Resistance Training for Obese Children and Adolescents 

Abstract

The prevalence of obesity among children and adolescents is increasing at an alarming rate. If current trends continue, this

epidemic will likely pose an unprecedented burden on youth, their families and our health care system. It is important to

understand how sensible lifestyle choices such as regular exercise can enhance the health and well-being of obese children

and adolescents. While aerobic exercise has traditionally been recommended for obese youth, a growing body of scientific

evidence indicates that resistance training can be a safe, effective, and enjoyable method of exercise provided that

appropriate training guidelines are followed and qualified instruction is available. In addition to favorable changes in body

composition, regular participation in strength-building activities gives obese youth a chance to experience success, feel

good about their performances, and gain confidence in their abilities to be physically active. Moreover, participation in

resistance exercise gives youth with a high percentage of body fat a chance to be exposed to a form of exercise that can be

carried over into adulthood. In this paper, we will discuss the potential benefits of resistance training for obese youth and

describe program design considerations for designing resistance training programs for obese children and adolescents.

The prevalence of obesity during childhood and adolescence has reached epidemic proportions worldwide.41, 52 This

unabated epidemic is occurring in boys and girls across all socioeconomic strata

and it appears that obese children and adolescents are at high risk for becoming

obese adults.14, 27, 29, 31 These trends have led some observers to predict that the

overall adult life expectancy will decrease due to the increased prevalence of

obesity-related co-morbidities such as type 2 diabetes, cardiovascular disease

and cancer.40 Today, childhood obesity, with its associated co-morbid conditions

and its likelihood of persistence into adulthood, is considered a critical public

health threat for the 21st century.29, 31 Learning how sensible lifestyle choices,

such as regular exercise, can improve the body composition and enhance the

health and well-being of obese children and adolescents is a growing area of

interest among health and physical education teachers, researchers, health care

providers, and government officials. 

While both normal weight and obese youth have traditionally been encouraged

to participate in aerobic activities such as walking and cycling, over the past two

decades a compelling body of evidence has accumulated to indicate that

resistance training can be a safe, effective and beneficial method of exercise for

all youth regardless of body size.24, 38, 54 Research into the effects of resistance

exercise on normal weight and obese children and adolescents has increased

over the years, and the qualified acceptance of youth resistance training by

medical and fitness organizations has become almost universal.1, 3, 6, 16 This paper

discusses the potential benefits of youth resistance training and provides

program design considerations for developing resistance training programs for

obese children and adolescents.

For the purpose of this paper, the term “obese” refers to youth (both children

and adolescents) with a body mass index (BMI [weight in kg/height in m2])

equal to or greater than the 95th percentile of the age- and gender-specific BMI

Series 8, No. 3 Sept. 2007

Published quarterly by the

President’s Council on

Physical Fitness and Sports

Washington, D.C.

★

Guest Authors:

Avery D. Faigenbaum, Ed.D., CSCS,

FACSM, FNSCA

Department of Health

and Exercise Science 

The College of New Jersey, Ewing, NJ

Wayne L. Westcott, Ph.D., CSCS

South Shore YMCA, Quincy, MA

★

Co-edited by:

Dr. Barbara Ainsworth,

Arizona State University,

Dr. Deborah R. Young,

University of Maryland, and

Dr. Michael La Monte,

University of Buffalo,

The State University

of New York

President’s Council on Physical Fitness and Sports

ResearchDi est
distribution.35 The term “at risk for obesity” is defined as

a BMI at or above the age- and gender-specific 85th

percentile but less than the 95th percentile. The term

“resistance training” is defined as a specialized method

of physical conditioning that involves the progressive

use of a wide range of resistive loads and a variety of

training modalities to increase one’s ability to exert or

resist force. The term “children” refers to boys and girls

who have not yet developed secondary sex

characteristics (approximately age 11 in girls and 13 in

boys) and the term “adolescence” refers to the period

between childhood and adulthood and includes girls 12

to 18 years and boys 14 to 18 years. 

Potential Benefits of Resistance Training

for Obese Youth

Although psychosocial, economic and environmental

factors likely play a role in the development of obesity

during childhood and adolescence,

2 it is becoming more

apparent that the increasing prevalence of obesity in

school-age youth is due, at least in part, to a reduction in

total daily energy expenditure. Societal changes during

the last several decades have reduced the need to be

physically active and increasing urbanization has

resulted in the lack of safe play areas in some

communities.10, 11, 43 Even though the absolute energy

cost of any given movement increases as a child

becomes obese, fewer boys and girls participate

regularly in physical activity. For example, only 28% of

high school students attend physical education class

daily11 and children’s motorized transportation to and

from school has increased.10 Furthermore, youth spend

more time with electronic media (e.g., video games and

computers) and on a typical day 33% of children watch

television for more than 3 hours.43

Clearly, all children and adolescents need to be

physically active on most, if not all, days of the week.49

However, obese youth often lack the motor skills and

confidence to be physically active, and they may actually

perceive prolonged periods of aerobic exercise to be

boring or discomforting. In support of these

observations, researchers have reported that total body

fat was inversely related to minutes of vigorous physical

activity per day in both boys and girls.12 Sadly, the

decline in regular physical activity may start early in life

in obese youth.28

Conversely, obese youth seem to enjoy resistance

training because it is typically characterized by short

periods of physical activity interspersed with brief rest

periods between sets, as needed.

15 The intermittent rather

than continuous nature of resistance training is more

consistent with how youth move and how youth play.5

Scientific evidence and clinical observations support the

contention that participation in strength-building

activities gives obese children and adolescents a chance

to experience success and gain confidence in their

abilities to be physically active.45, 47, 48, 54, 56

In addition to enhancing muscular strength and local

muscular endurance, appropriately prescribed and

competently supervised resistance training programs

may also positively influence bone mineral density,

cardiorespiratory fitness, blood lipids, and psychosocial

well-being.15 Moreover, regular participation in a

resistance training program may result in favorable

changes in fat and lean tissue in obese youth.54 Several

studies have reported favorable changes in body

composition in children and adolescents who were obese

or at risk for obesity following participation in a

resistance training program.44, 45, 48, 50, 51, 53, 57 In short, a

stronger musculoskeletal system will enable obese youth

to perform life’s daily activities with more energy and

vigor. The potential health-related benefits of resistance

training for obese youth are summarized in Table 1.

Table 1

Potential Health-Related Benefits of

Resistance Training for Obese Youth

• Increase muscle strength

• Increase local muscular endurance

• Improve neuromuscular control

• Increase bone mineral density

• Increase cardiorespiratory fitness

• Improve blood lipid profile

• Improve body composition 

• Reduce risk of sports-related injuries

• Enhance psychosocial well-being 

• Stimulate a more positive attitude towards lifetime

physical activity

Although resistance training is not typically

characterized by high caloric expenditure, this type of

training has proven to be an important component of

weight management programs for obese youth. Sothern

et al.48 studied the safety and feasibility of a progressive,

moderate intensity resistance training program (1 set of

8-12 repetitions, with weights (e.g., intensity) of 60% 1

repetition maximum [RM]) in a group of obese children

during a multidisciplinary outpatient treatment program.

2
26%. Moreover, it was reported that participation in a

progressive resistance training program significantly

decreased body fat and significantly increased insulin

sensitivity. Since the increase in insulin sensitivity

remained significant after adjustment for changes in total

fat mass and total lean mass, it appeared that resistance

training produced qualitative changes in skeletal muscle

that contributed to enhanced insulin action. Longitudinal

investigations are needed to determine if these observed

benefits of resistance training during adolescence will

correspond to the prevention of atherosclerotic disease

and type 2 diabetes during adulthood.

Program Design Considerations

The first step in encouraging obese children and

adolescents to exercise is to increase their confidence in

their ability to be physically active, which in turn may

lead to an increase in regular physical activity, an

improvement in body composition and, hopefully,

exposure to a form of exercise that can be carried over

into adulthood. Nevertheless, youth resistance training

programs need to be carefully prescribed because

unsupervised and poorly performed resistance training

may be injurious.42 This is particularly important for

obese youth who typically have limited experience

participating in a structured exercise program.

Accordingly, when working with inactive youth it is

always better to underestimate their physical abilities

and gradually increase the volume and intensity of

training than overestimate their abilities and risk an

injury. 

When working with obese children and adolescents, it is

important to remember that the goal of the program

should not be limited to increasing muscle strength and

improving body composition. Other program objectives

include teaching youth about their bodies, promoting

safe training procedures, and providing a stimulating

program that gives participants a positive attitude

towards resistance training and physical activity. As

such, the “pass-fail” mentality that may discourage some

obese boys and girls from participating is to be avoided.

Instead, the workout should be considered as a

“challenge” in which all participants can feel good about

their performance and get excited about monitoring their

progress. 

The emphasis on guaranteed outcomes should be

reduced, and instead the focus should be placed on

intrinsic factors, such as skill improvement, personal

success and having fun. Because obese youth tend to be

the strongest students in class, they often receive

unsolicited positive feedback from their normal weight

During the intervention period, there were no reported

injuries or accidents, and 79% of the subjects completed

the 10 week program. Body weight, BMI and percent

body fat were reduced significantly at 10 weeks and had

not significantly increased at one year follow-up

assessment. 

Treuth et al.51 reported gains in fat-free mass in obese

children who participated in a five month resistance

training program (2 sets of 12-15 repetitions, with

weights > 50% 1 RM). Compliance with the resistance

training program was high, with 83% of the participants

completing the five month training program. Participants

in this study increased their bench press and leg press

strength by about 25%. While total body weight and

percent body fat (measured by dual-energy x-ray

absorptiometry) also increased during the intervention

period, intra-abdominal adipose tissue (measured by

computed tomography) did not significantly change

from before training to after training. Since central

obesity is associated with cardiovascular risk in children,

this finding may have important health implications.

Schwingshadl et al.44 also demonstrated gains in fat-free

mass (estimated from bioelectrical impedance analysis)

in obese youth who participated in a 12 week resistance

training program (2 to 4 sets with weights > 50% 10

RM) as compared to those who did not resistance train.

In addition, the changes in body weight at one year

follow-up were inversely correlated with the change in

fat-free mass after 12 weeks. This finding suggests that

loss of fat-free mass during weight reduction in obese

youth may be associated with subsequent weight regain.

Watts et al.53 found that circuit training (the combination

of cycle ergometry [65% to 85% maximum heart rate]

and resistance training [55% to 70% 1 RM]) not only

improved the body composition of obese adolescents,

but it also normalized brachial artery endothelial cell

responsiveness (e.g., improved arm blood flow capacity)

in these subjects. Since endothelial cell dysfunction is an

early manifestation of atherosclerotic disease,9 this

important finding highlights the potential clinical

relevance of circuit training in obese adolescents. 

More recently, Shabi et al.45 examined the effects of 16

weeks of resistance training (1 to 3 sets, 3 to 15

repetitions, with weights of 62 to 97% 1 RM) on insulin

sensitivity and body composition in adolescent males

who were at risk for obesity. Compliance to this

intervention was impressive with 96% of participants

completing the exercise training program. These

researchers reported that subjects in the training group

increased their bench press and leg press strength about

3
4

peers who are often impressed with the amount of

weight they can lift. Unlike prolonged periods of

continuous aerobic exercise, participation in resistance

exercise gives youth with a high percentage of body fat a

chance to “shine” and gain confidence in their abilities to

be physically active. This is where the art and science of

developing a youth resistance training program come

into play: The principles of training specificity and

progressive overload need to be balanced with individual

needs and abilities in order to optimize gains, prevent

boredom and promote exercise adherence. 

Although there is no minimal age requirement for

participation in a youth resistance training program, it is

important that all participants understand the potential

risks and benefits associated with resistance training. All

training sessions should be conducted by qualified

professionals who understand the fundamental principles

of resistance exercise and appreciate the uniqueness of

childhood and adolescence. Close supervision, ageappropriate instruction and a safe exercise environment

are paramount. Also, obese children and adolescents

should be seen by their physician or health care provider

before they begin this or any other exercise program.1, 16

Despite various claims about the best resistance training

program for children and adolescents, there does not

appear to be one “optimal” combination of sets,

Table 2

General Youth Resistance Training Guidelines

• Provide qualified instruction and supervision

• Ensure the exercise environment is safe and free

of hazards

• Begin each session with a 5 to 10 minute dynamic

warm-up period

• Start with one light to moderate set of 10 to 15

repetitions on a variety of exercises 

• Progress to 2 or 3 sets of 6 to 15 repetitions

depending on needs and goals

• Increase the resistance gradually as strength

improves

• Focus on the correct exercise technique instead of

the amount of weight lifted

• Cool down with low intensity activities and static

stretching

• Resistance train two to three times per week on

nonconsecutive days

• Keep the program fresh and challenging by

systematically varying the training program.

repetitions, and exercises that will promote favorable

adaptations in muscular strength, muscular power, local

muscular endurance and body composition in youth.

Rather, by periodically varying the training variables

over time, the training stimulus will remain effective and

adaptations to the training program will be maximized.

The program variables that should be considered when

designing a resistance training program include:

(1) choice of exercise, (2) order of exercise, (3) training

intensity, (4) training volume (total number of number of

sets and repetitions), (5) rest intervals between sets and

exercises, (6) repetition velocity and (7) training

frequency.26 By varying one or more of these program

variables, a limitless number of resistance training

programs can be designed. Table 2 summarizes youth

resistance training guidelines. Detailed information on

designing youth resistance training programs is available

elsewhere.21, 33, 39, 55

Choice and Order of Exercise. Although a limitless

number of exercises can be used to enhance muscular

fitness, it is important to select exercises that are

appropriate for an obese child’s body size, fitness level,

and exercise technique experience. Also, the choice of

exercises should promote muscle balance across joints

and between opposing muscle groups (e.g., quadriceps

and hamstrings). Weight machines (both child-sized and

adult-sized) as well as free weights (barbells and

dumbbells), elastic bands, and medicine balls (weighted

balls filled with sand or cloth) have been used by

children and adolescents in school- and clinical-based

exercise programs.4, 17, 18, 23, 47, 53, 56

Of note, excess body fat can hinder the performance of

obese youth on weight-bearing exercises such as pushups and pull-ups. However, excess body weight does not

hinder the performance of obese individuals on most

weight machine exercises. This is an important

consideration when choosing exercises for obese youth

who have limited experience with resistance training. It

may be reasonable to start resistance training on weight

machines and gradually progress to weight-bearing free

weight and medicine ball exercises that generally require

more coordination and skill to perform correctly.

Regardless of the mode of exercise, the concentric

(muscle shortening) and eccentric (muscle lengthening)

phases of each lift should be performed in a controlled

manner with proper exercise technique. 

There are many ways to arrange the sequence of

exercises in a resistance training session. Most obese

youth will perform total body workouts two or three

times per week, which involve multiple exercises

stressing all major muscle groups each session. In this
type of workout, large muscle group exercises should be

performed before smaller muscle group exercises, and

multiple-joint exercises should be performed before

single-joint exercises. Following this exercise order will

allow heavier weights to be used on the multiple-joint

exercises because fatigue will be less of a factor. It is

also helpful to perform more challenging exercises

earlier in the workout when the neuromuscular system is

less fatigued. Thus, if an obese child is learning how to

perform a squat exercise, this exercise should be

performed early in the training session so that the child

can practice the exercise without undue fatigue. 

Training Intensity. One of the most important variables

in the design of a resistance training program is the

training intensity.34 Gains in muscular strength and

performance are influenced by the amount of weight

lifted, which is highly dependent upon other program

variables such as exercise order, training volume (total

work performed), repetition speed and rest interval

length. To maximize gains in muscle strength, youth

should first learn how to perform each exercise correctly

and then learn how to perform each set to temporary

muscular fatigue using the appropriate resistance. In

short, the act of resistance training in and of itself does

not ensure that favorable changes in muscular strength

and body composition will be realized. Rather,

individual effort combined with a well-designed training

program will ultimately determine the adaptations that

take place. 

The use of RM loads is a relatively simple method to

prescribe resistance training intensity. RM loads refer to

the amount of weight at which an exercise can be

performed for a specified number of repetitions. For

example, a 1 RM load is the amount of weight that can

be lifted one time. Research studies involving adults

suggest that RM loads of 6 or less have the greatest

effect on developing muscle strength, whereas RM loads

of 20 or more have the greatest impact on developing

local muscular endurance.7 However, most studies

involving youth suggest that lighter loads and higher

repetitions (e.g., 10-15 RM) are most beneficial for

enhancing muscular strength during the first two months

of training.19, 22, 23 Since different combinations of sets

and/or repetitions may be needed to promote long-term

gains in muscular fitness, the best approach for an obese

child may be to start resistance training with one set of

10 to 15 repetitions on a variety of exercises, and then

systematically perform additional sets and vary the

training intensity in order to limit training plateaus,

maximize performance gains, and reduce the likelihood

of overtraining. 

Interestingly, Falk et al.25 observed that the level of

adiposity was a strong negative predictor of the

resistance training effect of the lower limbs following

three school years of resistance training (2-3 days/week;

1-4 sets, 5-30 repetitions/set [mean weight load of 50-

60% 1 RM]. Since the individually prescribed training

program resulted in greater strength gains in normal

weight children (14.5 to 16.7% body fat) compared with

the non-responders (23.5 to 32.8% body fat) over the

study period, it was suggested that a training intensity to

increase strength in normal weight children may be

insufficient in children who have excess body fat. These

researchers suggested that obese youth may need a

higher relative training intensity in order to produce the

desired result. This may be particularly important for

lower extremity exercises since the lower body of obese

youth is relatively strong as it is stimulated on a daily

basis through carrying greater body weight. Thus, when

prescribing an appropriate training intensity for obese

youth it seems reasonable to first establish a repetition

range (e.g., 10 to 15), and then manipulate the training

load to maintain the desired training intensity. 

Training Volume. The training volume refers to the total

amount of work performed in a training session. The

number of exercises performed per session, the

repetitions performed per set and the number of sets

performed per exercise all influence the training volume.

For example, if a child performs two sets of 10

repetitions with 100 lb on the leg press exercise, the

training volume for this exercise would be 2000 lb

(2 × 10 × 100 = 2000). Although there is some debate

regarding training volume, it is important to remember

that every training session does not need to be

characterized by the same number of sets, repetitions

and exercises. 

In general, a one-set training protocol will be effective

for obese youth during the first few resistance training

sessions provided that reasonable training loads are used.

However, multiple-set training protocols are likely to be

more effective than a single-set protocol for maximizing

training adaptations and maintaining exercise adherence

in youth over the long term.32 A reasonable

recommendation is for obese children and adolescents to

start resistance training with a single-set program and

then gradually increase the number of sets to two or

three on selected exercises depending on personal goals

and time available for training. 

Rest Intervals Between Sets and Exercises. The rest

interval between sets and exercises is an important but

often overlooked resistance training variable. In general,

5
per week of resistance training may be suboptimal for

enhancing muscular strength in youth.20 A training

frequency of two or three times weekly on

nonconsecutive days will allow for adequate recovery

between sessions (48 to 72 hours between sessions) and

will be effective for enhancing muscle strength and

performance. Factors such as the training volume,

training intensity, and exercise selection should also be

considered when prescribing a training frequency for an

obese participant, as these factors may influence one’s

ability to recover from and adapt to the training program. 

Summary

Regular participation in a resistance training program,

along with other types of physical activity, gives obese

children and adolescents yet another opportunity to

improve their health, fitness and quality of life. While

additional studies are needed to examine the long-term

effects of resistance exercise on obese children and

adolescents, scientific evidence and clinical observations

suggest that progressive resistance training programs

may offer observable health and fitness value to boys

and girls who are obese or at risk for obesity. In addition

to enhancing musculoskeletal strength, resistance

training beneficially modifies body composition and

seems to provide obese youth with an opportunity to

experience success and feel good about their

performance. When conducted by competent

professionals who possess a sound understanding of

resistance training principles and who genuinely

appreciate the physical and psychosocial uniqueness of

childhood and adolescence, regular resistance training

can offer many benefits and lead to a lifelong interest in

an enjoyable type of physical activity. There is a growing

body of evidence to recommend participation in

resistance training for children and adolescents who are

obese or at risk for obesity.

6

the length of the rest period will influence energy

recovery and the training adaptations that take place. For

example, if the goal is to promote energy expenditure,

lighter weights and shorter rest periods (e.g., 1 min) are

required. Training intensity, training goals, and fitness

level will influence the length of the rest interval. In

general, a rest period of 1 to 2 min between sets is

appropriate for most beginners. Short rest periods (< 30

seconds between sets and exercises) need to be carefully

prescribed because of the muscular discomfort

associated with this type of training. However, over time,

the rest periods can be reduced gradually to provide

ample opportunity for the body to tolerate this type of

resistance training (e.g., circuit weight training).

Repetition Velocity. The velocity or cadence at which a

strength exercise is performed can affect the adaptations

to a training program.26 Since beginners need to learn

how to perform each exercise correctly with a light

resistance, it is recommended that untrained obese youth

perform exercises in a controlled manner at a moderate

velocity. As youth gain experience in resistance training,

different training velocities may be used depending on

the choice of exercise and program goals. For example,

selected medicine ball exercises (e.g., chest pass) can be

performed at a higher velocity than traditional strengthbuilding exercises (e.g., bench press). Although

additional research is needed, it is likely that the

performance of different training velocities within a

training program may provide the most effective

resistance training stimulus.

Training Frequency. Training frequency typically refers

to the number of training sessions per week. A resistance

training frequency of two to three times per week on

nonconsecutive days is recommended for children and

adolescents.3, 16 Limited evidence indicates that one day

Science Board of the President’s Council on Physical Fitness and Sports 2006-2007

Members:

Barbara Ainsworth, PhD; Arizona State University

Wojtek Chodzko-Zajko, PhD; University of Illinois at Urbana-Champaign

Doris Corbett, PhD; Howard University

Patty Freedson, PhD; University of Massachusetts, Amherst

Ed Howley, PhD; University of Tennessee

Thom McKenzie, PhD; San Diego State University

Tedd Mitchell, MD (PCPFS Member Liaison); Cooper Clinic

James Morrow, PhD; University of North Texas

Maureen Weiss, PhD; University of Virginia

Deborah Rohm Young, PhD; University of Maryland

Weimo Zhu, PhD; University of Illinois at Urbana-Champaign
7

Please Post

Avery D. Faigenbaum, Ed.D., CSCS, FACSM, FNSCA

The College of New Jersey, Ewing, NJ

Wayne L. Westcott, Ph.D., CSCS

South Shore YMCA, Quincy, MA

Regular participation in a resistance

training program can improve health and fitness

among obese children and adolescents.

Obese youth tend to enjoy resistance training

because it provides an opportunity for

all participants to experience success and

feel good about their performance. Thus, the

first step in encouraging obese youth to

exercise may be to increase their confidence in

their abilities to be physically active, which

in turn may lead to an increase in regular

physical activity, an improvement in

body composition and, hopefully, exposure to

a form of exercise that can be carried over

into adulthood.
8

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