Effects of Physical Activity on Motor Development, Balance, and Psychosocial Well-Being in Children and Adolescents with Down Syndrome: A Systematic Review.

Background

Physical activity is relevant for physical and psychosocial development in children and adolescents with Down syndrome. However, evidence regarding the effects of structured physical activity interventions across different motor and psychosocial domains remains limited and heterogeneous. This systematic review aimed to examine the effects of structured physical activity interventions on motor and psychosocial outcomes in this population.

Methods

The review was conducted according to PRISMA guidelines and registered in PROSPERO (CRD42025114068). Scopus, PubMed, and Web of Science databases were searched, with the final search conducted on 15 December 2025. Eligible studies were peer-reviewed articles published in English within the previous 10 years that investigated structured physical activity interventions in children and adolescents with Down syndrome and reported motor or psychosocial outcomes. Methodological quality was assessed using a modified Downs and Black Checklist. Due to substantial clinical and methodological heterogeneity across interventions, comparators, and outcome measures, findings were synthesized narratively. The certainty of evidence was assessed using the GRADE approach.

Results

Five studies, including 186 participants, were included, of whom 166 had Down syndrome and 20 were typically developing children. The included studies reported improvements in motor skills, balance, coordination, and psychosocial outcomes. Interventions included Pilates, core stability and treadmill training, fundamental movement skills training, adapted football, and traditional Indian dance. Motor outcomes were generally associated with improvements in balance, postural control, coordination, and motor competence. Psychosocial outcomes were assessed in only two studies and showed preliminary improvements, including reductions in aggression, attention problems, anxiety/depression, and social problems. Overall, the certainty of evidence was rated as low across the assessed outcome domains.

Conclusions

Structured physical activity interventions may be associated with improvements in motor development, while their effects on psychosocial outcomes appear encouraging but require further investigation. The findings should be interpreted cautiously because of the small number of studies, methodological limitations, and heterogeneity of interventions and outcome measures. Further high-quality randomized controlled trials with larger samples and standardized outcome measures are needed.