Journal of Science in Sport and Exercise (2019) 1:208–216

[Link]

REVIEW ARTICLE

Resistance Exercise for the Prevention and Treatment of Pediatric

Dynapenia
Avery D. Faigenbaum1   · Tamara Rial Rebullido2 · Javier Peña3,4 · Iván Chulvi‑Medrano5

Received: 3 August 2019 / Accepted: 18 September 2019 / Published online: 2 October 2019
© Beijing Sport University 2019

Abstract
Temporal trends of youth muscular fitness (i.e., muscular strength, muscular power and local muscular endurance) indicate
that contemporary children and adolescents are weaker and slower than previous generations. Consequently, this generation
of millennials appear to be just as vulnerable as older adults to the inevitable consequences of muscle disuse and neuro-
muscular dysfunction. The modern-day construct of pediatric dynapenia describes an identifiable and treatable condition
in youth characterized by low levels of muscular strength and power and consequent physical and psychosocial limitations
not caused by neurologic or muscular disease. An interaction of modifiable physical and psychosocial factors can influence
the development and progression of pediatric dynapenia. Without structured interventions that target strength deficits and
build strength reserves in a supporting environment, the divergence in performance between weaker and stronger children
may persist into adolescence because weaker youth may be unable to break through a so-called strength barrier. Regular
participation in a well-designed youth resistance training program provides an opportunity for youth to enhance their health
and fitness while acquiring the physical skills and behaviors that support an active lifestyle. New insights have highlighted
the importance of initiating strength-building interventions early in life to optimize performance gains in other important
components of physical fitness. Developmentally appropriate resistance training should be integrated into school- and
community-based youth fitness programs and strength-building activities should take a more prominent position in public
health physical activity recommendations for children and adolescents.

Keywords  Children · Kinesiophobia · Muscle · Physical activity · Strength training · Weightlifting

Introduction

It is well established that regular participation in active play,

exercise and sport activities is associated with a constella-
tion of physical, psychosocial and cognitive benefits that can
enhance the health and well-being of all youth regardless
* Avery D. Faigenbaum of age, sex or clinical status [66]. Indeed, physical activ-
faigenba@[Link]
ity plays a critical role in the prevention and management
1
Department of Health and Exercise Science, The College of non-communicable diseases and is recognized as one of
of New Jersey, 2000 Pennington Rd, Ewing, NJ 08628, USA the most important actions youth can take to improve their
2
Tamara Rial Exercise and Women’s Health, Newtown, PA, health [66, 76]. Despite this knowledge, epidemiological
USA reports from 49 countries with varying levels of human
3
Sport and Physical Activity Studies Center (CEEAF), development indicate that a vast majority of youth world-
University of Vic - Central University of Catalonia, wide are failing to accumulate at least 60 min of moderate to
Barcelona, Spain vigorous physical activity (MVPA) daily [4]. In the United
4
Sport Performance Analysis Research Group (SPARG), States, only 24% of youth 6 to 17 years of age participate
University of Vic - Central University of Catalonia, in 60 min of MVPA every day and there is a significant
Barcelona, Spain
drop in physical activity levels with increasing age [42].
5
Department of General and Specific Didactics, University Similar observations were found in youth from Australia,
of Alicante, Alicante, Spain

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Journal of Science in Sport and Exercise (2019) 1:208–216 209

Brasil, Canada, Ethiopia, Mexico and Spain [4]. Of concern, owing to its health-enhancing, performance-improving and
global declines in levels of MVPA have coincided with tem- injury-reducing effects [25, 35, 48]. Without developmen-
poral declines in measures of muscular fitness (i.e., muscular tally appropriate interventions that include strength-building
strength, muscular power and local muscular endurance) in exercises and directed movement practice, it is unlikely that
modern day youth [25, 72]. modern day youth will be prepared for the physical and
A low level of muscular strength and muscular power is psychosocial demands of exercise and sport. The efficacy
a well-recognized risk factor for functional disability and of youth resistance training has been well-investigated and
mortality in older adults [31] and, in the same light, chil- evidence indicates that supervised resistance training pro-
dren and adolescents appear to be just as vulnerable to the grams that are technique-driven and sensibly progressed are
inevitable consequences of dynapenia and neuromuscular relatively safe for children and adolescents [7, 8, 25, 48].
dysfunction [26, 35, 62]. While the term dynapenia has tra- However, there is little information available linking tempo-
ditionally been associated with older adults to describe the ral trends in youth muscular fitness to the modern-day con-
poverty of strength or power often seen in this population struct of pediatric dynapenia, and the potential health- and
[13], the construct of dynapenia also applies to modern day fitness-related benefits of youth resistance training appear
youth who are weaker and slower than previous generations to be overshadowed by the promotion of aerobic exercise
[12, 24, 27]. By definition, pediatric dynapenia is an iden- activities. Therefore, the aim of this narrative review is to
tifiable and treatable condition in youth characterized by explore temporal trends in youth muscular fitness, discuss
low levels of muscular strength and power and consequent the interaction of factors that influence pediatric dynapenia,
functional limitations not caused by neurologic or muscular and describe the potential benefits of resistance training as
disease [27]. Since weaker youth may be less likely to par- a primary agent in the prevention and treatment of pediatric
ticipate in outdoor play, exercise and sport activities with dynapenia in modern day youth.
competence and confidence, they may be more prone to
suffer adverse health consequences associated with muscle
disuse and physical inactivity [11, 26, 54]. To alter the cur- Temporal Trends in Muscular Fitness
rent trajectory towards physical inactivity and related mor-
bidities, structured programs that target strength deficits Technological advances and social media usage have
are needed to manage youth before they develop unhealthy decreased the need to move, physical education and recess
physical activity behaviors and become resistant to exercise are considered expendable in some school districts, and the
interventions later in life. high cost of some youth sport and fitness programs limit
Current public health guidelines recommend that chil- participation for lower income families. Children and ado-
dren and adolescents should participate in aerobic, muscle- lescents are not as active as they should be and the observ-
strengthening and bone-strengthening activities, yet it is sug- able decline in physical activity that begins early in life tends
gested that most of the 60 min or more per day of physical to continue across the primary-secondary school transition
activity should be moderate to vigorous intensity aerobic [64]. Since muscular fitness underpins many of the biomo-
exercise [76]. These general recommendations that focus tor qualities that are needed to perform activities of daily
on the total amount of aerobic physical activity accumulated living and movement skills proficiently [7, 48, 53], reduced
throughout the day undervalue the critical importance of levels of muscular fitness may inevitably lead to a decrease
resistance exercise to combat physical inactivity and pre- in physical activity and physical literacy [26, 72, 82]. Even
pare youth for ongoing participation in active play, exercise young athletes who do not address neuromuscular deficits
and sport activities. Since prerequisite levels of muscular and build high strength reserves may be more likely to suf-
strength are needed to jump, hop, kick, and run proficiently fer a sports-related injury and less likely to attain elite-level
[53], concerted efforts are needed to identify and treat defi- performance [25, 28]. From an athletic perspective, high
cits in muscular strength early in life before youth become strength reserves can be used (or not) to overcome physical
disinterested, disengaged, and predisposed to functional challenges or unexpected stressors during sport practice and
limitations, activity-related injuries and adverse health out- competition.
comes [35, 62, 82]. Notwithstanding the importance of tracking temporal
A population wide approach for preventing and treating changes in cardiorespiratory fitness in youth, equal impor-
pediatric dynapenia is needed because youth who are defi- tance should be given to monitoring trends in muscular fit-
cient in muscle strength may not develop a level of motor ness since strength deficits during childhood and adoles-
skill prowess that is needed for ongoing participation in cence may result in physical inactivity and adverse health
active games and fitness activities. Hence, the promotion of outcomes [26, 62, 72]. Evidence supports an association
youth physical activity should not focus on aerobic exercise, between muscular fitness and physical activity early in life,
but rather integrative training centered on resistance exercise with the strongest link for vigorous intensity activity and

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210 Journal of Science in Sport and Exercise (2019) 1:208–216

organized sports [54, 72]. As shown on Table 1, over the Test-specific differences in performance were observed in
past few decades there has been a decline in selected field young New Zealanders who decreased performance on the
measures of muscular fitness in school-age youth in a major- standing long jump test but increased performance on the
ity of countries or areas. sit-up test over a 12 year study period [1].
A study of temporal trends in muscular fitness of English Secular increases in weight status in youth could
10 year olds found downward trends in standing long jump, explain, at least in part, the aforementioned observations.
handgrip, sit-ups and bent arm hang which were consistent Australian researchers reported children and adolescents
with self-reported declines in physical activity [70]. Similar were jumping 7  cm less in 2015 than in 1985; yet the
declines in measures of muscular fitness were reported in prevalence of obesity was threefold higher in 2015 than in
American [45], Australian [37], Canadian [74], Chinese [3], 1985 [37]. These observations are consistent with Swed-
Czech [59], Flemish [55], Lithuanian [78], Spanish [57] and ish researchers who noted the decline in performance on
Swedish [22] youth. The observed declines in youth muscu- the bent arm hang test was consistent with an increase in
lar fitness across the globe are consistent with decreases in the prevalence of overweight among adolescents during
participation in active play and sport activities and increases the study period [22]. In addition, the findings on Table 1
in sedentary behaviors (e.g., screen time) [4, 64]. suggest a progressive decline in selected measures of
In contrast, temporal trends in muscular fitness of Dutch muscular strength (e.g., handgrip) and muscular power
[69], Finnish [40], Mozambican [21], New Zealand [1], (e.g., standing long jump) in comparison with a more sta-
Portuguese [18] and Welsh [75] youth appear to be more ble trend (or improvement) in measures of local muscu-
stable, with sex-specific or test-specific differences on lar endurance (e.g., sit-up). Although speculative, testing
selected outcomes. For example, over a 20-year study procedures for different measures of muscular strength,
period involving Mozambican youth the handgrip strength muscular power and local muscular endurance may have
of females decreased whereas males increased their hand- influenced the observed trends in muscular fitness. Since
grip strength [21]. Similarly, over a 10 year study period a testing procedures for the handgrip and standing long jump
decrease in handgrip strength was reported in Welsh males tests are less dependent on exercise technique factors than
but no significant change was observed in females [75]. the sit-up test, it is possible that local muscular endurance

Table 1  Summary of temporal trends in muscular fitness in youth around the world

References Country/area Data period Age (year) Tests Main findings

[1] New Zealand 1991–2003 10–14 SLJ, SU ↓ SLJ in F & M; ↑ SU in F & M

[3] China 1985–2014 12 PU, SLJ, SU ↓ PU, ↓ SLJ, ↑ SU in F & M
[18] Portugal 1993–2013 10–11 SLJ, SU ± SLJ & ↑ SU in F & M
[21] Mozambique 1992–1999–2012 8–15 HG ↓ HG in F & ↑ HG in M
[22] Sweden 1987–2001 10, 13, 16 BAH, SU, VJ ↓ BAH & ↓ SU in F & M;
↓ VJ in M & ± VJ in F
[37] Australia 1985–2015 9–15 SLJ ↓ SLJ in F & M
[40] Finland 1976–2001 13–16 BAH (F only), PU (M ↑ SLJ in F & ± SLJ in M;
only), SLJ, SU ± BAH in F; ↓ PU in M;
↑ SU in F & M
[45] USA 1980s–2012 5–15 MPU ↓ MPU in F & M
[55] Belgium 1969/74/79/80–2005 12–18 BAH ↓ BAH in M & F
[57] Spain 2001/02–2006/07 12–17 BAH, HG, SLJ ± BAH in F & M;
↓ HG & ↓ SLJ in F & M
[59] Czech Republic 1986–2013 8/9–12/13 SLJ, SU ↓ SLJ & ↓ SU in F & M
[69] Netherlands 1980–2006 9–12 AP, BAH, LLT, VJ ↑ AP in F & ↓ AP in M;
↓BAH in F & M; ↑LLT in M & F;
↑VJ in M & F
[70] England 1998–2014 10 BAH, HG, SLJ, SU ↓BAH, ↓SLJ, ↓HG, ↓SU in F & M
[74] Canada 1981–2007/2009 6–19 HG ↓ HG in F & M
[75] Wales 2003–2013 10–11 HG ± HG in F & ↓HG in M
[78] Lithuania 1992–2012 11–18 BAH, SLJ, SU ↓ BAH & ↓ SLJ in F & M;
↑ SU in F ± SU in M

F female, M male, AP arm pull, BAH bent arm hang, BS back strength, HG handgrip, LLT leg lift test, MPU modified pull-up, PU pull-up, SLJ
standing long jump, SU sit-up, VJ vertical jump, ↑ increase, ↓ decrease, ± stable

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Journal of Science in Sport and Exercise (2019) 1:208–216 211

(assessed in a valid and reliable manner) could be declin- has been found to be associated with metabolic dysfunction
ing at a similar rate as muscular strength and power. [36], cardiovascular risk [11], and major causes of premature
When looked at collectively, the available evidence indi- death [63]. Data from a large cohort study of 1.2 million
cates that declines in muscular strength and muscular power men found a strong association between muscular weakness
are prevalent in modern day youth from different countries during adolescence and all-cause disability 30 years later
and that performance gains in muscular fitness in a growing [38].
number of children and adolescents are not optimal. Find- Low muscle strength, poor fundamental movement skills
ings from a global review found adolescent participation (FMS) and inadequate physical activity can interact syner-
in resistance training across regions ranged from 0.3% in gistically to predispose youth to dynapenia and associated
Africa to 12.4% in the Eastern Mediterranean and participa- changes in contractile function and morphology of skeletal
tion in resistance training by children was not in the top 10 muscle [12, 25, 62]. Without regular opportunities to engage
sport and leisure-time physical activities reported [39]. Of in strength- and skill-building activities during unstructured
potential relevance, the American College of Sports Medi- (e.g., outdoor play and recess) and structured (e.g., physical
cine’s worldwide survey of fitness trends for 2019 did not education and sport) events, school-age youth may be less
list any topic related to children’s programing (e.g., school likely to attain a level of muscular fitness and neuromuscular
fitness, youth resistance training, childhood obesity) in the dexterity that are needed for ongoing participation in moder-
top 20 [73]. ate to vigorous physical activities on the playground, in the
The divergence in performance between weaker and gymnasium and at sport practice [54, 72, 77]. An under-
stronger children appears to persist into adolescence [34], standing and appreciation of the interrelated factors that
and without interventions that target strength deficits weaker influence pediatric dynapenia may help to alter the current
youth may not catch up with their healthy peers who have trajectory towards physical inactivity and related co-mor-
higher levels of relative strength and power [32, 33]. Youth bidities. Figure 1 illustrates a proposed model of systemic
with relatively low levels of muscular fitness and poor motor and causal interactions of factors that influence pediatric
skills are often unwilling and at times unable to perform dynapenia.
activities of daily living proficiently or participate in out- Years ago Forbes described an undesirable phenotype in
door games or sports with energy and enthusiasm. The children characterized by low muscle mass [30] and Micheli
long-term consequences of poor muscular fitness include recognized the consequences of poor muscle strength in
decreasing participation in MVPA (Martínez-Gómez et al. young athletes [56]. During this era others hypothesized that
2011), increasing rates of sport-related injuries [5], and poor children with poor motor skills would not be able to break
cardiometabolic health [36]. From a public health perspec- through a so-called motor proficiency barrier and, therefore,
tive, it appears that most children and adolescents are not would be less prepared for active games and recreational
prepared for the physical demands of active play, exercise activities that required more mature movement patterns [71].
and sport activities and, therefore, concerted efforts are
needed to enhance muscular fitness in early in life to alter
physical activity trajectories and reduce the likelihood of
adverse health outcomes.

Pediatric Dynapenia

Aging is associated with a variety of anatomical and physi-

ological changes that contribute to a decrease in muscle
mass and function which, in turn, can lead to undesirable
physical and psychosocial consequences in older adults [31].
Even with healthy aging, an interaction of genetic, biologi-
cal, environmental, and behavioral factors result in muscle
weakness and functional challenges which are highly associ-
ated with mortality and physical disability [13, 31]. Thus,
the life changing consequences of dynapenia are not limited
to adult populations because muscular weakness at any age
predisposes individuals to functional limitations, activity-
related injuries and adverse health outcomes. In support Fig. 1  Systemic and causal interactions of the factors that influence
of these observations, dynapenia during the growing years pediatric dynapenia

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212 Journal of Science in Sport and Exercise (2019) 1:208–216

While recent evidence supports the presence of a motor challenging environment, youth are more likely to become
proficiency barrier for meeting physical activity guidelines physically illiterate [29]. That is, they will lack confidence
[19], prerequisite levels of muscular strength are needed to and competence in their physical abilities and will tend to
enhance the performance of movement skills [14, 15], pre- avoid nonessential MVPA in order to guard against embar-
pare youth for the demands of vigorous physical activity rassment, humiliation or failure [80].
[72] and reduce the likelihood of sport-related injuries [44]. The fear of MVPA is a relevant factor in inactive youth
A certain level of force-production and force-attenuation who may be less willing to experience (and tolerate) feelings
is needed to perform movement skills proficiently and, there- and sensations associated with exercise and sport activities.
fore, muscular strength should be considered foundational While the term kinesiophobia has been used in the context of
for long-term physical development [25, 47]. Without ade- rehabilitative medicine to describe an irrational and debili-
quate levels of muscular strength it is unlikely that youth will tating fear of movement due to a feeling of vulnerability to a
gain confidence and competence in their physical abilities to painful injury [43, 51], the avoidance of physical activity due
optimize performance gains in other important components to fear of failure or discomfort is also observed in modern
of physical fitness [61, 82]. As such, a growing number of day youth. Just as the construct of kinesiophobia can help to
modern-day youth may be unable to break through a so- conceptualize the processes and mechanisms through which
called strength barrier that would allow them to perform acute pain can become chronic [51], MVPA fear-avoidance
basic movement skills proficiently, engage in MVPA enthu- factors may help explain why physically inactive youth may
siastically and enhance performance gains in other impor- be more susceptible to pediatric dynapenia than active par-
tant components of physical fitness. New insights have ticipants. Children at risk for physical inactivity tend to have
highlighted the importance of increasing muscular strength lower perceptions of their motor competence [23] and higher
and initiating interventions early in life to improve muscular perceptions of pain [67]. Injured adolescent athletes reported
fitness, enhance athletic performance and reduce associated psychosocial barriers to return to sport with greater consist-
injury risks in children and adolescents [9, 47, 60]. ency than physical barriers [20]. All together, these findings
Since FMS such as jumping, kicking and running serve as suggest a decrease in MVPA and concomitant reductions in
building blocks for more complex movement patterns, youth muscular strength and FMS can result in a downward cas-
with poor FMS are more likely to have functional limitations cade of adverse physical and psychosocial outcomes which
and less likely to engage in regular physical activity and can influence the development and progression of pediatric
achieve desired levels of physical fitness [52, 77]. Recent dynapenia [26].
meta-analytic findings indicate that resistance training can
have a positive impact on sprinting, jumping and throwing
performance in youth [14, 15] and others found a significant Underappreciated Benefits of Youth
positive correlation between gains in FMS and the mean Resistance Training
intensity of youth resistance training programs [8]. These
findings are supported by meta-studies that characterized An evidence-based approach to preventing and treating pedi-
dose–response relationships of resistance training on physi- atric dynapenia should include resistance training given its
cal performance in young athletes and found higher intensi- strength-building and health-enhancing benefits [26, 35, 48].
ties (80–89% of 1 repetition maximum) resulted in the great- Resistance exercise interventions have proven to be so effec-
est gains in physical performance measures [46]. Due to tive for combating age-related declines in muscular strength
the synergistic relationship between muscular strength and and functional mobility that resistance training has been
FMS, youth who are deficient in muscular strength and FMS considered “medicine” for adults [79]. Due to the remark-
fitness may be more likely to suffer from pediatric dynapenia able efficacy of resistance training on age-related mobility
during this period of life. declines, the American College of Sports Medicine recom-
From a developmental perspective, ongoing exposure to mends that frail older adults should increase their muscular
strength-building activities during active play, exercise and strength before they engage in aerobic training [2]. Likewise,
sport can augment the interrelated components of physical youth resistance exercise that is consistent with individual
fitness and, in turn, sustain participation in MVPA across the needs, goals and abilities has proven to be a polypill due
lifespan. If youth engage regularly in strength-building activ- to its unique anatomical, physiological, and psychological
ities and learn how to move proficiently with confidence, benefits [24, 35, 48].
confidence and enthusiasm in a variety of settings, they may As shown on Fig.  2, regular participation in a well-
be more likely to acquire the physical skills and behaviors designed youth resistance training program can offer a vari-
that support a physically active and healthy lifestyle [29, ety of health and fitness benefits that can prevent the decline
35, 82]. Conversely, without regular opportunities to par- in physical activity and upsurge of disease risk factors during
ticipate in exercise and sport activities in a progressively this critical phase of life. In addition to the aforementioned

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Journal of Science in Sport and Exercise (2019) 1:208–216 213

instruction, children can learn how to perform strength-

building movements (e.g., animal like exercises) as well as
complex exercises that require a high degree of technical
skill (e.g., weightlifting exercises and derivatives) [24,
48]. There appears to be an unparalleled opportunity for
youth fitness specialists to target strength deficits early in
life with strength-building games and exercises that are
developmentally appropriate, engaging and enjoyable.
Notably, well-designed youth resistance training programs
can be performed in a time efficient manner before sports
practice, during physical education, or after school in fit-
ness programs. Without school- and community-based
resistance exercise interventions, health care providers
may eventually need to treat pediatric dynapenia in the
clinic in order to manage neuromuscular limitations and
related health issues.
The age of 6 years has been proposed as an appropriate
time for most children to begin organized sports [50], and
this starting age seems suitable for participation in resistance
training exercise that is developmentally appropriate [24,
47, 61]. Regular participation in a youth resistance training
Fig. 2  Potential benefits of youth resistance training
program provides an opportunity for participants to enhance
their muscular fitness while improving their resistance train-
improvements in muscular fitness, FMS, and MVPA [14, 15, ing skill competency [25]. Thus, the “dose” of resistance
25, 48, 72], resistance training can have a favorable influence exercise should be carefully prescribed because the quantity
on musculoskeletal health, body composition, metabolic of training (e.g., weight lifted) needs to be balanced with the
function and mental health in children and adolescents [6, quality of the training experience (e.g., exercise technique)
14–16, 35, 68]. As participants increase their muscular fit- in a challenging and supportive environment [65].
ness they can build their strength reserves and concomitantly As participants gain confidence and competence in
increase their resistance to activity-related injuries as they their abilities to perform basic resistance exercises, they
gain confidence and competence in their physical abilities can optimize training-induced adaptations by performing
[28, 44, 82]. From a clinical perspective, survivors of child- more complex movements as part of a structured training
hood acute lymphoblastic leukemia are at risk for a condition paradigm. For instance, young children can create animal-
called cancer cachexia which is characterized by a progres- movements or exercises with lightweight medicine balls
sive deterioration of skeletal muscle and muscle weakness as they apply learned skills in novel situations [24]. Other
[10]. Exercise interventions than include resistance train- modes of resistance exercise including free weights (barbells
ing can be used to increase amino acid reserves and muscle and dumbbells) and elastic bands can be used to promote
strength in youth with cancer as well as in apparently healthy the development of muscular fitness and enhance funda-
children and adolescents [58]. This effect is attributed to mental movement skill competency. Youth without prior
the physiological and dynamic relationship between protein resistance training experience could begin with 1 or 2 sets
synthesis and breakdown processes that can shift as a result of 8 to 10 repetitions with a light load (≤ 60% 1 repetition
of stressful or pathophysiological conditions that can lead maximum) for a range of exercises and movement patterns.
to muscle catabolism [81]. As resistance training skill competency improves, partici-
The early years of life are characterized by rapid pants could perform 2 to 4 sets of 6 to 8 repetitions with a
changes in brain development and associated neuroplas- moderate training intensity (≤ 80% 1 repetition maximum).
ticity and, therefore, the salubrious effects of a well- With ongoing instruction and technique-driven progression,
designed youth resistance training program may be the youth could be introduced to periodic phases of higher inten-
most promising and long-lasting [61]. Just like the skills sity training (> 85% 1 repetition maximum) with lower rep-
of reading and writing, children need to learn how to move etition ranges (≤ 6 repetitions) [48]. This type of program
proficiently and should be provided with daily opportuni- design can contribute to a mastery-oriented climate that can
ties to engage in different types of MVPA that enhance enhance the learning experience and promote participation
muscular fitness and reinforce desired movement pat- in youth resistance training programs. Although specific
terns. With age-related teaching strategies and ongoing youth resistance training guidelines and sample programs

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214 Journal of Science in Sport and Exercise (2019) 1:208–216

are beyond the scope of this review, they are available else- Regular participation in a well-designed youth resistance
where [24, 49]. training program throughout the growing years can alter
Since muscular strength is inversely associated with mor- physical activity trajectories so inactive youth can break
tality risk in various acute and chronic conditions throughout through a so-called strength barrier and catch up with their
the life course [41], participation in exercise programs that stronger peers. In addition to increasing muscular fitness and
include resistance training should begin before the onset of FMS, youth resistance training can have a favorable influ-
neuromuscular deficits and related health conditions. Due to ence on musculoskeletal health, body composition, meta-
temporal trends in muscular fitness and the consequent pres- bolic function and mental health. New insights into long
ence of pediatric dynapenia in contemporary youth, resist- term physical development have highlighted the importance
ance training should be included in youth fitness programs of initiating interventions early in life to improve muscular
and participation in strength-building activities should take fitness, enhance performance and reduce associated injury
a more prominent position in public health physical activity risks in children and adolescents [9, 47]. Informing parents,
recommendations. For example, the physical activity pyra- clinicians, and public health officials about the adverse con-
mid for kids places “muscle fitness exercises” on the second sequences of pediatric dynapenia and the potential benefits
to the last rung of the pyramid just below flexibility exercises of well-designed youth resistance training programs may
[17]. This modern-day mindset that focuses on the quantity help to increase participation in strength-building activities.
of time youth spent in MVPA undervalues the importance Since muscular fitness is considered foundational for all
enhancing muscular fitness, improving FMS and helping types of MVPA, resistance training should be more promi-
youth develop attitudes and behaviors that support a physi- nent in youth physical activity recommendations and should
cally active lifestyle. be considered first-line treatment for pediatric dynapenia. A
At present, there appears to be a persistent focus on aer- new framework for addressing physical inactivity in youth
obic games and endurance activities even though weaker and encouraging participation in resistance training activi-
youth may lack the requisite confidence and competence to ties as part of multi-faceted exercise and sport programs is
participate in active games and sport activities. Dispelling needed because our current strategies are suboptimal.
misperceptions associated with youth resistance training
and informing parents, clinicians, and public health officials
about the adverse consequences of pediatric dynapenia and
the potential benefits of well-designed youth resistance train- References
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