A systematic review of 22 randomized controlled trials found that hopping/jumping training, simplified boxing, and general balance training showed promise for improving balance in children and adolescents with intellectual disabilities . The overall evidence quality was low to very low, meaning these findings are hypothesis-generating rather than sufficient for strong clinical recommendations.
Intellectual disability affects balance development in children, with research showing this population experiences particular difficulty with postural control and coordination. These deficits can limit physical activity participation and independence. The researchers conducted a comprehensive network meta-analysis to determine which exercise approaches work best, systematically reviewing 22 randomized controlled trials published across multiple databases (PubMed, Scopus, Cochrane Library, and others).
Three exercise interventions showed the largest effect sizes. The Hopping and Jumping Training Programme (HJP) demonstrated the strongest effect, with a mean difference of 16.60 points on balance measures (95% CI: 13.18 to 20.02). Simplified Five-Step Boxing (SFSB) showed a more modest but still meaningful improvement of 2.09 points (95% CI: 1.43 to 3.04). General Balance Training (BT) produced a mean difference of 1.40 points (95% CI: 0.50 to 2.30). All three interventions outperformed control conditions, suggesting exercise itself provides benefit.
However, the researchers issued a critical caveat: the overall certainty of the evidence was rated as low to very low across the included studies. This assessment reflects limitations in study design, sample reporting, and heterogeneity in how balance was measured. The authors explicitly stated that these findings are "hypothesis-generating rather than definitive" and that "strong clinical recommendations cannot be made" based on current evidence. This distinction matters. While the direction of effect appears positive, the quality of supporting evidence does not yet justify confident clinical implementation.
The Hopping and Jumping Training Programme's larger effect size stands out, though researchers note this may reflect both the intensity of the intervention and potential bias in the included trials. The relatively smaller effects for boxing and general balance training, while still positive, underscore that different exercise modalities produce different degrees of benefit. The variation in outcomes also highlights why individual responses may differ and why personalization of exercise programming remains important.
If you work with or care for children or adolescents with intellectual disabilities, this research signals that structured exercise interventions targeting balance are worth considering as part of comprehensive care, while acknowledging the evidence base is still developing. The finding that multiple exercise types showed benefit (not just one specific method) suggests flexibility in choosing an approach based on individual preference and feasibility.
For practitioners designing interventions, the relatively strong performance of hopping and jumping exercises provides a concrete starting point, though the low certainty of evidence means outcomes should be monitored individually rather than assumed. These findings also highlight a research gap: higher quality, larger trials with standardized outcome measures are needed before definitive recommendations can be made.
The broader implication is that physical activity remains valuable for this population, consistent with existing guidelines, but the specific question of "which exercise works best for balance" requires further investigation. Don't treat these findings as established clinical fact, but rather as an evidence-informed direction for continued exploration and assessment.
| Attribute | Value |
|---|---|
| Study type | Systematic review and network meta-analysis |
| Number of trials included | 22 RCTs |
| Population | Children and adolescents with intellectual disabilities |
| Interventions examined | Hopping/jumping training, boxing, balance training, and others |
| Primary outcome | Balance performance |
| Effect sizes | HJP: MD 16.60 (95% CI 13.18-20.02); SFSB: MD 2.09 (95% CI 1.43-3.04); BT: MD 1.40 (95% CI 0.50-2.30) |
| Evidence quality | Low to very low certainty |
| Journal | Frontiers in Public Health |
| Publication status | Published |
| PROSPERO registration | CRD420251208290 |
Frontiers in Public Health. https://pubmed.ncbi.nlm.nih.gov/42630433/
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