The health benefits of an active lifestyle that includes moderate amounts of medium to vigorous physical activity on a regular basis have been detailed in the Surgeon General's Report on Physical Activity and Health: "...regular physical activity greatly reduces the risk of dying from coronary heart disease, the leading cause of death in the United States. Physical activity also reduces the risk of developing diabetes, hypertension, and colon cancer; enhances mental health; fosters healthy muscles, bones and joints; and helps maintain function and preserve independence in older adults" (Foreword of the Executive Summary). Unfortunately, the vast majority of people with physical and cognitive disabilities are not obtaining the recommended amount of physical activity needed to confer health benefits and prevent secondary conditions associated with a sedentary lifestyle (e.g., heart disease, obesity, osteoporosis).

The current version of the Healthy People 2010 report notes that significantly more people with disabilities reported having no leisure-time physical activity, 56% vs. 36% for people who did not indicate they had any disability. The HP 2010 Chapter, Disability and Secondary Conditions, suggests that the significantly lower rate of participation among people with disabilities may be related to environmental barriers, including architectural barriers, organizational policies and practices, discrimination, and social attitudes (Chapter 6, p. 6-22), and recommends that public health agencies begin to evaluate which environmental factors enhance or impede participation.

In a recent study assessing the physical activity patterns of African-American women with physical disabilities, it was found that one out of four adults with a mobility impairment was either in a seated or recumbent position 24 hours a day, and that over 90 percent of the sample did not participate in leisure or recreational activity. A more recent investigation found that the majority of subjects with mobility limitations felt that fitness centers did not have the type of equipment or professional staff needed to assist them in improving their fitness level. Several investigators have noted that the majority of local and state parks, fitness centers, health clubs, spas, gyms, playgrounds, pools, trails and sports fields are considered unfriendly environments for people with disabilities because of their lack of accessibility, and that most fitness professionals have had little training in working with people with disabilities.

Much of the general literature on promoting a more active lifestyle has been to encourage Americans to walk more often, with the goal of 30 minutes a day most days of the week. While this recommendation may be appropriate for the general population, it is inappropriate for people who have difficulty walking (e.g., cerebral palsy, multiple sclerosis, stroke) or who are unable to walk (e.g., spinal cord injury, polio). A modification of this recommendation would be to recommend some form of upper body exercise either in a home-based or fitness-based setting.