Training Clients With Down Syndrome

According to the National Down Syndrome Society (NDSS), “Down Syndrome occurs when an individual has a full or partial extra copy of chromosome 21”, thus giving them 47 chromosomes instead of the typical 46.  The NDSS notes that due to the additional chromosome (partial or full), there are changes in the person’s development which can lead to the characteristics often associated with people with Down Syndrome.

When working with a client who has Down Syndrome, it is important to understand all the possible health complications that can be associated with the condition and to make sure they have consent from their physician first.  According to The National Center on Health, Physical Activity & Disability (NCHPAD), people with Down Syndrome are prone to congenital heart defects, problems with vision and hearing, respiratory issues, thyroid and metabolic conditions, sleep apnea, and have a tendency to develop Alzheimer’s or symptoms of dementia at an earlier age.   There is a chance that many of these health complications are potentially avoidable with a well-designed exercise program.

All exercise programs should be individualized for each client and even the basic guidelines put up by experts in the field will still need to be adjusted depending on the client’s current level of fitness.  For instance, the NCHPAD suggests that clients with Down Syndrome perform cardiovascular exercise at “an intensity of 60-80% of an individual's maximal heart rate (MHR), 3-5 days a week, for 20-60 minutes per session.” This might be exactly right for an individual with Down Syndrome who is in decent shape and has no other health issues but way too intense for another individual who is overweight or has respiratory issues.  The NCHPAD also says that “resistance training exercises should be 70-80% of [one rep max] for 3 sets of 8-12 repetitions” for clients with Down Syndrome.  This again might be perfect for an otherwise healthy individual but not at all right or safe for an individual who has poor muscle tone and/or loose joints.

It is important to note that there is one area of training that is NOT suggested in clients with Down Syndrome: flexibility training. This is due to the hypermobility and joint laxity that individuals with Down Syndrome often have.  

Just as important as designing the exercise program itself, it is also key to understand the common behavioral difficulties that may be present in clients with Down Syndrome and the strategies that work best for managing them.  For instance, it has been shown that the use of a “token reward system” in which the clients can receive tokens for following directions and completing tasks (or workout exercises) can increase adherence and motivation to stay with the program.  A progress chart that shows all their workout data is also a good way to work with clients with Down Syndrome. Even better, if the trainer is able to teach the client how to record their own information and workout data on a progress chart, that can lead to long-term growth and success.

Of course, all individuals with Down Syndrome differ in personality and don’t all have the same behavioral issues which is why the trainer must be able to assess what the client’s triggers are and understand how to work with that client specifically.  Some clients might do great with a token reward system, others might find it to be very ineffective, and for some, it might just be unnecessary.

In conclusion, personal training clients with Down Syndrome may be effective and can potentially make a huge difference in their quality of life.  With an understanding of all their health conditions and potential triggers, there are no reasons why a trainer can’t succeed in training a client with Down Syndrome.


“Down Syndrome : NCHPAD - Building Inclusive Communities.” National Center on Health, Physical Activity and Disability (NCHPAD),

Quaglio, Laura, et al. “A Transforming Experience: Working with Clients Who Have Down Syndrome.” NASM Blog, 21 Aug. 2013,

“What Is Down Syndrome? | National Down Syndrome Society.” NDSS,

Wing, Cary. “ACSM/NCHPAD Resources for the Certified Inclusive Fitness Trainer.”ACSM/NCHPAD Resources for the Certified Inclusive Fitness Trainer, American College of Sports Medicine, 2012.