Socio-Ecological Factors of Physical Activity in Children and Adolescents With Down Syndrome: A Mixed-Methods Systematic Review

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 Studies assessing the effectiveness of PA, systematic reviews and unpublished studies were excluded.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.