The major components of a fitness program for people with disabilities are the same as for the general population: cardiovascular endurance, strength, and flexibility. What may vary, however, are the types of activities that would be used to improve fitness (e.g., use of an upper-extremity ergometer to improve cardiovascular endurance in a person with a lower-extremity disability, use of a recumbent bicycle in place of a stand-up bicycle for a person with poor upper-body control) and the intensity, frequency, and duration of the activities. With some individuals who are lacking in balance and pulmonary function, additional exercises may have to be added to the exercise prescription. When developing an exercise program for a person with a disability in a community-based setting such as a YMCA, the fitness instructor should be in close communication with the physical therapist to ensure that the program is safe and effective for the client. Closely supervised programs are often not available in many fitness facilities unless the person is able to pay for a personal trainer.