Dose–response relationship of physical exercise interventions for balance performance in children and adolescents with intellectual disabilities: a systematic review and meta-analysis

Abstract

Objective: To systematically evaluate the impact of exercise interventions on balance performance in children and adolescents with intellectual disabilities and examine the dose–response relationship of key intervention parameters. Methods: A comprehensive search of PubMed, Web of Science, Embase, Scopus, and the Cochrane Library identified eligible randomized controlled trials (RCTs). Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Subgroup analyses and non-linear meta-regression were performed to explore potential effect modifiers and dose–response patterns. Results: A total of 23 eligible studies comprising 31 datasets and 1,179 participants were included. Pooled analysis showed significant improvement in balance performance [SMD = 0.69, 95% CI (0.48, 0.89), p < 0.001]. Dose–response modeling indicated maximal benefit at approximately 717 MET·min/week (Hedges' g = 0.76). Subgroup analyses revealed greater effects with a frequency of ≥3 sessions/week [SMD = 0.76, 95% CI (0.48, 1.03), p < 0.001], session duration >60 min [SMD = 0.82, 95% CI (0.35, 1.29), p = 0.001], and intervention period < 8 weeks [SMD = 0.78, 95% CI (0.46, 1.10), p < 0.001]. Conclusion: Moderate-dose exercise (717 MET·min/week) can significantly improve the balance performance in children and adolescents with intellectual disabilities, with specific frequency, duration, and intervention period combinations yielding superior outcomes. These findings provide an evidence-based basis for precision health strategies. However, moderate heterogeneity highlights the need for confirmation through larger, multicenter, and long-term trials.