Research suggests that parents and caregivers need support and information to encourage their children to engage in healthy eating and physical activity. Specifically, they need guidance about healthy eating and nutrition. They also need practical strategies to engage their children in physical activity.

Research by Julie Murray and Patricia Ryan-Krause suggests restricting the number of calories that children consume, using portion control strategies, and limiting the number of times children are allowed to eat at fast food restaurants.

Researchers also suggest engaging children in active forms of movement such as walking, jogging, and yoga. Research found that adolescents with Down Syndrome preferred activities like yoga because yoga did not require engaging in competition.

An individual with Down syndrome can participate in most forms of physical activity. Overall, this is a healthy population that enjoys the social aspects of physical activity. With over 80 clinical characteristics seen in individuals with Down syndrome, the physical characteristics most related to exercise are:

• muscle hypotonicity (muscles have the ability to be stretched far beyond normal limits)
• hypermobility of the joints or ligamentous laxity (increased flexibility in their joints associated with increased susceptibility to subluxation and dislocation)
• mild to moderate obesity (greater among adult women with intellectual disabilities than men with intellectual disabilities) (Rimmer et al., 1993)
• an underdeveloped respiratory and cardiovascular system
• short stature (short legs and arms in relation to torso), and
• poor balance and perceptual difficulties (Winnick, 1995).

It is important to note that hypotonia and hypermobility are often associated with lordosis, ptosis, dislocated hips, kyphosis, flat pronated feet, forward head, and atlantoaxial instability (AAI) (Winnick, 1995). AAI is a severe cervical disorder that occurs in 17% of the population with Down Syndrome and is characterized by increased laxity between the first and second cervical vertebrae. A possible side effect of this joint laxity is that the vertebrae may sublux and cause spinal cord injury. It is important for an individual with Down syndrome to find out if they have AAI before participation in physical activity; contact sport activities are contraindicated when AAI is present (Pueschel, 1998).

Additional medical factors to consider include:

• Congenital heart disease
• Mitral valve prolapse
• Leukemia
• Bowel defects
• Alzheimer’s disease
• Thyroid hormonal deficiencies
• Abnormal energy expenditure and substrate utilization
• Impaired sympathetic response to exercise
• Anemia