Comment on Exercise Equipment and Furniture

Introduction

The ADA already requires exercise equipment that is usable by people with disabilities in exercise facilities through, at a minimum, the ADA’s general non-discrimination requirements. Public and private entities that offer exercise equipment are required to engage in a considered process to provide usable equipment. The comments below are the provisions, reasons, and analysis we propose about how to regulate this existing requirement.

Summary

A typical exercise facility has dozens of pieces of equipment that require the use of the legs and are utilized by people who can get exercise from walking or running. However, exercise equipment is virtually never provided for people who can’t get exercise from walking or running and for whom exercise equipment may be essential to maintain their health and wellness. This discrimination against people with disabilities can have a severe negative impact upon their health, and excludes people with disabilities from engaging in an important social and recreational activity available to non-disabled people. Universally designed exercise equipment that can be used by people with and without disabilities is an essential right under the Americans with Disabilities Act. Therefore, we strongly support regulations specifically requiring accessible exercise equipment.

Covered Entities Do Not Currently Provide Accessible Exercise Equipment Thereby Denying Disabled Patrons the Health Benefits of Exercise

The U.S. has a variety of exercise facilities. There are 30,000 for-profit health clubs with 45.5 million members generating annual revenues of $19 billion.[1] There are an equal number of other exercise facilities including YMCAs; public recreation centers; public elementary, secondary, and post-secondary institutions; hotel fitness centers; and other establishments that offer exercise facilities.

Over 20 million adults have a mobility disability and either cannot walk or have difficulty walking.[2] Many sit all day, using a wheelchair or scooter. Other adults with disabilities use a walker, crutches, or cane and have limited mobility. For many, the only way to engage in physical activity is by using an exercise machine. These individuals have a variety of medical conditions and health-related issues that require regular exercise to improve their ability to live independently and maintain their health and function. Lack of movement increases the risk of cardiovascular disease, obesity, type 2 diabetes, deep vein thrombosis, and dependence on others for assisting with activities of daily living. Serious medical complications can often be avoided by engaging in a regular routine of cardiovascular and strength exercise that involves, when possible, the lower extremities. There are also social and other benefits to utilizing exercise facilities that are precluded when the facilities have no accessible exercise equipment.

Exercise facilities often provide between 40 and 100 cardiovascular machines. These include treadmills, ellipticals, stair climbers, rowers, upright bikes, recumbent bikes, spinning bikes, and dozens of different types of strength machines. Virtually all of the publicly available cardiovascular machines require use of the legs to propel the machine and thus are either unable to be used by people with a mobility impairment, or may be minimally usable by some individuals who have partial use of their lower extremities. People who are elderly often have extreme difficulty mounting or unmounting the machine, or difficulty initiating the motion due to high initial loads required to start the machine.

Exercise facilities also provide many kinds of strength training equipment. Strength training is particularly important for people who use wheelchairs or crutches since transfers from a wheelchair, pushing a wheelchair, or using crutches are repetitive motions that increase the risk of overuse injuries. Strengthening opposing muscle groups has been shown to protect certain joints, thereby reducing the risk of these repetitive stress injuries. However, most of this equipment either requires a person using a mobility device to transfer to a bench seat, which is often unsafe or difficult to do, or to stand to lower the bars containing the weight, which many mobility impaired individuals cannot do.

There are also eight million adults who are blind or have vision impairments.[3] Many and perhaps most of these individuals are also unable to use most of the cardiovascular and strength machines because they cannot read the displays. Although they are physically capable of a brisk walk or run, it is difficult, if not dangerous, for them to do so because of impaired vision. Many would prefer to use an exercise machine for cardiovascular activity.

For example, treadmills and ellipticals, the two most popular types of cardiovascular exercise equipment, have controls for speed and incline. It may be dangerous to use this equipment without being able to operate the controls. Although cardiovascular machines with raised iconography are available and can be used equally by the people with and without vision impairments, exercise facilities virtually never provide them.

In sum, the millions of Americans with mobility or vision impairments are unable to obtain the health benefits from some of our nation’s most popular forms of exercise due to the failure of exercise facilities to provide equipment they can use.

Question 12. What types of accessible exercise equipment and furniture are available on the commercial market? What types of equipment and furniture are already accessible to individuals with disabilities? Is independently operable equipment and furniture available for individuals who are blind or who have low vision, or who have manual dexterity issues.

Universal Design: Accessible Exercise Equipment is Available

The principle of universal design is to develop and manufacture facilities and equipment that can be used equally by all people to the greatest extent possible. Since 2001, the Inclusive Fitness Initiative (IFI) in England has been working with the fitness industry to create universal design standards. IFI is the first systematic attempt to develop universal design standards for exercise equipment.

In the U.S., ASTM (originally known as the American Society for Testing and Materials) promulgates design standards for exercise equipment. In 2008, a special ASTM committee was formed to draft Universal Design Fitness Equipment Guidelines for the U.S. The committee includes representatives from IFI, the major exercise equipment manufacturers, and the disability community. Issuing of these standards is expected by 2012.

One hundred exercise machines representing 15 major international manufacturers have been certified as meeting the IFI universal design standards. These machines include:

  • Treadmills (9)
  • Recumbent Cycles (9)
  • Upright Cycles (7)
  • Upper Body Ergometers (3)
  • Rowing Machines (3)
  • Cross Trainer/Elliptical Trainers (3)
  • Upper Body Resistance (26)
  • Lower Body Resistance (25)
  • Multi-stations (11)
  • Vibration Training (2)

All of the IFI certified machines have the following features to assist people who are blind or have vision impairments:

  • Raised iconography on their consoles.
  • Large buttons.
  • Large text.
  • Color contrasted levers and grips.
  • Laser-cut numbering for seat adjustments.
  • Treadmills have bright color contrast between the deck and the moving belt to allow users to differentiate between the moving and non-moving parts.
  • Treadmills have multiple belt logos to ensure that one logo is always visible, so all users can recognize that the belt is moving.

All of the IFI certified machines have the following features to assist people with limited manual dexterity or mobility:

  • Swing away seats that allow easy access for wheelchair users.
  • Single-handed seat adjustment levers that can be used with either hand to accommodate those who have the use of only one hand.
  • Weight machines have lower starting weights and low increments between weights.
  • Weight machines with an overhead bar have a seat level handle to adjust the height of the bar, so that a person who cannot stand can use the machine.
  • Treadmills have slower starting speeds.
  • Treadmills have an emergency stop lanyard to provide safe stops for people with limited upper limb function.
  • Ellipticals have a locking mechanism for foot pedals, providing stability for users when stepping on and off the equipment.
  • Machines with pedals incorporate a fixed heel strap and adjustable toe strap for increased foot support.
  • Recumbent machines have a step-through design so that a person with limited mobility can access the machine.

In addition to IFI certified machines, there are many exercise machines manufactured in the U.S. that have not applied for IFI certification but are nevertheless accessible to people with mobility impairments. These include both cardio machines and strength machines.

The strength machines include;

  • FreeMotion Dual Cable Cross
  • Vectra VX-FT
  • TriActive Accessible Multi-Gym

The cardio machines include:

  • SciFit Recumbent Stepper
  • SciFit Recumbent Elliptical
  • NuStep T5 –Recumbent
  • BioStep Recumbent Elliptical
  • KRANKcycle-upper body ergometer
  • Technogym upper body ergometer

Many manufacturers offer accessories that assist people with disabilities in using exercise machines. These accessories include:

  • Gloves that assist in gripping equipment for upper body exercises, for people who cannot control their hands.
  • Bicycle pedal adapters that secure the foot to the bicycle pedal.
  • Devices that stop the pedals on a recumbent machine to assist in getting the feet in the pedals.
  • Seats for rowing machines.

The recumbent cardio machines listed above are particularly important for people with mobility impairments. These machines have pedals for feet and handles for arms. The arms and feet can move together or separately. Someone who does not have the use of their legs can use their arms to move the leg pedals. Such a machine not only provides cardiovascular benefits, it also helps decrease muscle loss in the legs and reduces the risk of edema (swelling), which can cause severe health problems such as deep vein thrombosis (blood clots) and bacterial infections.

In sum, there are numerous accessible exercise machines commercially available today. The problem is that very few of them are available in exercise facilities. When they do exist, they are generally found only in rehabilitation facilities, which are rarely, if ever, available to be used for regular fitness activities by people with disabilities. Moreover, for rehabilitation facilities to be the primary location for accessible exercise machines turns ordinary exercise into a medical activity for people with disabilities, and ignores the fact that people in the United States have many reasons for visiting the local gym, all of which should be available to the disability community.

Question 13(a) Should the Department require covered entities to provide accessible exercise equipment and furniture?

We strongly support specific requirements for covered entities to provide accessible exercise equipment and furniture for the following reasons:

  • Since the vast majority of people with disabilities cannot afford home-based exercise equipment and very few fitness facilities today provide any accessible exercise equipment, millions of people with disabilities have no way of improving their health and wellness, and engaging in the social and other benefits of gym exercise.
  • The failure of covered entities to provide readily available accessible exercise equipment is a clear violation of the ADA.

Question 13(b) How much of each type of equipment and furniture should be provided? Should the requirements for accessible equipment and furniture be the same for small and large exercise facilities, and if not, how should they differ?

Exercise facilities with 30 or more pieces of exercise equipment should be required to have the following:

New facilities (30 or more pieces of exercise equipment)

  1. A minimum of one piece of combination upper and lower extremity aerobic exercise equipment with universal design features (see definition below) that has a seat that can be removed to allow usage by a wheelchair user while seated in their wheelchair.
  2. A minimum of one treadmill with universal design features
  3. A minimum of one piece of upper extremity strength exercise equipment with universal design features that allows a person to do multiple exercises while seated in their wheelchair. This could either be a multi station machine or a dual pulley system that either has no seat or a removable seat.
  4. A minimum of one piece of upper extremity aerobic exercise equipment with universal design features that has a seat that can be removed to allow usage by a wheelchair user while seated in their wheelchair.
  5. Whenever there are three pieces of equipment in the same category, e.g. treadmill, cycle, elliptical, etc., one of the pieces must have universal design features.
  6. Accessories to enhance accessibility shall be provided.

Existing facilities (30 or more pieces of exercise equipment)

  1. Items 1, 2 and 3 above.
  2. Whenever new cardiovascular equipment is acquired, it shall have universal design features unless there is already one piece of equipment in that category with universal design features.
  3. Accessories to enhance accessibility for existing machines shall be provided.

Exercise facilities with less than 30 pieces of exercise equipment should be required to have the following:

New facilities (less than 30 pieces of exercise equipment)

  1. A minimum of one piece of combination upper and lower extremity aerobic exercise equipment with universal design features (see definition below) that has a seat that can be removed to allow usage by a wheelchair user while seated in their wheelchair.
  2. A minimum of one piece of upper extremity strength exercise equipment with universal design features that allows a person to do multiple exercises while seated in their wheelchair. This could either be a multi station machine or a dual pulley system that either has no seat or a removable seat.
  3. At least one of every category of cardiovascular exercise machine shall have universal design features.
  4. Accessories to enhance accessibility shall be provided.

Existing facilities (less than 30 pieces of exercise equipment)

  1. Comply with the requirements for a new facility to the extent it is readily achievable.
  2. To the extent compliance with the requirements for a new facility is not readily achievable, whenever new cardiovascular equipment is acquired, it shall have universal design features unless there is already one piece of equipment in that category with universal design features.
  3. Accessories to enhance accessibility for existing machines shall be provided.

“Universal design features” shall mean equipment that is either accredited by IFI or substantially complies with the IFI standards. Upon promulgation of the ASTM universal design standards, “universal design features” shall mean compliance with the ASTM standards.

All of these items are readily available. Moreover, the price differential between the same machine with or without universal design features is minimal.

In addition, all information and interface aspects of all exercise equipment must meet the technical and functional accessibility standards of Section 508, which will guarantee access to on-screen information through audio output and tactile controls. This will make the exercise equipment accessible to people who are blind or have vision impairments.

Conclusion

Regular physical activity can substantially reduce the risk of many diseases or medical conditions, and provides social and other benefits. However, the benefits of exercise are not available to many people with disabilities. More importantly, the lack of exercise can directly cause other disabling medical conditions such as obesity and type 2 diabetes.

The Healthy People 2010 report was published by the Department of Health and Human Services in 2000. It presented a comprehensive, nationwide health promotion and disease prevention agenda designed to serve as a roadmap for improving the health of all people in the United States during the first decade of the 21st century.It stated that one of the factors that adversely affects the health and well being of people with disabilities is “fitness centers may not be staffed or equipped for people with disabilities.” It further stated: “Compliance with the Americans with Disabilities Act (ADA) would help overcome some of these barriers.”[4] Then, Healthy People 2010 made the following recommendation.

For people with disabilities to have the opportunity for healthy lives, both physically and emotionally, programs and facilities that offer wellness and treatment services must be fully accessible. Effective enforcement of the Americans with Disabilities Act can improve services for people with disabilities and help prevent secondary disabilities.[5]

It has been 20 years since the passage of the ADA and 10 years since the above recommendation was made. More progress is needed to make exercise facilities usable by people with disabilities. It is time for the Department of Justice to issue regulations specifically requiring accessible exercise equipment so that millions of people with disabilities can engage in important health activities at an equivalent rate as the general population. Exercise in people with disabilities can help minimize reliance on other people to assist with activities of daily living, reduce health care costs associated with sedentary behavior, protect from secondary health conditions such as pain, fatigue, depression and weight gain (all of which exist at significantly higher rates among people with disabilities), and improve overall quality of life.[6]

Every subject area in this ANPRM is of vital importance to the disability community across the United States. We urge the Department tomove ahead with eacharea of rulemaking independently as it is able, and notallow time delays in onearea to hold up rulemaking on the other issues raisedin this ANPRM, and in all ofthe ANPRMs issued by the Department in July 2010.

[1] The IHRSA Global Report 2009

[2] Data on the number of people with mobility impairments comes from the U.S. Census Bureau.

[3] Data on the number of people with vision impairments comes from the U.S. Census Bureau.

[4] Healthy People 2010: Objectives for Improving Health; Disability and Secondary Conditions, p. 6-3.

[5] Healthy People 2010: Objectives for Improving Health; Disability and Secondary Conditions, p. 6-20.

[6] Jim Rimmer, “The Conspicuous Absence of People With Disabilities in Public Fitness and Recreation Facilities: Lack of Interest of Lack of Access?”, The Science of Health Promotion, May/June 2005 and Healthy People 2010.