Socio-Ecological Factors of Physical Activity in Children and Adolescents With Down Syndrome: A Mixed-Methods Systematic Review.
Youth with Down syndrome stay inactive because ability, family, friends, programs, and policy all drag at once.
01Research in Context
What this study did
Liu et al. (2026) searched every study that asked why kids and teens with Down syndrome move so little.
They kept both numbers and interviews, then sorted answers into four layers: the child, the family, the neighborhood, and the policy world.
What they found
The review shows a web of barriers: low muscle tone, parents who fear injury, few friends to play with, rare programs, and no public rules that help.
No single cause sits alone; the layers stack on top of each other.
How this fits with other research
Meier et al. (2012) used waist trackers and proved the problem is real: these kids sit far more than guidelines allow.
Diaz (2020) added a national parent survey showing the same gap, so the new review simply explains why those numbers happen.
Moya et al. (2022) showed COVID-19 made things even worse and levels never bounced back; Hyeon’s map tells you where to push for recovery.
Greenlee et al. (2024) listed ten ways to measure peer connection; pair their tools with Hyeon’s findings and you can track both movement and friendship gains.
Why it matters
You now have a checklist: child skills, parent worries, peer invites, program slots, and policy support. Rate each layer for every client, then pick the weakest spot and start there.
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02At a glance
03Original abstract
BACKGROUND: Children and adolescents with Down syndrome (DS) are at risk of obesity due to a reduced level of physical activity (PA). PA in children and adolescents with DS is a multifaceted phenomenon that includes personal, relationship, community and other social factors. Hence, a comprehensive understanding of how each component interacts with the others is required. Based on the socio-ecological model, this study aimed to identify the socio-ecological factors associated with PA in children and adolescents with DS through a mixed-methods systematic review. METHODS: A systematic search was performed using PubMed, CINAHL, PsycINFO and Web of Science databases in February 2024. Inclusion criteria were studies investigating factors related to PA, involving at least one of the target populations (children and adolescents with DS or their parents), published in peer-reviewed journals and written in English. Studies assessing the effectiveness of PA, systematic reviews and unpublished studies were excluded. The methodology was appraised using the Mixed Methods Appraisal Tool. Data were extracted and synthesised in a sequential explanatory design using the socio-ecological model. RESULTS: Databases were searched for 1022 articles; 17 studies (10 quantitative and 7 qualitative) were included and synthesised in this review. Based on the socio-ecological model, the following factors were identified at four levels: (1) physical and cognitive ability to participate in PA at the personal level, (2) competing family responsibilities and overprotective parenting at the family level, (3) peer support and community programmes at the community level and (4) absence of state support for PA programmes at the policy level. CONCLUSIONS: To support the PA of children and adolescents with DS, factors affecting PA at the personal, family, community and policy levels must be considered. Community stakeholders and policymakers can use the findings of this review to develop and improve programmes for children and adolescents with DS.
Journal of intellectual disability research : JIDR, 2026 · doi:10.1111/jir.70092