The Effect of Exercise Programmes on Physical and Physiological Health Indicators in Individuals with Down Syndrome: A Systematic Scoping Review

Aim: The aim of this two-stage systematic review is (1) to outline the scope of health problems commonly seen throughout the lives of individuals with Down syndrome (DS) and (2) to synthesise the effectiveness of exercise interventions implemented for these problems through multidimensional health outcomes. The review aimed to comprehensively evaluate the clinical value of exercise-based approaches for problems observed in individuals with DS in the cardiovascular, respiratory, metabolic, neuromotor, musculoskeletal, postural control, gait, and cognitive/psychosocial domains. Methods: The review was conducted in accordance with the PRISMA 2020 guidelines, and the study selection/exclusion processes were managed using the Covidence programme. Searches were conducted in the Web of Science, Scopus, PubMed, and MEDLINE databases using relevant keywords. After removing duplicate records, two independent researchers performed title-abstract and full-text screenings. Experimental or observational studies describing health problems in DS or implementing exercise/physical activity interventions for these problems were included in the review. Results: A total of 51 studies were included. In the first phase, individuals with DS demonstrated a high prevalence of congenital heart disease (CHD) (40–67%), predominantly ventricular septal defect (VSD), atrial septal defect (ASD), and atrioventricular septal defect (AVSD). CHD markedly increased mortality risk in complex cases, while early echocardiographic screening and timely surgery improved survival. Obesity and obstructive sleep apnoea were highly prevalent from early childhood, and aerobic capacity indicators (VO₂peak, HRpeak) were consistently reduced independent of adiposity. Musculoskeletal abnormalities—including pes planovalgus, impaired postural control, and altered gait patterns—were common and contributed to reduced functional performance. In the second phase, exercise interventions demonstrated clear multidomain clinical benefits in DS. Core stability and treadmill-based training improved balance, whereas structured motor programmes enhanced fundamental motor skills. Resistance and multicomponent exercise improved muscle strength, functional fitness, and oxidative stress markers. Sports-based interventions (e.g., swimming, Nordic walking, basketball) enhanced locomotor capacity and participation. Respiratory-focused approaches such as proprioceptive neuromuscular facilitation (PNF) and chest physiotherapy improved pulmonary function. Technology-assisted modalities—virtual reality (VR) and transcranial direct current stimulation (tDCS)—supported neuroplasticity and yielded clinically meaningful motor and cognitive gains. Conclusion: This systematic review demonstrates that health problems affecting multiple systems are common and determine quality of life in individuals with DS; however, appropriately planned exercise programmes provide meaningful benefits at biological, motor, cognitive and psychosocial levels. Early screening and follow-up, along with individualised, multi-component exercise approaches, are considered a fundamental intervention strategy for reducing cardiometabolic risks, maintaining functional independence, and increasing social participation in DS.