Eighteen-year-old Ella McKinney hits the gym twice a week. But this isn't your garden-variety gym with rows of dumbbells and treadmills—SheStrength in Hutchinson, KS, is a more intimate space.

Built on the footprint of two former racquetball courts, the exercise studio is run by Anna Woods, a certified personal trainer who developed for the American Council on Exercise a special certification for fitness professionals interested in working with people who have neurologic disorders. McKinney, who lives in Hutchinson, was diagnosed two years ago with functional neurologic disorder, symptoms of which can include epileptic-like seizures and narcolepsy.

“I could go to a regular gym, but it wouldn't be safe for me,” she explains. “I could have a seizure or fall asleep.”

Instead, McKinney works one-on-one with Woods in a high-intensity, 30-minute session that involves weightlifting, aerobic training, and floor exercises with some subtle and not-so-subtle adjustments specific to McKinney's condition. She uses rubber-edged dumbbells and elastic bands for any over-the-head movements and works out on a large, open space in the gym covered with floor mats, “so if she falls or seizes, we can catch her and get her to a safe place,” Woods says.

She also keeps an eye on McKinney's menstrual cycle, which impacts her seizure activity. “We work out early in the day before fatigue sets in and she has more problems,” Woods says. “We do less high-impact, less heavy lifting during her cycle times because she's usually very worn out and more prone to seizures.” Woods even adjusts the lighting in her studio to better accommodate McKinney: “We want to make sure it's not flickering or too bright so that the light doesn't trigger a seizure.”

Thanks in part to these adjustments, McKinney finds her briskly paced sessions at SheStrength (which, despite its name, also is open to males with neurologic disorders) are challenging but empowering. “I do enjoy it. It's a really cool atmosphere there,” she says “I feel a lot stronger and a lot more capable. It definitely builds confidence.”

For his morning workout, Norbert Holowat, 27, heads to his local Planet Fitness—part of a nationwide chain of gyms with a wide range of cardio and strength-training equipment—in Syosset, NY, alongside the retirees and young parents who make up the typical daytime crowd. Holowat knows strength training is a key part of his exercise regimen (along with aerobics and balance and flexibility training), because being stronger will help him push his racing wheelchair even faster. He has used a wheelchair since having a diving accident in 2019 and eventually became involved in competitive wheelchair athletics. Holowat has completed 13 marathons as a wheelchair racer, most recently the London Marathon this April.

And with the occasional help of a training buddy, he's quite happy to muscle up at the gym. Like many others, he finds the whole scene—the music, the hum of activity, the energy of training with others—appealing and motivational. “I definitely enjoy the gym atmosphere,” Holowat says.

Specialized Approach

Despite their differences in age and neurologic conditions, both McKinney and Norbert recognize the importance of exercise. And with the support of their neurologists and care teams, they have taken different approaches toward working out.

While still few in number, adaptive gyms and fitness studios like McKinney uses have emerged across the country. Facilities such as Ability 360 Sports & Fitness Center in Phoenix and SpecialStrong, which has a growing number of locations around the United States, promise specialized equipment and fitness professionals trained to help patients safely and effectively get the exercise they need.

Holowat, on the other hand, trains at a large, mainstream gym, which he believes is good for not only him but also the others who work out there. “The general public are not used to interacting with people in wheelchairs,” he says.

Many patients with neurologic injuries tend to become homebound, sometimes only leaving their residences for brief trips or doctor's appointments, so anything that can reduce that seclusion, such as exercising in a gym, can help, says Michael Su, MD, associate professor of neurology at the David Geffen School of Medicine at UCLA and associate medical director of the California Rehabilitation Institute.

“The issue of feeling stigmatized by being seen with a disability is very real,” he adds, so specialized gyms for people with neurologic conditions may have certain advantages. “Going to the gym often requires overcoming so much inertia, so anything to lower that hurdle is good. Those with a neurological condition may find a more welcoming community at a specialized facility.”

A welcoming community is what Hal Hargrave hopes to create at A Perfect Step, his gym in Pomona, CA, that specializes in helping clients with paralysis. Patients don't exercise in their wheelchairs—they use therapy benches, mats, or standing frames to get into anatomically aligned positions, which promote proper posture and access to all planes of motion.

Hargrave, 35, who suffered a spinal cord injury in an automobile accident, understands the pros and cons of training at a specialized facility as opposed to a mainstream gym. “I'm in a wheelchair, and I know there's nothing better than being among an able-bodied crowd that shows empathy and support by treating me as if I'm no different than them,” he says.

But he also points out that the fitness industry in general has moved toward more specific, personalized training. “Just look at everything that's offered today for the general population: high-intensity training, Pilates, yoga,” Hargrave says; and shouldn't people with mobility deficits or other neurologic conditions have their own options for “specific, inclusive” training?

Consider Your Options

While she has extolled the benefits of exercise to her patients for years, neurologist Lisa M. Shulman, MD, FAAN, reminds them to consider many factors when choosing a fitness facility, beyond whether to join a specialized studio or a traditional gym.

“When we're talking about these programs, the level of disease severity is going to require different approaches for both benefits and safety,” says Dr. Shulman, the Eugenia Brin Professor of Parkinson's Disease and Movement Disorders at the University of Maryland School of Medicine. “In other words, taking people who are more advanced in their disease progression and pushing them as hard as possible can be more stressful and can cross the line from benefits to risks.”

For example, she says, “people with Parkinson's disease develop problems with balance and risk of falls as the disease progresses. Aerobic and resistance exercises need to be modified for safety.” Patients may develop gait impairment or freezing, too, she notes, while those with extreme dyskinesia may be unable to manage weights safely. Others may become lightheaded when they stand up after exerting themselves.

There's something to be said, then, about a specialized facility where the staff are more attuned to these risks and experienced with neurologic conditions. But despite years of research and practice as a neurologist, Dr. Shulman acknowledges she doesn't know everything about such facilities or the fitness professionals administering them.

“The concept of developing programs that would promote exercise and activity for neurological diseases is something that's very important,” Dr. Shulman says. “But when it comes to individual programs, it's telling that I don't have any personal experience with these programs. And if neurologists aren't aware of the quality of these programs, they're less likely to recommend them.”

Woods, the adoptive mother of a teenager with Down syndrome, recognizes the two schools of thought on choosing a fitness facility. “As a parent who's pushing inclusion, I want to see him in gym programming that his peers are in, that are ‘typical.’ So on one hand, I don't necessarily think there needs to be just an adaptive gym for him,” she says. “On the other hand, I have clients who have extreme needs and can't be accommodated in a ‘typical’ gym. They can't use the dumbbells or the machines. Our facility is better set up for them.”

Certainly, it's worked well for McKinney. While taking a gap year before college, she has worked hard to keep herself fit as she manages her illness. The intimate environment of SheStrength is the right place for her, for now. “I'd been begging my mom to let me go to my regular gym,” she says. “But she wanted me to work with a trainer that knew what they were doing and had some experience with my condition.” They found that trainer in Woods. “She's very cool, and she's really helped me,” McKinney says.

Holowat, meanwhile, continues to maintain a high level of training on the road—where he pushes his specialized, lightweight racing wheelchair for miles to prepare for his marathon races—and at the local gym, where he works to get stronger and fitter, just like all the others there. “It's healthy for people to see that just because you're in a chair or you have a neurological disability, you can still go to the gym like everybody else and just work on becoming a better you,” he says.

Discover More

To learn about how to find the right exercise routine, visit Brain & Life's Exercise and Nutrition page.