Physical Activity in People with Intellectual Disability: A Narrative Review

Document Type : Review Articles


1 Associate Professor, Musculoskeletal Research Center AND Department of Physical Therapy, School of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran

2 Instructor, Musculoskeletal Research Center AND Department of Physical Therapy, School of Rehabilitation Sciences, Isfahan University of Medical Sciences, Isfahan, Iran



Introduction: The levels of physical activity and exercise are two important factors to improve health in people with intellectual disability. Several studies addressed the level of physical activity, and the benefits, cautions, and principles of exercising in this group of disabled people. The aim of the current study was to review the articles related to both topics of intellectual disability and exercise to provide a suitable framework for improving physical activity in people with intellectual disability.Materials and Methods: Databases including PubMed, PEDro, Science Direct, and Magiran were considered to search, using the keywords physical activity, exercise, intellectual disability, and Down’s syndrome to find related articles. Finally, twenty two studies which met the inclusion criteria were selected, and the related data including the level of physical activity, and the benefits and principle of exercise prescription were extracted.Results: Despite approved benefits of physical activity, the level of exercise in people with intellectual disability was lower than other peer groups. In people with intellectual disability, especially people with Down’s syndrome, medical conditions such as cardiovascular, physical, mental, and health disorders should be assessed before prescription of any exercises. Aerobic, resistance, and balance training are the most important exercises in people with intellectual disability.Conclusion: Exercise has a pivotal role for improving health in people with intellectual disability. These people have to pass some medical examinations before prescription of any exercise program.


  1. Yu C, Li J, Liu Y, Qin W, Li Y, Shu N, et al. White matter tract integrity and intelligence in patients with mental retardation and healthy adults. Neuroimage 2008; 40(4): 1533-41.
  2. Luckasson R, Schalock RL. Defining and applying a functionality approach to intellectual disability. J Intellect Disabil Res 2013; 57(7): 657-68.
  3. Fernhall B. Mental retardation. In: American College of Sports Medicine, Durstine JL, Moore GE, editors. ACSM's exercise management for persons with chronic diseases and disabilities. Champaign, IL: Human Kinetics; 1977. p. 221-6.
  4. Day SM, Strauss DJ, Shavelle RM, Reynolds RJ. Mortality and causes of death in persons with Down syndrome in California. Dev Med Child Neurol 2005; 47(3): 171-6.
  5. Reppermund S, Trollor JN. Successful ageing for people with an intellectual disability. Curr Opin Psychiatry 2016; 29(2): 149-54.
  6. Higgins S. Physical health of adults with intellectual disabilities. Learning Disability Practice 2004; 7(10): 25-6.
  7. Baynard T, Pitetti KH, Guerra M, Unnithan VB, Fernhall B. Age-related changes in aerobic capacity in individuals with mental retardation: A 20-yr review. Med Sci Sports Exerc 2008; 40(11): 1984-9.
  8. Boer PH, Moss SJ. Effect of continuous aerobic vs. interval training on selected anthropometrical, physiological and functional parameters of adults with Down syndrome. J Intellect Disabil Res 2016; 60(4): 322-34.
  9. Wouters M, Evenhuis HM, Hilgenkamp TIM. Physical fitness of children and adolescents with moderate to severe intellectual disabilities. Disabil Rehabil 2019; 1-11. [Epub ahead of print].
  10. Boonman AJN, Schroeder EC, Hopman MTE, Fernhall BO, Hilgenkamp TIM. Cardiopulmonary profile of individuals with intellectual disability. Med Sci Sports Exerc 2019; 51(9): 1802-8.
  11. American College of Sports Medicine, Franklin BA, Whaley MH, Howley ET, Balady GJ. ACSM's guidelines for exercise testing and prescription. Philadelphia, PA: Lippincott Williams and Wilkins; 2000. p. 299-305.
  12. Momeni M, Taheri HR. The effect of Special Olympics programs on Down syndrome people's self-efficacy. J Rehab 2013; 13(4): 100-7.
  13. Fadaei-Dehcheshmeh M, Shamsi-Majelan A.. Comparison of physical fitness in persons with intellectual disability with and without experience of Special Olympics Iran. J Res Rehabil Sci 2018; 14(3): 175-82. [In Persian].
  14. Bartlo P, Klein PJ. Physical activity benefits and needs in adults with intellectual disabilities: systematic review of the literature. Am J Intellect Dev Disabil 2011; 116(3): 220-32.
  15. Shin IS, Park EY. Meta-analysis of the effect of exercise programs for individuals with intellectual disabilities. Res Dev Disabil 2012; 33(6): 1937-47.
  16. Jeng SC, Chang CW, Liu WY, Hou YJ, Lin YH. Exercise training on skill-related physical fitness in adolescents with intellectual disability: A systematic review and meta-analysis. Disabil Health J 2017; 10(2): 198-206.
  17. Robertson J, Emerson E, Gregory N, Hatto C, Turner S, Kessissoglou S, et al. Lifestyle related risk factors for poor health in residential settings for people with intellectual disabilities. Res Dev Disabil 2000; 21(6): 469-86.
  18. Walsh PN. Ageing and health issues in intellectual disabilities. Curr Opin Psychiatry 2005; 18(5): 502-6.
  19. Lifshitz H, Merrick J, Morad M. Health status and ADL functioning of older persons with intellectual disability: community residence versus residential care centers. Res Dev Disabil 2008; 29(4): 301-15.
  20. Hilgenkamp TI, van WR, Evenhuis HM. (Instrumental) activities of daily living in older adults with intellectual disabilities. Res Dev Disabil 2011; 32(5): 1977-87.
  21. Oppewal A, Hilgenkamp TI, van WR, Schoufour JD, Evenhuis HM. Physical fitness is predictive for a decline in daily functioning in older adults with intellectual disabilities: results of the HA-ID study. Res Dev Disabil 2014; 35(10): 2299-315.
  22. Oppewal A, Hilgenkamp TIM. Physical fitness is predictive for 5-year survival in older adults with intellectual disabilities. J Appl Res Intellect Disabil 2019; 32(4): 958-66.
  23. Stanish HI, Curtin C, Must A, Phillips S, Maslin M, Bandini LG. Does physical activity differ between youth with and without intellectual disabilities? Disabil Health J 2019; 12(3): 503-8.
  24. Tremblay MS, Aubert S, Barnes JD, Saunders TJ, Carson V, Latimer-Cheung AE, et al. Sedentary Behavior Research Network (SBRN) - Terminology Consensus Project process and outcome. Int J Behav Nutr Phys Act 2017; 14(1): 75.
  25. Franciosi E, Baldari C, Gallotta MC, Emerenziani GP, Guidetti L. Selected factors correlated to athletic performance in adults with mental retardation. J Strength Cond Res 2010; 24(4): 1059-64.
  26. Golubovic S, Maksimovic J, Golubovic B, Glumbic N. Effects of exercise on physical fitness in children with intellectual disability. Res Dev Disabil 2012; 33(2): 608-14.
  27. Hilgenkamp TI, van WR, Evenhuis HM. Low physical fitness levels in older adults with ID: Results of the HA-ID study. Res Dev Disabil 2012; 33(4): 1048-58.
  28. Raitakari OT, Juonala M, Kahonen M, Taittonen L, Laitinen T, Maki-Torkko N, et al. Cardiovascular risk factors in childhood and carotid artery intima-media thickness in adulthood: The Cardiovascular Risk in Young Finns Study. JAMA 2003; 290(17): 2277-83.
  29. Andersen LB, Hasselstrom H, Gronfeldt V, Hansen SE, Karsten F. The relationship between physical fitness and clustered risk, and tracking of clustered risk from adolescence to young adulthood: Eight years follow-up in the Danish Youth and Sport Study. Int J Behav Nutr Phys Act 2004; 1(1): 6.
  30. Halle JW, Gabler-Halle D, Chung YB. Effects of a peer-mediated aerobic conditioning program on fitness levels of youth with mental retardation: two systematic replications. Ment Retard 1999; 37(6): 435-48.
  31. Lotan M, Isakov E, Kessel S, Merrick J. Physical fitness and functional ability of children with intellectual disability: Effects of a short-term daily treadmill intervention. ScientificWorldJournal 2004; 4: 449-57.
  32. Podgorski CA, Kessler K, Cacia B, Peterson DR, Henderson CM. Physical activity intervention for older adults with intellectual disability: report on a pilot project. Ment Retard 2004; 42(4): 272-83.
  33. Shields N, Taylor NF, Dodd KJ. Effects of a community-based progressive resistance training program on muscle performance and physical function in adults with Down syndrome: a randomized controlled trial. Arch Phys Med Rehabil 2008; 89(7): 1215-20.
  34. Ghasemi A, Momeni M, Sohrabi M. The effect of sport activities on perceptual-motor skills among obese children with Down syndrome. J Rehab 2015; 16(2): 168-75. [In Persian].
  35. Kong Z, Sze TM, Yu JJ, Loprinzi PD, Xiao T, Yeung AS, et al. Tai Chi as an alternative exercise to improve physical fitness for children and adolescents with intellectual disability. Int J Environ Res Public Health 2019; 16(7).
  36. Vuijk PJ, Hartman E, Scherder E, Visscher C. Motor performance of children with mild intellectual disability and borderline intellectual functioning. J Intellect Disabil Res 2010; 54(11): 955-65.
  37. Zafeiridis A, Giagazoglou P, Dipla K, Salonikidis K, Karra C, Kellis E. Muscle fatigue during intermittent exercise in individuals with mental retardation. Res Dev Disabil 2010; 31(2): 388-96.
  38. Westendorp M, Houwen S, Hartman E, Visscher C. Are gross motor skills and sports participation related in children with intellectual disabilities? Res Dev Disabil 2011; 32(3): 1147-53.
  39. Dedlow ER, Siddiqi S, Fillipps DJ, Kelly MN, Nackashi JA, Tuli SY. Symptomatic atlantoaxial instability in an adolescent
  40. with trisomy 21 (Down's syndrome). Clin Pediatr (Phila) 2013; 52(7): 633-8.
  41. Kuijken NM, Naaldenberg J, Nijhuis-van der Sanden MW, van Schrojenstein-Lantman de Valk HM. Healthy living according to adults with intellectual disabilities: Towards tailoring health promotion initiatives. J Intellect Disabil Res 2016; 60(3): 228-41.
  42. Seddon PC, Khan Y. Respiratory problems in children with neurological impairment. Arch Dis Child 2003; 88(1): 75-8.
  43. Hsieh K, Rimmer J, Heller T. Prevalence of falls and risk factors in adults with intellectual disability. Am J Intellect Dev Disabil 2012; 117(6): 442-54.
  44. Hale LA, Mirfin-Veitch BF, Treharne GJ. Prevention of falls for adults with intellectual disability (PROFAID): A feasibility study. Disabil Rehabil 2016; 38(1): 36-44.
  45. Carmeli E, Reznick AZ, Coleman R, Carmeli V. Muscle strength and mass of lower extremities in relation to functional abilities in elderly adults. Gerontology 2000; 46(5): 249-57.
  46. Enoka RM, Stuart DG. Neurobiology of muscle fatigue. J Appl Physiol (1985) 1992; 72(5): 1631-48.
  47. Gandevia SC. Spinal and supraspinal factors in human muscle fatigue. Physiol Rev 2001; 81(4): 1725-89.
  48. Hatzikotoulas K, Patikas D, Ratel S, Bassa E, Kotzamanidis C. Central and peripheral fatigability in boys and men during maximal contraction. Med Sci Sports Exerc 2014; 46(7): 1326-33.
  49. Fitts RH. Cellular mechanisms of muscle fatigue. Physiol Rev 1994; 74(1): 49-94.