As a health and exercise professional, you know how to coach and train clients with common health goals, such as weight loss, improved mobility, greater strength and better balance. However, would you know what to do if a client with Down Syndrome came to you with those same goals? Individuals with developmental disabilities or delays are largely underserved by the fitness industry—in fact, one study found that more than 80% of adults with intellectual disabilities do not meet the minimum recommended amount of daily physical activity. Clearly, this population represents a tremendous opportunity to expand your reach while improving the lives of individuals who can greatly benefit from the types of guidance you can provide. 

From communication tips to developing powerful motivators, this article and accompanying videos cover how to effectively train individuals with Down Syndrome and how you can make a significant impact on the health and well-being of this underserved population.

What You May Not Know About People With Down Syndrome

According to the World Health Organization, the estimated incidence of Down Syndrome is between 1 in 1,000 to 1 in 1,100 live births worldwide, and it is the most common chromosomal disorder in the United States. Because of the presence of an extra chromosome, common physical traits of people with Down Syndrome include poor muscle tone, wide and short hands with short fingers, smaller facial features, upward slanting eyes, and slower physical development than their peers. Although, it may take them longer to meet physical development milestones, they are still capable of achieving them. 

Because common symptoms of Down Syndrome include low aerobic capacity and muscle strength and congenital heart disease, these individuals have an increased risk for obesity and heart disease, according to the National Center on Health, Physical Activity and Disability. Intellectually, common struggles may include a short attention span, impulsive behavior, slowed learning, and delayed speech and language development. While these struggles may make communication more difficult, people with Down Syndrome can still communicate and interact effectively in their own ways. 

Other barriers that prevent people with Down Syndrome from participating in physical activity include a lack of money, transportation, access and support from family and caregivers. Unfortunately, many parents and caregivers mistakenly believe that individuals with Down Syndrome are too fragile to participate in exercise and physical activity. The rewards, however, far outweigh the risks and barriers, asserts Sheila Goscha, vice president and chief operating officer of Disability Supports of the Great Plains, LLC. 

“Through the years that a personal trainer has worked with our individuals with Down Syndrome,” says Goscha, “I have seen improvements in mobility, strength, weight loss, energy and self-esteem in our clients. And all these improvements help our clients maintain their independence and confidence, which is a win for everyone.” 

Designing and implementing a fitness program for a person with Down Syndrome can be rewarding for both you and the client. Despite the barriers described earlier, an exercise program can have a significant impact on the health of a person with Down Syndrome by helping to improve both muscular and cardiovascular health. Research has shown it also can help people improve function, which enhances their independence in performing daily tasks and vocational skills. 

DeVona Roble, an occupational therapist in Wichita, Kansas, has a sister with Down Syndrome and has witnessed firsthand the benefits of physical training. “My sister had a need for strengthening to help manage stability with walking, managing functional movements for more independence and to manage joint pain,” explains Roble. “I thought a local personal trainer would be helpful to establish a health routine for her, along with the added benefit of weight management and nutrition recommendations. I am so glad we established this relationship—it was a game changer.” 

The Importance of Adaptability and Communication

Adaptability is one of the most important things to remember when designing and implementing training programs for individuals with Down Syndrome. Due to impulsiveness, delayed learning and a short attention span, overstimulation due to environmental, emotional or mental factors can affect the progress of a training session. The ability to process multiple avenues of sensory input can be overwhelming for someone with a slower processing ability. Therefore, before starting a session, ensure the noise in the room is lessened or find a quiet place to complete each workout session. It also helps to turn off extra visual distractions, such as electric signage and television or computer screens, and to reduce loud sounds coming through the radio, clanging weights and loud instructors or trainers working in the same area.  

Being able to adapt to the unique needs of each client is crucial to his or her success. For example, anxiety, rumination and inflexible behaviors are common mental health concerns related to Down Syndrome, as well as slow mental processing, which affects program adherence. For these reasons, it’s important to pay attention to the times of the day, week, month and year when scheduling weekly workout sessions. For example, trainings that occur around holidays and weekends, days leading up to vacations, times around lunch or dinner, and dates to which a person is emotionally attached can make it more difficult for a client to complete his or her workout session effectively due to anxiety about a change in the routine. It is best to schedule training sessions at a consistent day and time each week that is least affected by the situations listed above to help alleviate disruptions that may alter routines.

Communication, like adaptability, is another important consideration when working with this population. Understanding how a person with Down Syndrome learns is essential to his or her success. Generally, people with Down Syndrome learn best through a visual, hands-on approach. For example, demonstrating workout movements while the client watches can be an effective learning technique. Auditory cueing, however, is usually not as effective because most people with Down Syndrome typically retain the last few words of a sentence being spoken and need more time to process information before retaining or responding to directions given. This, in turn, leads to delays in learning and performing. 

When describing a required exercise, keep cues to a minimum and rely primarily on providing visual cues and tangible objects for the client to manipulate, feel and see. Repetition is also important in communication, so repeating similar visual cues throughout the workout session helps the client retain the benefits of that particular movement. 

Lastly, remember to use transitional words between exercises to help the client know when it is time to switch from one movement to another. This allows him or her a chance to process that a change is coming and adapt accordingly, which helps reduce anxiety about the unknown. 

Managing the Training Session

While your instinct may tell you to try and control all aspects of the training session, a better approach is to allow the client to be actively involved in the planning and outcome of the training session. Anxiety is common in people with Down Syndrome, and if they do not know what their training session will include, they will ask a lot of questions, become distracted and may not fully engage in the workout. Therefore, before beginning, lay out the schedule of what exercises are planned and end with something that is the client’s choice, or an activity that he or she enjoys the most. 

A checklist works particularly well because the client can visually see what he or she has accomplished and what is left to complete. In addition, clients with Down Syndrome are typically motivated by rewards, so if-then statements are very effective. Using statements like, “If you do this______, then we will do this_______,” can encourage adherence to the assigned tasks. This also works great as a motivational tactic throughout the workout session when the client wants to quit. 

Although it may seem overly repetitive to your programming, a client with Down Syndrome learns best through repetition in movements. Because of a limited processing ability, learning common body movements takes time, so repeating the same movements from session to session is key to the client’s success. While you may find the repetition boring, your client is more likely to find comfort in the similarity of each workout. 

When working through strength movements, always use a task-based motivation. Clients with Down Syndrome are not motivated by time-based goals because of their slow processing time. Again, using if-then statements can be very effective in this situation as well. For example, statements such as, “We will complete 10 reps of this movement (demonstrate visually) and then we will stop.” Be very precise and brief in your descriptions and repeat the visual instruction until the client is ready to try. Encourage the client to count each rep aloud for added cognitive function and interaction. Using visual markers or cones for stations helps delineate set points and provides clear indicators of the required distance of the task. 

This approach of using of task-based goals applies to cardio-style workouts as well. For example, use cues such as, “We will jog to this marker and then we get to walk to the next marker, and then we get to stop.” Or, “We will do 20 fast skips in place before we get to move to the next cone, and then get to rest.” 

Specific Programming Ideas

When designing specific exercises for a client with Down Syndrome, consider the fact that he or she most likely has low muscle tone, lax joints and low motor development. As such, the program design should be different than most typical warm-ups and muscle-strengthening workout sessions in that it should limit excessive stretching and heavy joint loading. Following the guidance of the ACE Integrated Fitness Training^® Model, the program design should meet the client where he or she is by initially keeping movements simple, direct and functional. Start with basic movement patterns to determine the client’s abilities. An effective approach is to cue the client to squat, walk, push/pull, rotate and maneuver using everyday activities as examples. 

After the initial assessment, the success of each workout session depends on your own personal creativity because most clients with Down Syndrome do not typically enjoy exercise or fitness. Therefore, it’s your task to disguise exercise in each session as something different. Research suggest that if workouts are appealing and enjoyable, attendance rates for adults with intellectual disabilities can be as high as 70% over 24 workout sessions.

Workouts should combine muscular strengthening with cardiorespiratory work, but can be disguised in the form of dance aerobics, role-playing, rhythmic gymnastics, games, relays and competitive play. For example, workout sessions could include dances like the Cupid Shuffle, Wobble, Cha-Cha Slide, Head-Shoulders-Knees and Toes, and the Hokey Pokey. 

You can also use weighted objects as manipulatives to add for external resistance. For task-based exercises, objects such as ribbons, sticks, weighted bars, paper plates, towels, balls, sidewalk chalk, agility ladders and sandbags are great manipulatives for strength movements. Other ideas include changing up common board games to include exercises in place of colors or tasks, using decks of cards or apps with sounds to create unique ways to encourage active participation in the exercise session, while also keeping anxiety levels down.

Coaching or training a client with Down Syndrome requires creativity, flexibility and patience, particularly when you’re first getting started, but over time it can become one of the most rewarding jobs you’ll ever have. While some might focus on the limits of what individuals with Down Syndrome might be able to learn or achieve, in reality there are no limitations to what they might be able to accomplish with appropriate programming, communication and coaching.