As a child diagnosed with juvenile rheumatoid arthritis, my attitudes about health and disability were formed early in life. I believe that disability does not preclude a person from being "healthy" when health is defined multidimensionally (physical, emotional, intellectual, interpersonal, and spiritual).

I take an active, preventative and holistic approach to health. Although I have a challenging form of arthritis, I can influence it to an extent through vitamins, supplements, herbs, nutrition, adequate sleep, massage, good relationships, attitude, and spirituality. It is the exercise portion of my health equation that is deficient.

Appropriate exercise is very important for people with arthritis. If you don't use it, you lose it. Low-impact exercises such as walking, swimming or water aerobics improve muscle, bone and cartilage; increase range of motion, flexibility, strength and endurance; lower blood pressure and cholesterol; enhance cardiorespiratory function; and assist with weight control, mood and general health.

Unfortunately, exercise options are seldom tailored to accommodate the people who could most benefit from movement. Being shut out of physical exercise begins in school. Students who require adaptive exercises, sports and equipment do not have the same opportunities for recreation or sports as non-disabled peers.

As a child, I watched or read books from the sideline while my classmates participated in team sports or games. My exercise consisted of structured physical therapy. Exercise was routine, boring and painful: something I was forced to do and couldn't wait to finish. I didn't understand why my exercise couldn't be as fun as what the kids had in school physical education (P.E.) classes.

Even today, only a few schools offer adaptive P.E. With creative, flexible and willing instructors, children with disabilities can participate in exercise and sports. In addition to the physical benefits, participation decreases isolation and feelings of depression and increases self-esteem and personal efficacy.

Into adulthood, health becomes even more an issue, yet society and the fitness world continue to leave us on the sideline. Few community facilities, programs, group recreational tours, sports, fitness clubs, and hotel recreation centers can routinely accommodate people with physical limitations.

A study on increasing physical activity levels of women with disabilities conducted by the University of Kansas Research and Training Center for Independent Living (UK RTCIL Link) documents the barriers to health promotion that face many people with disabilities. Assessment indicated that while some areas of the facilities, such as parking and entrances, generally complied with Americans with Disabilities Act Accessibility Guidelines (ADAAG), many important features did not meet accessibility guidelines. Similarly, research by Carol J. Gill, Ph.D., on the health perceptions of women with physical disabilities (RIC Link), found that women know that they should exercise but do not because of multiple factors, including accessibility, affordability, transportation, and need for assistance and adapted equipment to exercise.

I use a wheelchair for mobility and have major joint limitations, so my ability to exercise is further complicated. I considered yoga or chi gong for gentle movement, but there is a lack of knowledge on how to accommodate people with disabilities in exercise classes. I know there is a way to practice modified yoga, yet I will have to explore this on my own; the yoga courses in my hometown require me to be nothing less than a human pretzel, unless I want to join the yoga group at the local senior home.

My physician suggested I could swim for exercise. Set to take action, I had no idea that a seemingly simple task could become so complicated. I knew the recreation facility/pool at the university was inaccessible, which is ironic, since a family who owns a medical supply company and donates to programs for children with disabilities funded its construction.

When I attended college and graduate school, the student fees we paid covered the library, game attendance, and the pool; I could have used the pool for no charge, but stairs prevented the pool from being accessible. Back then, I paid a modest fee and swam at the local YWCA, so I decided to try the YWCA again today.

First of all, the YWCA no longer offers a "swim-only" membership. It does offer scholarships for individuals with limited income; however, the least expensive is still $300 annually, which may not be affordable for many persons with disabilities or senior citizens. The facility is undergoing renovation to make the whirlpool accessible and re-ramp the main pool; while the pool is closed, members are temporarily swimming at the university!

Thwarted, I decided to try the local YMCAs (YMCA Link). Parking at the main branch is accessible - and that's about the extent of accommodation. I thought that the newest YMCA on the south side, constructed in the last six months, surely would be ADA-compliant. On the phone, the receptionist pleasantly described the facility as completely accessible with a zero-depth entry pool. Things were looking up, so I went to investigate.

I found the facility staff friendly, helpful and sensitive to my requirements; however, the board of directors and the architect obviously needed to solicit input from people with disabilities prior to construction. Initial optimism on the facility tour soon plunged. The locker room is fairly well-designed with lockers, sinks and counters at reasonable heights; the shower has plenty of room, handrails on the wall, and a fold-down bench at wheelchair height for easy transfer.

Unfortunately, the pools diminished any hope for adaptive design. It must be assumed that persons with physical limitations never swim in deep water or lap-swim, because the large pool is inaccessible. Likewise, whirlpool entry is inaccessible as it has stairs. The small pool has a zero-depth entry into the water through a ramp that curves around the whirlpool and continues until it reaches the small pool. Though a 15-foot curved ramp can accommodate someone able to walk in, wheelchairs were not designed to be submerged in gradually deepening water.

I inquired about a plastic submersible wheelchair, such as a shower chair, but the YMCA does not have one. They could not find a company to donate one, and could not spend the necessary $1,000 to buy one. I thought to myself that $1,000 is cheaper than an ADA noncompliance lawsuit.

At this point, the architect's curved design is even more problematic: you cannot roll in with a swim chair because the chair is too wide for the curves in the ramp. Additionally, halfway down the slope, you are already at a depth at which the roll-in chair would float, become uncontrollable, and bang against the walls.

The last remaining YMCA branch in my town is on the north side. The locker, shower and pool are accessible. It has a swim chair and a straight ramp. The one thing that isn't accessible is the whirlpool. The branch offers a sliding-scale fee based on income, and there is no charge for someone to accompany me for assistance. Out of three YMCAs in the city, the one farthest from me is my only option. It's a good thing that I have a sense of humor and can laugh at life's adversity; now that I have located a place to swim on the north side of the city, the bridge I need to use has been slated for repairs and periods of closure. How badly do I want to exercise?

My experience left me wondering if physicians who tell persons with disabilities to exercise have the knowledge to engage in substantive discussion of fitness options or insight into the obstacles to health promotion. Furthermore, non-disabled persons who review and make cuts to Medicare, state budgets, and insurance often hold a stereotype of persons with disabilities as unhealthy, sick and a financial burden.

If health maintenance/illness prevention resources were readily available, perhaps we could allocate a little less to medical expenditures for secondary conditions, such as obesity, high blood pressure, high cholesterol, osteoporosis, cardiovascular disease, and pain management.

For those individuals who want to take advantage of exercise, partially supplementing a fitness membership might cost less than funding medications, countless doctor visits, and even surgeries. Exercise facilities, clubs, programs, courses, and so on should be aware of and comply with their legal obligations under the Americans with Disabilities Act.

Finally, we as persons with disabilities need to be a visible presence. Persons with physical limitations must continue to appear in sports manufacturers' advertisements, participate in sports and recreation, request adaptations, support organizations and athletic competitions, shatter the societal invalid stereotype that invalidates us, and advocate for policy and health.