Spandex doesn't necessarily rule at the Gold's Gym in Gaithersburg. Some of the gym's best weight lifters propel themselves by the arms to places where standard benches have been removed, permitting wheelchair athletes to pull alongside the racks of free weights. And several times a week, a few wheelchair exercisers puff along with other members of an aerobics class, relying on the club's owner and aerobics director, Margie Weiss, to adapt routines to their physical abilities. When they're done sweating, they can wash off in the club's wheel-in showers.

Weiss says the needs of her own four-generation family helped drive her decision to make the club more inclusive. Even her 93-year-old father, who uses a wheelchair, comes to the club for modified workouts when he can.

"I don't like the idea of a gym where you only have the big, buff athletes," says Weiss. "I want a woman of 65 with arthritis to feel comfortable as well. It doesn't take much to have a man or woman with weak joints do sit-ups on a special ball positioned against the wall -- to reduce wear and tear on the knees -- while most of the others in the class are lying on their backs."

The lengths to which the Gaithersburg gym has gone to accommodate people with disabilities due to age, injury or illness may be somewhat unusual, but its interest in this population is not unique. Slowly the number of fitness centers welcoming disabled members and adapting equipment and classes to their needs is increasing, says James Rimmer, director of the National Center on Physical Activity and Disability (NCPAD) in Chicago, an academic research center funded in part by the federal Centers for Disease Control and Prevention (CDC).

Cleveland physical therapist Kathleen Ferguson, who is president of Breakout Fitness, a gym designed for people with physical disabilities, says 15 percent of gyms now have at least some capacity to accommodate the disabled, up from 2 percent to 3 percent 10 years ago; she projects that by 2012 this figure will reach 25 percent. According to a recent census by the International Health, Racquet and Sports Clubs Association (IHRSA), which represents about 40 percent of U.S. health clubs, 11 percent of its member clubs have programs specifically for physically disabled members.

These initiatives involve more than making it easier for people to get inside. Thanks to the Americans With Disabilities Act, just about anyone with a disability can get into gyms built or remodeled since the early '90s. But until recently access often stopped at the front desk. No more.

Among other examples of disability accommodations by local private gyms: The Sports Club/LA has installed chairlifts for two swimming pools; a special rail runs along the length of one pool for balance and assistance. Like the Gold's Gym outlets in Fairfax and Gaithersburg, it also has weight resistance machines that can be adjusted for people in wheelchairs. At the YMCA in Chevy Chase, a six-day-a-week dance exercise class designed for older people takes into account participants' limited flexibility and strength; class members include many recovering from strokes.

The gyms' outreach to the disabled, says Rimmer, is in part pragmatic -- a way to increase membership in a sour economy. Regardless of motive, however, the change is benefiting a group of people in critical need of physical exercise.

For those with serious physical disabilities, exercise can be critical to maintaining mobility, coordination and function and offsetting the effects of debilitating conditions. Strength conditioning, says Rimmer, can help compensate for decreases in muscle contraction and range of motion that mark progression of a physical disability. Exercise can also improve the health of heart, lungs, muscles and bones and help build stamina needed for the demands of daily living -- such as propelling a manual wheelchair, getting around an office or house and transferring from bed to chair.

But as poor as the general state of physical fitness is among able-bodied people, it's far worse among those with disabilities. According to government health goals published in a document called Healthy People 2010, 36 percent of Americans say they get no physical activity whatsoever. For disabled individuals, who make up 19 percent of the U.S. population between the ages of 15 and 64, that rate climbs to 56 percent.

A Measure of Protection

Limited gym access isn't the only reason that many disabled people are sedentary, say experts. Membership fees, transportation problems and the stress of getting through the day can push physical activity way down on a disabled person's priority list.

"Most disabled people don't dream about working, much less about physical exercise," says Kimball Gray, executive director of the Maryland Council on Independent Living, which helps disabled people in Maryland find equipment, services and other assistance to allow them to live on their own.

In addition, Rimmer and others say, in many cases disabled people take their cues from doctors and physical therapists, who focus more on helping patients regain some use of an injured part of the body rather than on general conditioning.

Too many caregivers still follow an "old paradigm of providing rehabilitation and practice on activities of daily living as the sole sum and substance of physical activity for people with disabilities," says Janet Seaman, executive director of the American Association for Active Lifestyles and Fitness, a Reston-based group that advocates for underserved groups. She says that perspective is slowly being replaced by recognition of patients' desire for play, sport, work and the social companionship that participation in physical activity can provide.

If positive reasons to exercise don't move patients, there are some powerful negative ones.

"People with disabilities have a much thinner margin of good health -- one small illness or injury [can] put them below the line and then their whole life is compromised," says Rimmer. Maintaining fitness, he says, is the best protection against that.

Ask Kimball Gray. Now 41, the onetime college weight lifter and football player is a paraplegic as a result of a car accident more than 20 years ago. On his own, the Silver Spring man managed some upper body exercise but until recently couldn't find a place that would help him build his upper arm strength, needed so he can lift himself from bed to wheelchair and from wheelchair to toilet, and shift position several times a day to prevent painful and dangerous pressure sores.

About a year ago Gray slipped during such a lift, breaking his collarbone. Immobilized for his recovery, Gray developed pressure sores so severe he needed two surgeries to cut away infected skin and graft other skin from his body to cover the exposed tissue.

Only after his second surgery at the National Rehabilitation Hospital in Northwest Washington, Gray says, did a physical therapist mention that the facility's specially adapted gym is open to former patients, with fees negotiated according to need. Delighted at the discovery, Gray hopes to make it to the gym three times each week.

Equal-Opportunity Injury

Not all caregivers are thrilled with the idea of private gyms opening their doors to those with disabilities. Some worry whether not just equipment but supervision and training there are adequate to protect patients from injury.

While physical therapists at Georgetown University Hospital's rehabilitation program help patients develop an exercise program before they discharge them, Meris Chang, head of physical therapy at the hospital, is adamant about not recommending gyms to these patients. "How do I know the trainer I'm recommending will still be there when the disabled person joins," says Chang. She's equally skeptical about encouraging wheelchair patients to join exercise classes designed for able-bodied people. "First off," she says, "we'd have to make sure they're in the right wheelchair."

That attitude is pervasive, says Russ Holt, a 34-year-old quadriplegic who publishes the Washington Access Guide, a directory of accessible venues. "The disabled have the same right to fall and hurt ourselves at a gym as an able-bodied person," says Holt, who used to work out at either of two local gyms before buying a special stationary bike that moves his arms and legs to build up their strength.

Holt says health care professionals should recommend exercise to their disabled patients with the same fervor that internists should use for non-disabled patients. "Facilities where activity programs are conducted," says Seaman, "are no more liable for injuries to people with disabilities than they are for injuries sustained by any other consumer [if] the facilities and equipment are properly maintained and appropriate instruction and supervision are provided."

That's largely right, says personal injury lawyer John A. Rothschild, a partner in Fox Rothschild O'Brien & Frankel in Philadelphia. "As a general rule, gyms probably do not have greater liability to disabled members than to non-disabled members, though individual states and the ADA (Americans with Disabilities Act) could have more specific rules," he said. Thomas Schmokel, a Tallahassee, Fla., building expert on who surveys facilities for compliance with the Americans with Disabilities Act, says that so long as a gym complies on general access, parking and restrooms, it has no greater liability for a disabled member than another.

Because recovery from an injury can be harder and take longer for a disabled person, however, experts recommend precautions. For example, says Rimmer, trainers working people with high-level spinal cord injuries must know to design workouts so as not to exceed a heartbeat rate of 90 beats per minute -- well below the aerobic target of most physically able people. It's also important for this group and for people recovering from a stroke to check blood pressure at the start of each workout session and cancel the workout if figures are too high. Rimmer advises patients to consult with a rehabilitation specialist or physical therapist who knows their abilities and limitations before starting an exercise regimen.

Winging It

Advocates for people with disabilities are doing what they can to make sure other obstacles don't get in the way of gym participation. Like inexperience with disability issues, for gym owners, or affordability, for prospective gym members.

Even gyms that don't have special equipment, they say, can find ways to accommodate members with physical disabilities.

For example, the District of Columbia Jewish Community Center gym on 16th Street NW, which doesn't have any disability programs per se, took extra steps to accommodate a member's needs. Last year a member with multiple sclerosis teamed up with a Fitness Center trainer who helped her on and off the weight resistance machines so that she could start and complete a workout. Now, she mostly uses the Center's pool. At the SportsClub/LA, a trainer worked with a client with severe arthritis, contacting her physician and arthritis associations to help build a workout program for her.

Rimmer encourages trainers and gym owners to call NCPAD at 800-900-8086 (voice and TTY) and work with his staff to help tailor classes and individual programs to a member's needs, regardless of the disability. While workouts needn't always take place at a gym, he says, added benefits there include social interaction, professional supervision and a mix of activities.

On the affordability question -- gym memberships usually run at least $40 per month on top of a sometimes-steep initiation fee -- insiders advise candor. Bill Howland, spokesman for IHRSA, encourages disabled members who can't afford the fees to talk with a club owner or manager to explain their needs and try to work out a payment plan or a reduction in cost.

For those who can't get to the gym or prefer to exercise at home, NCPAD is also working on exercise regimens and videos that disabled persons can download or order. And at least two companies offer equipment for home use. (See "Options for the Physically Disabled.") NCPAD's Rimmer hopes his efforts will dispel any notion among the disabled that their choice is an Olympic wheelchair athlete or nothing.

Perhaps the person they should meet is a quiet man from Cleveland who has been blind since birth. Last year the man joined Breakout Fitness, a club in Cleveland with all accessible equipment for the disabled, including a treadmill with sounds cues to allow blind members to exercise without assistance.

"The man came in about 40 pounds overweight and worked daily for a year until he lost the excess pounds and vastly improved his gait and posture," says the club's president Kathleen Ferguson. Club members and staffers celebrated his achievement until he told them that weight loss was not his goal. The man, who lives on his own, had been denied a seeing eye dog because the private firm that provides them said his general health and his gait were too poor to allow the dog to lead him.

Just a few months ago, with his weight down and gait steady, he got the dog -- and, with it, greater freedom.

Francesca Lunzer Kritz is a regular contributor to the Health section.

Jonathan Venskus, who has cerebral palsy, works out at Gold's Gym in Gaithersburg, known as disability-friendly. At Gold's Gym in Gaithersburg, which integrates exercise space for all physical abilities, Jonathan Venskus, left, works out near Leon Evans.