Improving muscular strength in special populations is gaining in popularity. Here is your chance to dramatically improve the lives of Down syndrome clients.

In a past article, the virtues, and the challenges of training clients with Down syndrome, were addressed. A wide range of topics from program design to cardiovascular regimens as well as improvements in ADL were covered.

Now, we delve a bit deeper into the specific area of strength training, and how it may benefit this unique population.

Assessing The Physical Pitfalls

Individuals born with the genetic aberration of Trisomy 21, commonly referred to as Down syndrome, face particular challenges in life of which we may not be aware. Despite the fact that their body shapes tend to be on the stocky side, those living with Down syndrome tend to be lacking in physical power. According to the American College of Sports Medicine, such individuals tend to exhibit 40-50% less strength than their healthier counterparts.

Down Syndrome Exercise Precautions

Armed with this knowledge, we can design a training program for clients living with Down syndrome that is both effective and safe. In addition, there are other considerations to keep in mind before escorting your client onto the gym floor. This special population tends to present with hypermobility, and often finds balance and stability to be a challenge.

Individuals with Trisomy 21 also may suffer from poorly developed respiratory and cardiovascular systems.  While each of these aspects might not be evident in every client, your knowledge of the aforementioned possibilities will assist in taking a precautionary approach to fitness protocols.

Exercises for Down Syndrome

Creating a fun and effective training session can challenge us to expand our typical coaching style and our repertoire of exercises. Exercises selection is important, as a negative experience can dissuade these young clients from future participation.

Basic total-body movements, taught with more demonstration and less verbal communication while under constant supervision, are a prudent way to begin. Reinforcing newly acquired skills requires considerable verbal encouragement from us as well, and becomes a key aspect of the all-important rapport we are seeking to create.

A primary goal is to strengthen large muscle groups. Training typically falls into the pattern of 3 sets of 8-12 repetitions, at an intensity of 70-80% of the client’s probable 1-rep max. Below are some sample workout ideas.

  • Warm-up: bodyweight squats, with a large stability ball placed against the wall and positioned at the mid-to-lower back region.
  • Leg presses and leg extensions
  • Leg curls
  • Lat pull-downs
  • Chest press
  • Upright rows
  • Push-up’s (may be performed from the knees)
  • Cool-down: walking around a track, followed by a variety of stretches, focusing on the lower body.

If an aerobic burst is to be introduced at the halfway point of the strength training, consider such methods as jogging around a track, up-and-down stepping on a low bench, marching in place, or even 5 minutes on an exercise bike (under supervision).

Cultivating Power

While the exact mechanisms causing this weakness have yet to be fully understood, the good news is that through proper and careful training, professionals have been successful at increasing muscular strength in this demographic while also demonstrating gains in other areas of fitness and wellness.

A research study was conducted on 12 test subjects ranging in age from 18 to 36 years, and comprised of 7 females and 5 males. Over the course of 10 weeks, the participants engaged in a protocol involving 6 strength-based exercises; each exercise was performed with 3 sets of 10 repetitions. The exercise sessions took place twice a week.

At the end of the 10-week trial, a significant improvement in strength was observed. The 3 upper-body exercises revealed an average increase of 42%, while strength gains attributed to the 3 lower-body exercises averaged a 90% uptick.

Real-Life Work Translates To Real-Life Gains

Another study utilized test subjects as well as a control group.  For this 10-week trial, the active individuals engaged twice a week in a progressive resistance- training regimen at a local gym. The control group participated in a weekly 90-minute social program, which consisted of purely recreational activities.

The researchers were interested in 2 skill sets: work task performance and muscle strength/physical activity level. The work task performance assessment consisted of weighted box stacking and weighted pail carrying. Muscle strength/physical activity was measured with an RT3 activity monitor, a device used to assess the amount of energy expended during periods of activity and rest.  At the end of the trial, the activity-based participants had significantly increased muscular strength in both their upper and lower limbs.

Body weight and flexibility remained essentially unchanged for the participating Down syndrome individuals over the course of these 10-week experiments. However, flexibility is a unique parameter and is best addressed and improved upon through methods other than pure resistance training.

Building Self-Esteem Along With Strength

The good news does not seem to be limited to gains within the physical realm. Down syndrome adults who participate in a professionally supervised fitness-based education program have been able to successfully alter their attitudes towards exercise. This result seems to correlate strongly with positive expected outcomes, fewer cognitive-emotional barriers, and an overall improved outlook on life.

Self-efficacy is definitely at play here, enhancing our goal of increasing participation of clients with unique and specialized needs.  Once again, the role of the personal trainer deserves to be acknowledged and recognized. Our challenge remains in effectively promoting such research with the hope of raising awareness of the virtues of strength training within this community.


Learn More About Personal Trainer Certification

Article References

  1. Review Article TheScientificWorldJOURNAL (2007) 7, 7–19 ISSN 1537-744X; DOI 10.1100/tsw.2007.20

Cathleen Kronemer

Cathleen Kronemer is an NFPT CEC writer and a member of the NFPT Certification Council Board. Cathleen is an AFAA-Certified Group Exercise Instructor, NSCA-Certified Personal Trainer, ACE-Certified Health Coach, former competitive bodybuilder and freelance writer. She is employed at the Jewish Community Center in St. Louis, MO. Cathleen has been involved in the fitness industry for over three decades. Feel free to contact her at She welcomes your feedback and your comments!