Accessibility of Fitness Centers and Healthcare Facilities for People With Limb Differences

Created 05/2015

Introduction

Regular visits to fitness centers and healthcare facilities can help people with limb loss to maintain healthy lifestyles and promote well-being. However, many people with limb loss decide not to visit these places as often as they should due to physical and social barriers that make it difficult to access them. Equipment may not be available at the facility to accommodate disabilities, or the staff may not have been trained to interact with and assist people with limb loss. Increasing availability in these places encourages people to take advantage of resources in their community and to live healthier lifestyles with their disabilities.

1. What Steps Can I Take to Ensure Safety During My Visit?

In order to access these facilities safely and comfortably, here are some points to consider:

Your Needs	Considerations
Your level of comfort	People with limb loss may wish to contact fitness centers and healthcare facilities before a training session or a medical appointment to discuss potential challenges and barriers with staff members. During this pre-visit discussion, you should evaluate the staff’s comfort level with individuals with disabilities. It is important to feel welcomed by the staff and feel confident that they will help you address your needs (1-3).
Access to the building	It is important that building features are easy and safe to use when wearing a prosthesis or using devices such as crutches, walkers or wheelchairs. Check for: Parking options close to the building· Wide exterior and interior doors· Wide hallways Lowered counter areas Restrooms with wide stalls and sinks, and toilets that are easy for you to reach and to use comfortably (2-5).
Equipment	Make sure that fitness or medical exam equipment is safe and appropriate for the exercise, test or treatment that you need during your visit. You may need to ask the healthcare center staff about the accessibility of equipment for things such as physical exams, weight measurement, mammograms and colorectal screenings, and about the accessibility of common imaging tools such as X-rays, CT scans and MRI scans (2-4). Ask questions such as: Will using this equipment be more difficult for me than for someone without a disability? What makes this equipment accessible to me? Is the equipment high enough or low enough for me to reach? Can I easily mount and dismount equipment that I need to sit or stand on?
A personal trainer certified in fitness for people with disabilities	People with limb loss who want to be more physically active may find it helpful to work with a physical trainer. The American College of Sports Medicine has created a special Fitness Certification for trainers. You can find a certified fitness professional who can help you design and follow an individualized fitness program that is safe and effective for you by clicking here. (2)To learn more, click here.
Availability of adaptive recreation activities at fitness centers	You may want to ask the fitness center staff about whether there are specific classes available that fit your interests and level of ability. Classes specifically designed for people with disabilities or for seniors may be appropriate for you as well. (1, 2)

2. What is Universal Design?

Universal design is the concept of creating environments, facilities, products and services that are usable by all people, regardless of age, ability or status in life. Adding these features to a facility can also add to the value of the property, create a more interactive environment, relieve staff of unnecessary extra work, and help maintain a comfortable place to work and visit. The point of all-around design is that the fitness center or healthcare facility is able to make you comfortable as a person with limb loss.

Examples of University Design Features

Weather protection at entrance doors.
Wide doors and power door operators at interior and exterior entrances.
Spaces reserved for wheelchairs in waiting areas.
Spacious toilet stalls.
More than one spacious toilet and dressing room.

More Examples of University Design Features

Scales that allow people to be weighed while sitting in a wheelchair.
Adjustable height examining and treatment tables.
Mammography machines that can be used on a woman in a seated position.
Awareness and sensitivity training for all staff and professional personnel on interacting with people with limb loss and limb difference.

Source: “Removing Barriers to Health Care,” 2007, NC Office on Disability and Health.

2. What is Universal Access?

Universal access, or universal design, is the concept of creating environments, facilities, products and services that are usable by all people, regardless of age, ability or status in life. Adding these features to a facility can also add to the value of the property, create a more interactive environment, relieve staff of unnecessary extra work, and help maintain a comfortable place to work and visit. The point of universal access is that the fitness center or healthcare facility goes beyond the minimum requirements of the law to make you comfortable as a person with limb loss.

Table 2.1: Examples of Universal Design Features
Weather protection at entrance doorsWide doors and power door operators at interior and exterior entrancesSpaces reserved for wheelchairs in waiting areasSpacious toilet stallsMore than one accessible toilet and dressing room	Scales that allow people to be weighed while sitting in a wheelchairAdjustable-height examining and treatment tablesMammography machines that can be used on a woman in a seated positionAwareness and sensitivity training for all staff and professional personnel on interacting with people with limb difference
Source: “Removing Barriers to Health Care,” 2007, NC Office on Disability and Health

Creating universal access does not have to be expensive for the business owner. Features that increase accessibility do not usually increase the cost of building a facility, and making changes to an existing building is not always expensive either. However, in order to create universal access, a facility must follow certain legal guidelines.

Table 2.2: Codes and Laws Regarding Accessibility
Americans with Disabilities Act (ADA)	The ADA is a federal law that prohibits discrimination against, or segregation of, people with disabilities in all activities, programs or services. While the ADA is similar to and patterned after other civil rights laws, it differs because it also has a major impact on the design, construction and operation of buildings and facilities, transportation vehicles, and many of the products that go into them.
Rehabilitation Act of 1973	Section 504 of the Rehabilitation Act of 1973 requires that any program or service receiving federal financial assistance be accessible to everyone. Most public services fall into this category. Meeting these requirements can be accomplished by changing policies, providing specific services, or relocating the program to an accessible building.
State and Local Building Codes	Most states have codes or other regulations that specify and require accessibility for people with disabilities in building design and construction. These vary in scope, detail and enforcement. Some are local, city or county codes instead of statewide. Some states also have civil rights laws prohibiting discriminatory practices.
Source: “Removing Barriers To Health Care”, 2007, NC Office of Disability and Health

3. What Should Fitness Centers do to Improve Access?

These five simple steps can help transform a facility into a more welcoming place for people with disabilities (2):

Remember that any effort to address the needs of people with disabilities is an opportunity to market and expand membership to a growing population.
Assess how environmental barriers can be removed and accessible features incorporated into all areas of the facility.
Go beyond the minimum requirements of the law to incorporate principles of universal design to make the facility usable to many more people.
Purchase or replace exercise equipment with equipment that offers more features to make it usable for those with varying degrees of ability.
Treat people with disabilities as you would any other member, taking into account individual needs and using the many exercise options that may be available.

“Part of the problem is that club owners and exercise equipment manufacturers traditionally focused on what is generally classified as ‘the 7 percent.’ Even though the demographics of health clubs are changing, and people with disabilities and the elderly are becoming a larger part of the general population, many clubs are still trying to attract the 7 percent of the population between the ages of 19 and 30, and the equipment that is usable by a larger portion of society is slow to appear in facilities.”

Bennett, R.P. (1999). “Equipping for People With Disabilities,” Fitness Management, 15, 32–33.

Examples of ADA Requirements for Fitness Centers

Source: “Removing Barriers to Health Clubs and Fitness Facilities,” 2008, NC Office on Disability and Health.

Building Access

Accessible parking spaces that are wide and close to the entrance.
Accessible front entrance with curb cuts at appropriate locations.
Interior and exterior doors that are at least 36 inches wide and easy to open.
Space for wheelchair user to approach and to maneuver between pieces of exercise equipment.
Accessible bathrooms large enough for a wheelchair user to maneuver.

General Areas

Low counters in reception areas.
Low counters at snack and juice bar.
Accessible locker area and changing room.
Accessible shower stall with bench.
Accessible sauna and steam room.
Accessible entrances into swimming pool.
Accessible water fountains and phones.

4. What Should Healthcare Facilities do to Improve Access?

Healthcare facilities are required by the Americans with Disabilities Act to take certain steps to achieve universal accessibility for their patients with physical disabilities.

Examples of ADA Requirements for Healthcare Providers

Building Access

Accessible parking spaces close to the entrance.
Accessible front entrance with ramp and curb cut at appropriate grades and surfaces.
Accessible route throughout the facility, connecting all accessible features and service areas.
Controls, storage facilities and amenities, such as magazine and literature racks, that can be reached by wheelchair users.

General Areas

Interior and exterior doors that are wide and easy to open.
Low counters, service windows or receptionist stations for transactions with short or seated people.
Desk-height writing surfaces with knee space for use by wheelchair users and others who cannot stand while transacting business.
Accessible toilet and dressing rooms large enough for a person using a wheelchair to navigate.

Healthcare facilities are required by the Americans with Disabilities Act to take certain steps to achieve universal accessibility for their patients with physical disabilities.

Also, as with fitness centers, healthcare facility staff should be trained to interact with people with limb difference in a sensitive and nondiscriminatory manner.

Offering Assistance

Treat all people with respect.
Offer assistance but wait until your offer is accepted before you help and listen to any instructions the person may give you.
Speak directly to the person rather than through a companion who may be with them.
Be considerate of the extra time it may take for a person with a disability to get things done. Let them set the pace.
Any aid or equipment a person may use is part of that person’s personal space – do not touch it unless otherwise asked to do so.

Wheelchair Guidance

Always ask before you move a person in a wheelchair.
If a person transfers from a wheelchair or crutches to an examining table, etc., be sure not to move the chair or crutches beyond easy reach.
Always make sure the wheelchair is locked before helping a person transfer.
When conversing at length with a person in a wheelchair, sit or place yourself at that person’s eye level.
Do not patronize people who use wheelchairs by doing things like patting them on the head.

Source: “Removing Barriers To Health Care,” 2007, NC Office on Disability and Health

5. What if the Facility Does Not Meet ADA Accessibility Requirements?

If you feel that you have encountered a facility that does not meet ADA accessibility requirements through building modifications and/or appropriate treatment of patients or customers, you can contact the owner or manager of the facility to bring this to their attention.

You may also file a disability discrimination complaint with the U.S. Department of Justice about your experience. Following are instructions on how to file such a complaint.

Provide the following information:

Your full name, address, the telephone numbers where you can be reached during the day and evening, and the name of the party discriminated against (if known).
The name and address of the business, organization, institution or person that you believe has committed the discrimination.
A brief description of the acts of discrimination, the dates they occurred, and the names of individuals involved.
Other information you believe necessary to support your complaint, including copies (not originals) of relevant documents.
Information about how to communicate with you effectively. Please indicate if you want written communications in a specific format (e.g., large print, Braille, electronic documents) or require communications by video phone or TTY.

To guide you in providing the requested information, you may use this ADA complaint form for any ADA complaint, but you are not required to do so.

Please keep a copy of your complaint and the original documents for your own records.

To file a complaint by mail:

U.S. Department of Justice
950 Pennsylvania Avenue, NW
Civil Rights Division
Disability Rights Section – 1425 NYAV
Washington, D.C. 20530

To file a complaint by fax: 202/307-1197

To file a complaint by email: ADA.complaint@usdoj.gov

It is important to remember that all new complaints are subject to processing and review, and that this may take up to three months. For more information on the process of filing a complaint, including frequently asked questions, please click here.

You may also call the ADA Information Line at 800/514-0301 (voice) or 800/514-0383. ADA specialists are available to answer questions on Monday, Tuesday, Wednesday and Friday from 9:30am to 5:30pm (Eastern Time). On Thursday, the information line is staffed from 12:30pm to 5: 30pm (Eastern Time).

6. Where Can I Learn More?

Americans with Disabilities Act (ADA) Information Line
800/514-0301
ada.gov/infoline.htm

ADA Standards for Accessible Design
ada.gov/2010ADAstandards_index.htm

Frequently asked questions about the ADA
civilrights.findlaw.com/discrimination/disabled-access-to-buildings-and-businesses-faq.html

7. Links in this Fact Sheet

To find Certified Fitness Trainers: certification.acsm.org/acsm-fitness-trainer
For more information: apens.org/certification.html

8. References

National Center on Health, Physical Activity and Disability. “Choosing a Fitness Center.”
North Carolina Office on Disability and Health. “Removing Barriers to Health Clubs and Fitness Facilities.” 2008.
North Carolina Office on Disability and Health. “Removing Barriers To Health Care.” 2007.
U.S. Department of Justice. Americans with Disabilities Act: “Access To Medical Care For Individuals With Mobility Disabilities.” 2010.
Center for Disease Control and Prevention. “Accessibility.” 2014.

It is not the intention of the Amputee Coalition to provide specific medical or legal advice but rather to provide consumers with information to better understand their health and healthcare issues. The Amputee Coalition does not endorse any specific treatment, technology, company, service or device.