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Design and Development of 'Building Opportunities for Optimal physical activity Skills Training in children with Down Syndrome (BOOST-DS)' Programme and its Content Validation through Consensus using Modified Delphi method.

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Title: Design and Development of 'Building Opportunities for Optimal physical activity Skills Training in children with Down Syndrome (BOOST-DS)' Programme and its Content Validation through Consensus using Modified Delphi method.
Authors: Megha Jain V; Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka, India., Rao BK; Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka, India., Ramachandran S; Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka, India.
Corporate Authors: Delphi Expert Panel
Source: Journal of intellectual disability research : JIDR [J Intellect Disabil Res] 2026 Aug; Vol. 70 (8), pp. 811-822. Date of Electronic Publication: 2026 May 22.
Publication Type: Journal Article
Language: English
Journal Info: Publisher: Blackwell Scientific Publications on behalf of the Royal Society for Mentally Handicapped Children and Adults Country of Publication: England NLM ID: 9206090 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1365-2788 (Electronic) Linking ISSN: 09642633 NLM ISO Abbreviation: J Intellect Disabil Res Subsets: MEDLINE
Imprint Name(s): Original Publication: Oxford, UK : Blackwell Scientific Publications on behalf of the Royal Society for Mentally Handicapped Children and Adults, 1992-
MeSH Terms: Down Syndrome*/rehabilitation , Exercise Therapy*/methods , Exercise Therapy*/standards , Program Development*/standards , Exercise*, Humans ; Delphi Technique ; Child ; Consensus ; Female ; Male
Abstract: Background: Children with Down syndrome (DS) often do not meet daily physical activity requirements, which affects their participation in daily activities and overall quality of life. Structured physical activity programmes could address these issues, but accessible, participation-based activities are limited.
Method: The Building Opportunities for Optimal physical activity Skills Training in children with Down Syndrome (BOOST-DS) programme was designed, developed and content validated in three phases. A conceptual framework was developed from the relevant literature, followed by the identification physical activity components through brainstorming and discussions. The final content validation phase involved expert consensus using a modified Delphi method.
Results: The BOOST-DS identified 62 active play items across six domains of physical activity. After three Delphi rounds, 53 items achieved expert agreement.
Conclusion: The content-validated BOOST-DS programme includes 53 play-based activities across six physical activity domains to enhance participation outcomes in children with DS.
Trial Registration: The study was registered in the Clinical Trial Registry of India: CTRI/2023/08/056291 on 5 August 2023.
(© 2026 The Author(s). Journal of Intellectual Disability Research published by MENCAP and John Wiley & Sons Ltd.)
References: Alba‐Rueda, A., J. A. Moral‐Munoz, A. De Miguel‐Rubio, and D. Lucena‐Anton. 2022. “Exergaming for Physical Therapy in Patients With Down Syndrome: A Systematic Review and Meta‐Analysis of Randomised‐Controlled Trials.” Games for Health Journal 11, no. 2: 67–78. https://doi.org/10.1089/g4h.2021.0172.
Alhammad, S. A., A. S. Alqahtani, K. S. Alwadeai, M. F. Algabbani, and A. A. Alhusaini. 2024. “Walking Capacity and Its Association With Quality of Life Among Children With Down Syndrome in Saudi Arabia.” BMC Pediatrics 24, no. 1: 55. https://doi.org/10.1186/s12887‐023‐04519‐8.
Alhusaini, A. A., M. A. Al‐Walah, G. R. Melam, and S. Buragadda. 2020. “Variables Correlated With Physical Activity and Conformance to Physical Activity Guidelines in Healthy Children and Children With Down Syndrome.” Physikalische Medizin, Rehabilitationsmedizin, Kurortmedizin 30, no. 3: 141–145. https://doi.org/10.1055/a‐1068‐9610.
Alqahtani, A. S., M. F. Algabbani, S. A. Alhammad, K. S. Alwadeai, and A. Alhusaini. 2024. “Physical Activity Status and Its Association With Quality of Life Among Children With Down Syndrome in Saudi Arabia: A Comparative Cross‐Sectional Study.” PLoS ONE 19, no. 2: e0297111. https://doi.org/10.1371/journal.pone.0297111.
Altman, M., T. T. K. Huang, and J. Y. Breland. 2018. “Design Thinking in Health Care.” Preventing Chronic Disease 15: E117. https://doi.org/10.5888/pcd15.180128.
Astuti, Y., B. Erhan Orhan, Erianti, D. Amsari, and D. Novita Sari. 2024. “Improving Fundamental Motor Skills in Children With Intellectual Disabilities Through Adapted Sports and Games.” Journal of Physical Education and Sport 24, no. 1: 96–102. https://doi.org/10.7752/jpes.2024.01013.
Bahiraei, S., E. Nasab Firouzjah, and A. Abbaszadeh. 2023. “Exercise Training to Improve Balance Ability for Individuals With Down Syndrome: A Systematic Review and Meta‐Analysis.” Advances in Rehabilitation 37, no. 1: 12–22. https://doi.org/10.5114/areh.2023.124256.
Barr, M., and N. Shields. 2011. “Identifying the Barriers and Facilitators to Participation in Physical Activity for Children With Down Syndrome.” Journal of Intellectual Disability Research 55, no. 11: 1020–1033. https://doi.org/10.1111/j.1365‐2788.2011.01425.x.
Bull, F. C., S. S. Al‐Ansari, S. Biddle, et al. 2020. “World Health Organisation 2020 Guidelines on Physical Activity and Sedentary Behaviour.” British Journal of Sports Medicine 54, no. 24: 1451–1462. https://doi.org/10.1136/bjsports‐2020‐102955.
Di Fabrizio, G., M. C. Parisi, C. Crescimanno, F. Orofino, M. Frattalemi, and O. G. M. Mingrino. 2021. “Global Postural Evaluation and Motor Treatment in the Subject With Down Syndrome: Clinical Case Reports.” Journal of Human Sport and Exercise ‐ 2021 ‐ Winter Conferences of Sports Science 16: S938–S962. https://doi.org/10.14198/jhse.2021.16.Proc3.11.
Downs, S. J., L. M. Boddy, Z. R. Knowles, S. J. Fairclough, and G. Stratton. 2013. “Exploring Opportunities Available and Perceived Barriers to Physical Activity Engagement in Children and Young People With Down Syndrome.” European Journal of Special Needs Education 28, no. 3: 270–287. https://doi.org/10.1080/08856257.2013.768453.
El, Ç., and E. D. Hüzmeli. 2020, May 13. “Investigation of the Relationship Between Physical Activity and Body Mass Index in Children With Down Syndrome.” Journal of Pediatric Research 7, no. 2: 92–96. https://doi.org/10.4274/jpr.galenos.2019.95530.
Ferreira, F. K., E. H. Song, H. Gomes, E. B. Garcia, and L. M. Ferreira. 2015. “New Mindset in Scientific Method in the Health Field: Design Thinking.” Clinics 70, no. 12: 770–772. https://doi.org/10.6061/clinics/2015(12)01.
Georgiadis, E. 2021. “Design Thinking Applications in Physical Activity and Exercise Literacy.” In Contemporary Advances in Sports Science, edited by R. Taiar. IntechOpen. https://doi.org/10.5772/intechopen.97479.
Hojlo, M. A., A. L. Milliken, N. T. Baumer, and E. J. Davidson. 2022. “DSFit: A Feasibility Pilot Study of a Group Exercise Programme for Adolescents With Down Syndrome.” Journal of Intellectual Disability Research 66, no. 12: 952–966. https://doi.org/10.1111/jir.12977.
Imms, C., B. Adair, D. Keen, A. Ullenhag, P. Rosenbaum, and M. Granlund. 2016. “‘Participation’: A Systematic Review of Language, Definitions, and Constructs Used in Intervention Research With Children With Disabilities.” Developmental Medicine and Child Neurology 58, no. 1: 29–38. https://doi.org/10.1111/dmcn.12932.
Jacinto, M., R. Oliveira, J. P. Brito, A. D. Martins, R. Matos, and J. P. Ferreira. 2021. “Prescription and Effects of Strength Training in Individuals With Intellectual Disability—A Systematic Review.” Sports 9, no. 9: 125. https://doi.org/10.3390/sports9090125.
Jain, P. D., A. Nayak, S. D. Karnad, and K. N. Doctor. 2021. “Gross Motor Dysfunction and Balance Impairments in Children and Adolescents With Down Syndrome: A Systematic Review.” Clinical and Experimental Pediatrics 65, no. 3: 142–149. https://doi.org/10.3345/cep.2021.00479.
Johnson, M., V. Nocera, N. Kaushal, L. Simon, R. Hasson, and ACSM Strategic Health Initiative on Health Equity. 2021, March 22. “Why We Must Prioritise Equitable Access to Physical Activity for Children With Disabilities.” ACSM_CMS. https://www.acsm.org/blog‐detail/acsm‐blog/2021/03/22/prioritize‐equitable‐access‐to‐physical‐activity‐for‐children‐with‐disabilities.
Johnstone, A., A. R. Hughes, L. Bonnar, J. N. Booth, and J. J. Reilly. 2019. “An Active Play Intervention to Improve Physical Activity and Fundamental Movement Skills in Children of Low Socio‐Economic Status: Feasibility Cluster Randomised Controlled Trial.” Pilot and Feasibility Studies 5, no. 1: 45. https://doi.org/10.1186/s40814‐019‐0427‐4.
Kamińska, K., M. Ciołek, K. Krysta, and M. Krzystanek. 2023. “Benefits of Treadmill Training for Patients With Down Syndrome: A Systematic Review.” Brain Sciences 13, no. 5: 808. https://doi.org/10.3390/brainsci13050808.
Kang, L.‐J., R. J. Palisano, G. A. King, and L. A. Chiarello. 2014. “A Multidimensional Model of Optimal Participation of Children With Physical Disabilities.” Disability and Rehabilitation 36, no. 20: 1735–1741. https://doi.org/10.3109/09638288.2013.863392.
Kashi, A., H. Dawes, M. Mansoubi, and Z. Sarlak. 2023. “The Effect of a Physical Exercise Package on the Motor Proficiency of Students With Down Syndrome.” Iranian Journal of Pediatrics 33, no. 1: e120408. https://doi.org/10.5812/ijp‐120408.
Kaur, A., and A. Kaur. 2020. “Assessment of Risk Factor Associated With Down Syndrome: Journal of the Pediatrics Association of India.” Journal of the Pediatrics Association of India 9, no. 1: 24–30. https://doi.org/10.4103/jpai.jpai_3_20.
Khan, R. 2016. “How Frugal Innovation Promotes Social Sustainability.” Sustainability 8, no. 10: Article 10. https://doi.org/10.3390/su8101034.
Kumar, S. G., G. Roy, and S. S. Kar. 2012. “Disability and Rehabilitation Services in India: Issues and Challenges.” Journal of Family Medicine and Primary Care 1, no. 1: 69–73. https://doi.org/10.4103/2249‐4863.94458.
Lakhan, R., and M. T. Kishore. 2016. “Down Syndrome in Tribal Population in India: A Field Observation.” Journal of Neurosciences in Rural Practice 7: 40–43. https://doi.org/10.4103/0976‐3147.172167.
Li, R., C. H. P. Sit, J. J. Yu, et al. 2016. “Correlates of Physical Activity in Children and Adolescents With Physical Disabilities: A Systematic Review.” Preventive Medicine 89: 184–193. https://doi.org/10.1016/j.ypmed.2016.05.029.
Lin, H.‐C., and Y.‐P. Wuang. 2012. “Strength and Agility Training in Adolescents With Down Syndrome: A Randomized Controlled Trial.” Research in Developmental Disabilities 33, no. 6: 2236–2244. https://doi.org/10.1016/j.ridd.2012.06.017.
Lubans, D. R., C. Lonsdale, K. Cohen, et al. 2017. “Framework for the Design and Delivery of Organized Physical Activity Sessions for Children and Adolescents: Rationale and Description of the ‘SAAFE’ Teaching Principles.” International Journal of Behavioral Nutrition and Physical Activity 14, no. 1: 24. https://doi.org/10.1186/s12966‐017‐0479‐x.
Marra, L. R., K. Stanton‐Nichols, Y. Hong, K. Gottschild, I. Pirzadeh, and S. Stamatis. 2018. “Design Thinking as a Strategic Planning Tool for Adapted Physical Activity Programs Within a University Setting.” PALAESTRA 32, no. 4: Article 4. https://js.sagamorepub.com/index.php/palaestra/article/view/9523.
McGarty, A., N. Jones, K. Rutherford, et al. 2021. “Feasibility of the Go2Play Active Play Intervention for Increasing Physical and Social Development in Children With Intellectual Disabilities.” Pilot and Feasibility Studies 7, no. 1: 43. https://doi.org/10.1186/s40814‐021‐00783‐6.
Mero Piedra, A. L., O. Pesthy, and K. Marton. 2024. “Effects of a Physical Education Intervention on Attention and Inhibitory Control in Ecuadorian Children With Intellectual Disabilities.” Journal of Intellectual Disabilities 28, no. 1: 261–274. https://doi.org/10.1177/17446295231189018.
Milroy, J. J., L. R. Oakes, and B. D. Hickerson. 2021. “Design Thinking: Assessing the Health Needs of College Students With Intellectual and/or Developmental Disabilities.” Journal of Applied Research in Intellectual Disabilities 34, no. 6: 1408–1420. https://doi.org/10.1111/jar.12882.
Phillips, A. C., and A. J. Holland. 2011. “Assessment of Objectively Measured Physical Activity Levels in Individuals With Intellectual Disabilities With and Without Down's Syndrome.” PLoS ONE 6, no. 12: e28618. https://doi.org/10.1371/journal.pone.0028618.
Pitetti, K., T. Baynard, and S. Agiovlasitis. 2013. “Children and Adolescents With Down Syndrome, Physical Fitness and Physical Activity.” Journal of Sport and Health Science 2, no. 1: 47–57. https://doi.org/10.1016/j.jshs.2012.10.004.
Priyono, A., U. Sahudi, and Y. Hendrayana. 2021. “Improvement on Gross Motor Skills of Intellectual Disability Students Through Games.” International Journal of Human Movement and Sports Sciences 9, no. 4A: 20–24. https://doi.org/10.13189/saj.2021.091304.
Regaieg, G., G. Kermarrec, and S. Sahli. 2020. “Designed Game Situations Enhance Fundamental Movement Skills in Children With Down Syndrome.” Journal of Intellectual Disability Research 64, no. 4: 271–279. https://doi.org/10.1111/jir.12717.
Ritter, S. M., and N. M. Mostert. 2018. “How to Facilitate a Brainstorming Session: The Effect of Idea Generation Techniques and of Group Brainstorm After Individual Brainstorm.” Creative Industries Journal 11, no. 3: 263–277. https://doi.org/10.1080/17510694.2018.1523662.
Rodríguez‐Grande, E.‐I., O.‐C. Vargas‐Pinilla, M.‐R. Torres‐Narvaez, and N. Rodríguez‐Malagón. 2022. “Neuromuscular Exercise in Children With Down Syndrome: A Systematic Review.” Scientific Reports 12, no. 1: 14988. https://doi.org/10.1038/s41598‐022‐19086‐8.
Ross, S. M., K. R. Bogart, S. W. Logan, L. Case, J. Fine, and H. Thompson. 2016. “Physical Activity Participation of Disabled Children: A Systematic Review of Conceptual and Methodological Approaches in Health Research.” Frontiers in Public Health 4: 187. https://doi.org/10.3389/fpubh.2016.00187.
Sallis, J. F., J. J. Prochaska, and W. C. Taylor. 2000. “A Review of Correlates of Physical Activity of Children and Adolescents.” Medicine & Science in Sports & Exercise 32, no. 5: 963–975.
Sarkar, S., and S. Mateus. 2022. “Doing More With Less—How Frugal Innovations Can Contribute to Improving Healthcare Systems.” Social Science & Medicine 306: 115127. https://doi.org/10.1016/j.socscimed.2022.115127.
Shang, Z. 2023. “Use of Delphi in Health Sciences Research: A Narrative Review.” Medicine 102, no. 7: e32829. https://doi.org/10.1097/MD.0000000000032829.
Shields, N., and A. Synnot. 2016. “Perceived Barriers and Facilitators to Participation in Physical Activity for Children With Disability: A Qualitative Study.” BMC Pediatrics 16, no. 1: 9. https://doi.org/10.1186/s12887‐016‐0544‐7.
Sugimoto, D., S. L. Bowen, W. P. Meehan, and A. Stracciolini. 2016. “Effects of Neuromuscular Training on Children and Young Adults With Down Syndrome: Systematic Review and Meta‐Analysis.” Research in Developmental Disabilities 55: 197–206. https://doi.org/10.1016/j.ridd.2016.04.003.
Teixeira, P. J., E. V. Carraça, D. Markland, M. N. Silva, and R. M. Ryan. 2012. “Exercise, Physical Activity, and Self‐Determination Theory: A Systematic Review.” International Journal of Behavioral Nutrition and Physical Activity 9, no. 1: 78. https://doi.org/10.1186/1479‐5868‐9‐78.
Wang, Y., X. Wu, and H. Chen. 2023. “Badminton Improves Executive Function in Adults Living With Mild Intellectual Disability.” International Journal of Environmental Research and Public Health 20, no. 4: 3673. https://doi.org/10.3390/ijerph20043673.
Wentz, E. E., J. Looper, K. S. Menear, D. Rohadia, and N. Shields. 2021. “Promoting Participation in Physical Activity in Children and Adolescents With Down Syndrome.” Physical Therapy 101, no. 5: pzab032. https://doi.org/10.1093/ptj/pzab032.
Weyrauch, T., and C. Herstatt. 2016. “What Is Frugal Innovation? Three Defining Criteria.” Journal of Frugal Innovation 2, no. 1: 1. https://doi.org/10.1186/s40669‐016‐0005‐y.
Wolcott, M. D., J. E. McLaughlin, D. K. Hubbard, T. R. Rider, and K. Umstead. 2021. “Twelve Tips to Stimulate Creative Problem‐Solving With Design Thinking.” Medical Teacher 43: 501–508. https://doi.org/10.1080/0142159X.2020.1807483.
World Health Organization, World Bank. 2011. “World Report on Disability 2011 World Health Organization.” https://iris.who.int/handle/10665/44575.
Yang, W., X. Liang, and C. H.‐P. Sit. 2022. “Physical Activity and Mental Health in Children and Adolescents With Intellectual Disabilities: A Meta‐Analysis Using the RE‐AIM Framework.” International Journal of Behavioral Nutrition and Physical Activity 19: 80. https://doi.org/10.1186/s12966‐022‐01312‐1.
Zhu, G., K. Chen, C. Ling, P. Zhao, and L. Guo. 2023. “The Impact of Physical Activity on Cognitive Function in Children and Adolescents With Intellectual Disabilities: A Meta‐Analysis.” International Journal of Human Movement and Sports Sciences 11, no. 6: 1253–1265. https://doi.org/10.13189/saj.2023.110609.
Contributed Indexing: Investigator: D Expert Panel; BSS Kanna; DP Poojari; D Metgud; K Joshi; M Vijaykumar; R Attal; R Alva; ST Parmar; SD Karnad; SE Joseph; T Mohanty
Keywords: agility; balance; children with Down syndrome; coordination; endurance; exercise programme; flexibility; physical activity participation; strength
Entry Date(s): Date Created: 20260522 Date Completed: 20260702 Latest Revision: 20260726
Update Code: 20260726
PubMed Central ID: PMC13327175
DOI: 10.1111/jir.70119
PMID: 42172083
Database: MEDLINE
Description
ISSN:1365-2788
DOI:10.1111/jir.70119