The Adoption of the GameSquad Exergaming Intervention for Young Adults with Down Syndrome: A Qualitative Analysis

Adults with Down syndrome face persistent barriers to physical activity, including mobility limitations, lack of accessible programming, and low self-efficacy. Exergaming represents a potentially scalable, home-based approach to increasing physical activity in this population.

This qualitative study explored the experiences, preferences, and perceived barriers of young adults with Down syndrome and their live-in caregivers who participated in a 12-week exergaming intervention. The program paired the narrative-based game Ring Fit Adventure ^™ (Nintendo Switch^™) with weekly 15-minute virtual health coaching sessions designed to review weekly progress, reinforce the importance of moderate-to-vigorous physical activity address any technical issues (e.g., related to the game, system, or Fitbit), and provide social support and encouragement.

Twenty adults with Down syndrome (M age= 23.2 ± 3.9, 85% non-Hispanic white, 65% female) enrolled and 19 completed the trial. One participant ceased communication with the research team after completing pre-testing. Semi-structured exit interviews were conducted with participants and their caregivers. Interviews were transcribed verbatim and analyzed using reflexive thematic analysis. Themes were developed iteratively using a six-step framework.

Through analysis, we identified five distinct themes that reflect shared and unique experiences related to 1) engagement, 2) autonomy, 3) physical challenge, 4) technology, and 5) long-term value. Participants were motivated by the immersive game design and reported a preference for playing independently. Caregivers described their roles in supporting routine formation and providing occasional technical assistance.

Exergaming, supported by light-touch health coaching, was perceived as an engaging, accessible, and sustainable strategy to increase physical activity among young adults with Down syndrome. These findings support the design of home-based interventions that promote autonomy and long-term adherence for individuals with intellectual disabilities.