I’ve had the pleasure of knowing a strong and resilient 43-year-old man living with Down syndrome, whom I have assisted to participate in 2 hours of exercise each week at my gym for the last 5 years. He has told me that none of his friends with Down syndrome participate in a similar exercise routine. I commend my client and the support he gets from his loving family that has enabled him to engage in regular exercise for the previous 25 years of his life. I wish my client has more role models, friends and social support to continue to make his exercise experiences enjoyable, engaging and sustainable. This blog is inspired by him.

Down syndrome makes up approximately 15% of genetic caused intellectual disability in Australia. Approximately 1 in every 1100 babies born in Australia have Down syndrome. Their average lifespan is around 60 years of age (Bull et al., 2020) compared to 73 years in people without Down syndrome (WHO, 2019). Since 2009, we have known physical inactivity (PA) is the 4th leading cause of human mortality globally, behind high blood pressure, smoking and diabetes. The globally recommended guidelines are to complete PA at a moderate intensity for at least 150-300 min or at a vigorous intensity for 75 min per week and complete 2 strengthening exercise sessions per week (WHO, 2023). Globally, depending on the study you look at, between 75-85% of the whole population do not meet the recommended weekly PA guidelines. If you have Down syndrome, like most other people, it is likely you do not participate in the recommended amounts of weekly physical activity (Ginis et al., 2021). This puts you at risk of not developing and maintaining the most important training goals for increased health span; aerobic capacity, muscle mass and strength.

Supervised exercise is very safe for Down syndrome participants (Hardee et al., 2017; Alesi et al., 2017). A recent review of 11 studies from Barnard and colleagues outlined the modifiable health risks in people with Down syndrome that could be improved by exercise. There is an increased risk of cardiovascular disease (CVD), metabolic syndrome, diabetes, cognitive decline/dementia, falls and sarcopenia in individuals with Down syndrome. Regular completion of resistance and aerobic training consistently reduces the risk of developing these conditions by lowering:

• body fat, which is a risk factors for most chronic conditions,

• negative blood lipid, improving an overall cholesterol profile and reducing progression of vascular damage, which are key components of reducing CVD and dementia through reducing atherosclerosis and high blood pressure,

• insulin resistance- reducing the risk of diabetes,

and increasing:

• aerobic capacity/fitness – a risk factor for most chronic conditions,

• muscle strength – a risk factor for premature mortality,

• balance – a common goal reported by PWDS,

• muscle mass- reducing the risk of sarcopenia and most chronic conditions.

Another review has showed positive effects of regular resistance training on bone health in people with Down syndrome (Melo et al., 2022) which will reduce the risk of fall related fractures and hospitalisation. Lastly, the positive effects of exercise on social behaviours and cognitive health for people with Down syndrome has been confirmed (Perić et al., 2022; Fleming et al., 2021).

The genetic affects and physically inactive lifestyle of people living with Down syndrome are associated with a reduced lifespan. Chronic conditions that contribute to an early death rate are consistently improved by regular physical activity and exercise. Let’s continue to encourage regular exercise for people living with Down syndrome so we can all benefit from their increased independence and participation in habitual and community activities.

Future blogs will discuss suggestions for assisting those living with down syndrome to work towards the international recommendations for weekly PA. Example programs from our current cliental will be included also. Stay tuned. Thank you for reading.

Written by Tom Murphey, DPT.

“Unfortunately for our community, scientific scaremongering is common, easy to believe and hard to heal. Research is often messy, and strong stances or beliefs can be both erroneous and dishonest. I aim to produce honest reviews of some high-quality research to provide informed insight so you can make up your own mind on the science you value.”

References

• Alesi, M., & Pepi, A. (2017). Physical activity engagement in young people with Down syndrome: Investigating parental beliefs. Journal of Applied Research in Intellectual Disabilities, 30(1), 71-83.
• Barnard, M., Swanepoel, M., Ellapen, T. J., Paul, Y., & Hammill, H. V. (2019). The health benefits of exercise therapy for patients with Down syndrome: A systematic review. African journal of disability, 8(1), 1-9.
• Bull M. J. (2020). Down syndrome. N. Engl. J. Med. 382, 2344–2352. 10.1056/NEJMra1706537
• Fleming V., Piro-Gambetti B., Patrick A., Zammit M., Alexander A., Christian B. T. et al. (2021) Physical activity and cognitive and imaging biomarkers of Alzheimer’s disease in Down syndrome. Neurobiology of Aging 107, 118–127.
• Ginis K. a. M., Van Der Ploeg H. P., Foster C., Lai B., Mcbride C. B., Ng K., et al. (2021). Participation of people living with disabilities in physical activity: A global perspective. Lancet 398, 443–455. 10.1016/S0140-6736(21)01164-8
• Hardee, J. P., & Fetters, L. (2017). The effect of exercise intervention on daily life activities and social participation in individuals with Down syndrome: A systematic review. Research in developmental disabilities, 62, 81-103.
• Melo, G. L. R., Neto, I. V. D. S., Fonseca, E. F. D., Stone, W., & Nascimento, D. D. C. (2022). Resistance training and Down Syndrome: A narrative review on considerations for exercise prescription and safety. Frontiers in Physiology, 1802.
• Perić, D. B., Milićević‐Marinković, B., & Djurović, D. (2022). The effect of the adapted soccer programme on motor learning and psychosocial behaviour in adolescents with Down syndrome. Journal of Intellectual Disability Research, 66(6), 533-544.
• https://www.downsyndrome.org.au/about-down-syndrome/statistics/
• https://www.who.int/data/gho/data/themes/mortality-and-global-health-estimates/ghe-life-expectancy-and-healthy-life-expectancy
• https://www.who.int/data/gho/indicator-metadata-registry/imr-details/3416#:~:text=Insufficient%20physical%20activity%20is%20the,attributable%20to%20insufficient%20physical%20activity.