Risk of intensive sports training on young athletes

Abstract

Children involved in sports should be encouraged to participate in a variety of different activities and develop a wide range of skills. Young athletes who specialize in just one sport may be denied the benefits of varied activity while facing additional physical, physiologic, and psychologic demands from intense training and competition.

This statement reviews the potential risks of high-intensity training and sports specialization in young athletes.

Cardiac

Child athletes have superior cardiac functional capacity compared with nonathletes. Nonetheless, there is some cause for caution.

A limited number of studies have failed to identify an adverse effect of intense endurance training on the heart of the child athlete. In these investigations, no differences in resting echocardiograms or electrocardiograms have been observed between trained prepubertal runners and nonathletes.

Based on these limited data, currently there is no indication that intense athletic training of the child athlete results in injury to the heart. However, closer study of the cardiac characteristics of children training at elite levels is necessary before this conclusion can be verified. Careful assessment of cardiovascular status (heart murmurs, abnormal rhythms) remains important in ongoing medical care of the child athlete.

Musculoskeletal Injury And Growth

Overuse injuries (tendinitis, apophysitis, stress fractures) can be consequences of excessive sports training in child and adult athletes. Certain aspects of the growing athlete may predispose the child and adolescent to repetitive stress injuries such as traction apophysitis (Osgood � Schlatter disease, Sever disease, medial epicondylitis [Little League elbow]), injuries to developing joint surfaces (osteochondritis dissecans), and /or injuries to the immature spine (spondylolysis, spondylolisthesis, vertebral apophysitis).

Because of the potential for long - term growth disturbances, injuries to epiphyseal growth centers are a particular concern for young athletes.

The long � term effects of repetitive microtrauma to the epiphysis is still under investigation.

Nutrition

For child athletes, an adequate diet is critical because nutritional needs are increased by both training and the growth process. Young athletes and their parents are frequently unaware of the appropriate components of a training diet. The following 4 areas are of particular concern.

Τοtal caloric Intake/Balanced Diet

The Food Guide Pyramid can be used to plan a diet that is balanced and provides sufficient nutrients and calories for both growth and training needs.

Iron

The body�s requirement for iron is greater during the growing years than at other time in life. Adequate iron stores are important to the athlete to provide adequate oxygen transport (hemoglobin), muscle aerobic metabolism (Krebs� cycle enzymes), and cognitive function.

Calcium

Normal bone growth, and possibly, prevention and healing of stress fractures, are contingent on sufficient dietary calcium.

Sexual Maturation

Athletic girls tends to experience menarche at a later age than nonathletic girls, leading to concern that intensive sports training might delay sexual maturation. Undernutrition, training stress, and low levels of body fat have been hypothesized to account for this delay.

Secondary amenorrhea, or cessation of menstrual cycles after menarche, can occur as a result of intense athletic training. Prolonged amenorrhea may cause diminished bone mass from the associated decrease in estrogen secretion, augmenting the risk for stress fractures and the potential for osteoporosis in adulthood. Efforts to improve nutrition or diminish training volume in these girls may permit resumption of menses and diminish these risks.

Studies of males have indicated no evidence of an adverse effect on sexual maturation related to sports training. Progression of Tanner stages of pubertal development has not been observed to be retarded in athletic compared with nonathletic adolescents.

Psychological Development

Considerable research has addressed anxiety and stress that affect children who engage in competitive sports but little data exists about the effects of more intense or sustained training on young athletes. Anecdotal reports suggest risks of "burnout" from physical and emotional stress, missed social and educational opportunities, and disruptions of family life. Unrealistic parental expectations and/or exploitation of young athletes for extrinsic gain can contribute to negative psychological consequences for elite young athletes.

Heat Stress

Child athletes differ from adults in their thermoregulatory responses to exercise in the heat. They sweat less, create more heat per body mass, and acclimatize slower to warm environments. As a result, child athletes may be more at risk for heat-related injuries in hot, humid conditions. They also should be aware that limiting sports play and training in hot, humid conditions and ensuring adequate fluid intake can prevent heat injury.

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