Physical activity improves motor skills and body composition in children with intellectual disabilities

BACKGROUND: The development of fundamental motor skills (FMS) and changes in body composition among children and adolescents with intellectual and developmental disabilities (IDD) are an emerging public health issue. Physical activity serves as a dual protective mechanism, enhancing motor skills and optimizing body composition. Yet no systematic reviews have been published examining the effects of structured exercise programs on both FMS progression and weight management in this population. METHODS: Web of Science, PubMed, Cochrane Library, and Medline databases were searched for peer-reviewed English-language literature, from the establishment of the database to October 1, 2025. Risk of bias was assessed using a modified Cochrane Collaboration's tool and PEDro scale. The inclusion criteria comprised randomized or controlled trial that reported on FMS or body composition in children and adolescents (4-18 years) with IDD. Subgroup analyses were performed according to the type of physical activity. RESULTS: Thirty-three studies ( = 5,245, average age ranging from 4 to 18 years) were included. Physical activity significantly improved FMS (standard mean difference (SMD) = 1.21, 95% CI [0.85-1.57],  < 0.001). Subgroup analyses showed significant improvements in locomotor skills (SMD = 1.13, 95% CI [0.83-1.42],  < 0.001) and object control skills (SMD = 0.87, 95% CI [0.57-1.17],  < 0.001). Among physical activity types, virtual reality (VR) games (SMD = 1.00, 95% CI [0.60-1.40],  < 0.001), motor skills (SMD = 1.79, 95% CI [1.11-2.47],  < 0.001), and sport-specific programs (SMD = 1.13, 95% CI [0.57-1.70],  < 0.001) improved the FMS. In terms of body composition, moderate intensity continuous training (MICT) significantly reduced body mass index (SMD = -0.29, 95% CI [-0.50 to -0.08],  = 0.006) and body fat percentage (SMD = -0.55, 95% CI [-1.01 to -0.09],  = 0.020). In contrast, the reduction in waist circumference was not significant (SMD = -0.32, 95% CI [-0.69 to 0.04],  = 0.080). CONCLUSION: Our findings identify interventions focused on motor skills and MICT as effective strategies for improving FMS and body composition in this population, which may lay a foundation for their long-term health. In contrast, VR games have limited empirical support based on our assessment of the evidence quality.