Regular exercise and proper nutrition are the keys to good health, regardless of age. There are three important aspects to fitness – endurance, strength and flexibility. A proper fitness regimen includes all three of these aspects. When children are fit at an early age, they are more likely to remain active and physically fit throughout their lives. The benefits of regular exercise include maintaining a healthy weight and increased energy and self-esteem. In addition, regular exercise can help prevent many illnesses (e.g., high blood pressure, diabetes, heart disease).

It is important for parents and/or children to speak with a pediatrician before a child begins any new fitness regimen, including sports and athletic activities. A pediatrician can evaluate the child and help decide which activities are safe for the child’s physical condition and stage of development. Although exercise is important, too much may cause injuries and problems. If a child of any age refuses to engage in physical activity or complains about any pain while active, a pediatrician should be consulted. Anabolic steroids and other performance-enhancing drugs must be avoided. Anabolic steroids can be dangerous when used inappropriately. They can lead to various, long-lasting and in some cases, irreversible health problems (e.g., early heart attack, liver tumors).

There are many types of exercise to help keep children healthy. Exercise does not have to be an organized sport. Organized sports may not be appropriate for young children who have not yet mastered the basic skills. If children do belong to a sports team at a very young age, it is important that the entire league emphasize the fundamental skills, fitness and fun.

Strength training with free weights is only recommended for older children (e.g., late adolescence, early adulthood). Younger children can perform strength-training exercises without equipment, such as push-ups, stomach crunches and sit-ups. Children should always be supervised by a qualified adult when performing any type of strength training activity.

Between birth and age 2, children typically get all the exercise needed from daily life. The general recommendation for school-age children and adolescents include a minimum of 60 minutes of physical activity every day.

Children and adolescents are much more likely to engage in regular physical activity if they have the support of their family and friends. It is important for parents and caregivers to be positive role models. It is also important that children and adolescents participate in sports or activities that are fun. Forcing a child to engage in a disliked activity provides little motivation and may discourage the child from exercising all together. It is important to avoid presenting fitness as a punishment or a chore.

Exercise is defined as physical activity that is performed to develop or maintain fitness. Regular exercise along with proper nutrition are essential aspects of maintaining good health in people of all ages, including children. When children embrace fitness at an early age, they are more likely to remain active into adulthood and throughout their lives. Exercise increases body metabolism, helps oxygen to circulate and the intestines to function, and increases the ratio of muscle to fat. Regular exercise helps to maintain a healthy weight and increases strength, endurance and flexibility. It also increases energy, coordination and bone mass, and improves sleep. Remaining fit decreases the risk of numerous medical conditions and illnesses, including high blood pressure and cholesterol, type 2 diabetes, heart disease and osteoporosis (loss of bone mass).

Regular physical activity also appears to benefit children with chronic health issues. For instance, new research findings indicate that children with type 1 diabetes may improve their glucose (blood sugar) levels by engaging in regular exercise. Also, overweight teenagers – who are at risk of becoming obese and developing diabetes – can help prevent or delay onset of both conditions through regular strength training exercise, according to a new study.

The benefits of proper fitness are not just physical. Regular exercise also improves self-esteem, reduces stress and increases alertness. It provides opportunities for social interaction and teaches children numerous life lessons, such as perseverance, and setting and achieving goals.

There are three important aspects to fitness, regardless of age:

• Endurance. Any sustained aerobic (exercise that improves oxygen circulation) activity increases endurance. These are activities that cause faster heartbeats and heavier breathing. However, if these exercises cause breathing so heavy that it makes it difficult to talk, it is best to cut back. When done properly, these exercises increase the strength of the heart and improve the delivery of oxygen throughout the body. Many sports (e.g., soccer, swimming, running) and other activities involve aerobic activity. However, sports that involve very short bursts of activity may not provide long enough periods of sustained activity to be beneficial in increasing endurance.
  
  
• Strength. This involves exercises that increase muscle tone and strength. For adults, this often means lifting weights. However, for children, it tends to include exercises and activities such as push-ups, sit-ups, pull-ups, stomach crunches and climbing.
  
  
• Flexibility. Stretching exercises increase flexibility (the ability of muscles and joints to bend and move). Stretching is important both before and after endurance and strength exercises.

It is important for parents and/or children to speak with a pediatrician before a child begins any new fitness regimen, including athletic activities. A pediatrician can evaluate the child and help decide which activities are safe for the child’s stage of development. A pediatrician should also be consulted if the child complains of pain or appears overly fatigued for the amount of effort an activity requires.

Children need to drink plenty of fluids (e.g., water) before, during and after exercising. Different forms of exercise also require various different types of preparation. For example, any equipment (including play equipment such as swings and climbing bars) must be secure and safe. Safety equipment (e.g., helmets, pads) are necessary for many sports and activities, including bicycle riding. Many activities (e.g., sports, strength training) require close supervision by a qualified adult.

Exercise does not have to be strenuous to be beneficial. When exercise is fun, children will be motivated to continue the activity. Daily exercise can also be broken up into several sessions throughout the day.

Children are naturally active and often exercise even when performing everyday activities. For example, children exercise when they are playing tag and other physically active children’s games and during gym classes, sports and other activities (e.g., dancing, bicycling). They also exercise when performing many household chores, such as mowing the lawn, shoveling snow and cleaning the house.

However, many modern forms of entertainment (e.g., television, videos, computers, video games) encourage children to remain inactive and sedentary. It is best to limit sedentary time to provide more time for physical activity. Other methods of increasing a child’s amount of physical activity include having children take the stairs instead of the elevator and walk or ride their bicycle to school.

According to the Centers for Disease Control and Prevention (CDC), children tend to participate in less physical activity as they get older. The number of overweight or obese children is increasing, according to the CDC. In 2003, 17 percent of American children were overweight, up from 11 percent in 1994. Daily enrollment in high school physical education classes has decreased over time, from 42 percent in 1991 to 28 percent in 2003, the CDC reports. In addition, almost half of American children and adolescents do not participate in regular vigorous physical activity, according to the CDC. This is leading to an overall trend of fewer fit children and adolescents and more children who are overweight or obese.

Some children and adolescents are natural athletes, and some are not. Fitness does not have to involve an organized sport. Free play is also important for all ages. Some examples of free play include solo basketball or one-on-one games, riding bicycles, playing tag, jumping rope and dancing.

Organized sports may not be appropriate for young children. If a child is not physically and emotionally ready for organized sports, the experience can be frustrating. As a general rule, children are ready for these sports sometime between the ages of 5 and 7 years, although there is wide variation among children.

It is typically recommended that children under the age of 10 years participate in a variety of sports and activities rather than focusing on just one. This helps to enhance the development of motor skills and can help prevent repetitive stress injuries.

Winning and losing are a large part of many sports and activities. Younger children may not be able to handle the pressures of highly competitive sports or activities. In general, a child may not be ready for highly competitive sports or activities until age 11 or 12. If children belong to sports teams at a very young age, it is important for the team to emphasize the fundamental skills, fitness and fun.

While endurance and flexibility exercises remain similar for any age, strength training differs greatly between adults, adolescents and children. It involves exercises that build muscle, typically by using resistance, weights and other equipment. It can also help strengthen the ligaments and tendons and increase bone density. The goal of strength training in childhood is to improve strength, not to bulk up. Bulking up should not even be a consideration until late in adolescence, or in early adulthood. Children’s strength training should always be performed with the supervision of a qualified adult.

Strength training is not the same as bodybuilding, and using heavy weights is not recommended for children and adolescents because developing bones, muscles and joints can be injured. Typically, when a child is ready for organized sports, then strength training can begin.

When weights are used, they need to be relatively light. If the child cannot perform 10 repetitions, the weight is too heavy. Over time the weight can be increased and the number of repetitions decreased. However, this progression must be thoroughly supervised by a qualified adult. Children can also perform strength-training exercises without equipment, such as push-ups, stomach crunches and sit-ups.

If a child resists sports, athletic activities or other forms of exercise, it is important to find out why. By talking with a child about their concerns or problems, a parent or caregiver can often help resolve the issue or help the child identify alternative forms of fitness. Common reasons why children may not want to engage in a particular sport, activity or other form of exercise include:

• Still working on the necessary skills. If the child has not mastered the physical skills necessary to play the sport or participate in the activity, it can be very frustrating. This is especially true when other children of the same age seem to have mastered the skills. Plenty of at-home practice can help children hone these skills. If the child can practice without his or her peers around, it can make the mistakes seem less important.
  
  
• Developmental issues. Different children develop at different rates. Some children are much more or less developed than others of the same age, which can make children feel self-conscious.
  
  
• Too much competition. Some children are not comfortable with a lot of competition. Some teams and leagues focus heavily on winning, making the sport or activity highly stressful. There are numerous sports and activities that are not competitive that the child can try. Some teams or leagues place less emphasis on the importance of winning. Even in the most highly competitive teams or leagues, it is important to maintain a positive overall atmosphere.
  
  
• High expectations. The pressures of living up to the expectations of others can be very hard for many children. Even the best athletes make mistakes. It may only take one big mistake (e.g., missing a goal) to discourage some children. Maintaining realistic expectations helps to keep the pressure appropriate. It is also important that the child’s coach, teammates, and other parents and children involved maintain a positive, supportive outlook.
  
  
• Looking for the right sport or activity. Children have particular talents and interests. Some children prefer individual sports over team sports. For example, while one child may enjoy baseball, another may be better suited for swimming.

Between birth and age 2, children get all the exercise they need from daily life. Although there are no generally recognized fitness requirements for this age, it is typically recommended that physical activity that aids in motor development be encouraged.

Regular fitness begins with toddlers, who are naturally active. Toddlers are developing the basic movement skills (e.g., walking, running, kicking, throwing). By the age of 2 years, most children can walk, run, and jump in place with both feet. By 3 years, most can run and jump well and can often balance on one foot for a short time, climb, pedal a tricycle, kick a ball forward and throw a ball overhand.

It is typically recommended that toddlers spend a minimum of 30 minutes every day in structured physical activity (adult-led), as well as a minimum of 60 minutes every day in unstructured physical activity (free play). It is also recommended that time watching the television or videos and time spent in a high-chair or car seat be limited in young children.

Age-appropriate active toys (e.g., balls, push-and-pull toys, riding vehicles) can provide a great deal of exercise for toddlers. Activities, including exploring a backyard or playground, imitating animal movements, simple dances, and children’s games are also good forms of exercise for toddlers.

Children between the ages of 5 and 10 years still have a natural tendency to be active. They have generally mastered the basic movement skills and are improving their coordination. They are typically learning new, more complex tasks (e.g., hopping, skipping, swimming). Older children continue to improve these skills.

It is generally recommended that preschoolers and school-age children get a minimum of 60 minutes of adult-led (structured) physical activity daily. Younger children can also include 60 minutes of free play (unstructured physical activity) each day. The American Academy of Pediatrics (AAP) recommends that sedentary activities (e.g., the computer, television, video games) be limited.

Preschoolers and older children often enjoy exploring a backyard or playground, kicking a ball back and forth, treasure hunts, riding bicycles and simple obstacle courses. Swimming, hiking, dancing, children’s games and household chores are also good sources of exercise. Access to plenty of games and sports equipment, such as balls and jump ropes, encourages activity in children. This may also be a good time to investigate local children’s sports leagues or other activities.

Participation in physical activity may decrease during adolescence as more factors (e.g., increased emphasis on academics, preparation for college, jobs) tend to consume time in a teenager’s day.

It is typically recommended that adolescents spend at least 60 minutes of every day performing moderate to vigorous physical activity. However, if the adolescent is overweight or very sedentary, it may take time to work up to this goal. Limiting sedentary activities (television, videos, computer) during adolescence is also recommended. Overweight adolescents are at risk for becoming overweight adults, with all the potential health problems (e.g., high cholesterol, diabetes) common among overweight adults.

There are numerous activities adolescents can participate in to remain physically fit. Sports and other athletic activities (e.g., dancing, skateboarding, rollerblading, swimming, surfing) are popular during adolescence. Adolescents may also enjoy strength training, going to a gym or exercising with home exercise videos. Active jobs, such as babysitting and working as junior camp counselors or assistant coaches can also be beneficial.

Children and adolescents are much more likely to engage in regular physical activity when encouraged by family and friends. It is important for parents and caregivers to be positive role models and to exercise regularly. This demonstrates that fitness is important. Good role models also emphasize the importance of good sportsmanship. The most important goals are fitness and fun, not winning the game.

Parents and caregivers can also provide support by learning more about the child’s sport or activity. Positive attitudes are also important among coaches, trainers and others involved with a child’s fitness. Parents and caregivers should not be afraid to remove the child from a program if negative attitudes are being taught or proper safety measures are not followed.

Many schools have reduced or eliminated daily physical education classes due to budget and time problems. Parents and caregivers who stress the importance of these programs may be able to influence such decisions.

It may be more fun for children to exercise with someone else. The entire family can regularly participate in physical activities together. Examples of active family activities include hiking, walking, cycling, swimming and playing tennis, touch football or other games.

It is important that children and adolescents participate in sports or activities that are fun and appropriate for them. Forcing a child to engage in a disliked activity provides little motivation and may discourage the child from exercising in the future. Children may also be discouraged if fitness is presented as a punishment or a chore.

Following proper exercise and sports safety rules and regulations can greatly reduce a child’s risk of injury while participating in sports and activities. A coach, trainer or other fitness professional can help explain the proper techniques, regulations and safety procedures for a particular sport or activity.

Children with chronic health problems or disabilities also need to participate in some form of physical activity. Some activities (e.g., walking, swimming) may be better suited for these children, and others may need to be modified or adapted to the child’s needs. In addition, children with medical conditions may require medications or monitoring. For example, children with diabetes require blood sugar (glucose) monitoring during exercise, while children with exercise-induced asthma may need to take preventive medications before exercising.

Although fitness and exercise are very important, so is moderation. Too much exercise can cause injuries and other problems. There are many reasons why children or adolescents may overdo it when it comes to fitness. Some signs of exercising too much include pain during or after a workout, amenorrhea (absent menstruation) in girls and being below normal weight for age and height.

Proper equipment and equipment fit is essential to fitness safety. If the equipment does not fit, it will not work properly. Major types of sports and fitness safety equipment include:

• Helmets. There are many types of helmets and it is important for the helmet to be appropriate for the sport or activity. For example, a bicycle helmet must have a sticker from the Consumer Product Safety Commission that specifies that it meets the safety standards for bicycling. Helmets must fit snugly but comfortably and should not tilt when worn. A helmet is only good for one impact. A helmet involved in a crash will not offer the same level of protection as before and should be replaced, even if there is no apparent damage.
  
  
• Eye protection. May include face masks, polycarbonate (plastic) guards or shields, or goggles. Regular eyeglasses should not be worn when playing most sports. Prescription goggles are available. Eye protection must fit securely, with cushions above the eyebrows and over the bridge of the nose.
  
  
• Mouth guards. Guards that protect the mouth, teeth and tongue. They are necessary for contact sports, such as hockey and football. These can be purchased at sporting goods stores or fitted by a dentist. Retainers should not be worn when playing most sports.
  
  
• Wrist, knee and elbow guards. Guards that help to prevent fractures, cuts and breaks. These are important for sports that involve risks of such injuries, such as bicycling and roller skating.

  

• Pads. Provide cushioning against blows and falls. These are necessary for contact sports, such as football. There are a variety of different pads, including shin, knee, elbow, wrist, chest, shoulder, hip and thigh pads.
  
  
• Bras, cups and athletic supporters. Bras support the breasts for girls during exercise. Cups and athletic supporters protect the genital area for boys. Cups provide protection during contact sports and athletic supporters provide support during running.
  
  
• Footwear. Helps to maintain a good grip on the ground and prevent tripping and falling. Different sports need different types of footwear. For example, a tennis shoe and a running shoe provide different amounts of support in different areas of the foot and ankle. Footwear that is worn out or no longer supportive needs to be replaced.

It is important to prepare the muscles and joints by warming up before and cooling down after strenuous exercise. This includes stretching exercises and light aerobics (e.g., jumping jacks, brisk walking). Similar exercises are used to cool down after a workout.

Some children may wish to participate in strength training, although pediatric strength training is not the same as adult strength training. The National Association for Sport and Physical Education has established guidelines for strength training in children. A ratio of at least one instructor for every 10 children is recommended. The instructor must have experience with both children and strength training and must supervise the children closely. Children can participate in two or three training sessions per week and should not train two days in a row.

Practicing helps children to hone the muscles in preparation for athletic activity. It also increases overall physical condition and improves coordination (including teamwork). All of these benefits help to prevent injuries. It is important to follow the sport’s rules and regulations and to learn and use the proper techniques. These improve safety for the individual, other participants and spectators.

Certain competitive sports or activities focus on adolescent participants (e.g., gymnastics, dancing). Children participating in these activities may be susceptible to injuries caused by repetition and overuse (e.g., shoulder and back injuries). Highly qualified programs and trainers along with appropriate medical care can help prevent injuries in young athletes.

Children should never exercise or participate in a sport or activity while injured or with an illness without consulting a physician. This can result in re-injury, inattentiveness, and complications to current conditions or injuries. It is recommended that individuals seek medical assistance when in moderate to severe pain, the injured area begins to swell, or the pain, injury or illness interferes with sleep or daily activity.

In recent years, the use of anabolic steroids or other performance-enhancing drugs among high school athletes has become controversial. About 6 percent of all high school athletes surveyed in the United States admitted to using steroids to enhance their performance, according to the Centers for Disease Control and Prevention. Abuse of steroids has been linked to liver cancer, heart attacks and increased cholesterol levels. In addition, steroids can interfere with the lengthening of bones in adolescents, stunting growth.

Preparing questions in advance can help patients and parents have more meaningful discussions with physicians regarding their or their child’s conditions. Patients and/or parents may wish to ask their doctor or healthcare professional the following questions about exercise:

1. Is my child getting enough physical activity?
   
   
2. What types of exercise are appropriate for my child?
   
   
3. Is my child healthy enough to participate in sports?
   
   
4. Can you recommend a sport or athletic activity that may suit my child?
   
   
5. Where can I find out about local children’s sports leagues and teams?
   
   
6. What safety equipment is appropriate for my child’s chosen sport or activity?
   
   
7. Can you recommend any resources to help me learn more about my child’s sport or activity?
   
   
8. Where can I find information about local children’s fitness trainers?
   
   
9. Is my child old enough to begin using weights and other strength training equipment?
   
   
10. Is my child exercising too much?
    
    
11. I suspect that my teen may be using anabolic steroids. How can I prevent him from doing so?