Background: Limited knowledge exists regarding the effectiveness of training programmes for individuals with Down syndrome, particularly innovative approaches like tele-coaching. Our pilot study aimed to improve strength and balance using tele-coaching sessions in children with Down syndrome. Materials and Methods: We enrolled 18 children and adolescents (aged 9-17 years) with Down syndrome. The intervention consisted of a training programme based on games and was conducted remotely through an online platform (e-gym) 3 days per week (15 weeks). Participants engaged in playful activities targeting limb strength and balance. Results: We found an improvement in systolic blood pressure (p = 0.04) and balance (p = 0.002). Our analysis showed a non-significant decrease in adiposity parameters, including weight, BMI, BMI z-score, WC and WC/H. Conclusions: Our findings contribute to evidence supporting online exercise interventions for individuals with Down syndrome. Integrating these interventions into community support programmes could enhance access to tailored services.