Some general exercise guidelines for individuals with Down Syndrome include: (a) obtaining physician consent; (b) understanding the effects of medications on the body in relation to exercise; (c) providing augmented supervision; (d) incorporating behavioral therapy and motivational techniques (i.e., token reward system) to improve adherence; and (e) starting the program with light activity that is enjoyable and pain-free. Behavioral therapy is highly recommended for individuals with Down Syndrome. This is a system of social reinforcement with primary and secondary reinforcers (Rimmer, 1994). An effective technique is recording progress on a wall chart once they reach their goal.