mile time has actually improved.

19:06

Mike Patrick: Yeah.

James MacDonald: So they're going to get improvement both in the strength and their half mile.

Mike Patrick: Yeah. And it kind of goes back to what we were talking about with a positive reinforcement and having success. I mean, if you're failing and it's tiring you out, and you just feel miserable because you're not conditioned to do something aerobically, then you're going to stop doing it and be discouraged. So the resistance training can be something where they can have success right up front.

Avery Faigenbaum: You know Dr. Mike, both positive and negative behaviors established during childhood carry over into adulthood, right? The secret companies know this, the fast food industry knows this, and we know this as physicians and exercise professionals. We need to change behavior early in life. OK. Starting them in adolescents is OK. In my view it's a little late. We need to start early and make physical activity a habitual part of children's lives.

Mike Patrick: So what age with regard to resistance training, what's a good age to start thinking about that? What's the earliest?

20:03

Avery Faigenbaum: You know I get asked that question a lot and it's a good question. And I'll answer that first by stating, when children need the emotional maturity to accept and follow directions. And most parents get this, when a child can accept and follow direction for example, if you think your child is ready for some type of sport, and they can accept and follow direction then they're probably ready for some type of structured strength training.

In our programs we start around age seven or eight. And most boys and girls can accept and follow directions. You know, strength training can be a very safe activity, but boys and girls needs to follow directions because you can get hurt.

Mike Patrick: Yeah.

Avery Faigenbaum: So I think seven and eight is a good place to start. Not at home without supervision, but in a supervised training program at schools, or YMCAs, or clinics, that's where they need to start.

Mike Patrick: I think a lot of parents out there and probably a lot of coaches and folks who work at YMCAs maybe thinking right now, 'Wow, seven or eight years old', you know, really? Really is that safe? Can you address that, I mean, is resistant training safe for these young kids?

21:04

Avery Faigenbaum: Let's think about push ups and sit ups which we've hold on, that's a form or resistance exercise. When you do a push up, you're lifting about 60% of your body weight. Nowadays lots of kids can't do pushups, they're just too heavy, their upper body strength is too weak.

But what about if I put that child who weighs 100 pounds, what if I put that child on a child size machine, and have them lift 20 or 30 pounds? That's OK. But what about if I started with a pair of two pound dumbbells and then a chest press, that's OK. Or what about if I taught that child do a medicine ball chest pass with the ball that weighs three pounds.

They are all developing his upper body strength because he can't do a push up which we all agree is appropriate. so it's all about starting at the appropriate level, building confidence, and gradually progressing over time.

Mike Patrick: Sure. So the supervision is important.

Avery Faigenbaum: The supervision is paramount.

Mike Patrick: We're going to give some resources that parents more towards the end of the program some website that they can go to and really get some of these resources in their hands to figure out how to do this in a safe way because that culture of proper technique and safety is so important.

22:07

James MacDonald: You can do something -you had mentioned in Dr. Faigenbaum answer, but get back to this Dr. Mike is that I think a lot of parents have this disconnect because their image when you talk about resistance training is big barbell, big dumbbell, Arnold Schwarzenegger type look.

And again with Dr. Faigenbaum is talking about, resistance training involves a broad spectrum of things, it has nothing to do with that. They could be an end destination, you might have a child that is very good and can bench press large weights down the road. But we start with things like push ups, so we'd start with medicine balls.

It would not start with those images I think where parents have that -I can't go any further than this, it's like 'Whoa, what a big London 2012 Olympic weightlifter? That's not my kid.'

Mike Patrick: Yeah.

James MacDonald: But that's not most kids doing resistance training.

Mike Patrick: Right.

23:00

Now. So in the beginning that makes sense. Starting out slow with things that kids can handle. But now you got a kid who's doing well, that have positive reinforcement, they're enjoying doing this. So step us through what a well designed program would look like to get kids to the point where maybe they are doing Snatch, and Clean and Jerk and those kind of things.

Avery Faigenbaum: Well as we mentioned it's all about proper supervision and proper coaching. What we start is a single set with a light load. You know in our programs we start literally with a broomstick, a wooden dowel and we focus on forming technique, and then we gradually progress.

And as that child progresses and it's entirely based on technique, not on the amount of weight they lift, we gradually add weight to the bar. And we go from simple movements such as a bicep curl, to more complex movement such as a dumbbell squat to the ultimate movement which is one of the weightlifting movement which require one's body to work as a unit.

But over time it could be gradually progress, and the children actually enjoy this type of training because it's somewhat challenging and if it is challenging, it's fun.

24:01

But it's all about supervision and progression.

Mike Patrick: And learning the technique before you're adding the weights.

Avery Faigenbaum: Exactly.

Mike Patrick: And when people get hurt it's when they don't have the technique down and they are trying to do something with too much weight.

Avery Faigenbaum: Exactly. And that's an important point because children do get hurt, and children get hurt because they lift too much weight whether it's at school, or at a sport center, or at home. But we need to redirect their energy and enthusiasm for training because that's what we want towards the development of proper form and technique.

And that's when a good prescription comes into play where we can get away from some of the simple exercises and make it a little more challenging for you, not by adding weight to the bar, but by making a movement more complex.

Mike Patrick: Now let's take kind of a step back and just talk about training programs for let's say someone is involved in an organized sport and so you want their training program to be sort of a mixture of resistance training and aerobic stuff. And in the course of that training program, there's a couple of terms that we talk about over reaching and over training. What Dr. Faigenbaum, is meant by over reaching, what is that?

25:04

Avery Faigenbaum: You know when a young athlete trains the fundamental principle of exercise science is that if you train you're going to build up tolerance, and you're going to improve your endurance and improve your strength. But if you keep on training harder, and harder, and harder this will result in extreme fatigue.

So that period of extreme fatigue we call over reaching, and if you're really smart about this, when an athlete experiences this extreme fatigue, you need to back off on that training, and allow them time to recover and rejuvenate. The theory being if I train really hard, let's for example talk about a group of high school swimmers.

If I train those swimmers really hard on Monday, and Tuesday, and Wednesday, I'm going to actually see their performance decrease. But if I'm a smart coach, I'm going to allow time for rest and recovery. And in theory they're going to come back even stronger.

So sometimes over reaching can be use tensibly, but you need to be careful because you need to respect the amount of rest and recovery that is needed and that might be a problem in our culture. Because over reaching without appropriate rest and recovery results in over training.

26:03

And those are the kids who suffer the injuries, who ends up in the sports medicine clinics.

Mike Patrick:Yeah.

Avery Faigenbaum: So remember children are not miniature adults. My motto is always, "It's better to undertrain than to over train when working with youth."

Mike Patrick: I suspect that there's a lot of kids out there who quit their sports because of over reaching, I mean, they just are exhausted, it's not fun for them anymore, and they quit. And they have the potential to really -to be great or to have a lot of positive reinforcement. And unfortunately they dropped out because of a coach that might have pushed them too hard.

Avery Faigenbaum: You know in our country, I think we spend too much –we train really hard when we're talking about young athletes, we train really hard on our hard days. But we don't rest enough on our easy days. And if you look in the literature so much has been written about training. But what we really need to do is take a look at rest and recovery, and rejuvenation.

And that's what we as parents need to do, to talk to our coaches who work with our children. So for work, I'm with a group of soccer players or age groups of swimmers or football players, you know those kids can train hard on their hard days, but they also need time for rest and recovery on their easy days. They cannot train hard everyday.

27:08

And with the kids that I work with, we respect that, we actually call it less intense training. It's part of our training cycle where today you're going to come in, you might not even sweat today, but we're going to work on technique and allow your body a chance to recover, that's essential not optional.

James MacDonald: One of the things I see on my end on the injury is that I'd say most of the time kids are good at self regulation. And if they are trending toward that over reaching, usually is a figure like a coach or a parent.

And I know what I'm about to say might be mildly contraverse, but I'm speaking as parent as well as a doctor, is if you have a child involved in sports, and you specifically as a parents are gaining anything from that. Some pride, some hope for a scholarship, I think you're tending toward a direction that could go very wrong.

28:00

Mike Patrick: Yeah.

James MacDonald: I think that it needs to be all about the kids when we're talking about organized sports participation. If your kid is driving the bus like, 'I love this soccer, I want to practice four days a week', it's rare for that kid to over reach. And when kids over reach, it usually is the grown ups who are the problem.

Mike Patrick:And I think that kind of spills over into so many aspects of life. I mean if the folks who end up being great in something have that self motivation that they love it. I mean, the ones that are truly are great, I mean the special people, when we talk about gymnastics, some ice skating. And whatever it is in life, I mean you really have to have that internal drive not just someone telling you to do it.

James MacDonald:That's right. And that's why it's good I think as a parent to be responsive to that if you have that child whose got that and you have the means and the desire, it's great to support that. Think all too often again the energy is coming from the other direction.

29:00

Mike Patrick: So Dr. MacDonald, in terms of over training, so we've over reached, and now we're to the point where we've gone into over training and we can see some injuries. What are some of the injuries that you see in the sports medicine clinic?

James MacDonald:Yeah. You know, probably the first one that comes to mind with that idea of over training would be stress, fracture, stress injuries. We see this very, very frequently, ironically here in the spring.

Track and LaCrosse are some of the big players, in the fall we'll see it a lot of times with soccer. In at least if not has been spoken already gets to something Dr. Faigenbaum has spoken about a great deal. A lot of seasons really need to start with that pre-ceasing conditioning. If you take a child who all winter has been sitting on a couch, and then throw them into five miles, three times a day, you've got like almost instant stress fracture there.

Mike Patrick: Yeah.

James MacDonald:We see high volumes of that. And that's probably the number one overused injury we see in our clinic.

30:05

Mike Patrick: Yeah. And then tendonitis, and sprain, and muscle strains.

James MacDonald:And absolutely. And then just to kind of fine tune it a little bit. As you know kids are not little adults. Kids actually will rarely get a true tendonitis like you and I, a little tennis elbow or achilles tendonitis.

If your child, your nine year old is playing soccer, and is complaining of heel pain, that's probably Sever's disease. It's not achilles tendonitis. And actually the way we treat that, the way we diagnose it, but also then how you treat and manage it. It's very different than how me and say a 48 year old runner with achilles tendonitis would be treated.

Mike Patrick: Sure.

James MacDonald: So I would encourage parents in general, if you hear your child complaining about a body part, a joint, say three days running, you're giving them Tylenol three days running for that heel pain, that hip pain. That's pretty unusual for most kids. And may warned being taken a look at.

31:04

Mike Patrick: And I think this is a good place to just point out the advantage of a pediatric sports medicine program for teenage athletes. And I know like here in Central Ohio, there's different places that you can go. But you really want a pediatric sports medicine who knows kid's joints and muscles.

James MacDonald: I would advocate up to easily age 25.

Mike Patrick: Sure.

James MacDonald: There are growth plates in our bodies for most of us. They will not completely fuse until around age 25. We're much, much more resemble we went, we make it up to around 23-24, we most still resemble physiologically and anatomically our younger selves than we will as middle aged people.

Mike Patrick: And parents you know, may say, "Oh the sports medicine such and such takes care of this major league baseball team player, so they must be good." But just because they take care of adults doesn't mean that they are in tune with kid bodies.

32:01

James MacDonald: Absolutely. And it's not definite, but I've seen all too often when they are treated as adults -kids that is. And yes I think it was because the provider was looking at them that way, and that was the wrong way it did to approach it.

Avery Faigenbaum: You know as we talk about this overuse injuries, I think it's interesting that most sports medicine professionals will say that 50% or half of these injuries could be prevented. When you talk to sports medicine physician and certified athletic trainers, I mean can you imagine that half of these injuries could be prevented with sensible training.

And when you look for that number one reason; it's training errors. Kids doing too much, too soon, or lifting load they shouldn't be lifting, or not having adequate rest and recovery. And parents need to be aware of this that at least half could be prevented with sensible training.

Mike Patrick: And when we think about that number, half of them could be prevented, not only are we you know, the pain and the recovery time that's involve, but from an emotional standpoint, I see so many kids you tell them that you have to set out for a couple of weeks. And I mean it's an emotional -I mean you're their number enemy.

33:05

James MacDonald: Many children get very, very invested in their identity as this athlete, I mean, I literally have seen adolescent football players who are out for the season become clinically depressed even contemplate hurting themselves.

They take very invested in that. And there's no medicine in the world that has a 50% success rate. That ounce of prevention is worth a pound of cure that Dr. Faigenbaum is talking about. Pre ceasing conditioning, improved neuro muscular function prior to sport is hugely important.

Mike Patrick: So unfit athlete shouldn't try to play themselves into shape?

James MacDonald: Absolutely. Well, Dr. Mike that's exactly..

Avery Faigenbaum: Dr. Mike, that's an important message for parents because you cannot go from the couch to the playing field. OK. You're an absolute set up for injury. In fact most sports medicine docs you can predict it. You do nothing all summer and you go out for cross country running, 30, 40, 50 miles, you're body is not prepared for that stress, and you end up seeing a sports med doc.

34:02

Now maybe for at least eight weeks prior to the start of the season, at least eight weeks. You need to participate in some kind of conditioning program something that prepares you for sport. And then just one last thing to kind of fine tune it.

And I would add especially as you get older more adolescent it becomes you really want sport specific conditioning. Like for instance as a young man this spring, really fit hockey player went straight from hockey to LaCrosse, developed within three weeks a foot stress fracture, he had no impact skating, he was unbelievably fit in terms of leg strength, cardio vascular strength, no calve strength to shock absorption.

Immediately going to impact and running. I did made him non weight bearing on crutches for six weeks. No sports specific pre season conditioning versus LaCrosse.

Mike Patrick: Could the program that you run here at Nationwide Children's and I suspect that there are similar programs around the country that affiliate with pediatric institutions. Can parents come in for a consultation on a sport specific training program?

35:07

James MacDonald: Absolutely. And we have a team of certified athletic trainers. They far outnumber the doctors. All of them pediatric trained, all of them certified athletic trainers with bachelor degrees which is the kind of background you're looking for, the expertise that work with kids.

And in fact there are some outreach going to the schools, including the middle schools. And we're contemplating trying to do that in elementary school level because as Dr. Faigenbaum said, he's talking about 16 year old and you're making an invention you're about 10 years too late.

Mike Patrick: Yeah. And we'll be sure to put contact information on the show notes, so folks can find sports medicine here at Nationwide Children's. You talked a little bit about multiple sports, how many sports should kids participate in one school year? Is there a maximum number?

James MacDonald: I don't think there is.

36:00

I think ironically, and I'm thinking he was a -I don't remember his name so I don't think I'm doing any heap of violence. I don't remember his name but I'm the team physician at Bexley High School here. And there's a great kid who is getting five varsity letters this year, ranging from soccer to football, to track to tennis.

Again, my sense is knowing this young man, he is auto regulating this. This is not being driven by his parents, and ironically those multiple sports, I actually think are benefiting him. In fact I probably have more about the kid who specialized too early. I mean, the story that probably worries me the most is I'm a soccer player, that's all I do, I'm soccer from my school, and I'm soccer for a league, and I'm soccer for like a travel.

So he's multiple soccer sports, those are the kids who probably are getting more problems than on baseball, football, swimming, doing multiple different task during a year.

37:01

Avery Faigenbaum: You know so many parents believe that early sports specialization during childhood that leads to success. And it's just not true, you know if you ask most Olympic athletes or professional athletes, what did you do when you were seven, or eight, or nine?

Most will mention two or three different sports. Rarely, rarely will you see a gold medal winner or a professional athlete who says, "When I was six I played this sports and that's all I did." So Dr. MacDonald is right, you need to expose children to a variety of different sports and enhance a variety of different skills, and maybe later in life during adolescence or college days you can participate.

But ask a successful division one athlete or a successful pro athlete, what did you do when you were seven? And you'll typically hear two or three different sports.

James MacDonald: You know, this is anecdotal, Rafael Nadal the great Spanish tennis player, well frequently attributed his great footwork, his great tennis skill to the soccer he played as a kid.

Mike Patrick: Yeah. Now, let's say you don't have a well developed pediatric sports medicine program in your ares, and there's a lot of folks who would have to travel for several hours to do that.

38:08

Are there other stuff online that parents can utilize to find a good way to do a resistance and aerobic training program?

Avery Faigenbaum: You know I would start in the local community. In the local community schools; the elementary, the middle, and the high schools are getting started this type of program if not during school, after school.

And there are some cases I've even heard, before school which I'm a strong supporter off to get their brain excited about and prepared for learning. Local recreation centers, local YMCAs, for the most part qualified staff and can offer this type of program that are readily available.

And again getting back to our initial discussion, it's important to find the right instructor who understands these fundamental principles of pediatric exercise science, and really enjoys working with children.

Mike Patrick: Yeah. Right.

James MacDonald: Can they visit your website Dr. Faigenbaum?

Avery Faigenbaum: Sure. Strongkid.com has some resources that dispels the myths about resistance training and provides reassurance that this type of training can be safe for children.

39:08

But if you were to ask me for one bit of advice, I want moms and dads to do some homework, and I want moms and dads, in their own community to find a certified athletic trainer or a physical therapist, or a physical education teacher who's wonderful in working with children to design this kind of program.

And there is in most communities. It may not be called strength training, but it might be called a fitness workout, or a kids program, but that's great. As long as it involves play and movement, that's what we want.

Mike Patrick: And if there are folks out there listening now who are involved in that on that training end, who maybe are in a smaller community and you're kind of focus on adults, but you do have some interest in kids, but maybe don't have the experience that you wish you had, then strongkid.com could be a place where the trainers could find some resources to sort of guide them into a more child friendly type of conditioning program.

40:01

Avery Faigenbaum: Sure. And there are different organization -professional organizations as well. For example the American College of Sports Medicine, and the National Athletic Trainers Association. The National Strength and Condition Association, are all organizations that offer advice, seminars, and trainings for professional who are interested in working within men and women, and boys, and girls of all ages and abilities.

Mike Patrick: Yup. And we'll put links in the show notes to all of those places, so both parents and athletic trainers everywhere can hopefully they already know, but if they don't know, now they do.

Avery Faigenbaum: Great.

Mike Patrick: All right. Dr. MacDonald, thinking about kids who don't necessarily have an inclination towards sports. And we just sort of talked about this a little bit. How can parents motivate them to get involved with physical fitness, I mean, how do you motivate your teenager who wants to just sit on the couch playing video games for hours at a time. How do you motivate that kid to be more active?

James MacDonald: That's a very, very good question. And I actually think if you've made it to that age and you're dealing with that problem, it would be very, very hard to address.

41:09

And so the way to address that would be to prevent it, to address it earlier. Gets back to where this conversation started. It's incorporating physical activity from the get go with your young child. I think what I'm about to say would fall in deaf ears with an adolescent.

But I'm familiar with many studies looking at not just the benefits of physical activity, but outdoor physical activity. And there was a great study I'm familiar with, "The longitudinal study", that its only intervention was having a parent go outside with either child for one hour a day, that was it. That was the intervention.

And they were able to look at outcome measures including objective ones like body mass index as well as physical fitness indicators. And rates for instance of overweight and obesity went down dramatically on the order of 25%. The only intervention being mom or dad went outside with the child for one hour.

42:06

They can do anything they want during that one hour. The child once again at a certain age as Dr. Faigenbaum has said, like little dynamos that run around, you don't typically regulate them, they'll climb, they can do whatever. So which I'd say it has to start young.

We parents have to have discipline, yes our children will be more quiet if they're in front of an iPod or an iPad, what are we training them to do for life by doing that? Sure they're going to be quiet for two hours, they'll be quiet when we go out to eat with them, and their faces are buried in the iPad.

We are developing skill sets, they're going to shoot them in the foot later on. We've got to let our kids play, we've got to motivate them to play, and the simplest thing we can do is to model that behavior, to encourage that behavior, and to do it young before you've got that 16 year old in front of the iPod.

43:00

Mike Patrick: And once you do have the 16 year old in front of the video games and the iPod, I think just speaking as a parent of a couple of teenagers, kids-they want attention from their parents, but as a parent you have to realize that you can't necessarily be the one directing what that attention is3 going to be.

So you really have to try to figure out what their interest are, and really try to have develop a relationship with your kid. And then our families today, things are so busy, and we've got this going on, and that going on, that sometimes we don't really have relationship with our kids. And so kind of has to start there.

Avery Faigenbaum: And I think you know, getting to again, you'll rule out many situations where OK, we weren't able to do that prevention, what do we do now? I'm a big believer, I'm not a pessimist like I'm like a big believer. No time is too late. You're 80 years old, don't use that phrase and 'an old dog can't learn new tricks'.

We can always learn something. So, you know again I don't say it would be easy, but I the ways I might approach this, 'Do you have a dog in the house?', "Are you mom and dad the only ones walking the dog?'

44:06

Sixteen year old easily can walk the dog. Probably have even less safety issues than you would when eight years old walking around the block solo 16. So you know, I'm not saying you won't get resistance from your adolescents, but once again there's whole body of literature of the health befits of having a pet and part of it includes, this pet needs interaction, this pet needs to be outdoors, this pet needs to be walked if they're a dog.

Get your adolescent out there walking the dog. Make privileges like driving a car, not a right. Privileges like driving a car contingent upon issues like, "Did you walk the dog?"

Mike Patrick: You can do that with video games too?

James MacDonald: Absolutely. You'll get pushed back, but I mean once again I think we have to be disciplined as parents and know that our kids will thank us for that later. They kind of give us grief now the adolescent, but they're going to thank us..

Mike Patrick: And sometimes parents I guess need to come out of their comfort zone a little bit too. I mean, let's go hiking, let's go canoeing, do some things that I'm not comfortable doing, but we're going to try this out together.

45:10

James MacDonald: And if you are an overweight parent out there listening, by all means think about resistance training. You're an overweight parent listening and you have let's say a 10 year old, and you're worried that this 10 year old is trending toward you're heading, take up resistance training, find that certified person.

Dr. Faigenbaum is talking about because both the parent and the child will benefit. And once again there are many stage that show the reinforcement when the parent and child do something together, again it's very holistic, it's not just about the body. Become about the mind, the soul if you will, the communication between the parent and child. There are so many things that can benefit.

Avery Faigenbaum: You know sometimes we talk, I hear the phrase, "exercise is medicine", and that's sort of a catch phrase that we see in the literature and we see in the media. But when talking about children perhaps,we need to call it, "Play is medicine".

46:00

Play -because playing books that desire to have fun and make friends, and learn something new. Because if you see that child running on a treadmill for example, that in my view is just burning calories. You know, when you think about play and movement, and enjoyment, ad making friends, we can't overlook that.

So we'll go back to the child you're talking about on the couch who has that disinterest in physical activity. Now I'm not sure if 30 minute jog is going to be appropriate for that child. he just won't do it. But we can have some games that are child appropriate. We can play, we can simply play with short burst of physical activity whether it's on the playground or on the backyard, or on a recreation center.

It's putting that movement back into this kind of experience. And we can't overlook the importance of making friends which are so important during adolescence.

James MacDonald: I'll tell you actually one of the great adolescent intervention is probably been studied, but give a couple of kids a frisbee, they'll play, they'll run around, they'll socialize. A frisbee is a great intervention for adolescent.

Mike Patrick: Yup. absolutely. And now we have the frisbee golf courses springing up all over the place. All right. Well, I really appreciate both of you stopping by today.

47:02

We are going to have lots of links in the Show Notes strongkid.com, Division of Sports Medicine here at Nationwide Children's Hospital. The Department of Health and Exercise Science at the College of New Jersey. And other resources for you as well.

Before we end the program, one of the things we always ask the folks who come in to interview in the PediaCast studio is just something fun that doesn't involve screen time. Just as an example in your own families, what you guys like to do.

And in the past I've kind of focus that on board games, and things sort of indoor. Seem appropriate now to sort of shift that to outdoor activities. And what do you think Dr. MacDonald, would something that your family likes to do together you know, that's an activity?

James MacDonald: So we do like being outdoors. I mean, we have a garden and we live in Bexley which is zone t have chickens. So we have backyard chickens in the garden, and our kids love being in the backyard, collecting the eggs, you know mocking a little chicken coop.

48:02

Digging you know, the little garden for mom to plant. So we love being in the backyard. And we have a huge magnolia tree decorated with multiple ropes and swings, so our kids knock their socks off in the backyard.

Mike Patrick:Oh that's great. Now how many chickens do you have?

James MacDonald: Two.

Mike Patrick: OK. That's another..

James MacDonald: They're both layers, and I wonder when they stop laying, what am I going to do?

Mike Patrick: That seems like ab appropriate number. I could see that -is there with the zoning is there a limit?

James MacDonald: You can have in Bexley, five pets. So we got a dog, a bunny, and two chickens. We have room for one more.

Mike Patrick: Yeah. That would not go well in my neighborhood.

[Laughter]

Mike Patrick: What about you Dr. Faigenbaum?

Avery Faigenbaum: You know I love teaching fundamental movement skills. And I presented on this, we've done some research on this. I like balloons as simple as they are. Dr. MacDonald spoke about a frisbee, but they kind of interventions we speak about now with work which are not expensive.

Literally I take a few balloons, particularly the punch balloons that you can buy with a rubber band. They are a little bit thick, or they don't pop. Just cut off the rubber band and we teach children how to squat, and hop, and skip, and do knew taps, just with the balloon.

49:03

When you give a balloon to a child it invokes his desire to play. It's a universal. So with a simple balloon, it's physical activity. So, how do we get that kid off the couch? Let's play some taps, some knee taps, and some punches, and some shoulder tips with a balloon. It's as simple as this, it's getting move in back in the lives of this children.

Mike Patrick: Yeah. Well, that sounds fun. Makes me want to go out and get one.

[Laughter]

Avery Faigenbaum: Go to Target, I'm told

[Laughter]

Mike Patrick: Well, really appreciate both of you stopping by and talking to us today.

James MacDonald: Thank you very much, Dr. Mike.

Avery Faigenbaum: Thank you. It's but a treat.

Mike Patrick: Yup. I want to remind everyone out there that -well first I want to thank everyone both Dr. James MacDonald and Dr. Avery Faigenbaum. And of course thanks to all of you out there for taking part in the show and making PediaCast a part of your weekly routine, we really appreciate it.

Don't forget iTunes reviews are helpful as our links on your web pages, and of course mentions in your Blogs, Facebook, and your tweets, and on Google +. And be sure to join our community by liking PediaCast on Facebook, following us on Twitter, tweeting with hash tag #PediaCast and hanging out with us on Google +

50:07

Also be sure to swing by the show notes at PediaCast.org, add your comments on today's show. We also appreciate you telling your family and friends, and neighbors about PediaCast.

And don't forget to talk us up with your child's doctor at your next well check up or sick office visit. We also have posters that you can download, and hang up wherever moms and dads hang out.

And you can find them over in the resources tab at PediaCast.org. Also want to remind you if you have a question or a comment for the show, you have an idea for a topic, just go to PediaCast.org, click on the contact link. You can also email pediacast@gmail.com, or call the voice line at 347-404-KIDS, again 347-404-K-I-D-S. And until next time. This is Dr. Mike saying stay safe, stay healthy, and stay involved with your kids. So long, everybody!

[Music]

51:09

Announcer 2: This program is a production of Nationwide Children's. Thanks for listening! We'll see you next time on PediaCast.

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