Intellectual disability (ID) encompasses diverse challenges that affect daily life and health. Sedentary behaviors, prevalent in this population, contribute to alarming health concerns, notably obesity and musculoskeletal issues. This review examines the role of physical activity (PA) interventions in addressing these health challenges among children and adolescents with ID. This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search was conducted in the Cochrane Library, PubMed, Scopus, and SPORTDiscus databases, using specific keywords aligned with the PICO framework (population, intervention, comparison, and outcome). From January 2013 to October 2024, a total of 5236 studies were identified, of which 17 met the inclusion criteria for this review according to PRISMA procedures. Randomized controlled trials (RCTs) focusing on the impact of PA on body composition, physical fitness, bone health, metabolic indicators, and overall quality of life were included. The study cohort consisted of individuals aged 13–24 diagnosed with ID. The findings consistently highlight the positive relationship between PA interventions and improved health markers in individuals with ID. Diverse PA interventions, ranging from strength training to high-intensity exercises, demonstrated significant improvements in body composition, physical fitness, and bone mineral density. Notably, higher-frequency PA programs (minimum three sessions per week) yielded more substantial benefits. This review underscores the potential of adapted PA interventions to address health concerns and enhance the quality of life for individuals with ID. Further comprehensive research is needed to establish standardized guidelines for effective PA interventions in this population