Medically reviewed by Jonathan B. Jassey, DO

• PWS affects hormones, muscle tone, and energy, making movement more difficult. However, movement is crucial since weight gain is common with PWS.
• Framing activity as fun, competitive, and rewarding can reduce resistance toward exercise.
• Consistent routines, child-friendly activities, and non-food rewards can increase motivation.

Children with Prader-Willi syndrome (PWS) often need extra support to stay active. By adjusting how you frame and structure movement, you can support motivation and make activity a positive part of daily life.

1. Approach Activity So It Doesn't Feel Like Exercise

Kids with PWS are more likely to engage when the activity feels like a choice, an adventure, or a shared moment. Here are some tactics you can use so that movement feels less like a chore:

• Frame it as fun, not fitness: Instead of, "Time for your walk," try, "Let's go see if we can spot any birds on the trail." Adventure-based language lowers resistance before it starts. You can mention that movement helps their body feel strong, but it helps to lead with a happy face and present the activity as fun.
• Give them a say: Having a say is a powerful motivator. You can offer two yes options, framing the task as their decision. For example, ask, "Do you want to do the boxing game or the dance video?" Both options get them moving, but the choice of activity is theirs.
• Make it competitive and playful: Many kids with PWS love friendly competition. You can create beat-the-clock challenges like, "Yesterday it took us five minutes to get to the park. Let’s see if we can do it in four today.”
• Do it together: Children are more likely to stay active when movement is part of what their loved ones do. You can appeal to their desire to help by saying, "I'm trying to hit my steps today. Will you walk to the mailbox with me so I don't have to go alone?" 
• Let them lead: Give your child a task, like counting reps or setting the timer while exercising. Or assign them active jobs, like turning off all the lights or organizing a shelf. Active tasks keep them moving and give them a sense of purpose. As they succeed, their confidence also grows.
• Build it into the routine: Kids with PWS feel safest when they know what to expect. Schedule the activity at the same time each day, perhaps right before a meal, to provide external structure. Consistency with some flexibility, rather than rigidity from the caregiver, helps. For example, a consistent five-minute walk is better than a 30-minute struggle or meltdown. 

2. Reward Your Child in Non-Food Ways

Non-food motivators build long-term success without complicating nutrition. To build trust and keep things manageable for yourself, keep the rewards realistic, consistent, and repeatable. You can try giving the following rewards:

• Praise: Celebrate effort and flexibility, not just big achievements. Genuine phrases like "You kept going even when that was hard" often provide more motivation than generic compliments like “great job.” 
• Visual rewards: Help your child set achievable goals. Break larger goals into small, immediate steps so they can feel the win. Use sticker charts, trackers, pedometers, or digital apps to show progress. Involve them in tracking when possible. Seeing their achievements helps build self-confidence that carries over into other areas of their lives.
• Points system rewards: Set up a points system that rewards effort and completion. Some reward ideas include a homemade trophy or small trinket, a special outing of their choice, their choice of the family movie, or extra time for a hobby.

3. Try a Variety of Activities

Focus on variety and fun to keep your child engaged. Include rest periods to keep activity enjoyable. You can do the following: 

• Start with the basics: Low-impact activities like walking, cycling, dancing, and swimming are good choices. Start with 10 minutes twice a day. Gradually build toward 40 minutes most days.
• Make activities fun and flexible: Add interest and purpose by bringing the family dog on walks. Music and audiobooks also add excitement to the adventure. Vary the environment by visiting different parks, zoos, aquariums, trails, beaches, or gardens to keep kids' sensory experience fresh.
• Make activities a game: Gamified activities improve motivation by adding structure, goals, and rewards to movement. You can set up scavenger hunts using a picture-based checklist, look for and take pictures of unique nature, or try geocaching using a smartphone app to find trinkets known as "caches" that other people hide. You can also set up a simple obstacle course, using painters' tape as a tightrope or maze and using boxes to create tunnels, safe islands, or a target for bean bags. If you have access to a pool, set up a mission to save floating or weighted toys at the other end.
• Exergame: Video games that require movement, such as dance or boxing simulators, provide mental rewards, like beating high scores, that often motivate children. You can also put on an online video of freeze dance and have a freeze dance party.

Why Kids With PWS Have a Hard Time Being Active

For little ones with Prader-Willi syndrome, movement is often more taxing due to: 

• Brain-based differences: Brain pathways that help you feel motivated and rewarded are different in PWS. The pathways also create a preference for routine to feel safe, making new activities feel stressful.
• Hormonal limitations: Lower growth hormone and adrenaline levels limit the burst of energy children need for activity.
• Low energy storage: Those with PWS have less energy available for physical play, and they need more recovery time.
• Poor muscle tone: This decreased strength causes muscles to work harder.
• Slower heart and lung response: Their heart and lungs may not speed up quickly enough to meet their oxygen needs during movement.

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Kristina Dawson