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Training the Developing Brain, Part I:

Cognitive Developmental Considerations for
Training Youth

Article in Current Sports Medicine Reports · September 2013

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EXTREMITY AND JOINT CONDITIONS

Training the Developing Brain, Part I:

Cognitive Developmental Considerations for
Training Youth
Gregory D. Myer, PhD, FACSM, CSCS*D1,2,3,4; Adam M. Kushner1; Avery D. Faigenbaum, EdD,
FACSM5; Adam Kiefer1,2; Susmita Kashikar-Zuck6; and Joseph F. Clark, PhD7

21% increase in the number of young

Abstract
athletes participating in sports in the
Based on the fundamental principles of pediatric exercise science and
United States that has now risen to
developmental physiology, childhood provides a critical window to de-
an estimated 30 to 40 million youth
velop the physical readiness of youth through age-related training pro-
(2,29,45). Furthermore young athletes
grams that are designed purposely to teach and reinforce fundamental
are initiating training for organized
movement skills to enhance preparedness for physical activity and sport.
sports competition at earlier ages. This
Successful implementation of developmental programs requires age-
trend may stem from increased com-
related instruction by qualified professionals who understand the physical
petition to make teams or from mis-
and psychosocial uniqueness of children and adolescents. An understand-
informed parents who encourage their
ing of the interaction of physical and cognitive development is needed to
child to specialize early; assuming spe-
design and implement training strategies that optimize training outcomes.
cialization in sports is the key to their
Regular training with structured and integrative modalities throughout the
child’s future athletic success. The esca-
developmental years as part of physical education, recreation, and sports
lation of early competition and sports
practice can improve athletic performance while reducing common sports-
specialization combined with the rise in
related injuries and can facilitate the adoption of healthy lifestyles through-
total participants is associated likely with
out adulthood. In this commentary, we outline cognitive developmental
the disturbing increase of sports-related
considerations in youth that may influence the design and implementation
injuries in young athletes (1,32,47).
of training programs aimed at optimizing motor skill development in youth.
The interest from parents, coaches,
and health care providers to help youth
enhance sports performance has fos-
Introduction
tered a concomitant growth in youth
Participation in organized youth sports has seen a dra-
strength and conditioning, performance enhancement, and
matic growth over the past decade (53). There has been a
injury prevention programs in fitness centers, private train-
1 ing facilities, and health care organizations (50). It is
Division of Sports Medicine, Cincinnati Children’s Hospital Medical
Center, Cincinnati, OH; 2Department of Pediatrics, College of Medicine, warranted that young athletes who wish to participate in
University of Cincinnati, Cincinnati, OH; 3Department of Orthopaedic competitive sport are prepared adequately for the physical
Surgery, College of Medicine, University of Cincinnati, Cincinnati, OH; and cognitive demands of competition and physical activ-
4
Athletic Training Division, School of Allied Medical Professions, ity. Participation throughout the growing years in struc-
The Ohio State University, Columbus, OH; 5Department of Health and
Exercise Science, The College of New Jersey, Ewing, NJ; 6Division of
tured activities that are designed purposefully to enhance
Behavioral Medicine and Clinical Psychology, College of Medicine, both general physical fitness (i.e., endurance, strength,
University of Cincinnati, Cincinnati, OH; and 7Department of Neurology power, and flexibility) and specific skill sets associated
and Rehabilitation, College of Medicine, University of Cincinnati, with physical fitness (i.e., agility, balance, coordination,
Cincinnati, OH and reaction time) has been proposed as an ideal mechanism
Address for correspondence: Gregory D. Myer, PhD, FACSM, CSCS*D, to reduce the risk of activity-related injuries and to promote
Division of Sports Medicine, Cincinnati Children’s Hospital Medical continued involvement in sports and recreational fitness
Center, 3333 Burnet Ave., MLC 10001, Cincinnati, OH 45229; activities (4,48). Based on the fundamental principles of
E-mail: greg.myer@cchmc.org. pediatric exercise science and developmental physiology,
1537-890X/1205/304Y310
childhood may provide a critical window to develop the
Current Sports Medicine Reports physical readiness of aspiring young athletes through age-
Copyright * 2013 by the American College of Sports Medicine related training programs that are designed purposely to

304 Volume 12 & Number 5 & September/October 2013 Training the Developing Brain

Copyright © 2013 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
 teach and reinforce fundamental movement skills to enhance
preparedness for sport (27,28,63).
However, considering the widespread age range of youth
that are involved in sports training programs and athletic
competitions, it is important for coaches and trainers to
be cognizant of their training instruction and feedback
methods. The effectiveness of these methods is influenced
by the individual participant’s developmental maturation
and prior learning experiences. Particularly the role of cog-
nitive development and its interaction with physical and
motor development must be considered to design appro-
priately and maximize strategically the benefits of training
program outcomes for youth. The purpose of this review
is to outline cognitive developmental considerations for
youth that can influence the design and implementation of
training programs aimed at optimizing motor skill de-
velopment, promoting continued involvement in physical
activity, and ultimately reducing the risk of physical
activity-related injuries.
Integrative Neuromuscular Training
Integrative neuromuscular training is a conceptual training
model that utilizes a developmentally appropriate condi-
tioning program that incorporates general (e.g., fundamen-
tal movement skills) and specific (e.g., exercises targeted to
motor control deficits) strength and conditioning activities
to enhance muscular fitness and motor skill performance
that ultimately influences sport performance and reduces
injury risk in youth (50,51,57). Integrative neuromuscu-
lar training activities integrate resistance training, dynamic
stability training, core-focused strength development, and
plyometric and agility exercises. These activities are focused
to promote development of neurocognitive processing and
visual-motor abilities, which are improved further by a quali-
fied instructor’s appropriate delivery of corrective feedback
for identified deficits. Potential benefits of youth strength
and conditioning include increased muscle strength, power
and endurance, improved body composition, increased bone
mineral density, increased cardiorespiratory fitness, improved
blood lipid profile, improved insulin sensitivity in overweight
youth, improved motor performance skills, enhanced sports
performance, increased resistance to injury, enhanced men-
tal health and well-being, and simulation of a more posi-
tive attitude toward lifetime physical activity (21,50). The
cornerstone of integrative neuromuscular training is an
age-related exercise prescription based on the fundamental
principles of pediatric exercise science and instruction and
supervision by qualified professionals who genuinely ap-
preciate the physical and psychosocial uniqueness of youth
F1 (Fig. 1) (22,50,57).
What Is Age-Related Training?
Due to the rapid rate of growth and maturation of the
nervous system and the sensory and perceptual abilities of
children, it is imperative to recognize and strategize train-
ing interventions based on age-related guidelines. Similar
to the instruction of arithmetic and language arts in aca-
demic settings, instruction of physical activity and exercise
technique must utilize age-related strategies and tools to
optimize coherence and outcomes. ‘‘Age appropriate’’ in
most contexts typically refers to chronological age. However
www.acsm-csmr.org
Copyright © 2013 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
chronological age only denotes the number of years a per-
son has lived and does not take behavior, biological matu-
ration, or intellectual capabilities into account (70).
Biological age, on the other hand, is determined by physi-
ology as opposed to chronology and accounts for changes
in physical structure such as height, body mass, and sec-
ondary sex characteristics (70). Training age represents an
individual’s prior experiences and learning of task-related
activities; this development plays a significant role in one’s
ability to learn new related tasks to execute proper exercise
mechanics and technique (57). Training age can provide a
theoretical construct that should guide the practitioner in
selecting appropriate exercise criteria. While a child’s
training age is particularly important, considerations of
cognitive development can be the key determinant to a
child’s ability to perform simple and complex movement
patterns with energy, vigor, and confidence. It may be that a
child’s cognitive-perceptive-motor interactions that are
necessary to perform complex movements should be the
primary determinant of how to initiate the individualized
programming of integrative neuromuscular training. Cog-
nitive age comprises one’s cumulative ability to execute
mental tasks of differing complexity, which requires a
combination of attention, alertness, memory, comprehension,
application, judgment, and problem-solving skills (15,31,62).
All of these ‘‘age-related’’ factors that are linked to child-
hood development affect the design and implementation of
training programs, which influence the potential to improve
fundamental movement patterns and ameliorate functional
deficits indicative of injury risk in children.
In this article, we propose that exercise training proto-
cols for children are limited often by their consideration of
solely chronological factors without sufficient attention to
cognitive development or training age. The ultimate limit-
ing factor is not one’s chronological or biological age but
rather one’s cognitive ability to focus, take direction, and
execute a task to gain competence and confidence in one’s
abilities (57). These factors are interdependent and must be
considered together when strategizing instruction and feed-
back for neuromuscular training at various ages. However
the importance of matching a child’s cognitive age and
training age cannot be underestimated because it sets the
foundation for physical development programming and ul-
timately determines the success of programs aimed to pro-
mote healthy behavior, enhance physical fitness abilities,
and reduce injury risk of youth (48).
It is important to understand that development is se-
quential in nature, and this sequence of maturation and
development should be the basis for developing a train-
ing strategy. The sequence of maturation can be identified
through the achievement of neurodevelopmental mile-
stones. While it is unlikely that a single gene encodes for
motor performance ability in children, there may be genet-
ically linked nervous system thresholds that differentiate
between a child’s ability to exploit critical maturational
thresholds for the development of dynamic interceptive
actions (i.e., physical acts of the body or an implement
must be moved into the right place at the right time in
order to accomplish a task) (52). Children and adolescents
likely have a genetically predetermined range of physical
ability potential. Hence integrative neuromuscular exercise
Current Sports Medicine Reports 305
Figure 1: Qualified education and instruction support the complex programming components for effective implementation of integra-
tive neuromuscular training. (Reprinted from Myer GD, Faigenbaum AD, Clark JF, Ford KR, Best TM. Train the developing brain: integra-
tive neuromuscular training to optimize motor skill development in youth. Med. Sci. Sports Exerc. 2013; Submitted for Publication. Used
with permission.)

progressions should be designed purposefully in relation
to a child’s physical and cognitive development, while care
should be taken to ensure that the progressions do not push
beyond one’s physical limits (53).
Genetic factors are key determinants of cognitive devel-
opment; however environmental factors also play a signi-
ficant role. Environmental factors are especially important
in cognitive development and learning of perception/action
relations within a specific environmental task. Specifically,
with regard to psychosocial behavior, this constitutes the
development and refinement of communication and lan-
guage abilities (30). It is required that an individual passes
this basal level threshold (e.g., acquisition of language and
communication skills that influence the child’s ability to
train at increasingly higher levels of challenge) in order to
benefit from training. Acquisitions of necessary neuromotor
skills are required in order for an individual child to attain
thresholds relative to the ability to comprehend instruc-
tions and then physically execute a task. For example, ap-
propriate neuromotor thresholds must be achieved before a
toddler can learn to walk. Then an additional threshold
must be passed before this young child can learn more ad-
vanced movements such as running and jumping (16,39).
These developments may not always occur at the same
chronological age in individuals. However normal children
progress through a similar sequential development process.
It is important to recognize that an individual’s ability to
reach one developmental threshold at an earlier than aver-
age age does not guarantee that an individual will reach
all developmental thresholds early (16,39,62). The initia-
tion of integrative training programs that are matched with
cognitive abilities early in youth can help increase training
age that is vital for children and adolescents whose motor
capabilities are highly ‘‘plastic’’ and responsive to training.
Research demonstrates that significant, amenable benefits
can be gained from training age-appropriate interventions
(57). Quality physical education or sport programs that
are designed purposely to consider both cognitive and de-
velopmental abilities are taught often by master teachers
and experienced coaches. Outlined below are key strategies
that may help to enhance the delivery and implementation
of integrative neuromuscular training programs by other

306 Volume 12 & Number 5 & September/October 2013 Training the Developing Brain

Copyright © 2013 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
qualified professionals who work with youth in sports fa-
cilities and medical centers.
It is important to note that physical growth and neu-
rodevelopment are gradient in nature and are influenced by
both genetic factors and environmental stimuli (53). Dif-
ferences in training strategy for various ages should not be
taken as clear-cut rules but rather as general guidelines that
should be utilized as a base plan to adapt to the demands of
individuals. It has been proposed that there is a high degree
of plasticity in neuromuscular development during preado-
lescence (53). This concept combined with an appropriately
timed implementation and progression of integrative neu-
romuscular training may allow for strengthened physical,
mental, and social development, which may contribute fa-
vorably to their physical fitness and athleticism later in life
(52). Specifically the behavior of a child emerges via an
interconnected dynamical system that is composed of a
network of critical subsystems (e.g., cognitive, sensory,
emotional, perceptual, and motor control) that optimally
evolve throughout the time course of childhood develop-
ment (33,51). Over time, the child learns to organize effi-
ciently these subsystems, and as described in classic motor
development theory, the skill acquisition process links the
relationships among neural codes and movement patterns
(71). A similar process of this phenomenon is seen in the
developing brain via synaptic pruning (43,75). Brain de-
velopment during childhood likely corresponds to the time
when these subsystems are developing optimally, and/or
rapidly changing, for the formulation and fine tuning of
specific skills during skill acquisition (51,72). Therefore spe-
cific considerations to cognitive development and maturation
of neurodevelopment in youth can support the formation of
specific strategies used to design and instruct integrative
neuromuscular training programs. When these skills are
learned at an early age, similar skills may be learned more
efficiently because they can use complimentary pathways
that exist from that earlier training.
Integrative Neuromuscular Training across the
Developmental Spectrum
One common outlet for children and adolescents to in-
crease physical activity is through sports and recreational
fitness programs. Compared with inactive youth, children
and adolescents who are physically active demonstrate in-
creased musculoskeletal strength, enhanced cardiorespira-
tory function, and improved metabolic health (41,67,73).
As previously described, integrative neuromuscular train-
ing is a conceptual training model that utilizes a develop-
mentally appropriate conditioning program instructed by
qualified professionals who understand the physical and
psychosocial uniqueness of children and adolescents. Ac-
cordingly integrative neuromuscular training incorporates
general (e.g., fundamental movement skills) and specific
(e.g., exercises targeted to motor control deficits) strength
and conditioning activities to enhance muscular fitness and
motor skill performance that ultimately influences perfor-
mance and reduces injury risk in youth (50,51,57). There-
fore integrative neuromuscular training programs provide
a mechanism to train youth across all stages of skill and
development and reduce their risk factors for injury during
sport and recreation.
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Copyright © 2013 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
Well-designed sports practice sessions can be associated
with increased energy expenditure and enhanced aerobic
and muscular fitness in participating athletes compared
with non-sports participants. This makes sport participation
a viable option to improve physical fitness and contribute
to the daily activity levels of children and adolescents.
While sport participation provides a mechanism to increase
physical activity levels in youth, sports participation with-
out adequate preparatory conditioning may increase risk
of injury (9,49,59). A drastic and sudden deficit in physical
activity from chronic pain or acute injury can initiate a
‘‘negative spiral of disengagement,’’ whereby reduced phys-
ical activity leads to diminished cardiorespiratory fitness,
increased adiposity, and poor health outcomes (66). Prelim-
inary data from our laboratory indicates that young girls
who reported a new knee injury demonstrated significantly
greater increases in body mass index z-score and body fat
percentage relative to their uninjured peers during the year
of the reported injury (49). In addition, youth who cease
sport participation during adolescence may be at the highest
risk of metabolic disease due to an inactive adult lifestyle
(24). Ultimately sports-related injury to children may initi-
ate a vortex of detrimental health outcomes, making them
less active during adolescence, which may manifest into
sedentary lifestyle habits and an increased risk of obesity
and diabetes during adulthood (5,6,19,20,25,26,50,52,65).
Based on Bernstein’s phases of motor learning, skill ac-
quisition in sport requires both learning and adaptation that
encompasses three levels: coordination, control, and profi-
ciency (8,42). In this context, coordination arises as a child
learns to exploit the many available relations between the
neuroanatomical and neuromuscular properties of their body
and the physics of the environment within they move.
During this stage of exploration, the child explores and
discovers their systems’ degrees of freedom (e.g., ranges of
their physical movement and neuromuscular control) (33).
Control arises through the management, or optimization, of
constraints via contributions from the vestibular, visual,
and proprioceptive systems that serve to link the systems’
degrees of freedom to form softly assembled functionally
specific units of control (i.e., coordinative structures). The
acquisition of skilled movement is a transition into explo-
ration of the motor control systems and controlling those
systems. Once the coordination of the various body seg-
ments is established, they are honed over time through
progressive training. During early learning, movements are
constrained overly due to the tendency of the child to freeze
or limit the various degrees of freedom, and the result is
movement inefficiency. As the child’s skill level increases,
the degrees of freedom are released gradually during the
intermediate stage of learning. It is here that feedback sys-
tems (whether augmented with visual/tactile or real time
via verbal biofeedback) that associate movement kinema-
tics and kinetics will benefit likely the child and allow fur-
ther advanced development of the desired skill (58,68). Task
proficiency is achieved once the coordinative structures
have reached a level of efficiency in which the child is able to
exploit the coordination of the myriad subsystems in pursuit
of performance goals in the late stages of learning (8,42).
This progression of motor learning in youth often
coincides with the transition of internal focus attention
Current Sports Medicine Reports 307
(induced when a performer’s attention is directed toward
their actual movements) to a more external focused atten-
tion that is directed toward an outcome, or the effects, of
the movement being produced (e.g., a goal, target, and
intended effect) (7,51). This stage of motor acquisition is
associated with youths’ ability to achieve cognitive and
motor system learning that can be retained for life, such as
riding a bicycle and learning to ski. Long-term retention of
adaptable motor performance is important for overall suc-
cess of integrative neuromuscular training. Therefore both
verbal and visual feedback given to youth during integrative
training exercises should be refined systematically to en-
hance overall motor skill learning and ultimate improve-
ment in movement patterns (51,77).
Limiting Distractions and Optimization of Peripheral
Reaction Time with Integrative Neuromuscular
Training in Youth
Another cognitive developmental consideration to opti-
mize integrative neuromuscular training for youth is to ac-
knowledge the varying attentive abilities of young athletes.
Hicks law describes that the more choices an individual has,
the longer it takes them to make a decision (64). In sports
with neuromuscular and neurocognitive processing, an ath-
lete may hesitate as he or she considers their options. This
hesitation may result in slower reaction times. Neurocog-
nitive processing training in youth, which helps youth learn
to focus on task performance during distractive sports-
related scenarios, or active perturbations to attention, may
have the potential to decrease injury risk reference. Pilot
evidence in our laboratory suggests that younger or new
learners are often not prepared to adapt to complex pro-
cessing (e.g., movement and cognitive) and likewise sus-
ceptible to distraction during complex sports-related tasks.
Conversely our more experienced athletes who have ac-
quired a strong motor skill base may remain consistently
focused on task performance and are less susceptible to dis-
tractions. The improved focus on the motor task actually can
achieve improved performance at higher levels in highly
distractive situations. It is prudent to utilize training strat-
egies that account for the varying attentive abilities of youth
to optimize training outcomes.
Integration of neurocognitive processing training (e.g.,
multitasking or dual tasking such as vision and reaction
training combined with vestibular/balance task) can im-
prove reactive and adaptive movement skills to adverse
conditions and unanticipated events. These skills may not
only improve an athlete’s general fitness and performance
but also enhance their ability to reduce their risk from
sports-related injuries. Gary Wilkerson (76) has suggested
an association between slower reaction times and increased
incidence of injury. For example, a leading theory related
to the underlying causes of concussion in youth sports is
an unanticipated blow to the head. With the unexpected
blow, the young athlete is unprepared to stabilize ade-
quately the head and trunk against oncoming forces. The
proposed theory states that if visual and cognitive aware-
ness provide an athlete time and ability to prepare for a
hit, there may be less adverse effects from potential con-
cussive events.
308 Volume 12 & Number 5 & September/October 2013
Copyright © 2013 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
Prevention of Knee Injury with Integrative
Neuromuscular Training in Youth
Interestingly there are known linkages between knee in-
jury and neurocognitive function (69). For instance, trau-
matic knee injuries can occur as the result of an unexpected
perturbation during dynamic sport scenarios (3,37,61). Fur-
thermore anterior cruciate ligament (ACL)-injured athletes
demonstrated slower reaction time and processing speeds
compared with uninjured athletes. In addition, those ath-
letes who went on to have an ACL injury also performed
worse on visual and verbal memory composite scores (69).
Therefore integrative neuromuscular training that combines
visual-motor and reactive perturbation training can expand
a young athlete’s peripheral attention to more information
that is readily available within their field of view. These
expanded abilities for risk identification and awareness may
improve a young athlete’s perceptual accuracy and assist
them to avoid the negative consequences (such as an injury)
of unexpected perturbations, ultimately improving sport
performance (12).
Contemporary young athletes tend to specialize earlier in
a favored sport and partake in associated specialized train-
ing with the assumption that this specialization is key to
their future athletic success (13). The escalation of com-
petition and specialization at younger ages without wide-
spread acceptance of associated integrated preseason training
may be related to the concerning increase in the number of
sports-related injuries in young athletes (1,32,47). Youth
participation in sport should not be initiated with compe-
tition but instead should evolve out of a well-rounded pre-
paratory conditioning program that is progressed sensibly
over time. The addition of integrative neuromuscular train-
ing into existing preseason activities better equips coaches
to ensure that youth will achieve gains in skill-related fit-
ness and health, with likely reductions in risk of sports-
related knee injury as a result.
While the total elimination of sports-related knee injuries
in youth is an unrealistic goal, appropriately designed and
sensibly progressed integrative neuromuscular training pro-
grams may help to reduce the likelihood of sports-related
injuries in young athletes (23,34,36,60). By addressing
the specific risk factors (e.g., low fitness level, muscle im-
balances, and errors in training) associated with certain
youth sport injuries, integrative neuromuscular training
programs reduce acute and overuse injuries by 15% to
50% (46,60,74). A traditionally effective adolescent train-
ing program (35,44,56) was modified into a 9-wk ‘‘inte-
grated injury prevention program’’ for use as an additive
training regimen during the warm-up period in young soc-
cer players (10 to 12 years). The addition of such an inte-
grative injury prevention training program into standard
soccer training influenced improvements in balance ability
and vertical jump height in the young soccer players (14).
The addition of similar resistance training into preseason
conditioning for adolescent football teams influenced a re-
duction in overall knee injuries as well, including the inci-
dence of knee injuries that required surgery over four
competitive seasons (11). In both cases, integrative neuro-
muscular training was protective of all injuries, but most
notably, injuries to the lower extremity and knee in young
soccer players (18).
Training the Developing Brain
 Notably protocols that incorporate resistance training
into preseason and in-season conditioning programs reduce
ACL injury risk factors and incidence in female athletes
(34,36). In addition, young female athletes took part in a
preseason integrative neuromuscular training program and
found a reduced prevalence of knee pain at postseason
follow-up (40). This is not surprising given that female
athletes who demonstrate risk factors associated with in-
creased lower extremity injury (38,54) are more responsive
to specially designed integrative neuromuscular training (55).
Although only a small minority of young athletes partici-
pate in integrative neuromuscular conditioning programs
prior to sports participation (10), current data indicate that
such multifaceted integrative conditioning programs reduce
sports-related injuries, and they may be most effective in
early youth (e.g., primary school years) (17,60).
Strong evidence indicates that integrative neuromuscu-
lar training is most effective at reducing injury when im-
plemented in younger populations (59). The accumulation
of the current evidence indicates that integrative neuro-
muscular training interventions implemented in childhood,
which take advantage of enhanced neuroplasticity, can sup-
port the development of muscular fitness and fundamental
movement skills that support safe, enjoyable, and worth-
while participation in sports and recreational physical ac-
tivities. Integrative neuromuscular training programs that
are considerate of the cognitive development abilities of
children and adolescents will be best prepared to capital-
ize on the neuroplasticity and motor learning potential
in youth.
Conclusion
Integrative neuromuscular training programs that con-
sider the cognitive and physical development of youth are
needed to support motor skill development, promote con-
tinued involvement in physical activity, and ultimately re-
duce the risk of common sports physical activity-related
injuries such as knee injuries in adolescent females. Prepa-
ratory training with developmentally appropriate programs
also appears crucial to circumvent the current rise in the risk
of injuries in competitive youth athletics. Integrative neu-
romuscular training requires age-related instruction by
qualified professionals who understand the physical and
psychosocial uniqueness of childhood and adolescence.
Furthermore these professionals must understand the
components of physical and cognitive development in or-
der to implement training strategies that optimize perfor-
mance outcomes and reduce the risk of training-related
injuries. Regular training throughout the developmental
years as part of physical education, recreation, and sports
practice can support regular physical activity, improve
sport performance, reduce injury risk, and further influ-
ence healthy lifestyles habits throughout adulthood.
Acknowledgments
The authors would like to acknowledge the funding support from the
National Institutes of Health/NIAMS Grant R01-AR05563.
The authors report no conflicts of interest.
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Copyright © 2013 by the American College of Sports Medicine. Unauthorized reproduction of this article is prohibited.
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