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One of the biggest gaps in healthcare isn't what happens during rehabilitation. It's what happens after. Every day, individuals with disabilities complete physical therapy goals, are discharged from services, and are told they've made great progress. That's exactly what physical therapy is designed to do. Restore function following an injury, surgery, illness, or change in medical status. When those goals are met, therapy ends. The need for movement doesn't. That's where too many individuals and families find themselves without a clear path forward. REHABILITATION AND FITNESS HAVE TWO DIFFERENT JOBS Physical therapy and professional fitness coaching serve different purposes, and both are essential. Physical therapy helps someone regain function after something has been lost. Fitness helps someone continue building strength, endurance, balance, confidence, and independence long after rehabilitation is complete. One isn't better than the other. They're different. The problem is that we often treat the end of therapy as the finish line when it should be the starting point for lifelong health. THE MISSING BRIDGE Imagine someone with cerebral palsy who has completed physical therapy after surgery. Or an adult with Down syndrome who has regained function following a hospitalization. Or an individual with autism who has spent months working with therapists to improve movement and coordination. They're stronger than they were. They're more capable than they were. But then what? Too often, the answer is... nothing. Families are left trying to find a gym that feels welcoming. Coaches aren't always confident working with individuals with disabilities because they were never taught how. The result is a gap between healthcare and lifelong wellness. WHY STRENGTH STILL MATTERS Strength training isn't just about lifting heavier weights. It's about maintaining independence. It's about reducing fall risk. It's about making everyday tasks easier. It's about having the strength to get off the floor, carry groceries, climb stairs, play with grandchildren, or continue living independently. Those needs don't disappear because therapy has ended. In many ways, that's when they become even more important. BUILDING THE NEXT STEP For the past 14 years, we've worked with individuals with disabilities after physical therapy, alongside therapists, and sometimes before therapy is ever needed. We've never viewed fitness as a replacement for healthcare. We see it as the next step. Good coaching reinforces the progress someone has already made instead of allowing it to slowly disappear. It creates consistency. It builds confidence. It helps people continue moving toward a healthier, more independent life. A BETTER SYSTEM Imagine a healthcare system where discharge from physical therapy didn't mean the end of professional support. Imagine if every therapist had a trusted strength coach they could refer families to. Imagine if exercise was viewed as part of long-term healthcare instead of something people were expected to figure out on their own. That's the bridge we should be building. Because rehabilitation restores what's been lost. Fitness helps protect what has been gained. And everyone deserves the opportunity to keep moving forward. 
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When most strength coaches hear the word "assessment," they think of movement screens, mobility testing, strength benchmarks, and training history. Those tools absolutely matter. Every effective strength and conditioning program starts with understanding the athlete in front of you. That doesn't change when coaching athletes with intellectual and developmental disabilities (IDD). What changes is how you gather that information. Too often, coaches assume they need a completely different assessment process for athletes with disabilities. In reality, the goals of a needs analysis remain exactly the same. You still need to understand the athlete's goals, medical history, training experience, movement competency, and readiness to participate in exercise. The difference is that building trust becomes just as important as collecting information. WHY THE FIRST SESSION MATTERS MORE THAN THE ASSESSMENTMany individuals with IDD have spent years moving from one appointment to the next.
For much of their lives, they've been assessed through the lens of what they can't do. By the time they walk into your facility, the last thing they need is another professional focused on deficits. Your first responsibility isn't to identify movement limitations. It's to create an environment where they feel successful. That's why I believe assessment should begin with relationships, not testing. When an athlete feels safe, understood, and excited to come back, you've already accomplished something far more important than collecting a few data points. BUILD TRUST BEFORE YOU BUILD A PROGRAMOne of the biggest mistakes I see coaches make is trying to gather every piece of information during the first five minutes. Instead, spend time getting to know the athlete. Ask about their favorite movie. Talk about video games. Find out what sports they watch. Ask about hobbies, pets, vacations, or what they're excited about this week. Those conversations may seem unrelated to strength and conditioning, but they're incredibly valuable. They help establish rapport, reduce anxiety, and often provide coaching tools you'll use later. If your athlete loves Mario Kart, maybe racing analogies become your coaching cues. If they're obsessed with football, maybe every lift becomes preparation for game day. Connection always improves coaching. YOUR BEST RESOURCE ISN'T ALWAYS THE ATHLETEParents, guardians, caregivers, and direct support professionals often know the athlete better than anyone else. They understand:
These conversations shouldn't feel like checking boxes on an intake form. There are opportunities to understand how to coach the individual sitting in front of you. They're also important because these support systems often determine whether training continues after the first session. When families trust you, consistency becomes much easier.  turn the first visit into an orientationI rarely think of the first visit as a testing session. Instead, I treat it as an opportunity to introduce the athlete to the environment. Let them explore the facility. Show them the equipment. Introduce the coaching staff. Explain what happens during a session. Reduce as much uncertainty as possible. For many athletes with IDD, a new environment can feel overwhelming. Giving them time to become familiar with the space often produces far better outcomes than rushing into formal assessments. While they're exploring, you can learn an incredible amount simply by observing. watch before you testSome of the most valuable assessment information comes from observation. Pay attention to:
These informal observations often tell you everything you need to know to begin programming safely. Remember, the goal isn't to produce a perfect movement screen on day one. The goal is to gather enough information to prescribe appropriate exercises while making the athlete excited to return. SAVE SENSITIVE CONVERSATIONS FOR LATERNot every discussion needs to happen in front of the athlete. Topics such as:
are often better discussed privately with parents, guardians, or support staff. This allows the athlete's first interaction with you to stay positive and centered around possibility rather than limitations. At the same time, you still receive the information necessary to design an effective training program. DEFINE SUCCESS BEFORE WRITING THE PROGRAMEvery needs analysis should answer one simple question: What does success look like for this athlete? For some athletes, success means competing in the Special Olympics or Paralympic sports. For others, it might mean:
These goals may look different, but your role as the coach doesn't. Your job is to identify the physical qualities required for success and build a program that develops them. COACH THE ATHLETE, NOT THE DIAGNOSISThe assessment process for athletes with intellectual and developmental disabilities isn't about lowering standards or eliminating structure.
It's about recognizing that trust is part of the assessment. When coaches invest time in building relationships first, movement assessments become more accurate, exercise adherence improves, and athletes are far more likely to stay engaged over the long term. The principles of strength and conditioning don't change. The athlete is still the athlete. The diagnosis simply changes how you introduce the process. And sometimes, the most valuable thing you assess during that first session isn't movement at all. It's whether the athlete leaves believing they belong in your gym. Adults with intellectual and developmental disabilities are significantly less physically active than the general population. The consequences are exactly what you'd expect: higher rates of obesity, cardiovascular disease, type 2 diabetes, reduced independence, and shorter life expectancy. None of this is new. We've known it for years. The real question is this: Why has the fitness industry done so little about it? At Specialty Athletic Training, we've spent the last 14 years working exclusively with individuals with disabilities. We've coached over 1,000 athletes across Eugene, Portland, and Vancouver, and one thing has become incredibly clear: The problem isn't motivation. The problem is access to coaches who know what they're doing. THE REAL BARRIER IS UNCERTAINTYThe biggest barrier isn't equipment. It's uncertainty. Most trainers were simply never taught how to coach individuals with disabilities. A coach can earn a certification without ever learning how autism affects sensory processing, how cerebral palsy influences movement, or why individuals with Down syndrome require specific programming considerations. As a result, many coaches don't feel confident working with this population. The reality is that they should. The principles of strength and conditioning don't suddenly change because someone has a disability. Progressive overload still matters. Building strength, improving balance, increasing work capacity, and increasing independence are still the goals. What changes is how those principles are applied. Exercise selection may look different. Coaching cues may need to be more visual or more concise. Sessions may require greater structure, predictability, or flexibility. Progressions may happen at a different pace. But the foundation of good programming remains the same. When coaches understand that, uncertainty turns into confidence. Without that confidence, many coaches either avoid working with individuals with disabilities altogether or unintentionally lower expectations. Neither serves the athlete. Too many families leave believing fitness isn't for them when, in reality, they simply haven't found a coach who knows how to apply sound strength and conditioning principles to the individual standing in front of them. THE GAP AFTER PHYSICAL THERAPYPhysical therapy is incredibly valuable. Its purpose is rehabilitation—helping someone recover after an injury, surgery, or medical event. But once those clinical goals are met, therapy ends. The need for movement doesn't. An adult with cerebral palsy still needs to maintain strength and mobility. An adult with Down syndrome still benefits from improving cardiovascular health, increasing muscle mass, and building lifelong strength. An autistic adult still deserves a training environment that is structured, predictable, and designed around how they learn best. Too often, they're discharged into a fitness industry that isn't prepared to support them long term. That's where the gap begins. STRENGTH CHANGES LIVESPeople often think strength training is about lifting heavier weights. For our athletes, it's about much more than that. It's getting off the floor independently. It's carrying groceries without assistance. It's reducing the risk of falls. It's having enough endurance to participate in community activities. It's sleeping better. It's building confidence that carries into every other part of life. We've watched athletes who once struggled to perform a bodyweight squat progress to confidently deadlifting weights their families never imagined possible. We've seen autistic adults who couldn't tolerate the unpredictability of a commercial gym become completely independent because the coaching environment matched the way they process information. These aren't extraordinary success stories. They're what happens when coaching is individualized, and expectations stay high. THE INDUSTRY HAS WORK TO DOWe don't need more coaches with good intentions. We need more coaches with confidence. That confidence comes from education, experience, and understanding that individuals with disabilities deserve the same quality of coaching as everyone else. We also need funding systems to catch up. Insurance will often pay for rehabilitation. It rarely pays for long-term fitness, even though regular strength training has the potential to reduce preventable health complications, improve independence, and lower long-term healthcare costs. Helping someone stay healthy will always be less expensive than treating a preventable disease after it develops. FITNESS IS A HEALTH EQUITY ISSUEThe disability community has fought for access to schools, employment, transportation, and community life. Fitness belongs in that conversation. Because strength creates opportunity. It builds confidence. It supports independence. And it gives people more choices about how they live their lives. The fitness industry has overlooked this community for decades. It's time we stopped asking whether individuals with disabilities belong in strength and conditioning. They do. The better question is whether we're willing to prepare coaches to serve them.  |
About the AuthorRyan Lockard, CSCS*D, CSPS*D, is the Founder and CEO of Specialty Athletic Training. He is accredited by the National Strength and Conditioning Association (NSCA) as a Certified Strength and Conditioning Specialist and a Certified Special Populations Specialist. Lockard is currently the NSCA Oregon State Director and has served on numerous non-profit boards serving the disability community, including the Autism Society of America.
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