兒童與青少年該怎麼運動？ (by 林杏青復健科總醫師：柔術醫師)
上一篇文章提到兒童不應該使用機器做重量訓練、不應該以大人的心肺訓練方式訓練、不應該為了專項運動成績而殺得頭破血流。
這不表示兒童不需要好好運動，只是方法和目標和大人是不一樣的。兒童與青少年應該是培養體能、增進健康為主。
那該怎麼做呢？
有研究指出兒童的肥胖能夠預測未來的健康程度，所以非常建議兒童和青少年每天應有六十分鐘中到高強度的運動，最好能每週三天的包含高強度的心肺運動、阻力運動、以及承受體重的運動(可以促進骨質發育)。
為什麼是復健科醫師來聊兒童與青少年的運動問題？
因為復健科醫師是最懂得開運動處方的醫師，並且擅長和各科醫師(兒科、骨科)、各種治療師、教練、專業運動防護員一起合作，提供更好的診斷、評估與訓練。
今天由喜愛巴西柔術的林杏青復健科住院醫師(柔術醫師)來和大家聊聊如何讓兒童與青少年健康又安全的運動。
特殊考量
我們先來說說比較特別的狀況，假設你或你的孩子是完全沒有運動習慣，且過度肥胖。那建議從中等強度的運動開始，漸漸增加到一週運動三天，時間慢慢增加到一天60分鐘。
中等強度的意思是運動時身體能量消耗是休息時的3~6倍，例如騎腳踏車半小時、快走之類的；而高強度運動是指能量消耗是休息時的6倍以上，例如跟人尬游泳之類的。
兒童、青少年運動的迷思
兒童和青少年其實不需要刻意練心肺。
因為和成人相比，兒童青少年的呼吸速率和心跳都比較快，血壓比較低，絕對氧攝取比較小，相對氧攝取(每單位體重攝取的氧氣)比較大。硬操心肺的話可能會缺乏訓練效果跟增加運動風險。
小朋友運動的過度訓練
不是只有職業運動員會被操爆，其實很多小朋友也都有被操爆的問題。
過度訓練可能造成心跳上升、免疫力下降和內分泌以及情緒(躁動、注意力不集中、負面情緒)的影響。
強烈運動後若沒有好好的休息以及過度承重，可能導致骨頭當中的生長板損傷。生長板受傷可能會影響發育。
由於大人和發育未完全的小朋友受傷之後的處理和結果不見得相同，絕對不要基於大人的私心將小朋友當成滿足自己期望的工具。
有研究顯示，比起過早專項運動化的小朋友，多方嘗試各種運動，並且不過度訓練的孩子，未來常常更有創意、表現更好、也更健康、對運動有更長期的興趣。
Osgood-Schlatter Disease
一種過度訓練可能導致的疾病，脛骨上緣被髕骨肌腱拉扯出來出現碎片。保守治療的方式包括伸展運動、紮貼、增生注射、震波治療，最重要的是要有足夠的休息時間。若保守治療無效，可考慮手術。
青少年運動的建議
| 有氧 | 阻力 | 增加骨密度 | |
| 頻率 | 每天 | 至少一週三天 | 至少一週三天 |
| 強度 |
每週至少三天高強度運動。 |
利用體重當阻力，或是8~15次最大強度(Submaximal Repetition)重複數次。 |
|
| 時間 |
各種類型運動加起來60分鐘。 |
各種類型運動加起來60分鐘。 |
各種類型運動加起來60分鐘。 |
| 種類 |
選自己喜歡的運動。 |
避免在未發育完整之前做大人重量的機器訓練。但可以做較輕的舉重、臥推之類的。 |
跑跳、各種球類運動、阻力運動都很不錯。 |
好～祝大家運動愉快！！！
運動受傷時幫助你找醫生與物理治療師的搜尋器 (www.EasePain.tw)
參考資料：
1, ACSM 10, p.153-155
2, Predicting adult obesity from childhood obesity: a systematic review and meta-analysis. Simmonds M, Llewellyn A, Owen CG, Woolacott N., Obes Rev. 2016 Feb;17(2):95-107. doi: 10.1111/obr.12334. Epub 2015 Dec 23.
3, Trainability of Young Athletes and Overtraining, Nuno Matos and Richard J. Winsley, J Sports Sci Med. 2007 Sep; 6(3): 353–367.
4, The Young Athlete: Challenges of Growth, Development, and Society, Michael F. Bergeron, Current Sports Medicine Reports 2010
5, Injection may be the best bet for young athletes’ knee pain, Mark Sakr, DOcorresponding author and Anne Mounsey, MD, J Fam Pract. 2012 Aug; 61(8): 486–488.
6, Extracorporeal shock wave therapy for patients suffering from recalcitrant Osgood-Schlatter disease, Lohrer H, Nauck T, Schöll J, Zwerver J, Malliaropoulos N., Sportverletz Sportschaden. 2012 Dec;26(4):218-22. doi: 10.1055/s-0032-1325478. Epub 2012 Oct 9.
7, Overuse Injuries in Children, Ortho info, AAOS
註：本部落格文章是以科普、衛教為出發點，不代表任何人的生理狀況。每個人的身體皆不相同，有任何疑問請詢問自己的醫師、物理治療師、專業教練。
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