Background The body index [body mass, body mass index (BMI), waist circumference and waist–height ratio] and functional fitness (aerobic capacity, muscular strength, balance, flexibility and functional ability) of people with Down syndrome (DS) are substantially lower than those in the general population, as DS has an overall negative impact on health. Aims This study explored the effect of a 24‐week basketball training programme on the body composition and functional fitness of adults with DS. Methods and procedure outcomes Twenty‐two adults with DS (24 ± 6 years; 25 ± 4 kg/m2) were randomly allocated to the experimental (n = 11, 67.04 kg) and control groups (n = 11, 69.36 kg). The experimental group performed 24 weeks of basketball programme training (3 times per week, 60 min per session), while the control group maintained their daily activities without any special physical training. Body composition and functional fitness parameters were measured before and after the intervention. To evaluate the differences between groups, an analysis of covariance (ANCOVA) was used while controlling for differences at baseline. Results Hip circumference and waist–height ratio were statistically different at baseline between the intervention and control groups. After the 24‐week basketball training programme, the results showed significant differences between the exercise and control groups for hip circumference, body mass, BMI, waist circumference, hip circumference, waist–height ratio, flexibility, aerobic capacity, static and dynamic balance, balance and basketball functional ability (P < 0.05). The exercise group showed significant improvements in all variables of body composition and functional fitness (P < 0.05) except for the waist–hip ratio. There was no statistical significance between all physical composition and functional health variables in the control group except for the standing long jump (P > 0.05), with effect sizes ranging from small to large. Conclusions and implications The basketball training programme improved body composition and functional fitness of adults with DS.

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