Review Question - QID 215009

This patient is engaging in appropriate physical activity that he enjoys and is supervised while weight lifting; thus, he should be encouraged to continue an activity that seems to be improving his weight and body composition.

Physical activity is one of the cornerstones of health. Pediatric patients should be encouraged to develop healthy habits including participating in physical activity in a structured manner. It may be challenging for some pediatric patients to engage in physical activity as they may not be particularly good at it or may not enjoy it. For this reason, it is important to find activities that the patient enjoys so that they can actively engage and build healthy habits. Running, swimming, hiking, and team sports are all appropriate methods of physical activity for pediatric patients. Weightlifting has historically been thought to stunt a child's growth if performed prior to puberty. However, there is no evidence to suggest this, and so long as a child is supervised, using proper form, and appropriate weights, there is no reason weight lifting should be avoided. Weight lifting can reduce weight, improve body composition, and prevent diseases such as diabetes and heart disease.

Barbieri et al. review the benefits and risks of strength training for children. The authors find that weightlifting is safe in pediatric patients as long as adequate guidance is provided. The authors recommend pediatric patients engage in activities with intensive physical effort to improve fat-free mass, reduce fat mass, and enhance bone health.

Incorrect Answers:
Answer 1: Continuing the physical activity regimen but recommending the patient use resistance bands only is incorrect as resistance bands are similar to weights and offer no benefit as compared to weights. Patients can use bands or weights as long as they have proper form and instruction.

Answer 3: Discontinuing weight lifting would not be appropriate for this patient. Children should be encouraged to engage in physical activity, and if this child is enjoying weight lifting, doing it with proper form, and is not having any injuries from the activity then they should be encouraged to continue. In this patient, this physical activity routine seems to be improving his health.

Answer 4: Discontinuing weight lifting and engaging in light aerobic activity only is incorrect. While light aerobic activity may have its benefits, resistance training builds bone density and leads to improved metabolic health as well. For this reason, the patient should be encouraged to continue the physical activity he enjoys as he is making progress in improving his health. If the child enjoys aerobic activity, it should be encouraged.

Answer 5: Discontinuing weight lifting and ordering ECG and echocardiograph prior to beginning an exercise program would be appropriate in older, high-risk patients or patients with a concerning cardiac family history. This sort of screening searches for ischemia, dysrhythmias, and structural abnormalities which may preclude a patient from exercising. An exercise stress test can also be performed to ensure that these patients are able to tolerate exercise. This patient's grandparents were quite elderly when they died of heart attacks; thus, it is not considered a risk factor for heart disease.

Bullet Summary:
Children should be encouraged to engage in physical activity in a structured, monitored fashion, and weight lifting is acceptable in young patients with proper instruction and form.