The Impact of Physical Exercise Interventions on Gait Performance in Individuals with Down Syndrome: A Systematic Review and Meta-Analysis

Purpose: The objective of this study was to assess the impact of structured physical exercise on gait performance among people with Down syndrome (DS), providing evidence-based exercise recommendations. Methods: A comprehensive search of EBSCO, PubMed, Cochrane Library, Embase, Web of Science Core Collection, and Scopus was conducted up to April 2024 and updated in April 2025. Randomized controlled trials (RCTs) and quasi-RCTs comparing structured physical exercise interventions with non-exercise or usual care controls were included. Meta-analyses were performed on gait-related outcomes, including the 8-foot Up and Go Test (8UG) and the 6-minute Walking Distance Test (6MWT). A descriptive synthesis was conducted for outcomes where a meta-analysis was not feasible due to substantial heterogeneity or insufficiently comparable data across studies. Results: A total of eight studies (seven RCTs and one quasi-RCT) involving 202 participants were included. Physical exercise interventions significantly improved 6MWT (mean difference (MD) = 43.19; 95% confidence interval (CI): 19.50 to 66.88; I² = 0%; P = .0004) and 8UG (MD = .76; 95% CI: .27 to 1.25; I² = 0%; P = .002). The descriptive analysis indicated that physical exercise may improve walking speed, the Timed Up and Go Test (TUG), spatial parameters, and joint kinematics among individuals with DS. Conclusion: Preliminary evidence shows that structured physical exercise may be associated with improvements in gait performance in individuals with DS; however, the overall certainty of the evidence remains low due to the small sample sizes and methodological limitations. Future high-quality studies are required to validate these findings, compare structured exercise interventions with active control programs matched for exercise volume, and identify the most effective exercise modes, intensities, and individualized strategies for gait rehabilitation in this population. Systematic review registration: INPLASY202540108