The requirements for accessibility of fitness equipment are not as carefully spelled out as those for architectural accessibility. Physical activity and disability is a developing field. There is simply not enough information on the effects of different types of exercise on different disabilities, not to mention what types of movement or activities would be most beneficial for which groups. This lack of research means we do not always know how people with disabilities can use existing equipment, what modifications work best, and what results can be expected.

Without specific guidelines from the ADA, club owners must make some decisions when deciding what types of fitness equipment to purchase. There are several possible physiological differences that should be taken into account when considering fitness equipment for people with disabilities. Mobility is the most obvious difference, as maneuvering or transferring into a piece of equipment may be very difficult for a person using a wheelchair, a person who is obese, or a person with limited range of motion or problems with balance and coordination. Once in position, upper- and lower-body strength, grip strength, and range of motion may also be compromised. Equipment should allow for very small increments of weight increase, beginning with a resistance of zero. Handles should have a larger circumference to make gripping easier or be compatible with specially designed gloves. The range of motion of the machine should be adjustable to fit individual abilities safely. In addition, numbers should be large and easy to read, weight pins and other adjustments easy to reach, and the number of adjustments necessary should be as few as possible.

As with architectural accessibility, "equal accessibility" would be ideal. These machines would be universally accessible and attractive to both people with and without disabilities. Strength equipment manufactures have not recognized the potential market for this kind of machine, and when they do, it will still be many years before these machines can be developed, tested and enter the market at reasonable prices.

Some equipment companies have designed and built equipment specifically for use by people who use wheelchairs. Apex Fitness has a circuit of eight strength machines for wheelchair users and Magnum Fitness has a multi-station machine for wheelchair users. However, these machines are unlikely to be found in the average health club, as they are just as expensive, if not more expensive, than traditional machines and can only be used effectively by people in wheelchairs. Because wheelchair users make up such a small percentage of health club users, owners are unwilling to invest the money and space for these machines.

In the meantime, existing equipment can be modified to address many of the difficulties encountered by people with disabilities. Well-trained staff can help with transfers into and out of equipment. Belts can provide stability during use. Elastic tubing could be mounted on a wall to allow a person in a wheelchair to perform exercises without getting out of the chair. Special gloves can be worn to overcome decreased grip strength or paralysis. Shoe clips can be added to cycles to help keep feet on the pedals. These and many other modifications are currently being developed and tested at university labs, including the University of Illinois at Chicago. Until universally practical and attractive machines are available, a little creativity may be the best way to make current equipment accessible. Modifying existing equipment will be faster and cheaper than waiting for the new machines, and will allow more clubs to provide services to more people.