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Children and youth with Down syndrome display a very stable pattern of physical inactivity, which gets worse with age. Less than 10% of children with Down syndrome who are 8 [...], Background. People with Down syndrome (DS) display consistent patterns of physical inactivity. If these sedentary behaviors continue over extended periods of time, there will be negative health consequences. Objective. The objective of this study was to investigate the physical activity and health-related outcomes of teaching children with DS to ride a 2-wheel bicycle. Design. This study was a randomized intervention in which the control group waited 1 year to receive the intervention. Setting. This intervention study was conducted in a community setting. Participants. The participants were children who were 8 to 15 years of age and who had been diagnosed with DS. Intervention. The participants were randomly assigned to an experimental group (bicycle intervention) or a control group (no intervention). Measurements. Measurements were obtained in the month before the intervention (preintervention), at 7 weeks after the intervention, and at 12 months after the preintervention measurement for all participants. Results. The results indicated no group differences at the preintervention session. Fifty-six percent of the participants in the experimental group successfully learned to ride a 2-wheel bicycle during the 5-day intervention. Analysis showed that participants who learned to ride spent significantly less time in sedentary activity at 12 months after the preintervention measurement and more time in moderate to vigorous physical activity than participants in the control group. Body fat appeared to be positively influenced over time in participants who learned to fide. Limitations. It is unknown how frequently the children in the experimental group rode their bicycles after the intervention. Conclusions. Most children who are 8 to 15 years of age and who have been diagnosed with DS can learn to ride a 2-wheel bicycle. Learning to ride can reduce time spent in sedentary activity and increase time spent in moderate to vigorous physical activity, which may influence the health and functioning of these children.