Promoting Participation in Physical Activity in Children and Adolescents With Down Syndrome

Abstract

Children with Down syndrome often have lower physical activity levels compared to their peers with typical development and face challenges such as medical co-morbidities, access issues and societal stigma, to being physically active. Physical therapists are experts in exercise prescription and physical activity and are thus uniquely qualified to successfully promote participation among children with Down syndrome in spite of inherent challenges. Our perspective is that a shift in physical therapy service delivery is needed. We suggest that physical therapists change the focus of their interventions for children with Down syndrome from underlying impairments such as low tone or joint laxity, or from developing motor skills in isolation and ‘correct’ movement patterns. Instead, physical therapists should allow the physical activity preferences and the environmental contexts of the children and adolescents they are working with to direct the treatment plan. In this way, physical therapy intervention becomes more child centered by concentrating on developing the specific skills and strategies required for success in the child’s preferred physical activity. In this paper, we consider the role of pediatric physical therapists in the United States, as well as in low- and middle- income countries, in promoting and monitoring physical activity in children with Down syndrome from infancy through adolescence. Examples of physical therapist interventions such as tummy time, movement exploration, treadmill training, bicycle riding and strength training are discussed, across infancy, childhood and adolescence, with a focus on how to successfully promote lifelong participation in physical activity.

Gender Differences, Motor Skills and Physical Fitness Heterogeneity in Adults with Down’s Syndrome

“…Our results are in agreement with those of previous studies confirming that adults with DS are less active and tend to engage in more light-intensity PA than MVPA compared to adults without DS [ 13 , 47 ] but also than their peers with intellectual disabilities without DS [ 48 ]. This observation is consistent throughout the developmental life of individuals with DS, being reported similarly in children [ 36 , 49 ], in adolescents [ 17 ] as well as in adults [ 13 , 47 ].…”

“…In Cluster 1, participants were significantly older than in Clusters 2 and 3 (mean age 34.4 ± 7.5 vs. 27.1 ± 6.2 and 25.7 ± 5.6 yrs, respectively). According to previous studies, individuals with DS present poor static and dynamic balance compared to control participants [ 50 , 51 , 52 ] and poor strength [ 13 , 17 ]. While there is a growing body of studies evaluating the PA program’s benefits in children with DS to prevent these impairments, there have been relatively few published reports on the effects of strength or balance training programs in adults with DS.…”

“…Down’s syndrome’s related motor impairments may lead to high levels of a sedentary lifestyle and decreased physical fitness, characterized by a lower aerobic capacity in adults when compared to healthy subjects [ 11 , 12 , 13 , 14 ]. Low levels of motivation for any PA [ 11 , 15 ] related to a negative perception of motor capacities and practice environment may contribute to sedentary lifestyle behaviors, the lack of PA engagement, and, finally, impaired physical fitness [ 5 , 9 , 10 , 16 , 17 ]. On the other hand, PA interventions may also be helpful in improving impaired motor skills.…”

Physical Activity in Youth with Down Syndrome and Its Relationship with Adiposity

“…Other potential factors contributing to this finding include an emphasis on early intervention services, specifically physical and occupational therapy as early as possible, highlighting to families the need and benefit of PA in youth with DS, as well as a greater inclusion of youth with special needs in gym classes with peers and community activities. 26 Furthermore, physical therapists have begun to shift emphasis from interventions focused specifically on addressing underlying impairments (e.g., low tone or join laxity and improving motor delays/skills) to a focus on skills and strategies to promote overall physical activities preferred by youth. 26 Several demographic characteristics associated with MVPA in non-DS were not associated with MVPA in our cohort with DS.…”

“…26 Furthermore, physical therapists have begun to shift emphasis from interventions focused specifically on addressing underlying impairments (e.g., low tone or join laxity and improving motor delays/skills) to a focus on skills and strategies to promote overall physical activities preferred by youth. 26 Several demographic characteristics associated with MVPA in non-DS were not associated with MVPA in our cohort with DS. Our results demonstrating that decreasing MVPA with increasing age in non-DS is consistent with the available literature in youth in general 27 ; however, this relationship was absent in our cohort with DS.…”