Inclusion programs offered at gyms and community centers nationwide are gaining recognition as successful tools of empowerment for individuals with special needs.

Down Syndrome, or Trisomy 21, is a condition in which the body has created an extra copy of the 21st chromosome. It is the most common form of mental retardation, affecting nearly 400,000 Americans to date.

The Need is Real

Individuals who live with this genetic disorder exhibit a number of physical and psychological differences. Due to a multitude of factors, both medically and socially, those who are born with Down syndrome are living longer and more productive lives. Maintaining at least a functional level of physical fitness can serve them well.

Children, as well as adults with Down syndrome, are at an increased risk for obesity and related health consequences. According to the Centers for Disease Control and Prevention, “Obesity rates for adults with disabilities are 58% higher than for adults without disabilities.” Interestingly, over half of all children living with Down syndrome fail to achieve the recommended amount of physical activity. Teenagers 15 and older exhibit the most sedentary lifestyles of all age groups.

Obesity and lack of exercise are not the only medical complications commonly observed by physicians. According to the National Center on Health, Physical Activity and Disability (NCHPAD), these individuals often present with abnormal energy expenditure, anemia, congenital heart disease, mitral valve prolapse, thyroid issues and hearing problems. Very often such co-morbid conditions are complicated by some degree of cognitive challenges, which can range from mild to severe.

Sedentary lifestyles may potentially exacerbate this population’s already low bone mineral density scores, the implications of which are early onset of osteoporosis and brittle bones. Damage due to oxidative stress is also greater in individuals with Down syndrome since the gene that codes for the enzyme superoxide dismutase lies on chromosome 21. Current research strongly supports the belief that exercise training can improve oxidative stress in such individuals.

Benefits of Physical Activity for Down Syndrome

Gross motor developmental delays are most likely due to hypotonia. Hypotonia refers to decreased muscle tone, and too much flexibility. Hypotonic children seem floppy when held and often have difficulty lifting their head and limbs, and performing fine and gross motor activities that require coordinated, controlled movements like sitting up without support. Short limbs and deficient muscular strength further exacerbate this problem. Research has indicated that by striving to lessen hypotonia and joint laxity through specific exercises, such clients may reduce their risk of hip dysplasia, degenerative arthritis, and sports-related injuries.

Increased active range of motion and strength can be accomplished through a dedicated program of resistance training, thereby enhancing physical performance. We as personal trainers can easily facilitate such processes, once we learn how to reach out to these individuals as potential future clients. It would be highly rewarding to assist clients seeking to participate in Special Olympics competitions, and help them be their best!

Overcoming Barriers

Individuals living with Down syndrome often face a vast array of non-medical situations that prevent them from participating in physical activities. Difficulties associated with overcoming the social and environmental barriers to actually entering a gym top the list. Other matters to consider are tight finances, transportation to fitness centers, and support from others.

It is vital that parents and caregivers change the all-too-common perception of individuals with Down syndrome as being too fragile to participate in exercise, especially vigorous physical activity, and provide encouragement rather than negative support.

In most cases, people with Down syndrome prefer to exercise with a partner or a small group of individuals. Sadly, suitable programs with appropriately trained staff are limited. The good news is that when individuals living with Down syndrome have participated in a structured exercise program, studies show that the dropout rate can decrease from the typical 50% to as little as 10-15%. If we are willing to delve into the details, we can provide a link to healthier futures for this unique population.

Strength Training Protocols

Prior to designing a workout program for a new client with Down syndrome, doing a little research can provide insight regarding expectations as well as limitations. Some important points to keep in mind when working with this special population are:

  • the prevalence of hypermobility
  • underdeveloped respiratory and cardiovascular systems
  • difficulties with balance

General guidelines when training individuals with Down syndrome include:

  • constant supervision
  • labeling machines with pictures and providing verbal encouragement
  • providing more visual instruction than verbal instruction
  • teaching clients to record their own information to improve long-term adherence and empowerment.

Keeping in mind the goal of strengthening the large muscle groups, training intensity should be in the range of 70-80% of a 1-rep max for 3 sets of 8-12 repetitions. Positive progress is typically seen within 10-12 weeks of beginning a strength program. Circuit training is also an appropriate training tool, including 2-minute stations with 30-60 seconds of rest intervals between each station.

Exercise Precautions

Children with Down syndrome may face greater challenges with motor skills and balance. Exercise selection is important, as a negative experience can dissuade these young clients from future participation.  Focusing on total body movements that do not require much skill before moving toward challenging exercises has proven effective. Building a rapport is also vital to establishing trust. Once the clients discover that these beginning exercises are fun, the trainer will find it much easier to up the challenge with the introduction of more complex moves.

Creativity Yields Success

Consider including jumping jacks, squats, and the bear crawl into your training circuit. Spending more time demonstrating exercises as opposed to giving verbal directions tends to help clients with Down syndrome learn more effectively. Bear crawls are typically performed over a specific distance, such as the length of a basketball court.

For the squats and jumping jacks, it is safe to begin with ten-second sets, and attempt to increase that over time.  Special-needs individuals may respond better to sets performed within a given time frame rather than being instructed to execute a specific number of repetitions. Performance and adherence increase when the duration of the timed set is not necessarily disclosed before starting the exercise.

Realigning Your Viewpoint

Our traditional clients often focus on appearance as a training goal. Clients with special needs, however, have a different focus: that of being healthy and functionally independent. This is an important distinction to keep in mind when designing a training regimen. While it may be tempting for us to emphasize praise for accomplishments and meeting goals, in the case of clients with Down syndrome, it is the journey that is most profound.

Beyond building muscle and skill, a challenging path of exercise has the capacity to strengthen internal character traits such as perseverance, determination, and optimism. These are aspects that will serve your clients well throughout their entire lives. Therefore, we as trainers must keep these objectives in mind and construct the best road to meet each one’s individuals needs. Something as simple as cultivating a client’s social skills can provide him/her with the confidence to walk into a gym and feel like he/she belongs there.

To help prevent maladies related to sedentary lifestyles and to enhance the ease of performing activities of daily living, a niche exists for personal trainers willing to offer insightful and practical ways to add exercise to the lives of these members of our community. Working with special populations can serve as a reminder of why we originally chose to embark upon our profession. Realizing that your client/trainer relationship is making a significant difference in someone’s life may reinvigorate your dedication and passion, and will certainly help you grow both professionally and personally.

If you have had success training special populations, please share your experiences with us.


Bodyweight Strength Training For Children With Down Syndrome


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!