A Systematic Review Plyometric Training Programs For Young Children

A SYSTEMATIC REVIEW: PLYOMETRIC TRAINING
PROGRAMS FOR YOUNG CHILDREN

BARBARA A. JOHNSON,
1
CHARLES L. SALZBERG,
2
AND DAVID A. STEVENSON
1,3
1
Movement Analysis Laboratory, Shriners Hospitals for Children Salt Lake City, Salt Lake City, Utah;
2
Department of Special
Education and Rehabilitation, Utah State University, Logan, Utah; and
3
Department of Pediatrics, Division of Medical
Genetics, University of Utah, Salt Lake City, Utah
ABSTRACT
Johnson, BA, Salzberg, CL, and Stevenson, DA. A systematic
review: plyometric training programs for young children.
J Strength Cond Res 25(9): 26232633, 2011The purpose
of this systematic review was to evaluate the efcacy and safety
of plyometric training for improving motor performance in young
children; to determine if this type of training could be used to
improve the strength, running speed, agility, and jumping ability
of children with low motor competence; and to examine the
extent and quality of the current research literature. Primary
research articles were selected if they (a) described the
outcomes of a plyometric exercise intervention; (b) included
measures of strength, balance, running speed, jumping ability,
or agility; (c) included prepubertal children 514 years of age;
and (d) used a randomized control trial or quasiexperimental
design. Seven articles met the inclusion criteria for the nal
review. The 7 studies were judged to be of lowquality (values of
46). Plyometric training had a large effect on improving the
ability to run and jump. Preliminary evidence suggests
plyometric training also had a large effect on increasing kicking
distance, balance, and agility. The current evidence suggests
that a twice a week program for 810 weeks beginning at 50
60 jumps a session and increasing exercise load weekly results
in the largest changes in running and jumping performance. An
alternative program for children who do not have the capability
or tolerance for a twice a week program would be a low-
intensity program for a longer duration. The research suggests
that plyometric training is safe for children when parents provide
consent, children agree to participate, and safety guidelines are
built into the intervention.
KEY WORDS strength, running speed, agility, jumping ability,
motor competence, prepubertal children
INTRODUCTION
I
mproving physical activity is a national health initiative
for children of all abilities (22). Current national health
initiatives recommend 60 minutes or more of
moderate to vigorous physical activity most days of
the week for school-aged children. The physical activity
should be enjoyable, developmentally appropriate, and
should consist of a variety of activities. Children have the
opportunity to begin playing competitive sports at the age of
78. However, before that time, young school-aged children
engage in playground games and recreational sports where
they run, skip, hop, jump, kick, and throw.
Children with low motor competence have lower levels of
physical tness (13), lower levels of physical activity (24), and
participate in fewer organized recreational and play activities
(2). Wrotniak et al. (24) suggested that running and jumping
are fundamental skills for participation in active games and
sports. Therefore, improving running and jumping in
children with low motor competence may be an appropriate
intervention for increasing physical tness, for increasing
physical activity levels, and for improving participation in
recreational and play activities. However, there is a paucity of
research on interventions that aim specically to improve
running and jumping ability in children with low motor
competence or in young children.
Plyometric exercise starts with a rapid stretch of a muscle
followed by a rapid shortening. The nervous system is
conditioned to react more quickly to the stretch-shortening
cycle. This type of exercise can enhance a childs speed of
movement, increase power production (5,15,18,21), and
strengthen bone (11). Plyometric training programs have
been shown to be effective in adults and pubertal children for
improving running speed and jumping ability (17) and for
increasing strength (21). Strength training can improve
muscle performance and coordination of muscle groups,
however, to improve sport performance, children benet
more from practicing and perfecting skills of the sport (4).
Therefore, plyometric training may be an appropriate
intervention for improving the motor ability of children to
run, jump, hop, skip, kick, and throw.
Plyometric training produces dynamic movements and
greater force on muscles and bones. Historically, plyometric
BRIEF REVIEW
Address correspondence to Barbara A. Johnson, bajohnson@shrinenet.
org.
25(9)/26232633
Journal of Strength and Conditioning Research
2011 National Strength and Conditioning Association
VOLUME 25 | NUMBER 9 | SEPTEMBER 2011 | 2623
Copyright National Strength and Conditioning Association Unauthorized reproduction of this article is prohibited.
training was deemed unsafe for youth, and a predetermined
level of strength was a prerequisite for participation in
a plyometric program. However, an update fromthe National
Strength and Conditioning Association determined that this
recommendation was not supported by current research or
observation of everyday play activities (10). Currently,
a limited number of studies have examined the inuence
of plyometric exercise on young children. Only 2 studies of
prepubertal children were included in a meta-analysis of
plyometric training (17,21). Clearly, more research is needed
to understand young childrens response to plyometric
exercise. It will also be necessary to determine the safest
and most effective method for progressing exercise load and
to clarify the need for strength or motor skill prerequisites for
participating in plyometric training.
The purpose of this systematic review was to examine the
extent and quality of the current research literature, to
evaluate the efcacy and safety of plyometric training for
improving motor performance in young children, and to
determine if this type of training could be used to improve the
motor skills of children with low motor competence.
METHODS
Experimental Approach to the Problem
To obtain relevant literature on plyometric training, abstracts
and citations were identied through a search using the Elton
B Stephens Company (EBSCO) and Proquest search engines
in March 2010. Databases selected within these search
engines include Cumulative Index to Nursing and Allied
Health Literature (CINAHL), HealthSource, SportDisc, and
MEDLINE. The initial search focused on nding literature
using plyometric training in children with low motor
prociency or low motor competence. Search terms included
physical therapy interventions, developmental coordina-
tion disorder, low motor competence, low motor
prociency, running training, jump training, and plyo-
metric exercise in various combinations. Two hundred
twenty-seven articles were located. The abstracts were
reviewed, and there were no articles that described using
plyometric training as an intervention for children with low
motor competence, low motor prociency, or for children
with developmental coordination disorder. A new search was
undertaken to identify articles describing plyometric training
programs for children. The following search terms were used
in various combinations to identify primary research articles:
plyometric exercise, plyometric training, jump training,
children, strength, balance, bone density, motor training,
neuromotor training, and sport performance. The earliest
randomized control trial to describe motor outcomes of
plyometric training on strength and balance in young
children was published in 1998. Therefore, only research
articles published in the last 12 years were selected for review.
Inclusion Criteria. Primary research articles were selected if
they (a) described the outcomes of a plyometric exercise
intervention; (b) included measures of strength, balance,
running speed, jumping ability or agility; (c) included
prepubertal children 514 years of age; and (d) used
a randomized control trial or quasiexperimental design.
Articles that met the 4 inclusion criteria were chosen for the
nal review. The reference lists of primary articles were
searched for additional research.
Judging the Quality of the Evidence. The Physiotherapy
Evidence Database (PEDro) Scale was used to evaluate the
quality of the research, and each study was coded for the 11
items described in the PEDro criteria (19). Table 1 describes
the results of the quality rating. Intrarater agreement for this
review was determined by having a second physical therapist
rate the quality of 3 randomly selected studies and comparing
agreement between the 2 raters. The operational denitions
of the PEDro criteria for rating quality were reviewed and
consensus was established for the rating process. The 2 raters
were in exact agreement for the 3 studies.
Synthesis of the Research. The GRADE method (1) is a recent
system for rating medical evidence which considers the
consistency or homogeneity of the effect size across studies
and the directness of the evidence (the extent to which the
people, interventions, and outcome measures are similar to
those of interest). Effect sizes were calculated for those studies
that reported means and SD s using Cohens d. Cohens
description was used to classify effect sizes as small, mediumor
large (3). The concepts of consistency and directness from the
GRADE method were adopted to synthesize the results of the
research. The author, source, date of publication, purpose,
design, exercise protocol, sample characteristics, primary
outcomes and study results are listed in Table 2.
The articles were organized into categories to assist with
synthesis (Tables 35). We looked for information about the
directness of the intervention (Table 3), the dosage of the
intervention, that is, frequency, duration, intensity, number of
repetitions (Table 4), the inuence on motor skill perfor-
mance, that is, running, jumping, agility, balance, throwing,
and kicking, strength or power (Table 5), and safety.
RESULTS
The process for identifying, screening, and selecting the nal
studies for analysis is depicted in Figure 1. The 8 studies were
judged to be of low quality (values of 36). Across the 8
studies, the strengths were (a) similarity of groups at baseline;
(b) statistically signicant results; and (c) methods that
addressed biases from maturation, gender, and age. The
weaknesses were (a) the lack of blinding of evaluators,
subjects, and coaches; (b) the lack of the use of condence
intervals to demonstrate statistical precision; (c) the lack of
reporting of effect sizes to describe the magnitude of change;
and (d) the exclusion of drop-outs in the statistical analysis
(intention to treat). The mean PEDro rating for the studies
was 4.5 out of 10. The low quality rating of the studies reects
2624 Journal of Strength and Conditioning Research
the TM
Plyometric Training Review
TABLE 1. Quality rating.
PEDro criteria
Study
Witzke and
Snow (23)
Diallo
et al. (5)
Ingle
et al. (14)
Kotzamanidis
(15)
Meylan and
Malatesta (18)
Rubley
et al. (20)
Faigenbaum
et al. (9)
DiStefano
et al. (6)
Eligibility criteria specied Yes Yes Yes Yes Yes Yes Yes Yes
Random group allocation 0 1 1 0 0 0 0 1
Concealed allocation 0 0 0 0 0 0 0 0
Similar groups at baseline 0 1 1 1 1 1 1 1
Blinding of subjects 0 0 0 0 0 0 0 0
Blinding of coaches 0 0 0 0 0 0 0 0
Blinding of assessors 0 0 0 0 0 0 0 0
85% of subjects received
1 key measurement
1 1 0 1 1 1 1 1
Intention to treat 1 1 0 1 0 0 0 0
Statistical sig reported for
1 key outcome
0 1 1 1 1 1 1 1
Effect sizes (Cohens d) or
condence levels reported
0 0 0 0 0 0 0 1
Totals (10 possible) 3 6 4 5 4 4 4 6
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TABLE 2. Evidence table.*
Author source Purpose Design (D), Protocol (P) Sample population Outcome measures Results
Witzke and
Snow (23),
Med Sci
Sports Exerc
To investigate the effects
of 9 mos of plyometric
jump training on bone
mineral content, lower
extremity performance
and static balance.
Design (D) quasiexperimental Power analysis not
reported.(N = 54
women)
Isokinetic dynamometry Groups equivalent in
pretest
Protocol (P) weeks 14 =
40100 jumps, weeks
59 = 3601,000 jumps per
week; 100 per session.
Purposive selection Static balance No signicant difference
in any variables between
groups
Instruction included Matching for age and
months postmenarche
Block Food Frequency
Questionnaire
T tests demonstrated
Home program performed
33 wk for the 9-mo school
year.
Mean age = 14 6 6 y
SD 0.6
Signicant [ in leg strength
and bone mineral content at
hip in exercise group
PE class recruitment
(both athletes and
nonathletes)
Diallo et al. (5),
J Sports Med
Phys Fitness
To examine the
effectiveness of
plyometric training and
maintenance on
performance of
prepubescent soccer
players.
(D) Random assignment
purposive selection
Power analysis not
reported (N = 20 men)
SJ, CMJ, DJ, M5B Body mass [ in both
groups (p , 0.01)
(P) 33 wk for 10 wks Mean age = 12 6 3 y,
SD 0.4
Sensitivity/specicity of
outcome measures
reported
% Body fat Y in the
experimental group (p ,
0.05) then increased in
maintenance (p , 0.05)
70 Per session per session
initially, progressed to 200
300 jumps per session at the
end
Tanner stage reported Sprint-cycling performance
[ (p , 0.01)
Intensity [ after 5 wks Participants were
athletes
CMJ [ (p , 0/01)
M5B [ (p , 0/01)
Kotzamanidis
(15), J
Strength
Cond Res
To examine the
effectiveness of
plyometric training and
maintenance on
performance of
prepubescent soccer
players
(D) Quasiexperimental
convenience sample
Power analysis not
reported
SJ Sig [ in running velocity in
1020 m run and 2030-
m run, not 10-m run
(P) 10 wks, 23 wk N = 20 male soccer
players
Used Chus protocol for
increasing intensity
Mean age = 12 6 3
(no SD)
Running velocity Sig [ in jump time
60 Jumps per session initially,
progressed to 100 jumps per
session at the end
Compared a plyometric
training group to a group
receiving physical
education
2
6
2
6
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Meylan and
Malatesta
(18), J
Strength
Cond Res
To determine the
inuence of a short-term
plyometric training
within regular soccer
practice on explosive
actions of early pubertal
soccer players during
the in season.
(D) Quasiexperimental Power analysis not
reported
SJ (ight time) No impact on ground
contact time
Purposive sample N = 25, mean, age =
13 6 3 y, SD = 0.6
CMJ No impact on M5BT
(P) 8 wks, 23 wk Gender not reported Agility test Sig [ in sprint time
92 jumps per session at
the end
All played soccer in the
same league
Running velocity Sig [ in agility time
Tanner stage not
reported
M5B
Rubley et al.
(20), J
Strength
Cond Res
To measure the effects of
low frequency, low-
impact plyometric
training on vertical jump
and kicking distance in
female adolescent
soccer players
reported
Vertical jump 5 trials,
3 best ave
No sig diff over time in
control group
Purposive selection N = 16, 10 training,
6 control
No diff between groups
pretest or 7 wks posttest
(P) 14 wks, 13 wk Mean age = 13 6 4 y,
SD = 0.5
Kicking distance Sig higher jump height at
14 wks
progressed to 60 jumps per
session at the end
Female soccer players Sig greater kicking
distance at 14 wks in
training group
Faigenbaum
(9), Physical
Ed
To examine the effects of
a school-based
plyometric training
program on childrens
tness performance
reported
Presidential Council of
Physical Fitness test
Sig greater gains
in long jump, push-up, and
half mile run
Purposeful selection N = 74, 40 children
training group, 34
children control
Random assignment Mean age = 8 6 11 y HR met guidelines for
vigorous physical activity
(P) 23 wk, 9 wks, Reps Y as
intensity [ 120 per session
initially, progressed to 72
jumps per session at the end
Boys and girls, 2 third-
grade classes and 2
fth- grade school PE
classes from the same
school
DiStefano et al.
(6), J Strength
Cond Res
Compare the effects of
a pediatric program to
a traditional program
(D) Randomized control trial Power analysis not
reported
Ground reaction forces
during
countermovement
vertical jump
Sig greater improvement
in TTS in the anterior/
posterior direction
Purposeful selection N = 66, 22 traditional
training, 22 pediatric
training protocol, 22
control group
TTS on depth jump on
1 leg
No sig differences in
ground reaction forces
during countermovement
vertical jump
Stratied assignment to group
based on age and sex
Mean age = 10 6 1 y, 37
men, 29 women from 67
soccer teams
(P) 33 wk, 9 wks
Exercise load remained
constant
*SJ = squat jump; CMJ = countermovement jump; DJ = drop jump; M5B = running velocity multiple 5 bound test; TTS = time to stabilization; HR = heart rate.
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the limited amount of research into this topic area and
suggests that caution be exercised when interpreting the
results. These 8 studies are the initial attempts of researchers
evaluating the efcacy of plyometric exercise training in
prepubertal children. Despite the low quality ratings, useful
information can be gained to determine the current state of
knowledge regarding plyometric training and to identify
future research recommendations. The aims of this review
were to rst determine the efcacy of plyometric training for
improving motor performance, then to determine the
optimum exercise dosage, and nally to determine the safety
of plyometric training for children. The following paragraphs
describe our ndings.
Efcacy of Plyometric Training for Improving Motor
Performance
Seven of the 8 studies (5,6,9,14,15,18,20) found statistically
signicant effects for improving motor performance. The
study by Witzke and Snow (23) did not nd statistically
signicant results. A close examination of the Witzke and
Snow (23) study suggested that the control group had greater
initial strength and power values and had participated in
more sports than the treatment group, possibly inuencing
their results. Therefore, only the results of 7 studies will be
discussed. The evidence describing the efcacy of plyometric
training is described in Table 5. A total of 275 children
participated in the 7 studies. The participants ranged in age
from 8 to 14 (mean age of 13). Diallo et al. (5), Ingle et al. (14),
Kotzamandis (15), and Rubley et al. (20) all studied
participants of the same sex and age (12- to 13-year-old
boys) which accounted for possible age/sex bias. All 7 studies
described programs consisting of jumping, hopping, skipping,
bounding, and jumping over hurdles. Ingle et al. (14) added
resistive exercises, Rubley et al. (20) added footwork and
sprint drills, Faigenbaum et al. (9) added sprints and throws,
and DiStefano et al. (6) added strengthening and balance
TABLE 3. Directness of the intervention.
Construct Articles Results Conclusion
Age Witzke and Snow (23) Mean =14.6-y-olds The studies included children 814 y of age
although tended to enroll at the older end of the
age spectrum. Those enrolling older children
used Tanner levels to determine prepubertal
status. One study used stratied sampling by age
and gender of 9- to 10-y-olds
Diallo et al. (5) Mean = 12.3-y-olds
Ingle et al. (14) Mean = 12.3-y-olds
Kotzamanidis (15) Mean = 12.3-y-olds
Meylan and Malatesta (18) Mean = 13.3-y-olds
Rubley et al. (20) Mean =13.3-y-olds
Faignebaum et al. (9) 2 Classes of 8- to
9-y-olds, 2 classes
of 10- to 11-y-olds
DiStefano et al. (6) Mean = 10.1-y-olds
Gender Witzke and Snow (23) Women The majority of studies (71%) studied 1 gender of
participants. Diallo et al. (5) Men
Ingle et al. (14) Men
Kotzamanidis (15) Men
Meylan and Malatesta (18) Women
Rubley et al. (20) Gender not reported
Faignebaum (9,10) Both
DiStefano et al. (6) Both
Motor
prociency
Witzke and Snow (23) Typical children All studies used typically developing children or
athletes with average or above average motor
abilities.
Diallo (5) Athletes
Ingle et al. (14) Typical children
Kotzamanidis (15) Athletes
Meylan and Malatesta (18) Athletes
Rubley et al. (20) Athletes
Faignebaum (9) Typical children
DiStefano (6) Athletes
Primary
outcome
Witzke and Snow (23) Reliability reported The reliability was reported in 50% of the studies.
Validity was not reported in any study. Diallo et al. (5) Reliability not reported
Ingle et al. (14) Reliability not reported
Kotzamanidis (15) Reliability not reported
Meylan and Malatesta (18) Reliability reported
Rubley et al. (20) Reliability reported
Faignebaum et al. (9) Reliability not reported
DiStefano et al. (6) Reliability reported
the TM
exercises to the plyometric program. Five studies
(5,6,17,18,20) included athletes from sports programs, and
2 studies (9,14) included typical children from local schools.
The outcomes evaluated were jumping (squat jumps, long
jumps, vertical jumps, depth jumps, countermovement jumps,
and multiple bounding), running velocity (distances from 10
m to one-half mile), balance, agility, strength, and kicking
distance. Three studies (15,18,20) measured the ability to
jump and found statistically signicant improvements in
jumping ability with large effect sizes (d = 2.2, 2, and 1.41,
respectively). One study (9) had a small effect size (d = 0.24)
possibly because the outcome instrument used may not have
been as sensitive to change (Presidential Fitness Test vs.
timed tasks from take-off to landing), and the purpose was to
examine the effects of a school-based plyometric training
program. One study (6) did not nd a statistically signicant
change in vertical jump although it did not progress the
plyometric exercise load during the 9-week program.
Four studies measured running velocity (5,9,15,18). Three
demonstrated statistically signicant improvements and
provided sufcient data to calculate effect size. Meylan and
Malatesta (18) had a large effect size (21.28), Kotzamanidis
(15) had a moderate effect size (d = 20.75), and Faigenbaum
et al. (5) had a small effect size (d = 0.22). Faigenbaum et al.
(5) included sprint drills and measured a half mile run. The 2
studies with the larger effect sizes performed only jump
exercise and demonstrated a large effect for running short
distances (between 10 and 30 m).
Two studies (9,14) measured strength outcomes and both
demonstrated statistically signicant improvements. The
study by Faigenbaum et al. (9) produced a small effect size
(d = 0.23), and the study by Ingle et al. (14) a moderate effect
size (d = 0.59). The study by Ingle et al. (14) may have shown
a larger effect because of the addition of resistive exercise
training to the plyometric program.
Outcomes for agility, balance, and kicking were measured
in 1 study each. Meylan and Malatesta (18) measured agility
and demonstrated a statistically signicant improvement,
with a large effect size (d = 22.15). Rubely et al. (20)
measured kicking distance and demonstrated a statistically
signicant improvement with a large effect size (d = 2.62).
DiStefano et al. (6) measured balance and demonstrated
TABLE 4. Consistency intervention effect.*
Construct Articles Results Conclusion
Strength
power
Witzke and Snow (23) No signicant improvement (typical) The current evidence suggests that
plyometric training produces a small
effect on strength and a moderate
effect on power
Faigenbaum et al. (9) Signicant [, small ES (typical)
Ingle et al. (14) Signicant [, mod ES (typical)
Running Diallo (5) Signicant [, ES not known (athlete) The current evidence suggests that
plyometric training produces
a variable effect on running speed
with athletes making the greatest
improvement in shorter distance
running.
Kotzamanidis (15) Signicant [, mod ES (typical)
Meylan and
Malatesta (18)
Signicant [, large ES (athletes)
Jumping Diallo et al. (5) Signicant [, ES not known The current evidence suggests that
plyometric training produces a large
effect on jumping ability
Kotzamanidis (15) Signicant [, large ES (typical)
Meylan and
Malatesta (18)
Signicant [, large ES (athlete)
Rubley et al. (20) Signicant [, large ES (athlete)
DiStefano et al. (6) No sig improvement
Throwing Ingle et al. (14) Not signicant Unknown effect on throwing
Agility Meylan and
Malatesta (18)
Signicant [, large ES (athlete) The current evidence suggests that
plyometric training produces
a moderate effect on agility
Kicking Rubley et al. (20) Signicant [, large ES (athlete) The current evidence suggests that
plyometric training produces a large
effect on kicking (1 study)
Balance DiStefano et al. (6) Signicant [ in the forward and
backward direction
The current evidence suggests
a traditional comprehensive training
program including plyometric
training improved in the forward and
backward direction
*ES = effect size.
the TM
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TABLE 5. Consistency of exercise dosage.
Construct Articles Results Strength rating and conclusion
Duration Witzke and Snow (23) No effect from 9 mos home program Moderate (3 studies): The current
evidence suggests that a training
effect could be achieved with a
10-wk program. Two studies
suggest that a training effect could
be achieved with a 9-wk program.
One study suggests that a training
effect could be achieved in 8 wks
Diallo et al. (5) Effect from 10-wk program
Ingle et al. (14) Effect from 12-wk program
Kotzamanidis (15) Effect from 10-wk program
Meylan and
Malatesta (18)
Effect from 8-wk program
Rubley et al. (20) No effect at 7 wks, effect at
14 wks
Faignebaum et al. (9) Effect from 10-wk program
DiStefano et al. (6) Large effect from a 9-wk program
Frequency Witzke and Snow (23) 3 Times a wk Moderate (3 studies): The current
evidence suggests that a twice a wk
program with a minimum of 1620
sessions can produce a training
effect.
Diallo et al. (5) 3 Times a wk, 30 sessions
Ingle et al. (14) 3 Times a wk, 36 sessions
Kotzamanidis (15) 2 Times a wk, 20 sessions
Meylan and
Malatesta (18)
2 Times a wk, 16 sessions 13 wk with 14 sessions showed
changes although required a longer
period of time. Rubley et al. (20) 1 Time a wk, 14 sessions
Faignebaum et al. (9) 2 times a wk, 20 sessions
DiStefano et al. (6) 3 Times a wk, 27 sessions
No. of jumps Witzke and Snow (23) 100 Jumps per session initial,
360 end
Moderate (3 studies)
Diallo et al. (5) 200 Jumps per session initial,
300 end
Ingle et al. (14) 64 Jumps per session initial,
120 end
Kotzamanidis (15) 60 Jumps per session initial,
92 end
Meylan and
Malatesta (18)
50 Jumps per session initial,
192 end
The current evidence suggests
beginning at 5060 jumps per
session at the beginning of the
intervention and performing 92190
jumps per session by the end of
intervention. One study suggests
that 60jumps a session over a longer
period of time will produce a training
effect. One study demonstrated that
30 jumps over 27 sessions would
improve balance.
Rubley et al. (20) 16 Jumps per session initial,
60 end
Faignebaum et al. (9) 120 Jumps per session initial,
72 end
DiStefano et al. (6) 30 Jumps per session initial,
30 jumps end
Progression
of intensity
Diallo et al. (5) Approximate [ 10 jumps per wk. Very low
Ingleet al. (14) Approximate [ of 5 jumps per wk The intensity of the program was
progressed in all but 1 study. No 2
studies [ # of reps per week at the
same rate.
Kotzamanidis (15) Approximate [ of 12 jumps per wk The Meylan and Kotzamanidis studies
demonstrated large effects on
jumping with their interventions
Meylan and
Malatesta (18)
Approximate [ of 18 jumps per wk
Rubley et al. (20) Approximate[ of 3 jumps per wk
Faignebaum et al. (9) Decreased repetitions as intensity
increased
DiStefano et al. (6) Did not progress exercise load
Maher, G, Sherrington, C, Herbert, RD, Moseley, AM, and Elkins, M. Reliability of the PEDro Scale for Rating Quality of Randomized
Controlled Trials. Phys Ther 83: 713721, 2005.
the TM
a statistically signicant improvement with a large effect size
(d = 2.30). The participants in all of these studies were soccer
players, and the soccer training may have inuenced kicking
and agility.
The evidence suggested that plyometric training had a large
effect on improving the ability to jump. This result would be
expected because the interventions in all studies included
jump training. The evidence suggested that plyometric
training also had an effect on running velocity, although
the effects were not consistently large across studies. The
effects were greatest for the 30-m distance and small for the
half mile run. Plyometric training also had a large effect on
improving kicking distance and agility. The jump training
may have had some transfer effect to these skills, although the
participants soccer training may have accounted for the
improvements seen in agility and kicking distance. Despite
the large effect size for agility and kicking improvement, there
was only one randomized controlled trial on each outcome.
Exercise Dosage
The evidence for recommending an exercise dosage is
summarized in Table 5. Seven studies (5,6,9,14,15,18,20)
demonstrated statistically signicant results and were used
for judging the consistency of the exercise dosage. The
categories evaluated were frequency, duration, number of
jumps, and the method for increasing exercise load.
The frequency of the training programs varied across
studies from once a week to 3 times a week. The early studies
performed by Witzke and Snow (23) and Diallo et al. (5)
exercised children 3 d wk
21
with large number of jumps per
session (100200 at the beginning of the session and 300360
at the end). Witzke and Snow (23) did not nd signicant
results. The Diallo et al. (5) study demonstrated statistical
signicance; however, they did not include data for
calculating the effect size, so the magnitude of the change
was unknown. Later studies exercised children twice a week
starting at 5060 jumps and ending at 92192 jumps a session.
Meylan and Malatestas (18) study showed the largest effect
sizes on running, jumping, and agility and incorporated
a twice a week program for 8 weeks. These authors began at
approximately 50 jumps per session and increased 18
repetitions a week to approximately 192 jumps per session
by the end of the intervention. Kotzamandis (15) had
a similar program and also produced large effect sizes for
running and jumping. Rubley et al. (20) exercised children
once a week for 14 weeks with a low number of jumps (16
jumps per session progressing to 60 at the end of 14 weeks).
This study did not have as large an effect size on jumping as
the studies by Meylan and Malatesta (18) or Kotzamandis
(15). Faigenbaum et al. (9) and Ingle et al. (14) exercised
children twice a week for 20 weeks and decreased repetitions
as intensity increased. These authors also used a method for
increasing exercise load. However, they did not describe their
methods in as much detail and their training program
resulted in smaller effect sizes for running, jumping, and
strength improvement. DiStefano et al. (6) exercised children
3 times a week for 9 weeks; however, this did not increase the
exercise load. This study had a large effect on improving
balance.
The current evidence suggests that a twice a week program
for 8 to 10 weeks beginning at 5060 jumps a session and
increasing repetitions weekly by 1218 repetitions to
a maximum of 90190 results in the largest changes in
running and jumping performance. An alternative program
for children who do not have the capability or tolerance for
a twice a week program would be a low intensity program for
a longer duration (20). Only 1 study (14) performed a follow-
up evaluation 12 weeks after the intervention. A decline of
strength occurred toward baseline at the follow-up evalua-
tion indicating a need to continue the exercise training to
maintain strength gains.
Safety
Two studies documented that there were no injuries during
the intervention. Faigenbaum et al. (9) exercised 74 children
and DiStefano et al. (6) exercised 66 children without a single
injury or complaint of muscle soreness. Additionally, every
study addressed safety in the description of the intervention.
Each study reported Institutional Review Board approval and
consent of parents and assent of participants. Two studies
(5,9) reported low participant to instructor ratios (1:4 and 1:5,
respectively) during the intervention. Five studies (5,6,9,15,18)
Figure 1. Summary of the review process.
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described a warm-up and cool-down period, emphasized
instruction and correct technique, and assured the use of
appropriate exercise surfaces and exercise spaces. Meylan and
Malatesta (18) described a program that was tailored to the
childs capability.
DISCUSSION
Previous reviews of research on adults suggested that
plyometric exercise improves strength (21), running, and
jumping (17). The results of this review of the literature on
young children also suggested that plyometric training had
a large effect on improving the ability to jump (15,18,20) and
run (15,18), but only a small effect on improving strength
(9,14). The small effect on improving strength may be
explained by the differences in the mechanisms for strength
gain in prepubertal children. Strength gains in young children
have been attributed to intrinsic muscle adaptation and
neural adaptation because prepubertal children lack circu-
lating androgens responsible for muscle hypertrophy (12).
The evidence suggested that plyometric training also had
a large effect on improving kicking distance (20), balance (6),
and agility (18), although replication of these results with
another carefully controlled study would improve our
condence in the outcomes from this research.
The participants in the research for this review had average
or above average motor competence (healthy, typically
developing children or athletes). More information is needed
to determine if children with low motor competence and
possible comorbidities such as learning and attention problems
or musculoskeletal impairments can participate in and benet
from plyometric training. Children develop motor prociency
by spontaneously engaging in running and jumping activities
on a daily basis. Children with low motor competence are not
as procient at running and jumping resulting in decreased
participation in active games and sports. Plyometric training
has the potential for improving running and jumping abilities if
similar improvements can be obtained safely in children with
low motor competence. Future research should also evaluate
the generalization of learning beyond the intervention sessions
and the transfer of skills to physical activity in daily routines.
There are many components of motor performance that
contribute to learning how to run, skip, hop, jump, kick, and
throw. Task-specic interventions emphasize teaching func-
tional motor skills and using principles of motor learning (verbal
instructions; amount, structure and schedule of practice; and
frequency of feedback) to enhance the intervention and
enhance the generalization or transfer of learning to new
situations (16). Meylan and Malatestas (18) study resulted in
the largest effect size on running and jumping. The authors
provided a comprehensive description of the intervention, the
exercise dosage, detailed participant instructions, and described
the focus for each session. First, they emphasized technique
including an upright posture, body alignment, avoiding
excessive side to side movement in vertical jumps, soft landings,
and instant recoil to prepare for the next jump. The specicity
of verbal instruction about the task requirements may have
resulted in enhanced understanding of the task. Verbal feedback
on the results of task performance may have also enhanced
learning. Next, they adapted the exercises to the coordination
capacity of the children and encouraged children to perform at
full speed. The drills lasted only 10 seconds with a 90-second
rest period between drills. Sessions were separated by 48 hours.
The focus of 1 session was to work on vertical power, the
second session to work on horizontal power. The intensity and
progression were determined by considering both intensity of
the exercise and number of ground contact times. The load was
varied and the researchers used a blocked practice paradigm.
Load was progressed for 3 weeks, decreased slightly the fourth
week, increased again for weeks 5 and 6, decreased slightly for
week 7, and increased in week 8. The attention to principles of
exercise and sport science for optimizing the benets of
plyometric exercise may have been responsible for the greater
improvements. DiStefano et al. (6) found that a pediatric
program with 3 progressive phases was not as effective as
a traditional program. The 9-week progressive pediatric
program may not have performed phase 3 exercises long
enough or provided a sufcient exercise load to cause change in
jumping ability and balance.
Safety is always a concern when initiating an exercise
intervention for children because of the possibility of injury,
muscle soreness, overtraining, or frustration. Many of the
studies included a description of procedures to address safety
concerns. The plyometric training programs were relatively
short (1025 minutes), included a warm-up and cool down,
had a low instructor to student ratio, emphasized correct
technique, provided guidelines for progressing the work load,
and were carried out on appropriate exercise surfaces and in
exercise spaces. The research suggests that plyometric
training is safe for children when parents provide consent,
children agree to participate, and safety guidelines are built
into the intervention.
The National Strength and Conditioning Association
guidelines call for adequate supervision and a properly
designed resistance training program for children. Plyomteric
exercise may be one of a variety of developmentally
appropriate activities included in a training program for
young children. However, coaches should use caution when
undertaking plyometric training interventions for young
children because the research to determine the safety and
efcacy is in its infancy. Future research is necessary (a) to
determine if there should be strength or motor skill
achievement prerequisites for participating in plyometric
training, (b) to replicate the safety and efcacy of plyometric
training for prepubertal children, and (c) to identify appropri-
ate progression of the exercise load during plyometric training.
PRACTICAL APPLICATIONS
The plyometric training programs used in the studies
reviewed for this manuscript can be used to design an
exercise program. The results of this review indicate that
the TM
plyometric training programs are effective for improving
running and jumping abilities in school children and athletes
between 8 and 14 years of age when the following guidelines
are followed. The studies which demonstrated the greatest
improvements used plyometric training alone without
additional training methods such as strengthening exercises,
sprinting drills, or throwing during the 8- to 10-week
program. Because the safety of plyometric training has not been
rigorously evaluated in young children, coaches should include
safety precautions in implementing these exercises.
Training effects can be achieved with a twice a week
programfor 810 weeks on nonconsecutive days. The focus
of the exercise should be specic to the desired outcome,
that is, if vertical jump height is the desired outcome,
vertical power should be emphasized in the plyometric
training program. Training effects can also be achieved with
a low intensity, 1 day a week program for 14 weeks.
Exercise load should be increased weekly by increasing the
repetitions or the level of difculty of the jumps. Research
on adults has used time to stabilization (7) and electromy-
ography (8) to quantify the intensity and nature of different
plyometric exercises and these studies may be useful for
determining an exercise load in children.
Exercise load must be increased to cause improvement;
however, no study has been conducted to evaluate the most
effective means of increasing the exercise load safely in
young children. Research suggests beginning the 10-week
exercise session with 5060 jumps the rst week and
progress to 90100 jumps by the end of the 10-week session.
If a once a week program is chosen, begin with 16 jumps the
rst week and progress to 60 jumps by the end of a 14-week
session. A once a week low-intensity program results in
smaller improvements in running and jumping ability.
Exercise sessions should be 1025 minutes in duration with
a sufcient warm-up and cool-down. Children should wear
appropriate footwear, exercise in appropriate environ-
ments, and exercise on absorbent surfaces (grass or mats).
Plyometric drills should last approximately 10 seconds with
a 90-second rest between drills.
There should be a low instructor-to-student ratio (1 in-
structor to 4 or 5 students). Instructors should emphasize
the correct technique and adapt the drills to the capacity of
the child.
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A Systematic Review Plyometric Training Programs For Young Children

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A SYSTEMATIC REVIEW: PLYOMETRIC TRAINING

PROGRAMS FOR YOUNG CHILDREN

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