Objective: This study systematically investigates the efficacy of exercise interventions in improving balance ability among children with Down syndrome (DS), aiming to establish a robust evidence-based foundation for future research and clinical practice. Through rigorous methodological analysis, the research seeks to inform the development of scientifically grounded, rational, and efficient personalized exercise intervention programs. The findings are expected to provide both theoretical frameworks and practical guidelines for optimizing motor skill rehabilitation strategies, thereby contributing to the enhancement of physical and mental well-being in this vulnerable population. This investigation underscores the critical intersection of evidence-based kinesiology and special needs rehabilitation, offering multidimensional insights for advancing targeted therapeutic approaches in developmental disability management. Methods: A comprehensive literature search was conducted across multiple electronic databases including PubMed, Embase, Web of Science, and Cochrane Library to identify relevant studies investigating exercise interventions for balance improvement in children and adolescents with Down syndrome. Two independent researchers systematically performed study screening and data extraction following predefined inclusion/exclusion criteria. The methodological quality of included studies was assessed using the Cochrane Risk of Bias Tool for randomized controlled trials. Statistical analyses were executed utilizing Review Manager 5.4 (RevMan) and Stata 15.1 software packages, with meta-analytical procedures implemented to quantify intervention effects, assess heterogeneity (I² statistics), and evaluate publication bias through funnel plot analysis and Egger's regression test. This dual-analyst approach with cross-verification mechanisms ensured methodological rigor in data synthesis and interpretation. Results: This systematic review incorporated 17 eligible studies involving 500 children and adolescents with Down syndrome (aged 0-17 years) from multinational cohorts spanning Egypt, India, Germany, Turkey, and other regions. The implemented interventions encompassed core strength training, dual-task balance exercises, traditional Indian dance, and equine-assisted therapy, with outcomes assessed through diverse measurement instruments.Meta-analytic synthesis revealed statistically significant improvements in balance control measured by the Biodex Stability System (BSS) across 7 studies [I²=74%, pooled SMD=-0.342 (95% CI: -0.450 to -0.233), P<0.01]. Sensitivity analysis excluding studies with substantial heterogeneity maintained significance [I²=65%, SMD=-0.387 (95% CI: -0.508 to -0.265), P<0.01]. Three studies utilizing the Bruininks-Oseretsky Test of Motor Proficiency (BOTMP) demonstrated clinically meaningful enhancements [I²=62%, MD=8.296 (5.792-10.800), P<0.01], with heterogeneity fully resolved upon outlier removal [I²=0%, MD=6.868 (4.586-9.150), P<0.01]. Conversely, no statistically significant effects were observed in three trials employing the Pediatric Balance Scale (PBS) [I²=80%, MD=1.363 (-0.963-3.689), P=0.251], potentially attributable to measurement insensitivity or intervention-protocol mismatch. Conclusion:The available evidence substantiates that exercise interventions demonstrate significant efficacy in enhancing postural control and balance performance among children and adolescents with Down syndrome.

The authors have declared that no competing interests exist.

The author(s) received no specific funding for this work.

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