It is difficult for James Outlaw, who has been a paraplegic since a March 1990 car wreck, to go to the gym for a workout.

Disabilities, disease & fitness

Key findings and recommendations of The Centers for Disease Control and Prevention report, "Inactivity Related to Chronic Disease in Adults with Disabilities:"

Nearly half, 47 percent, of adults with disabilities who are able to do aerobic physical activity do not get any. An additional 22 percent are "not active enough."

Working-age adults with disabilities are three times more likely to have heart disease, stroke, diabetes or cancer than adults without disabilities.

Adults with disabilities were 82 percent more likely to be physically active if their doctor recommended it.

The Physical Activity Guidelines for Americans recommend that all adults, including those with disabilities, get at least 150 minutes (2.5 hours) of moderate-intensity aerobic physical activity each week. If meeting these guidelines is not possible, adults with disabilities should start physical activity slowly based on their abilities.

In creating the report, the CDC analyzed data from the 2009-12 National Health Interview Survey and focused on the relationship between physical activity levels and chronic diseases among U.S. adults aged 18-64 years with disabilities, by disability status and type.

The focus was on adults with serious difficulty walking or climbing stairs, hearing, seeing, or concentrating, remembering, or making decisions.

Source: The Centers for Disease Control and Prevention

He must take public transportation for the disabled, CARTA's Tel-A-Ride, to and from his mobile home in North Charleston to Pivotal Fitness in West Ashley.

The service can arrive 15 minutes early and be as late as 30 minutes. And he must pay $3.50 each way.

The 49-year-old, who gets disability payments but works at Wal-Mart in North Charleston twice a week, tries to go to the gym four days a week. So the transportation cost alone adds up to more than what gym memberships cost.

Then there is transferring himself from his wheelchair to different pieces of fitness equipment, which is a workout in and of itself.

But he doesn't dream of giving up - it's too big of a part of his well-being.

"It's a mental thing as much as a physical thing," says Outlaw, who didn't start working out until after his accident and has been doing it nearly 18 years. "Just like anybody, there are days I don't feel like working out, but once I get in there and get the blood flowing, I'm a different person."

Being strong and fit, he adds, gives him "the confidence and willingness to do more stuff," such as going to concerts with his girlfriend, who also is disabled.

Disabled need fitness

Outlaw agrees he is in the minority when it comes to disabled people who are dedicated to a fitness regimen.

It's a problem that the Centers for Disease Control and Prevention identified recently in a report, "Inactivity Related to Chronic Disease in Adults with Disabilities."

The "Vital Signs" report, issued in early May, says that working-age adults with disabilities who do not get any aerobic physical activity are 50 percent more likely than their active peers to have a chronic disease such as cancer, diabetes, stroke or heart disease.

The report says 47 percent of adults with disabilities who are able to do aerobic physical activity do not get any and an additional 22 percent are not active enough.

In creating the report, the CDC analyzed data from the 2009-12 National Health Interview Survey and focused on the relation between physical activity levels and chronic diseases among U.S. adults aged 18-64 years with disabilities, by disability status and type.

The focus was on adults with serious difficulty walking or climbing stairs, hearing, seeing, or concentrating, remembering or making decisions.

The CDC report adds that doctors are not helping the situation. Only 44 percent of adults with disabilities who saw a doctor in the previous year got a recommendation for physical activity.

One of the purposes of the report was to get health care providers to urge activity.

"Physical activity is the closest thing we have to a wonder drug," says CDC Director Tom Frieden, in a release on the report.

"Unfortunately, many adults with disabilities don't get regular physical activity. That can change if doctors and other health care providers take a more active role helping their patients with disabilities develop a physical fitness plan that's right for them."

'Touchy subject'

Many people involved with the disabled in the Charleston area whole-heartedly agree with the CDC's report, but some also acknowledge the array of obstacles for getting the disabled moving, from the disability itself to transportation, costs, the need for assistance and accessible facilities.

"This is a touchy subject because some people feel like they are doing all they can to get up in the morning," says Kim Aquino, a certified therapeutic recreation specialist at Roper Rehabilitation Hospital.

"Knowing the physical work it takes a person with a quadriplegic injury just to do anything, I can see their point."

She says the CDC study doesn't account for people not being able to exercise, for example, because of respiratory problems caused by nerve damage.

Aquino says, however, that the approach should be taken with sensitivity, stressing the importance of maintain current health and the benefits of exercise in managing depression, gaining confidence and being socially engaged.

Disease first?

In some cases, the disease comes before the disability due to bad habits, notably losing a limb or one's vision due to diabetes.

Emily Nolan of the North Charleston-based Limbs Without Limits says many diagnosed with diabetes, even those who have lost a limb due to the disease, don't change.

"They continue to eat unhealthy food and get little to no exercise," says Nolan. "When an individual has lived a certain lifestyle for a number of years and is surrounded by people who have similar habits, it will be extremely difficult for that person to change if they don't truly want to change."

Nolan adds, though, that some don't start exercising because they are embarrassed about their weight or lack of athletic ability. She recalled meeting a young woman who declined to run in a challenge event because she was afraid people would laugh at her form.

Courtney Parades Plotner, program director at the Association for the Blind & Visually Impaired Charleston, says many of their adult clients have lost their vision due to diabetes or have developed it as a result of being less active due to blindness.

"Both scenarios are very serious. A lack of physical activity can fuel the effects of diabetes as well as lead to other serious health conditions. Most of our clients have plenty on their plate without the added health risks," says Plotner.

She adds that it's not easy for the blind to participate in physical activity.

"There are plenty of ways to exercise as a visually impaired person. However, it is generally more complicated, and a lot of times, less convenient than it would be for a sighted person.

For example, severely visually impaired people usually need a partner to run or ride a bike with, and while there are activities tailored for the blind, they are limited."

Plotner says the association offers yoga and fitness classes, customized for the visually impaired, at the association's center in West Ashley.

Local efforts

Other than Special Olympics and the Charleston Miracle League, local efforts to provide fitness opportunities to the disabled in the Charleston area have little to no success, either due to lack of able-bodied volunteers or to lack of participation or interest by the disabled.

But many remain committed to trying.

The Charleston County Park and Recreation Commission has long offered "adaptations" to existing program activities, but these haven't generated much interest by the disabled. So the commission is taking a different tack.

Susie Goudy, the commission's assistant recreation director, says PRC began to offer programs specifically for the disabled to avoid the intimidation that some may feel participating in able-bodied programs.

"In 2012, we expanded our programming efforts to include programs that were specifically designed for underserved populations providing an opportunity to rediscover new possibilities within their peer group. This led to the creation of our AccessABILITY program. Since the inception of the ... program, we have offered nearly 20 opportunities for underserved populations to recreate together," says Goudy.

Among the activities was a dance at the Mount Pleasant Memorial Waterfront Park pier and a special needs swim night at Whirlin' Waters waterpark.

On Sept. 28, PRC will host its first-ever Adaptive Recreation Expo at James Island County Park to build interest in the disabled community in an array of adaptive programs, as well as to find out what the community wants.

Similar to the East Coast Paddlesports & Outdoor Festival, the expo will provide opportunities to sample paddling, archery, bocce, yoga, climbing, wheelchair basketball and dancing, hand cycles and a chance to sample equipment or services for adaptive recreation.

"Participants will be encouraged to try any activity that interests them, with the hope that they might discover a lifelong hobby or recreational pursuit," says Goudy.

"The feedback we get from this event will drive our future programming efforts for our patrons with physical limitations."

Living by example

Seth Cantley, who was born without a forearm, is among the most avid, active disabled people in the Charleston area. The architect finds time to be an ultra-marathon runner, a certified yoga instructor and stand-up paddleboard instructor, manages Half-Moon Outfitters Endurance Team and is an adaptive paddling instructor.

Cantley works with people with "disabilities of all types" and hopes he is helping them find limitless opportunities to improve physical, mental and emotional health.

"My view, and hopefully the benefit that I offer, is to help people to become more active in sports like running, paddlesports, rock climbing, yoga and others for a totality of health. ... These activities help them become healthier. And these activities continue by helping them feel happier, more capable and accomplished," says Cantley.

"The interesting component is how people with 'disabilities' will often rocket into physical activity once they learn that they are not bound to previous personal and/or public expectations of themselves," he says.

"They stop seeing the boundary of their chair, prosthetics, ear piece or darkness (blindness). They will move with excitement beyond that limitation. And when they start to see what they are truly capable of doing, their minds will start to run towards new goals of freedom. And with that new movement and freedom, the health will grow through the mind, body and soul."

Reach David Quick at 937-5516.