Preadolescents, Obesity and Exercise
Research supports the idea that physical activity, along with a foundation of fun, is an effective intervention in the formative preteen stage of a young person’s life.
Preadolescence is a time of major change and growth, bringing psychological, physical and social shifts for boys and girls alike. Caught between the carefree days of childhood and the first throes of being a teenager, “tweens” (roughly aged 9–12) are a force to be reckoned with. Like many other populations, preadolescents are suffering from lack of exercise, which threatens to chart a course toward obesity and disease.
Today’s preteens are expected to have a shorter lifespan than their parents. That is disturbing, yet not unsurprising, given that 75% of Americans are predicted to be overweight or obese by 2020 (OECD 2010). Data from the Organization for Economic Cooperation and Development show that 1 in 5 children aged 5–17 is carrying excess body weight. Greece, the United States and Italy have ratios as high as 1 in 3. Only in South Korea, Turkey and China is the rate at 10% or less.
According to Tyler Norris, vice president for Total Health Partnerships at Kaiser Permanente, there are three major factors contributing to the obesity trend: “cheap, empty calories,” lack of exercise and an increase in the number of sedentary jobs (Miller 2012). Although preadolescents haven’t yet joined the workforce, many aspects of their video-gaming, desk-bound lives mirror that of adults who sit at computers and televisions all day. Fitness professionals are well-positioned to help young people extend their lifespan through exercise interventions. However, preadolescence is a tough “between phase.” If you’re training or teaching preteens, you can’t treat them like children or like adults.
This article explores research that supports the notion that exercise is an excellent way to help preteens become healthier and lose weight (if weight loss is a goal). Fitness professionals who specialize in this population share their insights into working with and creating programs for preadolescents.
Exercise Interventions and Research
Since so many important changes happen during preadolescence, it’s a prime time to plant the seeds of physical fitness and health. Numerous programs and studies offer important information on how to do this, and the payoff is huge. An April 2004 white paper by Gutin, Barbeau and Yin laid out some of the health issues that physical activity could solve for this population: “Physical training has favorable effects on total body and visceral adiposity, bone density, cardiovascular fitness, and some risk factors for [cardiovascular] disease and type 2 diabetes,” the authors noted, adding that “vigorous physical activity” may help prevent some major “adult” health problems (i.e., dyslipidemia, elevated blood pressure and insulin resistance).
In an unpublished dissertation by Henry and Beckemeyer (2009), 27 fourth- and fifth-grade girls (boys were intentionally left out) were put into an after-school nutrition and exercise program to determine whether this would help them improve their nutrition knowledge and increase their physical fitness. They met for a 1½-hour session twice a week for 12 weeks. By the end of the study, the girls had improved in a variety of measures, including waist circumference.
One interesting intervention that has proved effective occurs prior to exercise. Researchers Pollak et al. (2009) evaluated the audio recordings of 30 physician-adolescent encounters and found that patients “increased exercise, lost weight and reduced screen time” when the counseling physician used Motivational Interviewing techniques. The scientists also found that “female, older, normal weight physicians and pediatricians” were better able to adhere to those techniques. Although it’s probably not realistic or practical for fitness professionals to direct all their young clients to a doctor who fits this profile, it is possible to extrapolate from these findings to better align trainers and adolescent clients.
Brain development is another issue that exercise can positively influence during preadolescence. A program entitled COPE (Creating Opportunities for Personal Empowerment) was introduced to teens through Arizona State University. Overweight teens (age range not given) received 15 after-school sessions of a cognitive-behavioral skill-building program that included physical activity. The study had two phases: Phase 1 focused on urban adolescents and used no control group; Phase 2 was a randomized controlled study targeting suburban youths. The control group received training in attention skills. COPE was well received by all the participating teens, and by the end of the trial, weight and body mass index were significantly lower in the COPE groups than in the controls. Retention among the urban COPE group faltered, however, and there was lack of parental involvement in this group (suggesting that the program could be more successful if offered during the school day). Teens in the nonexercising control group actually gained weight over time (Melnyk et al. 2007).
Another intervention used motivational methods to increase physical activity and to improve body movement awareness (Sothern et al. 1999a). Perhaps because it included a motivational component in addition to exercise, this program showed successful results with youth both at the end of the program and at the 1-year follow-up mark. Known as the Moderate Intensity Progressive Exercise Program, it included four components of social-cognitive theory and self-efficacy: mastery, knowledge transfer, role modeling and physiological feedback.
Here’s an example of how the four components were used in the MPEP program. Seventy-three students participated in body locomotion, with an emphasis on the “engines” of the body—the aerobic and anaerobic metabolic systems.
- The students easily understood the concept of the body as an engine, which showed mastery.
- They received information about the anaerobic and aerobic metabolic systems, fulfilling the knowledge transfer requirement.
- Olympic power lifters, marathon runners, track and field stars and basketball stars served as role models.
- Rating of perceived exertion was monitored so students could identify vigorous or mild activity, satisfying the physiological feedback concept.
MPEP was based on the belief that the youth could change their sedentary habits if they became aware of the health risks associated with those habits and then decided to abstain from harmful behaviors. The expectation was that the children would adapt healthier habits if they believed they had the power, control and ability to make the necessary changes.
Although it doesn’t single out preteens, some recent research corroborates the relationship between a healthy lifestyle and one’s outlook and beliefs about self-efficacy and control (Cobb-Clark, Kassenboehmer & Schurer 2012). Information from this research can be applied to tweens. Based on data collected from the “Household, Income and Labour Dynamics in Australia (HILDA) Survey” (2012), researchers determined that those who believed their lives could be “changed by their own actions ate healthier food and exercised more.” According to Deborah Cobb-Clark, PhD, director of the Melbourne Institute of Applied Economic and Social Research, which published the report, “Those who have a greater faith in ‘luck’ or ‘fate’ are more likely to live an unhealthy life. Information alone is insufficient to change people’s eating habits. Understanding the psychological underpinning of a person’s eating patterns and exercise habits is central to understanding obesity” (ScienceDaily 2012).
Preadolescent bodies do not suffer the cumulative effects of poor eating and exercise habits to the degree that adult bodies do. Exercise can have a very positive effect on negative health factors related to obesity. In 1999, a clinical trial was conducted to determine whether exercise would improve certain components of insulin resistance syndrome in obese children (aged 7–11) (Ferguson et al. 1999). The good news: Some components (insulin, plasma triglyceride, percent fat) improved after the subjects consistently participated in an exercise program over a 4-month period. Sadly, those benefits were lost when the children became less active after the trial.
While looking at the same data on these obese children, researchers discovered that controlled physical activity, without dietary intervention, led to improved levels of visceral fat (Owens et al. 1999). Exercisers experienced improvements in body composition and accumulated significantly less visceral adipose tissue than did nonexercising controls. The exercisers were capable of participating in a substantial amount of high-intensity physical training over the 4-month period.
These interventions all point to the power of physical activity in improving health and wellness. Fitness professionals can arm themselves with this information and feel confident that their programming, when created with tweens in mind, can make a difference for a lifetime.
Strength Training Research
In addition to the research on cardiovascular activity, there is evidence that resistance exercise for preadolescent obese children is effective for weight loss (Sothern et al. 1999b). As part of a multidisciplinary weight management program, researchers included a moderate-intensity, progressive resistance training program for 10 weeks. At the conclusion of the study (which had 100% compliance), weight, percent ideal body weight, body mass index and percent fat were all significantly lower. More promising: These markers had not increased significantly at a 1-year follow-up.
Although there has been some controversy about offering strength training to preadolescents (CPSC 2012), there is extensive research that supports doing so, as long as certain conditions are met. In 2008 (in an update of its 2001 policy), the Council on Sports Medicine and Fitness reported in the journal Pediatrics that “in preadolescents, proper resistance training can enhance strength without concomitant muscle hypertrophy. [It] can also augment the muscle enlargement that normally occurs with pubertal growth in males and females. If long-term health benefits are the goal, strength training should be combined with an aerobic training program.” To this end, the committee offered a number of guidelines:
- Use proper training techniques and follow precautions.
- Avoid competitive weightlifting, powerlifting, bodybuilding and maximal lifts until preadolescents and adolescents reach physical and skeletal maturity.
- Have a pediatrician medically evaluate a child before he or she engages in a program.
- Include a warm-up and cool-down, which are essential elements of a strength training regimen.
- Address all major muscle groups and use full range of motion.
- Educate athletes about the risks of performance-enhancing substances, including anabolic steroids.
- Ensure proper intake of fluids and nutrition.
- Initially, teach some exercises with no load.
- Hold a certification and specialty training for working with this age group (Council on Sports Medicine and Fitness 2008).
Fitness professionals know that “what gets measured gets improved.” Assessment and biometrics are helpful ways to gauge progress and safely implement programs. In September 2012, the Institute of Medicine suggested new techniques for testing youth fitness. In an effort to evaluate which testing measures corresponded to desired health outcomes, the institute’s Committee on Fitness Measures and Health Outcomes in Youth undertook a comprehensive review of the science and found that it “supports the use of specific ways to measure three . . . components in young people—cardiorespiratory endurance, body composition and musculoskeletal fitness” (Pate et al. 2012).
Perhaps trainers can expect to see schools and surveys (and maybe one-on-one testers) emphasizing these ways over others. The committee specifically mentioned the following tests as being effective: progressive shuttle run, cycle ergometer, treadmill, BMI measurements (particularly waist circumference and skin fold thickness), handgrip strength and standing long jump. Committee members found that flexibility measurements were not linked to health outcomes, so the list does not include those measures (Pate et al. 2012).
In addition, the Centers for Disease Control and Prevention conducted the National Youth Fitness Survey in conjunction with the 2012 National Health and Nutrition Examination Survey (CDC 2012). NYFS is the first nationwide survey of fitness in young people since the mid-1980s. And in early September 2012, the President’s Council on Fitness, Sports, and Nutrition announced it is adopting FitnessGram®, a battery of tests provided by The Cooper Institute® that will become the basis for the Presidential Youth Fitness Program assessments. Its emphasis is on health over performance, which is an important distinction to be aware of for those working with preteens (PCFSN 2012).
Even the 4-H is getting involved in trying to help youth exercise. In August 2012, the Texas 4-H teamed up with UnitedHealthcare to launch “Youth Voice: Youth Choice,” a program to “help young people in the state improve their health and well-being through exercise, proper nutrition and attention to personal safety.” Texas Agriculture Commissioner Todd Staples, who was in attendance, commented, “It is more important than ever that educators, healthcare professionals and parents work together to emphasize the importance for our children of the ‘Three Es’ of healthy living: education, exercise and eating right” (Texas 4-H 2012).
With plans to go nationwide, this systemic collaboration is exactly what was suggested as one of three potentially successful models for decreasing childhood obesity (educate parents; work systemically; and change beliefs about exercise) in the November–December 2011 IDEA Fitness Journal article “Childhood Obesity Doomsday Countdown.”
Practical Tips for Getting Tweens to Exercise
Now that you’ve read the evidence that exercise works for tweens, how do you apply it in the real world? Preadolescents have grown up in a universe of technology and instant access and gratification. One way to get creative is to use fitness technology to engage tweens in their “world.” In late September, Life Fitness released its 2012 Fitness and Technology Survey, which found that “72% of exercisers surveyed use technology to support their workouts. More than half of respondents consider themselves more successful at achieving their weight and fitness goals because of technology” (Life Fitness 2012).
This survey—covering seven countries—targeted exercisers who owned tablets or smartphones. Of these exercisers, 72% of the younger (under-30) respondents said they used their devices outside the gym, accessing social media, apps and websites to track their progress; and 76% of the younger respondents said that “better technological access to personal content will make them work out more.” This may be an ideal entry point for engaging preadolescents.
Trainers and group fitness instructors who specialize in this age group have become very creative about finding ways to engage tweens in fitness (which used to be called “play”). Toni Tirapelli is the founder and CEO of STARS Sports and Educational Programs, in Elk Grove, California. “If fitness and nutrition are taught in a way that’s informative and exciting, kids are more receptive,” she says. “Make it fun, exciting and positive—and don’t forget to work out with them. You are their role model, and so are their parents, so educate the parents too.
“I rev them up by asking what sports or activities they enjoy,” she continues. “They yell out football, baseball, dodgeball, etc. I then ask, ‘So, what muscles do you use in these activities?’ They answer legs, arms, lungs, heart and so on. Once they’re amped up from calling out their answers, I ask them, ‘Do you want to play longer, jump higher, run faster and have a lot of fun without getting tired?’ They get the link and become much more receptive about participating.”
Tirapelli has more advice for fitness professionals, taken directly from the field. “Kids don’t like drill sergeants, and you may be the only positive influence in their lives. The STARS program was used as supplemental curriculum in the Elk Grove School District one year. The pre- and post-test results showed that kids’ spelling and reading scores went up 73% after just 4 weeks of 15 minutes of exercise a day.”
Sarah Jane Parker, a personal trainer from Gillette, Wyoming, has taught cardio dance to (mostly) girls aged 7–12. She is also doing some one-on-one training with this age group. “An adult may be able to tolerate 30 minutes on equipment, but children this age quickly become bored. Keep their attention with activities such as indoor rock climbing, park workouts, bike riding, ice-skating and boxing. Be consistent with certain activities so the children can get proficient and feel a sense of accomplishment. Don’t expect them to respond to training as an adult would. [Adjust your approach,] including how you talk to them, how you motivate them and especially how you focus on the task at hand. Avoid making it all about weight. Instead, emphasize the importance of strength, skill and enjoyment.”
As someone who has worked extensively with this age group, Brett Klika, director of athletic programs for Fitness Quest 10 in San Diego, has a lot of practical advice. “We focus on foundational movement patterns, strength and the life skills that exercise and training teach,” he says. “We’ve found that the race to get kids to perform for a particular sport has neglected the development of overall physical skill. You’ll see our kids crawling, rolling, climbing, grasping and performing other drills like this. We often put them into games.”
Klika recommends a big-picture, low-key approach to working with tweens. “Don’t get caught up in the race to turn kids into pro athletes,” he says. “Prepare them for a lifelong relationship with exercise. Kids want to have fun. Don’t think that decreasing a kid’s 40-yard dash time will accomplish anything meaningful. We have had numerous kids start to embrace exercise as a way of life—which is rewarding—as we see them grow into happy, healthy, pain-free adults.”
Coming from a background in musical theatre and dance, Ariana Ziskin of Mesa, Arizona, works with preadolescents as a director, choreographer and teaching artist. “Remember that everything you say will have an impact,” she says. “I was an overweight kid, and the things my teachers said to me still influence who I am today, as well as my perceptions of myself physically. Focus on the positive. Lead by example. Make it about the activity, not about fitness or weight. Praise their progress, but be sure it’s about the activity, not their physical appearance. Compare them to their own progress, not to each other. I’ve seen so many students come in hating dance because it scares them. They are not in excellent physical shape, but by the end they love it because they gain confidence and learn to enjoy physical activity.”
In her Badass (she calls them “Bad Donkeys”) Bootcamps, Shannon Colavecchio, Tallahassee, Florida–based CEO of Badass Fitness, emphasizes drills and core work. She includes shuttle runs, suicides, leapfrogs, crab walks, lunges, running on stadium stairs or ramps (at Florida State University, no less), burpees, push-ups, triceps dips and partner drills. Her goals are to help young people get stronger, faster and more agile and to give them a confidence boost.
“The kids in this age group are just starting to get into sports, so give them an ‘active break’ from the tedium of sport practice,” she says. “Also, since kids this age are not fully developed physiologically, they can overheat faster or might have asthma that they haven’t yet learned to control, so monitor and pace [activities] accordingly. Equipment like the TRX® Suspension Trainer™ is better than heavy weights, as it doesn’t stress their still-developing bodies.”
Another person who has extensive experience with this group is Karen Jashinsky, MBA, founder and chief fitness officer of O2 Max Fitness, in Santa Monica, California. “A lot of the kids I work with usually fall into one of several categories: They want to get better at something specific, they’re looking for a noncompetitive environment where they can feel comfortable and confident, or they are starting to go through puberty and want an opportunity to ask questions about it in a more intimate setting.”
What is the secret to working with this age group, according to Jashinsky? “Be patient. Be able to connect and adapt based on the kid’s needs and personality,” she says. “Be realistic in your expectations.”
The overarching theme, both in the research and from the fitness pros who work with tweens, is to have fun. Adults can overlook fun for a while because they can easily visualize future rewards. With preteens, the reward has to be in the present (instant gratification). Your personality and ability to engage are probably more important than your ability to design a comprehensive workout plan. Be prepared, yes, but even more so, prepare for fun!
Early adolescence is a time of diverse and rapid change. When working with preteens, keep the following developmental milestones in mind:
- Physical development. Growth spurts are common during this time. Girls begin to develop breasts and start their periods, and boys grow facial hair. Since kids are developing at different rates, be mindful of comparisons or comments that may trigger a sensitive response. Focus on how exercise makes you healthier, not thinner or bigger.
- Cognitive development. During early adolescence the brain develops the capacities to think, learn, reason and recall. Preteens may focus on the here and now; however, they are also starting to comprehend long-term cause and effect. Leverage this fresh understanding to paint a picture of how healthy behaviors can create a lifetime of health and happiness.
- Emotional and social development. While this age group may feel the urge to be more independent and rely on friends instead of family for emotional support, they still need to know that their parents and role models are available. When working with tweens, encourage their parents to be as involved as they can. Strive to be a positive role model yourself.
- Sensory and motor development. It’s not uncommon for kids this age to be a little awkward or clumsy. Brains need time to adjust to longer limbs and bigger bodies. Be patient with preteens’ movement abilities and encourage consistent exercise as a way to improve coordination.
Source: Adpated from WebMD 2012.
If you’re a personal trainer who works with this age group, it’s essentially a given that the parents are also your clients. With that in mind, Alfonso Moretti, a Bethel, Connecticut–based personal trainer who works extensively with tweens and teens, shares this handy list of suggestions for parents:
- Lead by example. Tweens notice what you do and what you eat, and they emulate you.
- Consult with your child to find out what he or she enjoys. Let them tell you whether they prefer team or individual sports, or no sport at all.
- Advocate or volunteer at the local school for physical education classes.
- Take charge! Whether you negotiate or state the rules without discussion, it’s your job to ensure that video/television/computer time comes second to physical activity.
- Remember: Chores count as movement. Who is sweeping, mopping, vacuuming, lawn mowing, composting and so on? Preadolescents are old enough to take on these chores.
- Go outside! Kids need to play outdoors when the weather permits. Sure, things are different now than when you were a kid, but outside activity can still be a family habit. Fun tech gadgets and accessories are “extras” and are not a replacement for fresh air and neighborhood exploration.
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