Why physical health matters so much
Adults with intellectual disability are among the least active groups in the community. A systematic review found they achieve only around 17.5 to 33 per cent of the recommended physical activity levels. Low activity contributes to higher rates of obesity, heart disease, type 2 diabetes, constipation and poor mood and it can also limit confidence and social opportunities.
The same review found regular physical activity had a moderate to strong positive effect on weight, sedentary behaviour and quality of life. The key is finding an approach the person enjoys and can keep doing with the supports they already have.
What OT and EP each bring
Exercise physiology
- Fun, structured programs built around the person's interests
- Visual schedules and simple, consistent instructions
- Strength, balance, coordination and cardio fitness
- Weight management and heart health
- Community-based exercise: parks, pools, gyms and walking groups
- Training support workers so exercise happens between visits
Occupational therapy
- Daily living skills: cooking, cleaning, dressing and hygiene
- Money handling, shopping and using public transport
- Sensory assessment and regulation strategies
- Fine motor skills for writing, phones and fastenings
- Supporting moves towards more independent living
- Functional capacity assessments for NDIS plan reviews
Learning skills that stick
People with intellectual disability often learn best through repetition in the real setting, with the task broken into small steps. OTs are trained in task analysis: breaking a skill like making a sandwich or catching a bus into clear, teachable steps and then fading support over time.
EP and OT can reinforce each other here. A walk to the local shops becomes both cardio training and a chance to practise road safety, money handling and following a shopping list. Carrying groceries becomes functional strength training. Working this way means more progress from the same NDIS budget.
Example: A 22-year-old participant with Down syndrome wants to move into a shared living arrangement with friends. The OT works on cooking simple meals, doing laundry and a morning routine using a picture schedule. The EP runs a twice-weekly program at the local gym focused on leg strength, endurance and a healthy weight, with a support worker trained to run a third session each week. Both clinicians report progress towards the same living goal.
Down syndrome: specific considerations
People with Down syndrome often have low muscle tone, very flexible joints and flat feet. This can affect posture, balance and endurance. Heart conditions, thyroid problems and sleep apnoea are also more common. A small number of people have instability in the upper neck (atlantoaxial instability), so exercises and activities that put heavy load on the neck, such as somersaults or diving, need care.
Your exercise physiologist will review medical history before starting and focus on building joint stability through strength training rather than stretching already-flexible joints. Your OT considers the same factors when recommending footwear, seating and equipment.
Making it work with support workers and families
Therapy sessions are only one or two hours a week. The real change happens in between. At Exercare we write simple home programs with photos, train support workers and family members and keep goals consistent between OT and EP so everyone around the person is using the same approach.
Practical therapy that fits real life
Exercare visits at home, at day programs or in the community across Melbourne: exercise physiology in the south-east and east and occupational therapy in the north-east, east and inner suburbs. One NDIS intake form covers both.
NDIS funding
Intellectual disability is one of the largest primary disability groups in the NDIS. Both are usually funded from your Capacity Building budget, most often under Improved Daily Living Skills (Category 15). Exercise physiology can also be funded under Improved Health and Wellbeing (Category 12). Equipment and home modification recommendations from your OT are funded from your Capital budget. Where a participant is self-managed or plan-managed, they can choose any registered or unregistered provider. Agency-managed participants need a registered provider.
Evidence referenced in this article
- A systematic review of physical activity: benefits and needs for maintenance of quality of life among adults with intellectual disability. Frontiers in Sports and Active Living, 2023.
- Atlantoaxial instability in people with Down syndrome. Adult Down Syndrome Center.
- Ligamentous laxity in people with Down syndrome. Adult Down Syndrome Center.
Written by the Exercare allied health team. This article is general information only and is not a substitute for individual medical advice. Exercare provides mobile exercise physiology and NDIS occupational therapy across south-east and eastern Melbourne.
OT services mentioned in this article:
Adult OT → · Paediatric OT →
Frequently asked questions
Can the NDIS fund exercise physiology for someone with intellectual disability?
Yes. Exercise physiology can be funded under Capacity Building where it links to the participant's goals, such as improving health, fitness, independence or community participation.
What does an OT do for adults with intellectual disability?
OTs teach practical daily living skills such as cooking, cleaning, personal care, shopping and travel, assess sensory needs and support moves towards more independent living.
Is exercise safe for people with Down syndrome?
Yes and it is strongly encouraged. Your exercise physiologist will check heart and thyroid history, screen for neck symptoms and focus on building strength to support flexible joints.
Can support workers be involved in sessions?
Yes and we encourage it. We train support workers and families to run home programs so progress continues between therapy visits.