Accessibility of Fitness Facilities for Persons with Physical Disabilities ...

Fitness Facilities and ADA Compliance

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Accessibility of Fitness Facilities for Persons with Physical Disabilities Using Wheelchairs Dorothy E. Nary, A. Katherine Froehlich, and Glen W. White

This study was conducted to evaluate the accessibility of fitness facilities in Topeka, Kansas, using the Americans with Disabilities Act Accessibility Guidelines (ADAAG). ADAAG identifies the specifics of architectural accessibility mandated by Title III of the Americans with Disabilities Act of 1990 (ADA). Eight facilities were evaluated using an 83-item checklist adapted from Figoni et al. (1998). Most facilities had at least one barrier in each area surveyed. Only one facility was close to meeting the accessibility standards in the areas of restrooms and access to exercise equipment. Noncompliance with ADAAG can create significant barriers for wheelchair users and limit engagement in physical activity. Research increasingly shows the importance of physical activity for this population in preventing secondary conditions, such as deconditioning and depression. Key words: Americans with Disabilities Act, fitness facilities, persons with physical disabilities, physical activity, secondary conditions, wheelchair accessibility

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HYSICAL ACTIVITY FOR persons with mobility impairments is increasingly viewed as a concern for the health of this population.1–7 The document containing the nation’s current goals for improving the health of its citizens, Healthy People 2010, includes objectives for reducing the sedentary lifestyle of people with disabilities.3 The Surgeon General’s Report on Physical Activity and Health identifies persons with disabilities as among the most inactive subgroups in the United States.6 The potential benefits of regular physical activity for this population are many. It is likely that health benefits of physical activity experienced by the nondisabled population, including reduced mortality from coronary heart disease (CHD) and reduced risk of developing high blood pressure and insulindependent diabetes mellitus (NIDDM),7 can be achieved by persons with disabilities who become more active. Additionally, regular physical activity can reduce symptoms of anxiety and depression.8

The benefits of physical activity may be even more important for people with disabilities than for the general population because of the high prevalence of secondary conditions, defined as conditions that “are causally related to a primary disability.”9 For example, a person with a spinal cord injury (SCI) might be at risk for such secondary conditions as pressure ulcers, urinary tract infections, autonomic dysreflexia, spasticity, joint contractures, depression, decondiDorothy E. Nary, MA, is Research Assistant, Research and Training Center on Independent Living, University of Kansas, Lawrence. A. Katherine Froehlich, MA, is Teaching Associate, Department of Occupational Therapy Education, School of Allied Health, University of Kansas Medical Center, Kansas City. Glen W. White, PhD, is Associate Professor, Department of Human Development and Family Life, University of Kansas, Lawrence. Top Spinal Cord Inj Rehabil 2000;6(1):87–98 © 2000 Thomas Land Publishers, Inc.

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tioning and weight gain, syringomyelia, poor cardiorespiratory function, chronic pain, and bowel and bladder problems.10 In some cases, the secondary disability may be more limiting than the primary disability.11 Heath and Fentem2 assert that active wheelchair users are generally more healthy than those who are less active. Physical activity can assist in improving or maintaining stamina, muscle strength, and flexibility, all of which contribute to functional ability and possibly to prevention of secondary conditions. Maintenance of this function can preserve personal independence and autonomy, thereby increasing the opportunity for independent living. Most important, loss of functional ability may not be inevitable and may, in fact, be reversible.2 Consequently, regular physical activity for persons with disabilities may play an important role in improving and preserving quality of life. Barriers to Physical Activity In order for persons with disabilities to engage in physical activity, barriers to fitness activities must be identified and addressed. Some of the barriers experienced by this group are similar to those cited by nondisabled persons, such as lack of time, lack of energy and motivation, and lack of convenient and affordable facilities.12–14 However, persons with disabilities typically experience additional barriers related to their disability. Numerous studies have identified a variety of disabilityrelated barriers that prevent people with disabilities from increasing their physical activity levels.15,16 Results of these studies typically identify barriers related to fitness facilities. In 1997, researchers at the University of Kansas conducted a survey of women with mobility

impairments in Kansas regarding barriers to physical activity prior to an intervention. The 200 women responding to the survey identified lack of information about accessible facilities and programs, inaccessible facilities, and lack of facility staff knowledgeable about the needs of persons with disabilities among the top 10 issues with which they were dissatisfied (A. K. Froehlich, MA, unpublished data, 1997). Impact of the ADA The Americans with Disabilities Act (ADA) of 1990 mandates the civil rights of individuals with disabilities and protects them from discrimination.17 Title III of the ADA mandates accessibility of most privately owned accommodations open to the public. Specifically, Title III “includes general prohibitions restricting a public accommodation from discriminating against people with disabilities by denying them the opportunity to benefit from goods or services, by giving them unequal goods or services, or by giving them different or separate goods or services.”17(p35,555) Fitness facilities are included in the list of public accommodations covered by Title III and thus are mandated to provide equal access to their facilities and services for persons with disabilities. ADA guidelines for fitness facilities have been available for several years and are included in a widely used resource disseminated by the American College of Sports Medicine.18 Study Purpose The purpose of this study was to evaluate the degree of Title III ADA compliance of


fitness facilities in a medium-sized US city (population 123,000) using an instrument based on the Americans with Disabilities Act Accessibility Guidelines (ADAAG).19 It is a replication of a study of fitness facilities conducted by Figoni and colleagues in the Kansas City area and uses an accessibility checklist based on ADAAG that is included in Figoni et al.20 ADAAG were developed to enforce Title III of the ADA and are derived from an earlier federal standard, the Uniform Federal Accessibility Standard (UFAS). The fitness facility survey focused on the portions of ADAAG that address access for persons with mobility impairments, as opposed to sensory and other impairments. The instrument was used to assess parking, ramps, entrances, and interior paths of travel to all areas open to the public, elevators, and restrooms/locker rooms. The survey included all fixtures within the building, including telephones, drinking fountains, access to fitness equipment, and customer service desks. Additionally, questions regarding access to areas not addressed by ADAAG were asked. Method Participants

Participants in this study were eight fitness centers open to the public in Topeka, Kansas. The list of eligible centers was obtained from the 1997 edition of the Topeka Southwestern Bell Yellow Pages under the categories of “fitness centers” and “health clubs.” Facilities that were advertised as martial arts, rehabilitation, weight loss, or athletic training organizations were excluded because it was not clear that their primary focus was fitness. School district and municipal recreation fa-

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This instrument covered 10 areas of fitness facilities to which users would expect access, including parking, ramps, exterior entrances/doors, interior paths of travel, elevators, restrooms and locker rooms, telephones, drinking fountains, customer service desk, and access to and around exercise equipment.

cilities were also excluded because their publicly funded status places them under a different title of the ADA. Included in the study were private, for-profit facilities and several facilities operated by private nonprofit organizations, including YMCAs and YWCAs. All of the facilities meeting the eligibility criteria were contacted and all agreed to participate in the study. Instrumentation

An 83-item wheelchair-accessibility checklist was adapted from a checklist originally developed by McClain et al.21,22 It was adapted for a survey of fitness facilities conducted by Figoni et al.20 The list was based on pertinent sections of the ADAAG. This instrument covered 10 areas of fitness facilities to which users would expect access, including parking, ramps, exterior entrances/doors, interior paths of travel, elevators, restrooms and locker rooms, telephones, drinking fountains, customer service desk, and access to and around exercise equipment. For each of these categories, between 4 and 12 specific items were measured using ADAAG standards. The assessors then checked whether

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the facility met or did not meet the standard. The original ADA Accessibility Stick (Access, Inc., Lawrence, KS) was used to measure threshold heights, ramp slopes and widths, doorway widths, path widths, toilet heights, drinking fountain heights, and knee clearances. Because many of the accessibility measurements are labeled on this device, it facilitated efficient and accurate measurement. An adapted digital fish scale (Stren by Remington Arms, Model # 1044400, Madison, NC) was used to measure the force required to open doors and a steel tape measure was used to measure various widths required by ADAAG. Six additional questions were asked about items that were not addressed by ADAAG, including pool access, adaptive equipment, staff training, adaptive programming, pro-rating of membership fees based on accessibility, and visits at no charge to assess accessibility for individual users. Procedures

Researchers contacted each facility by phone to explain the purpose of the study, obtain agreement to participate, and schedule a convenient time to conduct the survey. Information was mailed to the designated contact person at each participating facility before the visit. The mailing included an informed consent form that was reviewed and signed at the start of the survey. Two researchers conducted surveys while visiting each facility once during regular daytime business hours, with one researcher measuring and the other recording. Researchers reviewed the checklist and practiced measurement prior to the actual survey to ensure consistency of measurement; additionally, one of the researchers was a wheelchair user

and had extensive experience in conducting accessibility surveys of public buildings. However, no assessment of intertester reliability was performed. Data analyses

Data analyses for this study were descriptive. Individual items on the checklist were grouped into 10 areas of a facility, such as entrances or rest rooms. Accessibility scores for each area of each facility were based on the number of accessible items divided by the total items for each area. These areas included: (1) parking, (2) ramps, (3) exterior entrances/ doors, (4) path of travel, (5) elevators, (6) restrooms/locker rooms, (7) telephones, (8) drinking fountains, (9) accessibility to, between, and around exercise equipment, and (10) customer service desks. These scores were then averaged to obtain the accessibility mean score for each area across facilities. Responses to items not mandated by ADAAG (such as availability of adaptive equipment and staff training) were not calculated into the scores but are reported separately. Results Survey results in the form of mean accessibility scores for each of 10 areas assessed across facilities are summarized in Figure 1. (There is no mean score for elevators because none of the facilities surveyed had elevators.) This survey found only two facilities (38%) with parking that complied completely with ADAAG; a third facility lacked any designated handicapped parking on the premises. The most problematic parking issues for the remaining facilities were an insufficient number of designated spaces based on the size of the lot (50%) and access


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Fig 1. Mean accessibility scores for 10 areas assessed across facilities.

aisles that were too narrow to allow a person using a wheelchair to exit a van lift (50%). Three facilities (38%) were accessible without ramps, and the accessibility of ramps at the remaining facilities ranged from 25% to 75%. Lack of handrails on ramps longer than 72 in. was the most common problem. Entrances were the most accessible features of the facilities surveyed. Two facilities (25%) had completely accessible entrances, and all facilities had doorways at least 32-in. wide. Hardware that required grasping or twisting was a concern in half of the facilities, and two facilities had thresholds that were too high. Only one facility (13%) had a completely accessible path of travel throughout the interior (the definition of interior path excludes the area immediately between and around fitness equipment). Two facilities (25%) fea-

tured completely accessible paths between and around fitness equipment. Two facilities (25%) maintained the required 36-in. paths to move between pieces of equipment. Although none of the facilities had elevators that were available for use by members, only two of them required elevators for full access. These facilities had areas that might have been served by either a platform lift or an elevator; one area was an outdoor pool and the other was a balcony-like area with exercise equipment. Restrooms and locker rooms were the most extensively surveyed areas of the facilities because they contain many types of equipment typically used during member visits. None of the facilities were fully accessible in this area, although one facility (13%) came close. This facility had an accessibility score of 96% and lacked only insulation on

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the drainpipes under the sinks to prevent burns. Five facilities (63%) did not comply in having pipes insulated; other facilities lacked access in toilet stalls (63%) and in the following shower features: stalls (50%), seating (63%), controls (63%) that were inaccessible, and curbs (63%) that posed barriers to use of showers. Three facilities (38%) had public telephones that were fully accessible for persons using wheelchairs. Phones in three facilities (38%) were mounted too high and phones in two facilities (25%) had cords that were too short to permit use by a seated person. Only two facilities (25%) had drinking fountains that were fully accessible; fountains in five facilities (63%) lacked knee clearance, and in five facilities (63%) they were mounted so that the spout was too high for a seated person to use. Only three facilities (38%) had a service desk that was 36 in. or lower as required by ADAAG. Of the three facilities with swimming pools (38%), only one pool was fully accessible. One facility had stairs in the path of travel to the pool and also lacked a ramp or lift to facilitate entry into the pool for persons who are not ambulatory. Another facility had both a ramp and a lift for the pool, but the lift was not working at the time of the survey. None of the facilities reported having adaptive fitness equipment such as an arm ergometer. Although this does not preclude the possibility of adapting existing equipment for use by persons with mobility impairments, it does indicate lack of staff awareness of this possibility. Seven of the eight facilities (88%) reported employing staff with training in adaptive fitness, but no details regarding this training were obtained. Similarly, 50% of the facilities surveyed re-

ported the availability of adaptive programming, but the specifics of this programming are not known. Six facilities (75%) were willing to prorate membership fees based on the degree to which the facility was accessible to an individual, and all facilities indicated willingness to allow several free visits for a prospective member to assess the degree to which the facility would meet his or her needs. Discussion This study found that none of the facilities in Topeka were 100% wheelchair accessible based on ADAAG and that none had adaptive fitness equipment available. These results indicate that fitness facilities need to enhance access so that wheelchair users can use them to increase their physical activity and overall health. Even though this study includes only a small number of facilities in Topeka, Kansas, the results are similar to those of a study of fitness facility access conducted in the Kansas City metropolitan area in 1996 by Figoni et al.20 In both studies, entrances/exterior doors were among the most accessible features, and restrooms/ locker rooms were among the most inaccessible features. Results from both studies indicate that wheelchair users would have difficulty getting to fitness equipment and using it in all facilities surveyed. The level of ADAAG compliance is also similar to results of researchers who surveyed other types of public accommodations, such as restaurants and shopping malls.21–23 The built environment

In examining the physical barriers to accessibility found in this study, it is instructive


to consider how these barriers might prevent the use of facilities by persons in wheelchairs and how they might be remedied. Although the facilities surveyed in this study had a mean accessible parking score of 69%, the lack of one accessible feature at any facility could make it difficult or impossible for a wheelchair user to access the facility. For example, a facility might have the correct number of 96-in.-wide handicapped parking spaces marked with the proper signage and located close to the facility entrance. Thus, it would meet five of the six parking criteria required by ADAAG. However, lack of 60in.-wide access aisles adjoining one or more of those spaces would render the parking unusable by a person requiring an access aisle to let a wheelchair lift down in order to exit and enter a vehicle. Therefore, lack of compliance with one of the ADAAG parking specifications could result in a potential customer being unable to exit a vehicle to use the facility. In Topeka, the majority of facilities had designated handicapped parking. However, four lacked the sufficient number of spaces with access aisles wide enough to comply with ADAAG. This study found that there were entry ramps at each of the facilities requiring them. However, there are four criteria for entry ramps. The only accessibility criterion met by most of the facilities was the inclusion of landings at the tops and bottoms; ramps were the second most frequent area of noncompliance in the facilities surveyed. Most of the ramps were too steep to meet ADAAG, and all of them lacked the railings required for ramps of 6 ft or more. Ramps with a grade steeper than the 1:12 ratio (1 ft of ramp length for every 12 in. of rise) required by code are unsafe to use. Similarly, ramps that lack

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handrails required by ADAAG do not provide safe access for wheelchair users. Entrances to the facilities in this study were the most accessible features identified. All of the facilities had doorways with the required minimum clear width (i.e., the space between the edge of the opened door and the jamb on the other side) of 32 in. Those with sets of two doors adjacent to a common vestibule had them swing either in the same direction or away from the space between the doors, making entry easier by a wheelchair user. However, several facilities had thresholds that were too high (typically 1/2 in. or higher), and four facilities had door hardware that required grasping and twisting. Either of these features could pose significant barriers to entry by a person unable to push a wheelchair over a high threshold while simultaneously holding a door open or by a person with limited manual dexterity who could not manipulate a doorknob. Lack of interior accessibility posed significant barriers in all but one of the facilities in this study. Doors that required more than 5 lb of force to open, paths that were less than the required minimum of 36 in. wide, and obstructions in the paths of travel would make it impossible for a wheelchair user to have the same access to facilities as a nondisabled person. Some obstructions were part of the built environment, such as a narrow doorway; others were temporary and more easily remedied, such as a soft drink machine placed in a hallway that restricted passage or boxes stored behind a door that prevented it from opening wide enough to accommodate a wheelchair. However, it must be emphasized that these barriers, whether temporary or built in, can impede the movement of a wheelchair user throughout a

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Restrooms and locker rooms presented the most challenging areas for accessibility because of the types of equipment in these areas.

facility and prohibit the use of the facility at any given time. Removal of temporary barriers would be cost-free, whereas widening doorways would likely involve moderate expense. Several facilities had inaccessible areas due to a lack of elevators or platform lifts. ADAAG rarely requires that existing structures be retrofitted with elevators. However, the installation of platform lifts might be required as a more economical method of providing an accessible interior path of travel. Alternately, relocating a racquetball court to an accessible area or providing the same equipment on both upper and lower levels of a facility might effectively address this problem. Restrooms and locker rooms presented the most challenging areas for accessibility because of the types of equipment in these areas. These areas are important because it is typical for members to use the commode and take a shower while visiting a facility. All facilities surveyed had accessible restroom entrances with sufficient space for a person in a wheelchair to turn around while inside. However, half of the facilities had narrow stall doors, stalls that were too small to accommodate a wheelchair, or stall doors that swung inward rather than outward. This problem was compounded in some facilities by lack of, or improperly placed, grab bars and toilets that were too low to permit safe

transfers. Even if the stall itself did not pose a barrier, the equipment within the stall that did not comply with ADAAG might prohibit a person in a wheelchair from using it safely. Therefore, in some cases, partial access presented as much of a problem as no access. Other problems in several facility restrooms regarding access to sinks included lack of clear space in front, incorrect height, inaccessible controls, and bowls that were too deep. Similarly, restrooms in several facilities had mirrors, towel dispensers, and lockers mounted too high for use by wheelchair users. In five of the facilities surveyed, uninsulated drainpipes below sinks created a safety hazard. A person with an SCI who had little or no sensation in the lower extremities could unknowingly incur serious burns if a leg was in contact with a hot water pipe. Shower stalls were the most inaccessible item in the facilities surveyed for this study. Of the seven items related to showers on the checklist, only one facility was completely accessible. At least half of the others did not comply with ADAAG for each item. Problems with the stalls included small size, improperly sized seats that were mounted incorrectly, controls that were mounted out of reach and that required high dexterity for use, grab bars that were mounted at the wrong height and on the wrong wall, and high curbs and enclosures or doors that obstructed access. Because many of these inaccessible features would require the expense of remodeling to remedy them, it is not surprising that inaccessible restrooms and locker rooms posed the most frequent and substantial barriers to wheelchair users. Unfortunately, lack of access to a shower after a vigorous workout is likely to discourage many persons in wheelchairs from joining and using fitness facilities.


It should be noted that only the women’s restrooms and locker rooms were surveyed in most of the facilities in this study, primarily because the study was one component of a larger project to facilitate increased physical activity for women with mobility impairments. However, in the only facility in which both men’s and women’s restrooms and locker rooms were surveyed, both were almost exactly the same regarding accessibility. The only exception was that mirrors in the men’s restroom were mounted too high. Lack of accessible public telephones posed barriers in several facilities. However, this problem could be easily remedied by lowering the phone, installing a longer cord, or permitting use of a cordless phone at the service desk. Similarly, inaccessible drinking fountains might be remedied by adjusting the height, by providing disposable cups nearby, or by supplying water bottles. Five out of the eight facilities surveyed had customer service desks that exceeded the maximum allowed height of 36 in. This lack of accessibility could be uninviting for a group of customers who might be more likely than other users to have questions or to require services caused by inaccessibility in other areas, such as the moving of equipment or opening of a door. A remedy for this barrier would be the lowering of all or part of the service desk. Access between and around exercise equipment was a concern in all but two facilities surveyed. Most had equipment spaced less than the required minimum of 36 in. apart, and several had paths obstructed by articles such as free weights left on the floor instead of returned to a rack. In most facilities, the equipment could be rearranged to include adequate pathways between equip-

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ment; a few facilities with especially crowded rooms might need to eliminate or relocate a few pieces of equipment. In new arrangements, staff might also anticipate the need to accommodate wheelchairs left in the aisles by persons able to transfer onto equipment to use it. The problem of articles left on the floor could be remedied by reminding members to replace weights after use and by ensuring more frequent staff checks of the area. Results of this study were mixed regarding facility features considered to be accommodations for persons in wheelchairs. Included among these features is the availability of adaptive equipment because it is not technically required by ADAAG. ADAAG requirements for fitness facility equipment have not yet been issued, thus making it impossible to mandate the availability of specific pieces of equipment. Hence, the issue of pool access becomes more of a programmatic one and, therefore, a more difficult one to assess. Of the three facilities with swimming pools in this study, one had a ramp and another had both a ramp and a lift; both would permit a nonambulatory person to enter and exit the pool easily. However, both facilities were run by nonprofit organizations that typically solicit donations from the community and, therefore, might be more responsive to the needs of all members of the community. Additionally, the lift at one facility was in disrepair at the time of the survey, raising the issue of maintenance of adaptive equipment. If facility management observes some pieces of equipment being used by fewer members, that equipment may be assigned low priority in terms of available resources for repair, maintenance, and replacement. However, Title III of the ADA

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clearly states that accessible features of public accommodations must be maintained in the same timely manner that other features are maintained. The programmatic environment

All facilities offered prospective members a free trial visit or two, and all but one facility agreed to reduce fees according to the accessibility of the facility. However, lack of adaptive equipment in all facilities might make membership unattractive for most wheelchair users. Even if standard resistance equipment was usable by persons with disabilities, it is unlikely that standard aerobic equipment, such as stair steppers, treadmills, and stationary bicycles, would accommodate a person who lacks use of their lower limbs. Acquisition of adaptive equipment could constitute a considerable investment, depending on the size and budget of the facility. This lack of adaptive equipment, as well as the scarcity and possible limitations of staff training and programming in adaptive fitness, creates potential barriers as serious as those found in the built environment. Results of this study emphasized the scarcity of options available to facilitate a program of regular physical activity for a wheelchair user who is transitioning from rehabilitation therapy to community fitness activities. Future Promise Although many barriers existed in the fitness facilities surveyed, there are many reasons that fitness facility access may improve in the future. One reason is that the US Architectural and Transportation Barriers Compliance Board (ATBCB) has recently

issued Proposed Accessibility Guidelines for Recreation Facilities.24 The ATBCB is an independent federal agency whose primary mission is accessibility for people with disabilities. The proposed guidelines will add a new chapter on recreation facilities to ADAAG and will specify access requirements for items currently not covered by these regulations such as exercise equipment and access to swimming pools, saunas, and steam rooms. The proposed regulations were issued in July 1999 and were available for public comment through December 1999. The date for issuance of final regulations is uncertain; there is ongoing consideration of the comments submitted for incorporation. The need for the fitness facility industry to identify new markets is another reason to be optimistic about increased access in the future. People involved in facility management are increasingly recognizing the changing demographics of this nation and of their potential customer base.24 The acknowledgement that their potential customers are older and have more functional limitations may account for the 100% cooperation rate of facilities in the Topeka study and the interest expressed by most staff in obtaining the results of the surveys. In 1999, Fitness Management magazine, a fitness facility trade publication with national distribution, published three articles on serving people with disabilities.25–27 As the US population ages and as people of all ages live longer with functional limitations, it is likely that more facilities will incorporate accessible features as they remodel structures and replace equipment. The existence of tax incentives may also help to promote access. Another reason to anticipate increased accessibility of fitness facilities is the height-


ened interest in health promotion for persons with disabilities by governmental agencies, rehabilitation professionals, and persons with disabilities themselves. The recognition of secondary health conditions as serious health concerns has generated interest in health promotion activities, including efforts to increase physical activity levels and wellness programs to prevent and ameliorate these problems. Public health and rehabilitation professionals recognize the need for increased access to facilities in order to promote regular physical activity for people with a disability in the transition from clinical to community settings. Additionally, publications targeting people with disabilities, such as New Mobility, regularly publish articles on health, fitness, sports, recreation, and adaptive equipment, which further stimulates a demand for access to fitness activities. As promising as the future looks, the fact remains that many fitness facilities are currently noncompliant with ADAAG and, therefore, are largely inaccessible to persons in wheelchairs. Lack of access to restrooms and locker rooms, lack of accessible routes

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throughout facilities and in equipment rooms, and lack of adaptive equipment pose major barriers that likely prohibit most wheelchair users from enjoying the benefits of fitness activities in these facilities. Ongoing efforts by professionals and persons with disabilities are needed to advocate for increased accessibility, to educate regarding accessibility codes, and to enforce compliance with laws mandating accessibility. Only when wheelchair users have equal access to such health-preserving settings as fitness facilities will they have an equal opportunity to enhance and maintain their health and to take full advantage of increased opportunities in American society for persons with disabilities. Acknowlegements We would like to acknowledge the assistance of Bob Mikesic, of Independence, Inc., Lawrence, Kansas, in preparing this manuscript. This manuscript was made possible by funding from the University of Kansas Research Development Fund.

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