The practical concern that arises with limited activity is that of secondary conditions. Secondary conditions are those not present at birth but occur as a result of the primary disabilities. Secondary disabilities can presumably be prevented or lessened by better understanding and appropriate interventions (Streissguth, Barr, Kogan, and Bookstein, 1996). Deconditioning is one such secondary condition common with aging that often leads to physical deterioration, such as loss of muscle tone, limited joint flexibility, and conditions such as osteoporosis and pressure sores. Often we see a cyclical phenomena occurring: age-related pain, weakness, or inflexibility makes movement more difficult, resulting in a decreased incentive to move and subsequent increased pain and weakness. Endurance becomes limited and tolerance to activity is reduced. Health educators have urged all older adults to counteract this trend by exercising and staying active to prevent disease and disability (Ludlow, 1999).

Health promotion programs for people with disabilities aim at reducing secondary conditions, as well as maintaining functional independence and enhancing the overall quality of life. Maintaining functional independence not only has sweeping implications to the overall well-being of the client, but also benefits the caregivers. The additional burden of basic care for individuals who lose mobility is problematic, such as help with transfers and position changes.

Besides the secondary conditions related to deconditioning, one may also see physical effects from prolonged drug use in persons with I/DD, including osteoporosis and increased incidence of fractures. Since stress on bone (i.e., standing, walking, running) is advocated for bone health, exercise is strongly advised to help counteract some of these risk factors. Additionally, dependency on well-meaning caregivers is a common cause of secondary disability in this population. Individuals with I/DD are often assisted in activities they are capable of doing themselves but may not be as efficient in performing as the caregiver. This assistance limits the opportunities to practice the task and actually may teach an individual to ask for help rather than attempting the task on his or her own. Physical therapists are aware of this; for example, we hand a client his shoes to put on, and home staff report that the person cannot complete this task. When in an exercise promotion program, staff's perceptions of the client's strengths and capabilities often change as we try to play down and remove the perceived limitation.