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Eisenmann, Joey C. Ph.D.; Howard, Rick M.Ed.; Moreno, Tony Ph.D.

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ACSM's Health & Fitness Journal: 9/10 2020 - Volume 24 - Issue 5 - p 24-31
doi: 10.1249/FIT.0000000000000604
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Children and adolescents (6 to 18 years of age) are relatively healthy compared with adults (1); however, there still remains a concern about the health-related behaviors and fitness levels of American youth (2–6). More specifically, current U.S. trends indicate that relatively high percentages of youth are physically inactive, overweight, and physically unfit and have poor fundamental movement skill competency. In addition, sport-related injuries as a consequence of excessive or inappropriate training and competition are common (7). Beyond these physical health concerns, there also has been an increase in mental health issues (anxiety, depression, etc.) among young people (2), which may be related to either physical inactivity (8) or the hypercompetitive nature of youth sports, including verbal and emotional abuse from coaches and parents (9).

The good news is that a positive experience in sports and physical activity (PA) at a young age can enhance the physical, psychological, cognitive, social, and emotional health and well-being during youth, adolescence, and throughout adulthood (8). The long-term athlete development (LTAD) model provides such a framework for optimal health and well-being by engaging all youth in PA programs that promote both physical fitness and psychosocial well-being (10,11). In this regard, LTAD follows the American College of Sports Medicine’s mantra, “Exercise is Medicine,” or in other words and in the context of children and adolescents, PA and physical literacy is a polypill that has widespread effects on growth, maturation, and development. The aim of this article is to address how the 10 pillars of LTAD (10) (Table 1, [adapted from ref 12]) can be used to enhance the development of wellness in children and adolescence.

Ten Pillars and Recommendations for the Development of Youth Physical and Psychosocial Well-Being (10,12)

Long-term athlete development (LTAD) model provides a framework for optimal health and well-being by engaging all youth in physical activity programs that promote both physical fitness and psychosocial well-being.


First, it should be clearly understood that LTAD is not solely a pathway for competitive young athletes to reach the Olympics or college or professional sports (10). One example of this is the second pillar (10), that youth of all ages, abilities, and aspirations—irrespective of whether a child is involved in organized sport or engages in recreational PA—should engage in programs that promote both physical fitness and psychosocial well-being. In fact, to further emphasize this point, Canada Sport for Life changed the name of their model to “Long-term Development in Sport and Physical Activity” (11). Furthermore, it should be recognized that “athleticism” is merely a combination of health- and skill-related physical fitness (10) that includes “the ability to repeatedly perform a range of movements with precision and confidence in a variety of environments, which require competent levels of motor skills, strength, power, speed, agility, balance, coordination, and endurance” (10).

Although LTAD is actually a cradle to grave, or life span concept, that fits within the focus of this entire special issue, much of the attention is centered on youth ages 6 to 18 years, largely because of the role that the LTAD model serves in youth sports. However, it should be emphasized that the principles and tenets of LTAD transpire to physical education and general PA and fitness programs as well. Lastly, the outcomes of LTAD are to improve overall health, fitness, and well-being—both physically and psychosocially.

The Central Tenet of LTAD: Health and Wellness

In accordance with the focus of this special issue, the fifth pillar states that health and well-being should always be the central tenet of LTAD. Although there appears to be a focus on physical development, this pillar, and LTAD in general, goes far beyond the physical component of health and fitness and includes the psychological and social well-being of youth, including the development of a growth mind-set, motivation, perceived confidence, confidence, and resiliency. Furthermore, the second pillar notes that “practitioners should appreciate the potential impact that other lifestyle factors will have on physical fitness development and PA engagement, including dietary behaviors, educational stress, sleep patterns, psychosocial health, and unrealistic external pressures from significant others such as parents or coaches (10).” Taken together, the LTAD framework, therefore, provides a viable solution to integrate many, if not all, of the dimensions of wellness.

Health and well-being should always be the central tenet of LTAD.


It is often stated that “children are not miniature adults,” as the first two decades of life certainly represents a very dynamic life stage of growth, maturation, and development. To truly understand the nature of PA, fitness, health, and wellness during childhood and adolescence, it is essential that those working with this age-group first understand normal growth, maturation, and development when considering the implementation and effect of lifestyle behaviors (13).

Although often used interchangeably, the three interacting processes of physical growth, biological maturation, and behavioral development are separate but interrelated constructs. Growth refers to the increase in the size of the body as a whole and of its parts. As children grow, they observably become taller and heavier and increase in lean (bone and muscle) and fat tissues. Most organs and organ systems likewise increase in size following a similar growth pattern to either height or body weight. The nervous system is one exception, growing more rapidly during childhood and is near adult size before entering adolescents, whereas the reproductive system slowly develops during childhood and rapidly advances during puberty. As the body grows, it is also maturing biologically. Maturation refers to progress toward the biologically mature state and varies considerably between individuals in timing (maturity status at a given time) and tempo (maturity progress) especially during adolescence. The assessment of biological maturation (sexual and skeletal maturation and parameters of the adolescent growth spurt in height [i.e., age at peak height velocity]) (pillar 8) is beyond the scope of this article (13). In essence, maturation relates biological age to calendar age with individuals classified as early, average, or late maturing. Development refers to the acquisition of behavioral competence, the learning of appropriate behaviors expected by society. As children experience life at home, school, church, sports, recreation, and other community activities, they develop cognitively, socially, emotionally, and morally.

These three processes—growth, maturation, and development—occur simultaneously and interact in a complex manner to influence self-concept, self-esteem, body image and perceived competence, and also in skills and behaviors related to PA, lifestyle behaviors, fitness, physical performance, health, and wellness. As mentioned, the three processes also vary considerably within and among individuals, especially during adolescence; therefore, it is essential that the highly individualized and nonlinear nature of the growth and development of youth should be accommodated for when working with this age-group (pillar 1).


Fundamentals form the base from which everything else develops, and within human movement, the fundamental movement skills (shown in Table 2) provide the foundation or building blocks for developing confidence, competency, and physical literacy in sports, games, play, and PA. As a general example, a lack of confidence and competency in the fundamental movement skills may deter an individual from engaging in all forms of PA (14) and also may affect emotional and social development.

General Classification of Fundamental Movement Skills

The fundamental movement skills begin to be developed during toddlerhood and the preschool ages (15) as young children begin to move about and explore the environment. These skills continue to develop through mid-to-late childhood (approximately 7 to 10 years of age), until they are mastered. Recent studies (16) and anecdotal observations from coaches and physical educators report that many of today’s youth show low levels of fundamental movement skill proficiency. Therefore, there is a need for youth PA and sport programs to focus on developing a broad range of fundamental movement skills during childhood (pillar 3).

The fundamental movement skills provide the foundation or building blocks for developing confidence and competency in sports, games, play, and physical activity.

Recently, the term “foundational movement skills” was proposed to replace “fundamental movement skills” because it better reflects the broad range of movement forms, including traditional (Table 2) and other movement skills (e.g., bodyweight squat, pushup, cycling, swimming strokes) that can support PA engagement across the lifespan (14). With this in mind, the development of foundational movement skills incorporated within a wide variety of sports and games (i.e., sports sampling; pillar 4) along with resistance training (Table 3) and other modes of physical training (e.g., speed, agility, plyometrics, small-sided games, etc.; pillar 7) performed in a progressive and individualized manner (pillar 9) also deserves attention in youth. More specifically, fundamental motor skills can be blended into various activities and sport skills, and their refinement in varying and challenging environments enable youth to become more capable of solving the various movement problems that they will encounter during sport, recreation, or other forms of PA.

General Guidelines for Youth Resistance Training

Free play opportunities and simple games at the elementary grade levels provide a good proving ground for youth to explore and experiment with a trial-and-error approach at attempting new movement experiences. Over time, this experimentation can yield the competence and confidence needed when learning or refining more complex movement patterns found in sport or PA. Many playlike activities and games use fundamental movement patterns that easily transfer to multiple PAs and sports throughout the life course. Further, these simple games enhance the perceptual and spatial awareness that youth often lack because of their inexperience. In summary, mastery of fundamental movement capacities can trigger novel or perpetuate existing movement experiences that can engage the participant throughout the lifespan.

Youth PA and sports also should be fun, yet challenging, as the primary reason children engage in these activities is for fun and enjoyment (17). By contrast, a lack of fun and enjoyment are commonly the main reason for dropping out of sports. Practitioners can make sport or PA fun by including youth in the design process and providing time for free play in physical education and even during sports practice. In this regard, free play can be re-engineered back into childhood. Often, the most athletic individuals in a group will have fun regardless of the activity, but there are other children who are not as enthusiastic about sport or activity. One strategy to better engage this child, or children, is to select an activity that he/she will excel in so the child is recognized in a positive way. Practitioners can easily rotate activities and movements so that every child gets a chance to excel or lead, rather than the adult or the “athletic kids” directing every activity.

A final note here is that fundamental movement skills and fun can be implemented across all ages. As previously mentioned, today’s youth, including those who have specialized in a single sport at an early age, often do not display a competent level of a broad range of fundamental movement skills, so it is important to continue to train these movements. Likewise, adolescents still like to have fun, so childhood games such as tag or obstacle courses are a great way to create fun, engaging, and challenging sessions for both children and adolescents. In the sports setting, fundamental movement skills can be incorporated into the dynamic warm-up and also can be part of a broader strength and conditioning program.


Like PA, sleep and nutrition also can serve as a polypill for optimal growth, maturation, and development. Yet, as with PA, there also are concerns about current sleep and nutrition habits of children and adolescents. Although the American Academy of Sleep Medicine recommends sleep durations of 9 to 12 hours for 6- to 12-year-olds and 8 to 10 hours for 13- to 18-year-olds per 24 hours (18), data from the Youth Risk Behavior Survey indicate that 58% of middle school and 73% of high school students do not meet the recommended levels on school nights (4). A main reason for this may be related to electronic devices (19); however, overscheduling activities, excessive school work, time management, and mental health issues also can affect sleep time in youth and teens, which in turn can have negative consequences on overall wellness.


Like physical activity, sleep and nutrition can also serve as a polypill for optimal growth, maturation, and development.

The nutritional habits of all Americans are a major public health concern (6). Among children and adolescents, the overall quality of diet consists of many empty calories (e.g., soda, fruit drinks, and dairy desserts). Calories from added sugars, solid fats, and sugar-sweetened beverages contribute up to 50% of children’s total daily calories. It should therefore not be surprising that most youth do not meet fruit and vegetable recommendations.

For children, the parent or caregiver (including the school system) is often the main decision maker in food choice and meal preparation. As with other lifestyle and social behaviors, high school–aged youth typically have more independence and peer influence when it comes to food choice.

Education and interventions on both sleep and nutrition should be part of every PA, health, and wellness program. These activities can be incorporated into stand-alone sessions or the warm-up or cool-down periods of a PA session (e.g., physical education, sports, camps, etc.). Furthermore, this messaging should be consistent throughout and across a program (i.e., vertical and horizontal integration). For example, instead of just one or a few age-groups being exposed to nutrition and/or sleep education, it should be developed similar to physical skills (or other school subjects) progressively and consistently across ages.


During much of the calendar year, school occupies a majority of the waking hours for 6- to 18-year-olds. For elementary school youth, recess and physical education provide two potential avenues to engage in PA. In addition, actively commuting to and from school can provide an additional opportunity to increase daily PA for youth. However, recent trends show a decline in such opportunities (3), along with a decline in unstructured free play and outdoor play. Each of these may be contributing to the noted low levels of motor competency. Therefore, given these declines in opportunities for play and sport, organized youth sports represent a major outlet of PA for many.

Annually, an estimated 45 to 60 million youth participate in organized sport (20). Despite youth sports being a great opportunity for enhancing overall health and wellness, many youth have a poor experience, and approximately 70% drop out of sport by the age of 13 years. The decline and drop out also may relate to reduced opportunities as middle school and high school and club sports have limited rosters and/or are cost prohibited (“pay to play”). This decline in organized sports participation also coincides with a significant age-related decline in habitual PA expressed as time spent in moderate to vigorous PA (21). There are many biological, behavioral, and environmental factors that explain the age-related decline in PA during adolescence, including the timing of puberty and changes in body size and composition, which in turn, can affect behavioral and social aspects of the teenage lifestyle (21).

Aside from the physical concern of overuse injuries due to the high demands of youth sports, there is an equal, if not greater, concern for a lack of general physical preparedness given the generally poor physical fitness and sedentary lifestyle of contemporary youth. This essentially becomes an “underuse” issue as a risk factor for injury and health and fitness in general. Furthermore, many youth coaches do not effectively implement an injury prevention program (22), which also should be considered for physical education and general youth activity programs, as they not only decrease risk of injury but also can improve physical performance and motor competency (23) (pillar 6). Conversely, ill-advised strength and conditioning practices that do not follow general principles of exercise science and best practice for exercise program design and conduct also can lead to unnecessary injury.


Aside from the physical concern of overuse injuries due to the high demands of youth sports, there is an equal, if not greater, concern for a lack of general physical preparedness given the generally poor physical fitness and a sedentary lifestyle of contemporary youth.


The typical day described previously can be part of what many have described as our hectic, modern-day lifestyle for both adults and youth, whereby there is the challenge of finding a balance between school, sports, extracurriculars, family, social life, and for some teens, a job. Although many of these activities are part of “the business of growing up,” an imbalance or unhealthy exposure to daily activities can affect physical, psychological, emotional, cognitive, and social health and wellness.

Teaching youth (and perhaps educating parents as well) about time management skills and a balanced lifestyle can help distribute the proper amount of time to the activities and tasks that are important. From a practical standpoint, The three Ps (prioritize, plan, and prepare) are strategies that can help youth and parents better manage time.

Sport and extracurricular schedules also should consider the demands placed upon children from an academic perspective. Education should be emphasized, and the demands of sport and extracurriculars should complement the academic schedule, not conflict with it. The pulling demands of class work, examinations, social obligations, and peer groups all play a role in the overall wellness of youth, as stress levels, sleep, nutrition, and PA can all be negatively or positively affected depending on the ability to balance everything. Add to the situation the need to perform in athletic competition for a certain subset of youth, and the demands become even greater. Adults overseeing youth activities have a responsibility to monitor these factors to balance the sports and extracurricular schedule to allow for optimal growth and development.


Often times, assessment and monitoring of growth, maturation, and development are overlooked in youth PA and sports programs. When assessment and monitoring are used, they also can be misused, especially when intending to identify and select talented young athletes without considering maturity status. More specifically, the earlier maturing child will often be mistaken as the more talented child at the time of selection onto a sports team, yet the trajectory of development may fade allowing late maturing youth to catch up and compete (13).

Routine assessment and monitoring also can aid in the education and awareness of several health, fitness, and wellness concepts, including growth and maturation, fundamental movement skill acquisition, physical performance, injury prevention, nutrition, sleep, and psychosocial well-being (pillar 8). For example, the assessment of health-related physical fitness can be used to educate on the general concept of physical fitness and its role in health, disease prevention, and sport performance. Likewise, monitoring the training load of young athletes can facilitate discussions with coaches and athletes about the importance of the balance of training and rest and recovery, including sleep and nutrition. In addition, monitoring training load and communicating across stakeholders is important when a young athlete is participating on multiple teams so to avoid overtraining and injury. Assessment also can facilitate goal setting and motivation. However, it is important to consider the challenge of coordinating efforts and communicating among stakeholders (parents, teachers, coaches, trainers, etc.).


LTAD should be centered on the individual, but the program is often driven or coordinated by you—the coach or health and fitness instructor. Like a parent, the coach or instructor can play a vital role in shaping the young person physically, emotionally, cognitively, socially, and morally through a comprehensive, holistic approach. It is a major responsibility to understand how much of an impact a coach or instructor can have on positive youth development. Everything that the coach or instructor plans, says, and does will have an effect on the young person; thus, quality coaching and instruction are essential and defined as the consistent application of integrated professional, interpersonal, and intrapersonal knowledge to improve competence, confidence, connection, and character in specific coaching contexts (24) (pillar 10).


The acquisition and mastery of foundational movement skills, regular participation in a range of PAs, games, and sports, along with adequate sleep and nutrition, are key elements to normal growth, maturation, and development during the first two decades of life. Unfortunately, many youth do not meet recommendations for these key lifestyle behaviors, and many possess poor physical fitness, mental health, and physical literacy; suffer preventable musculoskeletal injury; or have a negative experience in sport or physical education. These trends are a concern for the next life stage given that these behaviors and experiences may track into adulthood and influence subsequent health and well-being. The principles and tenets outlined in the LTAD model and this article provide health and fitness stakeholders a framework for the development of physical and psychosocial well-being of children and adolescents.


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Fitness; Nutrition; Physical Activity; Sleep; Youth Sports

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