PHYSICAL ACTIVITY AND EXERCISE INTERVENTIONS TO REDUCE ACTIVITY LIMITATIONS IN CHILDREN WITH DOWN SYNDROME: A SCOPING REVIEW

J.R. Luces¹, E.J. Gorgon²

Background: Children with Down syndrome (DS) typically have activity limitations that result from delays in motor skill development. Physical activity and exercise have been shown to have a positive impact on reducing activity limitations in various patient populations. However, no study has comprehensively examined the extent of the evidence in children with DS, particularly at the level of clinical trials to guide practice.

Purpose: To map out clinical trials of physical activity and exercise interventions that targeted outcomes relating to reduced activity limitations in children with DS.

Methods: In this scoping review, we searched CENTRAL, PubMed, PEDro, and LILACS up to 29 February 2020 and independently assessed studies for eligibility. We included randomized and quasi-randomized controlled trials that involved children with DS (ages 0 to 21) and examined the effects of physical activity and exercise interventions on activity-level outcomes. We independently extracted data on trial characteristics and appraised trial quality using the PEDro scale. Reporting of interventions was assessed using a combined checklist from the Consensus on Exercise Reporting Template (CERT) and Template for Intervention Description and Replication (TIDieR). Outcomes were coded according to the International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY). Data were summarized descriptively.

Results: Eighteen articles representing 13 randomized controlled trials and 1 quasi-randomized trial were identified, featuring physical fitness exercises (2 trials); gait and balance exercises (7 trials); neuromotor development training (2 trials); and multicomponent programs (3 trials).  More than half of trials (57%) included children in the age range 4-12 years, while few focused on infants or adolescents as participants. Most of intervention features (14/20 items, 70%) on the combined CERT and TIDieR checklist were inadequately described in at least 50% of the trials. The most underreported components related to adverse reactions and decision rules on starting level. Few also described replicable motivation strategies and non-exercise components, with only 2 trials describing communication or coordination with caregivers. Outcome measures covered some mobility-related categories in the ICF-CY, and no patient- or caregiver-reported instruments were used. Most trials (57%) had poor quality (PEDro score 4/10 or less), with PEDro scores not improving over the time period covered in this review.

Conclusion(s): Available clinical trials targeting to reduce activity limitations in children with DS through physical activity and exercise have important limitations. Insufficient reporting of interventions and poor trial quality were identified in most of the studies, and can negatively impact usefulness of the evidence in practice. Caregiver components of interventions, which are critical to family-centered care, particularly need to be addressed in future trials.

Implications: There appears to be insufficient evidence at the level of clinical trials on the effects of physical activity and exercise in reducing activity limitations in children with DS to guide clinical practice. This knowledge gap warrants conducting high-quality trials that can feature in robust systematic reviews in the future. Use of the CERT and TIDieR can improve rigor of design and reporting in these future trials.

Funding, acknowledgements: The authors received no specific funding for this work.

Keywords: Down Syndrome, Exercise, Physical Activity

Topic: Paediatrics

Did this work require ethics approval? No

Institution: N/A

Committee: N/A

Reason: This is a systematic review.