The goal of an aerobic training program for individuals with Down syndrome is to increase cardiovascular fitness. Recommended modalities include: walking, jogging, stationary cycling, and low impact aerobic dance (Rimmer, 1994, Bliss, 1997). It is important to monitor heart rate and blood pressure whenever possible to determine the intensity level of the activity and to avoid early-onset fatigue. The general recommended protocol is training at an intensity of 60-80% of an individual's maximal heart rate (MHR), 3-5 days a week, for 20-60 minutes per session. Maximal heart rate can be obtained from a graded exercise test or can be predicted by subtracting the age of the individual from 220. A suggested starting protocol is a 5-10 minute continuous activity, 1-2 days a week. Once the participant achieves this level, the intensity can be increased to 40-60% MHR, for 10-30 minutes, 3-4 days a week. In the later stages of the training program, intensity should be increased to 60-75%, for 15-60 minutes, 3-5 days a week (Rimmer, 1994). Individuals can progress and regress through stages. A training effect is typically seen 16-35 weeks into a program (Fernhall, 1997). For game abstracts that can be used with individuals with Down syndrome, see Chapter 8 in the textbook written by Dr. James H. Rimmer, titled "Fitness and Rehabilitation Programs for Special Populations" (1994).