Opportunities to participate in regular exercise and recreational activities are especially important for people with spinal cord injury (SCI). They are less physically active than the general population, and secondary conditions associated with their disability (e.g., pain, deconditioning, fatigue), in combination with chronic conditions such as type 2 diabetes, obesity, and depression, severely compromise their overall health status. One way to alter this downward spiral of health is for engineers, exercise physiologists, and other scientists to provide more opportunities for people with SCI and other disabilities to engage in healthful exercise and recreation. This article proposes a conceptual framework for addressing the many barriers that people with SCI and other disabilities face when attempting to engage in these important areas of community living. The framework identifies four key areas necessary for an enriching and healthful experience in exercise and recreation: access, participation, adherence, and health and function. The significance of each of these elements is discussed along with a description of how this conceptual framework guides the research and development efforts of the Rehabilitation Engineering Research Center on Recreational Technologies and Exercise Physiology for People with Disabilities (RERC RecTech). © 2006 Thomas Land Publishers, Inc.