{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T11:16:03Z","timestamp":1788434163872,"version":"build-2803163510"},"reference-count":37,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T00:00:00Z","timestamp":1788393600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.3390\/jcm15176823","type":"journal-article","created":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T10:10:33Z","timestamp":1788430233000},"page":"6823","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Effects of Physical Activity on Motor Development, Balance, and Psychosocial Well-Being in Children and Adolescents with Down Syndrome: A Systematic Review"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3147-0545","authenticated-orcid":false,"given":"Ignazio","family":"Leale","sequence":"first","affiliation":[{"name":"Sport and Exercise Research Unit, Department of Psychology, Educational Sciences and Human Movement, University of Palermo, 90144 Palermo, Italy"},{"name":"Department of Psychology, Educational Science and Human Movement, University of Palermo, 90128 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4595-3994","authenticated-orcid":false,"given":"Manuel","family":"G\u00f3mez-L\u00f3pez","sequence":"additional","affiliation":[{"name":"Department of Physical Activity and Sport, Faculty of Sports Sciences, University of Murcia, Santiago de la Ribera, 30720 Murcia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martina","family":"Macaluso","sequence":"additional","affiliation":[{"name":"Sport and Exercise Research Unit, Department of Psychology, Educational Sciences and Human Movement, University of Palermo, 90144 Palermo, Italy"},{"name":"Department of Psychology, Educational Science and Human Movement, University of Palermo, 90128 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4410-2047","authenticated-orcid":false,"given":"Daniela","family":"Smirni","sequence":"additional","affiliation":[{"name":"Department of Psychology, Educational Science and Human Movement, University of Palermo, 90128 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7371-0228","authenticated-orcid":false,"given":"Michele","family":"Roccella","sequence":"additional","affiliation":[{"name":"Department of Psychology, Educational Science and Human Movement, University of Palermo, 90128 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7372-3205","authenticated-orcid":false,"given":"Marianna","family":"Alesi","sequence":"additional","affiliation":[{"name":"Department of Psychology, Educational Science and Human Movement, University of Palermo, 90128 Palermo, Italy"},{"name":"Disability and Neurodiversity Center, University of Palermo (Ce.N.Dis.), 90133 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7758-7175","authenticated-orcid":false,"given":"Giuseppe","family":"Battaglia","sequence":"additional","affiliation":[{"name":"Sport and Exercise Research Unit, Department of Psychology, Educational Sciences and Human Movement, University of Palermo, 90144 Palermo, Italy"},{"name":"Department of Psychology, Educational Science and Human Movement, University of Palermo, 90128 Palermo, Italy"},{"name":"Disability and Neurodiversity Center, University of Palermo (Ce.N.Dis.), 90133 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,3]]},"reference":[{"key":"ref_1","first-page":"638","article-title":"Risk factors in the origin of Down syndrome","volume":"61","year":"2023","journal-title":"Rev. Med. Inst. Mex. Seguro Soc."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1038\/s41572-019-0143-7","article-title":"Down syndrome","volume":"6","author":"Antonarakis","year":"2020","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"a346","DOI":"10.4102\/aveh.v75i1.346","article-title":"Down syndrome: An overview","volume":"75","author":"Wajuihian","year":"2016","journal-title":"Afr. Vis. Eye Health"},{"key":"ref_4","first-page":"169","article-title":"Chapter Six\u2014Motor development and Down syndrome","volume":"Volume 56","author":"Lanfranchi","year":"2019","journal-title":"International Review of Research in Developmental Disabilities"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1020","DOI":"10.1111\/j.1365-2788.2011.01425.x","article-title":"Identifying the barriers and facilitators to participation in physical activity for children with Down syndrome","volume":"55","author":"Barr","year":"2011","journal-title":"J. Intellect. Disabil. Res."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"576","DOI":"10.4102\/ajod.v8i0.576","article-title":"The health benefits of exercise therapy for patients with Down syndrome: A systematic review","volume":"8","author":"Paul","year":"2019","journal-title":"Afr. J. Disabil."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Mu\u00f1oz-Llerena, A., Ladr\u00f3n-de-Guevara, L., Medina-Rebollo, D., and Alcaraz-Rodr\u00edguez, V. (2024). Impact of Physical Activity on Autonomy and Quality of Life in Individuals with Down Syndrome: A Systematic Review. Healthcare, 12.","DOI":"10.3390\/healthcare12020181"},{"key":"ref_8","first-page":"Cd005176","article-title":"Aerobic exercise training programmes for improving physical and psychosocial health in adults with Down syndrome","volume":"2010","author":"Andriolo","year":"2010","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Post, E.M., Kraemer, W.J., Kackley, M.L., Caldwell, L.K., Volek, J.S., Sanchez, B.N., Focht, B.C., Newton, R.U., H\u00e4kkinen, K., and Maresh, C.M. (2022). The Effects of Resistance Training on Physical Fitness and Neuromotor-Cognitive Functions in Adults with Down Syndrome. Front. Rehabil. Sci., 3.","DOI":"10.3389\/fresc.2022.927629"},{"key":"ref_10","first-page":"e33475","article-title":"Role of Physical Activity on Mental Health and Well-Being: A Review","volume":"15","author":"Mahindru","year":"2023","journal-title":"Cureus"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1097\/PEP.0000000000000556","article-title":"Physical Activity Levels of Children With Down Syndrome","volume":"31","author":"Fox","year":"2019","journal-title":"Pediatr. Phys. Ther."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"pzab032","DOI":"10.1093\/ptj\/pzab032","article-title":"Promoting Participation in Physical Activity in Children and Adolescents with Down Syndrome","volume":"101","author":"Wentz","year":"2021","journal-title":"Phys. Ther."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Li, D., Wang, D., Cui, W., Yan, J., Zang, W., and Li, C. (2023). Effects of different physical activity interventions on children with attention-deficit\/hyperactivity disorder: A network meta-analysis of randomized controlled trials. Front. Neurosci., 17.","DOI":"10.3389\/fnins.2023.1139263"},{"key":"ref_14","unstructured":"Catama, B. (2026, August 25). Promoting Physical Activity for Children with Down Syndrome: An Evidence-Based Framework. Available online: https:\/\/papers.ssrn.com\/sol3\/papers.cfm?abstract_id=4899540."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1093\/ptj\/pzz012","article-title":"Do Exercise Interventions Improve Balance for Children and Adolescents with Down Syndrome? A Systematic Review","volume":"99","author":"Hue","year":"2019","journal-title":"Phys. Ther."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Lei, Z., Yuan, K., Xu, J., Miao, Y., Dai, Y., Wang, J., and Chang, J. (2025). Effects of physical exercises on balance in children with down syndrome: A systematic review and meta-analysis. BMC Sports Sci. Med. Rehabil., 17.","DOI":"10.1186\/s13102-025-01222-2"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Szabo, D.A., Stoian, A., Veres, C., Adumitrachioaie, H., P\u00e2rvu, C., H\u0103\u0219m\u0103\u0219an, I.T., and Sopa, I.S. (2026). The Effects of Physical Therapy in the Rehabilitation of Motor Delays in Children with Down Syndrome: A Systematic Review. J. Clin. Med., 15.","DOI":"10.3390\/jcm15051717"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Zhang, X., Xiong, Q., and Weng, S. (2026). Exercise dose and multidimensional motor function in young people with Down syndrome: A Bayesian network dose\u2013response meta-analysis. Pediatr. Res.","DOI":"10.1038\/s41390-026-05197-9"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1136\/jech.52.6.377","article-title":"The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions","volume":"52","author":"Downs","year":"1998","journal-title":"J. Epidemiol. Community Health"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Chuter, V., Spink, M., Searle, A., and Ho, A. (2014). The effectiveness of shoe insoles for the prevention and treatment of low back pain: A systematic review and meta-analysis of randomised controlled trials. BMC Musculoskelet. Disord., 15.","DOI":"10.1186\/1471-2474-15-140"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1197","DOI":"10.1136\/bjsports-2015-094879","article-title":"Efficacy of rehabilitation (lengthening) exercises, platelet-rich plasma injections, and other conservative interventions in acute hamstring injuries: An updated systematic review and meta-analysis","volume":"49","author":"Pas","year":"2015","journal-title":"Br. J. Sports Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"180","DOI":"10.3129\/i08-001","article-title":"Age-related macular degeneration and low-vision rehabilitation: A systematic review","volume":"43","author":"Hooper","year":"2008","journal-title":"Can. J. Ophthalmol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"924","DOI":"10.1136\/bmj.39489.470347.AD","article-title":"GRADE: An emerging consensus on rating quality of evidence and strength of recommendations","volume":"336","author":"Guyatt","year":"2008","journal-title":"BMJ"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1499","DOI":"10.1007\/s13760-024-02517-w","article-title":"Effect of Pilates exercises on balance and gross motor coordination in children with Down syndrome","volume":"124","author":"Reffat","year":"2024","journal-title":"Acta Neurol. Belg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2364","DOI":"10.1007\/s12325-019-01024-2","article-title":"Effect of Core Stability Exercises and Treadmill Training on Balance in Children with Down Syndrome: Randomized Controlled Trial","volume":"36","author":"Alsakhawi","year":"2019","journal-title":"Adv. Ther."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1111\/jir.12458","article-title":"Fundamental movement skills and balance of children with Down syndrome","volume":"62","author":"Capio","year":"2018","journal-title":"J. Intellect. Disabil. Res."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1111\/jir.12881","article-title":"The effect of the adapted soccer programme on motor learning and psychosocial behaviour in adolescents with Down syndrome","volume":"66","year":"2022","journal-title":"J. Intellect. Disabil. Res."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1080\/00222895.2021.1941736","article-title":"Effects of Traditional Indian Dance on Motor Skills and Balance in Children with Down syndrome","volume":"54","author":"Raghupathy","year":"2022","journal-title":"J. Mot. Behav."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Lee, K. (2025). Effects of Core Stability Training on Deep Stabilizing Muscle Function and Neuromuscular Control. Medicina, 61.","DOI":"10.3390\/medicina61030364"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Melo, G.L.R., Neto, I.V.S., da Fonseca, E.F., Stone, W., and Nascimento, D.D.C. (2022). Resistance training and Down Syndrome: A narrative review on considerations for exercise prescription and safety. Front. Physiol., 13.","DOI":"10.3389\/fphys.2022.948439"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"142","DOI":"10.3345\/cep.2021.00479","article-title":"Gross motor dysfunction and balance impairments in children and adolescents with Down syndrome: A systematic review","volume":"65","author":"Jain","year":"2022","journal-title":"Clin. Exp. Pediatr."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/j.braindev.2021.09.005","article-title":"Relationship between trunk muscle strength, reaching ability and balance in children with Down syndrome\u2014A cross-sectional study","volume":"44","author":"Jain","year":"2022","journal-title":"Brain Dev."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Garaigordobil, M., Berrueco, L., and Celume, M.P. (2022). Developing Children\u2019s Creativity and Social-Emotional Competencies through Play: Summary of Twenty Years of Findings of the Evidence-Based Interventions \u201cGame Program\u201d. J. Intell., 10.","DOI":"10.3390\/jintelligence10040077"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Zhao, Z., Che, X., Wang, H., Zheng, Y., Ma, N., Gao, L., and Shui, Y. (2025). The Relationship Between Soccer Participation and Team Cohesion for Adolescents: A Chain-Mediated Effect of Athlete Engagement and Collective Self-Esteem. Behav. Sci., 15.","DOI":"10.3390\/bs15020155"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"102426","DOI":"10.1016\/j.cpr.2024.102426","article-title":"Psychological wellbeing in parents of children with Down syndrome: A systematic review and meta-analysis","volume":"110","author":"Rutter","year":"2024","journal-title":"Clin. Psychol. Rev."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Xing, S., Yang, Y., Wu, J., Shao, Y., and Zang, W. (2026). Can physical exercise alleviate social anxiety in junior high school students by improving body image?. Front. Psychol., 17.","DOI":"10.3389\/fpsyg.2026.1780759"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/17\/6823\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T10:30:45Z","timestamp":1788431445000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/17\/6823"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,3]]},"references-count":37,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["jcm15176823"],"URL":"https:\/\/doi.org\/10.3390\/jcm15176823","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,3]]}}}