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The effects and durability of an 8-week dynamic neuromuscular stabilization program on balance and coordination in adult males with intellectual disabilities: a randomized controlled trial

BMC Sports Science, Medicine and Rehabilitation volume 17, Article number: 18 (2025) Cite this article

Abstract

Background

Individuals with intellectual disabilities (IDs) often exhibit lower levels of physical fitness, including reduced balance and neuromuscular coordination, compared to the general population. Dynamic neuromuscular stabilization (DNS) training has been proposed as a potential intervention to improve physical fitness in this population, but its effectiveness and durability on specific fitness components remain underexplored. This study aims to investigate the effects and durability of an 8-week DNS program on balance and coordination in adult males with IDs.

Methods

Thirty-one participants were randomly assigned to either an intervention group (n = 16) or a control group (n = 15). Balance and neuromuscular coordination were assessed at baseline, immediately after the intervention, and two months post-intervention using the Balance Error Scoring System (BESS), walking forward heel-to-toe test, and bilateral coordination test. The intervention group participated in the DNS training program for 8 weeks, with three sessions per week, while the control group maintained their usual activities.

Results

Analysis of the outcome measures revealed significant time, group, and time-group interaction effects. Post-hoc analyses indicated that the DNS group showed significantly greater improvements in BESS scores and coordination compared to the control group (p < 0.01). These improvements were maintained at the two-month follow-up assessment.

Conclusion

This study provides robust evidence that DNS exercises can significantly enhance balance and neuromuscular coordination in middle-aged males with IDs, with improvements maintained over two months post-training. However, the exclusive focus on male participants limits the extrapolation of these findings to the broader population of individuals with IDs, particularly females. Future investigations should aim to address this limitation by including more diverse samples to advance the generalizability and applicability of DNS-based interventions in this field.

Trial registration

RTC, Registered prospectively at the registry of the clinical trial (UMIN000053560), Registered on 07/02/2024.

Highlights

DNS improve Balance of Adults with Intellectual Disabilities.

DNS improve Walking of Adults with Intellectual Disabilities.

DNS improves Coordination in Adults with Intellectual Disabilities.

Peer Review reports

Background

Intellectual disability (ID), as delineated in the DSM-5 [1], is characterized by limitations in both intellectual functioning and adaptive behavior that manifest during the developmental period. Individuals with ID may exhibit variations in cognitive abilities, communication skills, social interactions, and motor skills [2]. This condition typically presents before the age of 18, with its prevalence estimated to affect approximately 1–3% of the global population, a trend consistent with findings in Iran [3]. While the prevalence of ID is reported to be 1.5 times higher in males than females [4], the differences in physical and motor characteristics between genders remain underexplored in this population. Research has indicated that males and females with IDs may exhibit distinct patterns of motor control, balance, and coordination due to variations in hormonal influences, neural architecture, and physical activity patterns (e.g., differences in participation in structured physical activities). Despite these known differences, the majority of studies, including the present investigation, have primarily focused on male participants, which limits the generalizability of findings [5]. ID is identified by intelligence quotient (IQ) scores below 70, along with difficulties in adaptive functioning, which impede the ability to perform daily tasks and engage fully in societal activities [6]. Despite the heterogeneous nature of experiences among individuals with intellectual disabilities, many encounter distinct challenges across various life domains that can adversely affect their independence and overall quality of life [7].

A prevalent challenge faced by individuals with intellectual disabilities is the manifestation of movement differences, particularly concerning postural control and balance [8]. These discrepancies may elevate the risk of falls, potentially resulting in injuries and subsequently diminishing overall quality of life. Contributing factors to postural instability within this population include visual impairments, proprioceptive differences, and variations in the vestibular system [9, 10]. Furthermore, alterations in the central nervous system (CNS), such as diminished processing speeds, atypical neural coordination, and differences in motor control, are frequently observed in individuals with ID [11, 12]. These CNS variations can significantly influence motor performance, including balance and coordination, thereby presenting challenges to an individual’s functional capacity and social participation [13].

Coordination, defined as the ability to execute both simple and complex movements smoothly and efficiently, is critical for balance, fine motor skills, and rhythmic actions [14]. Variations in motor coordination, which may present as difficulties in performing basic tasks (such as grasping objects or walking) or more complex movements (such as running or jumping), are frequently observed in individuals with intellectual disabilities [15, 16]. These challenges can significantly impact participation in activities of daily living (ADLs), including dressing, ambulating, or ascending stairs, all of which are vital for independent living [17]. Enhancing motor coordination can facilitate improved movement patterns, increase autonomy, and enable individuals with intellectual disabilities to perform tasks more efficiently and safely [15]. Furthermore, advancements in motor coordination may promote better social integration, as effective movement is essential for social adaptation and active engagement in community activities [18].

Physical activity has been demonstrated to provide numerous benefits for individuals with intellectual disabilities, including enhancements in physical health, mood, and social relationships [19]. Nonetheless, access to structured physical environments is often restricted, which may lead to decreased physical fitness and overall health within this population [20]. Regular exercise, particularly activities aimed at improving balance and coordination, has the potential to enhance both physical and psychological well-being [21]. Empirical evidence suggests that physical activity can diminish anxiety, elevate mood, and augment social engagement for individuals with intellectual disabilities [20, 21]. Consequently, interventions that prioritize movement quality and motor coordination are imperative for promoting the physical and mental health of individuals with intellectual disabilities.

Dynamic Neuromuscular Stabilization (DNS) represents an innovative rehabilitation technique aimed at enhancing the interaction between the central nervous system and the musculoskeletal system [22]. DNS exercises prioritize the restoration of optimal movement patterns by strengthening deep stabilizing muscles, promoting appropriate movement sequencing, and improving postural control through the integration of sensory and motor systems [23, 24]. Existing literature suggests that DNS can enhance balance, proprioception, and coordination in individuals with various neurological and musculoskeletal conditions, including older adults and those experiencing low back pain [24, 25]. The exercises typically involve functional movements that engage multiple muscle groups, emphasize body awareness, and rectify abnormal movement patterns [26]. Examples of DNS exercises include controlled squats, breathing techniques, and proprioceptive exercises aimed at improving postural alignment and neuromuscular coordination.

Despite its application in diverse clinical populations, research focused on the effects of DNS on adults with intellectual disabilities remains limited. Given the complex nature of central nervous system variations and motor control disparities in this population, DNS offers a promising approach for enhancing motor function, postural stability, and overall movement efficiency.

This study aims to investigate the effects and long-term durability of an 8-week DNS training program on balance and coordination in adult males with intellectual disabilities. By proposing a rehabilitation strategy that addresses both neural and muscular variations, this research seeks to contribute to developing more effective interventions for enhancing functional independence and overall health in this population. However, the exclusive focus on males in this study underscores the need for future research to include female participants, allowing for a more comprehensive understanding of the effects of DNS across genders.

Methods

Ethics statement

The present investigation was executed in strict accordance with the ethical standards set forth by the Ethics Committee of Shahroud University of Medical Sciences in Semnan, Iran (protocol code: IR.SHAHROODUT.REC.1402.031). The ethical protocols adhered to the principles articulated in the Declaration of Helsinki, along with supplementary criteria relevant to research in the domain of sport and exercise science. Prior to their participation, all subjects provided written informed consent, thereby affirming their voluntary engagement in the study.

Study design and participants

Participants were recruited from Hekmat Rasht for the Disabled, an organization affiliated with the Rasht Welfare Association, through direct contact with the administrator by the principal investigator. The study’s purpose, procedures, and potential benefits were communicated to all prospective participants. Males were included if they were between 30 and 55 years old, had a diagnosed intellectual disability (ID) with an IQ score ranging from 50 to 70, and could independently participate in an exercise program. The IQ scores were determined using the Wechsler Adult Intelligence Scale (WAIS), which is a widely recognized and validated measure for assessing intellectual functioning in adults [27]. The WAIS has been specifically validated for use within this population, ensuring that the IQ assessments were reliable and appropriate for the target demographic [28]. Exclusion criteria included a diagnosis of Down syndrome, participation in a structured exercise program within the past six months, current smoking status, and/or ongoing medication use. These criteria aimed to ensure a homogeneous study population and minimize confounding factors.

Experimental design and study procedures

The study protocol comprised three distinct phases: an initial assessment, an 8-week intervention, and a 2-month follow-up evaluation. In this study, the CONSORT guidelines were followed. During the initial assessment, participants completed an informed consent form and underwent a series of anthropometric measurements. In a separate session, evaluations of balance and neuromuscular coordination were conducted using various assessments, including firm surface and foam surface tests, the total Balance Error Scoring System (BESS) score, forward walking heel-to-toe tasks, and coordination tests. To minimize participant fatigue, a 15-minute rest period was provided between each assessment. Each field test was administered twice, with the best result recorded for each participant.

In total, 47 adult males with intellectual disabilities were identified, of whom 14 were excluded because they did not meet the inclusion criteria. Six participants were excluded due to medical issues and smoking, three due to Down syndrome, and five individuals were excluded for having an IQ of ≤ 50. A total of 33 participants remained eligible and were included in the statistical sample according to the inclusion and exclusion criteria of the study. Using random number generator software, the participants were randomly assigned to two groups: 16 participants in the control group and 17 participants in the training group. One participant from the control group was excluded from the study due to absence at the post-test, and one participant from the training group was excluded due to absence from the training sessions.

Finally, 31 individuals underwent the screening process and were subsequently assigned to either the control group (n = 15) or the DNS intervention group (n = 16). The sample size was calculated using the G*Power software, determining that a sample size of 16 individuals per group was necessary for a 2 × 3 mixed model analysis of variance (ANOVA). This calculation was based on an alpha level of 0.05 and a beta level of 0.20 (calculated as 1 − power). An effect size of 0.25, which is considered a medium effect size according to Cohen’s guidelines, was used in the power calculation. This sample size was selected to achieve a statistical power of 0.80, deemed adequate for experimental research. The choice of a 2 × 3 mixed model ANOVA was based on the study design, which involves analyzing the interaction between two independent variables and the repeated measures within subjects [29]. The control group participated in center-based activities, while the DNS intervention group engaged in targeted training exercises at the center from 8:00 AM to 1:30 PM. Participants who either chose not to participate in the DNS interventions or had an attendance rate below 60% were excluded from the data analysis (see Fig. 1).

During the 8-week intervention phase, eligible participants in the DNS group engaged in 25 to 30 min of supervised DNS exercises at the center. The DNS program emphasized key components such as posture, breathing patterns, and core stability, highlighting the importance of proper activation of the diaphragm and deep abdominal muscles prior to any targeted movements.

The implementation of a comprehensive assessment protocol, a structured DNS exercise intervention, and a follow-up evaluation adheres to the methodological rigor expected in high-quality exercise science research. The exclusion of participants who did not meet the eligibility criteria or failed to adhere to the intervention further enhances the internal validity of the study. This approach facilitates the establishment of a more homogeneous sample and allows for a precise evaluation of the effects of the DNS intervention.

Fig. 1
figure 1

Flow Chart

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Balance error scoring system

The Balance Error Scoring System (BESS) is a widely recognized and reliable tool for assessing postural stability, consisting of six testing conditions, each lasting 20 s. These conditions include three stances on a firm surface and three on a foam surface, with participants performing the test with eyes closed and hands placed on their hips. The stances assessed are: double-leg stance (feet together), single-leg stance (on the non-dominant foot), and tandem stance (non-dominant foot behind the dominant foot). Errors are recorded for behaviors such as opening the eyes, lifting hands off the hips, stepping, stumbling, or losing balance, with each error assigned one point. The total possible score ranges from 0 to 60, with higher scores indicating worse balance [30].

The Balance Error Scoring System (BESS) has demonstrated strong reliability and validity in assessing balance, with high test-retest reliability (ICC = 0.83) and good internal consistency (Cronbach’s alpha = 0.79), making it a reliable tool for balance assessment in individuals with intellectual disabilities [31].

Walking forward heel-to-toe on a walking line

The participant was instructed to walk forward along a designated line, placing the heel of one foot directly in front of the toes of the other, with hands positioned at their sides. The walking line was marked using 5-cm wide masking tape affixed to the floor. The total number of consecutive heel-to-toe steps taken on the line was recorded, with a maximum of six steps [32].

Reliability studies of the heel-to-toe walking test have demonstrated strong test-retest reliability (ICC = 0.87) and good internal consistency (Cronbach’s alpha = 0.81) in individuals with intellectual disabilities, supporting its use as a reliable measure of balance and coordination [33].

Evaluation of bilateral coordination: sequential and simultaneous coordination of the upper and lower extremities

In conducting this test, the examiner seated themselves in front of the participant and instructed them to position their arms approximately at or slightly below shoulder height, with their index fingers pointed toward the examiner. The participant was required to move one index finger in a clockwise direction while moving the other in a counterclockwise direction, simultaneously tapping their feet al.ternately on the ground. The participant had 90 s to complete 10 consecutive taps correctly. The examiner started the timer at the beginning of the test and began counting when the taps established a consistent rhythm. If the rhythm of the taps became disrupted, if the taps were not alternating, if the circles drawn with the fingers of both hands were not simultaneous, if the wrists and forearms were used to draw the circles, or if the circles were incomplete, the examiner would provide a reminder and restart the count [34].

Reliability studies of the bilateral coordination test have shown good internal consistency (Cronbach’s alpha = 0.83) and test-retest reliability (ICC = 0.85) in individuals with intellectual disabilities, supporting its use as a reliable measure of motor coordination [35].

Dynamic neuromuscular stabilization exercise program

The researcher implemented the dynamic neuromuscular stabilization (DNS) program for this study over 8 weeks, consisting of three sessions per week lasting 25 to 30 min each. The participants in the training group were paired up and conducted their sessions from 8:30 AM to 1:30 PM. This arrangement enabled the examiner to closely monitor the subjects’ ability to perform the exercises accurately, given the potential difficulties in learning and execution associated with the target population. The researchers tailored the exercises to fit each subject’s abilities, ensuring successful completion of the program [36, 37].

Table 1 Detailed description of the DNS training program
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Data analysis

The demographic details of the research participants were recorded, and Levene’s test was used to determine the homogeneity of variance. The mean and standard deviation of the data were shown, along with a 95% confidence range. A 2 × 3 mixed model analysis of variance (ANOVA) was used to examine the effects of therapy at different intervals. The study included an experimental and control group and certain time intervals (baseline, eight weeks, and follow-up). Post hoc Bonferroni analysis was carried out to ascertain the significant difference between intervals, and a mixed model was utilized to determine the significant difference among groups. A threshold of p < 0.05 was established for statistical significance. SPSS software (version 26.0; SPSS Inc., Chicago, IL, USA) was used for all statistical analyses.

Results

Basic characteristics of participants

Thirty-one male individuals with mild intellectual disabilities, ranging in age from 30 to 55, consented to participate in the study. The individuals in the intervention group were distributed similarly to those in the control group regarding age, height, weight, BMI, IQ, and sex. There was no significant difference (p > 0.05) in the baseline demographic characteristics between the intervention and control groups. Table 2 illustrates the data outcomes.

Table 2 Baseline demographic characteristics of study participants: mean (SD)
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Outcome measures

Table 3 presents the mean and standard deviation (SD) of the variables for the two groups across three time intervals. The baseline data regarding firm surface, foam surface, total BESS score, walking forward heel-to-toe, and coordination tests between the experimental and control groups showed no statistically significant difference (p ≥ 0.05).

Firm surface score of BESS

Table 3 shows the results of the tests of the intervention program. The firm surface score of BESS scores showed significant differences by time point (F = 64.25, p = 0.001, ηp2 = 0.68) and group (F = 35.60, p = 0.001, ηp2 = 0.55). The interaction effect of group × time was also significant (F = 60.68, p = 0.001, ηp2 = 0.67). In the post hoc analysis, the follow-up test (T3) showed an decrease of 9.37 points in the intervention group compared to the pre-test (T1) (Fig. 2). In contrast, the control group showed an decrease of 1.77 points, indicating a statistically significant difference between the groups (p = 0.001). The intervention group showed a clear decrease of 9.43 points after the test (T2) compared to the pre-test, while the control group showed a smaller decrease of 0.27 points. This difference between the two groups was significant (p = 0.001) and large, with a Cohen’s d of 2.87. Table 3 provides further details on the within-group comparison.

Foam surface score of BESS

Foam surface score of BESS differed significantly by time (F = 55.12, p = 0.001, ηp2 = 0.65) and by group (F = 43.70, p = 0.001, ηp2 = 0.60). In addition, the interaction effects of group × time were also statistically significant (F = 47.30, p = 0.001, ηp2 = 0.62). In the posttest analysis, the intervention group showed an decrease of 9.44 points compared to the pretest. In contrast, the control group showed an decrease of 0.2 points, which differed significantly from that of the intervention group (p = 0.001). The intervention group showed a significant decrease of 8.87 points in the follow-up test (T3) compared to the pre-test (T1) (Fig. 2). In contrast, the control group showed a decrease of 0.53 points, indicating a significant difference between the two groups (p = 0.001). Table 3 contains additional information on the comparison within the groups.

Total BESS score

The values for trunk lifting showed significant differences by time (F = 91.68, p = 0.001, ηp2 = 0.76) and group (F = 56.64, p = 0.001, ηp2 = 0.66). In addition, the interaction effects of group × time were also statistically significant (F = 82.35, p = 0.001, ηp2 = 0.74). In the post hoc analysis, the intervention group showed an decrease of 18.87 points in the post-test (T2) compared to the pre-test (T1). In contrast, the control group showed a decrease of 0.47 points, which differed significantly from that of the intervention group (p = 0.001). The intervention group, on the other hand, showed a significant decrease of 18.25 points in the follow-up test (T3) compared to the pre-test (T1) (see Fig. 2). The control group, on the other hand, showed a decrease of 0.53 points, indicating a significant difference between the two groups (p = 0.001). This was a large effect with a Cohen’s d of 3.60. Further details on the comparison within the groups can be found in Table 3.

Walking forward heel-to-toe

Chair sit and reach scores showed significant differences by time point (F = 4.80, p = 0.01, ηp2 = 0.14) and group (F = 15.37, p = 0.02, ηp2 = 0.35). In addition, the interaction effects of group × time were also statistically significant (F = 4.54, p = 0.01, ηp2 = 0.13). In the post hoc analysis, the intervention group showed an increase of 1.87 points in the post-test (T2) compared to the pre-test (T1). In contrast, the control group showed an increase of 0.13 points, which differed significantly from that of the intervention group (p = 0.003). The intervention group showed a no significant in the follow-up test (T3) compared to the pre-test (T1) (Fig. 2). These findings indicate a large effect, with a Cohen’s d of 1.14. Further details on the comparison within the groups can be found in Table.

Coordination

The values for trunk lifting showed significant differences by time (F = 61.57, p = 0.001, ηp2 = 0.68) and group (F = 20.19, p = 0.001, ηp2 = 0.41). In addition, the interaction effects of group × time were also statistically significant (F = 55.35, p = 0.001, ηp2 = 0.65). In the post hoc analysis, the intervention group showed an increase of 3.56 points in the post-test (T2) compared to the pre-test (T1). In contrast, the control group showed a slight increase of 0.13 points, which differed significantly from that of the intervention group (p = 0.001). The intervention group, on the other hand, showed a significant increase of 3.75 points in the follow-up test (T3) compared to the pre-test (T1) (see Fig. 2). The control group, on the other hand, showed a increase of 0.07 points, indicating a significant difference between the two groups (p = 0.001). This was a large effect with a Cohen’s d of 3.45. Further details on the comparison within the groups can be found in Table 3.

Table 3 Pre- and post-primary and secondary outcome measures analysis between the experimental and control groups. Mean (SD)
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Fig. 2
figure 2

Comparative Analysis of Variables Across Different Time Periods

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Discussion

This study provides compelling evidence supporting the efficacy of Dynamic Neuromuscular Stabilization (DNS) training in improving balance and coordination in adults with mild intellectual disabilities (ID). Specifically, the intervention resulted in significant post-test improvements in static balance (on both stable and unstable surfaces with closed eyes), dynamic balance, and coordination compared to the control group. These gains were not only statistically significant but also durable, as follow-up assessments revealed sustained improvements in static balance, dynamic balance, and coordination. Our results suggest that DNS training can be an effective, sustainable approach for enhancing key aspects of physical fitness in this population, particularly balance and coordination, which are critical for independent living and overall quality of life. However, it is important to note that this study exclusively focused on male participants, which limits the generalizability of the findings to females or the broader population of individuals with intellectual disabilities. Gender-based differences in motor coordination, physical fitness, and response to training interventions are well-documented in the literature, emphasizing the need for future studies to include female participants to comprehensively evaluate the effects of DNS training across genders. This study adds to the growing body of literature highlighting the potential of targeted DNS interventions for individuals with intellectual disabilities, a population that faces significant challenges in maintaining physical health and independence. By focusing on adults with mild ID, our study addresses a relatively under-explored group and demonstrates that tailored interventions, like DNS, can produce substantial improvements in physical functioning.

Our findings align with recent research exploring the effectiveness of DNS and other core stabilization interventions for individuals with mild ID. For example, Dehghani et al. (2023) reported significant improvements in static and dynamic balance in female students with intellectual disabilities following DNS training [38]. These findings underline the importance of gender-specific research, as they suggest that DNS training is effective for both males and females with intellectual disabilities, though further studies are needed to compare potential differences in outcomes between genders. These results corroborate our findings and suggest that the mechanisms underpinning DNS training—such as core engagement and sensory integration—may be beneficial for individuals with mild intellectual disabilities. Similarly, Rahmati Aran et al. (2020) emphasized the role of functional exercises in enhancing balance and coordination in individuals with intellectual disabilities, supporting the notion that targeted physical activity programs are essential for improving these skills [39]. Moreover, our study complements Shumway-Cook and Woollacott’s (2001) identification of balance and coordination deficits as prominent challenges for individuals with intellectual disabilities [40]. These deficits increase the risk of falls and injuries, highlighting the importance of interventions that improve postural control and movement efficiency. In our study, DNS training specifically addressed these challenges by integrating core stabilization and motor control exercises, which are consistent with the findings of Lesch (2024) and Horak (2006), who underscored the importance of sensory input from the visual, vestibular, and proprioceptive systems in balance and coordination [41, 42]. Future research should aim to replicate these findings in mixed-gender or female-only samples to provide a more comprehensive understanding of the effects of DNS training. Our results also resonate with the work of Mahdieh et al. (2020), who demonstrated that proper stabilization and breathing techniques in DNS exercises could enhance neuromuscular efficiency and postural control [37]. The improvements in coordination observed in our study could be attributed to the enhanced integration of sensory input and motor output, which is a key feature of DNS interventions. This is in line with Wolpert et al. (2011) work, which emphasized the brain’s ability to optimize movement patterns through the use of structured exercises that promote sensorimotor integration [43].

The observed improvements in balance and coordination following DNS training can be attributed to several key mechanisms. First, DNS exercises target the core muscles and promote neuromuscular coordination, which is essential for postural control and movement efficiency. By training individuals to engage their core and integrate sensory information, DNS exercises enhance the brain’s ability to process and respond to external stimuli, leading to improved balance and coordination [44]. Furthermore, the emphasis on breathing and stabilization techniques in DNS exercises may have contributed to improved autonomic regulation, further enhancing balance and coordination [45]. Our findings also highlight the long-term benefits of DNS training, with sustained improvements in balance and coordination observed at follow-up assessments. This suggests that DNS training not only provides immediate benefits but also facilitates lasting changes in neuromuscular function. These results are consistent with the work of Wuang et al. (2009), who showed that motor learning and task-specific training are effective in promoting long-term improvements in motor skills in individuals with intellectual disabilities [46].

While the study provides valuable insights into the effectiveness of DNS training for individuals with mild intellectual disabilities, several limitations must be acknowledged. First, the sample size was relatively small, which may limit the generalizability of the findings. A larger, more diverse sample would be beneficial to confirm the results and explore potential variations across different demographic groups. Additionally, this study lacked gender diversity, as the sample included only males. This limitation underscores the need for future studies to investigate the effects of DNS training in females or mixed-gender populations to determine whether gender influences the efficacy of DNS interventions. Additionally, the study did not control for factors such as motivation, health status, or prior physical activity levels, which may have influenced the outcomes. Future research should address these factors to better isolate the effects of DNS training on balance and coordination. Furthermore, the study’s reliance on post-test and follow-up assessments only provides limited information about the long-term impact of DNS training beyond the follow-up period. Future studies should consider longer-term follow-up assessments to assess whether the improvements in balance and coordination are maintained over time and whether they translate into better functional outcomes, such as reduced fall risk or improved independence in daily activities.

Future research should focus on addressing the limitations of this study, particularly the small sample size and the lack of control over external factors. Conducting studies with female participants, as well as larger, multicenter trials with diverse populations, is essential to establish the generalizability of DNS interventions. Larger, multicenter studies with more diverse participants could help establish the generalizability of the findings. Additionally, future studies could investigate the effects of DNS training on other populations with intellectual disabilities, such as individuals with Down syndrome or autism spectrum disorder, to determine whether the observed benefits are consistent across different syndromes. Further research could also explore the potential mechanisms underlying the improvements observed in balance and coordination. For example, studies examining neural adaptations to DNS training could provide deeper insights into how the central nervous system responds to such interventions. Finally, future studies could explore the feasibility and effectiveness of integrating DNS training into community-based rehabilitation programs or educational settings, to assess its impact on functional independence and quality of life in real-world environments.

The findings of this study have important implications for both clinical practice and theoretical understanding of motor control in individuals with mild intellectual disabilities. From a practical perspective, the demonstrated effectiveness of DNS training in improving balance and coordination suggests that this intervention could be incorporated into rehabilitation programs to enhance physical fitness and reduce fall risk in this population. The long-term benefits observed in our study also highlight the potential of DNS training to promote sustained improvements in functional independence, an essential goal in the care of individuals with intellectual disabilities. From a theoretical perspective, this study reinforces the importance of core stabilization and neuromuscular coordination in maintaining balance and coordination, particularly in populations with motor control deficits. The integration of DNS training into the existing body of motor learning research emphasizes the need for task-specific, sensorimotor interventions to address the unique challenges faced by individuals with mild intellectual disabilities. By extending our understanding of the neural mechanisms involved in balance and coordination, this study contributes to the broader field of motor control and rehabilitation.

Conclusions

In conclusion, this study provides strong evidence supporting the effectiveness of DNS training in improving balance and coordination in adult males with mild intellectual disabilities. These findings highlight the potential of targeted physical activity programs to enhance key aspects of physical fitness and promote independence in this population. However, the lack of female participants limits the generalizability of these results. Future studies are needed to examine gender-specific responses to DNS training, allowing for more inclusive and representative rehabilitation strategies. While the study’s limitations suggest areas for further exploration, the results have important implications for both clinical practice and theoretical research, underscoring the need for continued efforts to develop and implement effective interventions for individuals with intellectual disabilities.

Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors would like to express their gratitude to all the study participants.

Funding

This study did not receive any external funding.

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Authors and Affiliations

  1. Department of Sports Biomechanics and Motor Behavior, Faculty of Sport Sciences, University of Mazandaran, Babolsar, Iran

    Hamed Babagoltabar-Samakoush

  2. Department of Sports Injuries and Corrective Exercises, Faculty of Physical Education and Sport Sciences, University of Guilan, Rasht, Iran

    Behnoosh Aminikhah

  3. Department of Sports Injuries and Corrective Exercises, Faculty of Physical Education and Sport Sciences, Shahid Bahonar University of Kerman, Kerman, Iran

    Saeid Bahiraei

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  1. Hamed Babagoltabar-Samakoush
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Contributions

H. B-S and S. B. wrote the manuscript, H. B-S, and S. B. analyzed the data, and S. B. performed the exercise program. All authors have read and approved the final manuscript.

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Correspondence to Hamed Babagoltabar-Samakoush.

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This study was approved by the Institutional Review Board of Shahroud University of Medical Sciences, Semnan, Iran (code: IR.SHAHROODUT.REC.1402.031) and written informed consent was obtained from all participants.

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Not Applicable.

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Babagoltabar-Samakoush, H., Aminikhah, B. & Bahiraei, S. The effects and durability of an 8-week dynamic neuromuscular stabilization program on balance and coordination in adult males with intellectual disabilities: a randomized controlled trial. BMC Sports Sci Med Rehabil 17, 18 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s13102-025-01062-0

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Keywords

BMC Sports Science, Medicine and Rehabilitation

ISSN: 2052-1847

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