Tina Escher brings a no-nonsense approach to her job and a similar dedication to her weekly workouts at St. Petersburg's YMCA.
Toil is not always fun, but it is important, the 50-year-old says, reflecting values common among her generation — work hard and you'll be rewarded, stay active and improve the odds for a long, healthy life.
But it's not that simple for Escher, one of nearly 1.9 million American adults living with a developmental disability. With a mountain of intellectual and physical challenges, they face a constant battle for wellness the general population can't fathom.
Yes, obesity and heart and lung conditions are common problems for all aging Americans. But research shows that those living with developmental disabilities often suffer from ailments decades before their peers who don't have disabilities.
Florida includes people with cerebral palsy, mental retardation and autism in that category.
For some, genetics are responsible for serious medical conditions, including heart disease and diabetes. But others, particularly those living on a limited disability income or in a group home setting, are at greater risk because they lapse into a sedentary lifestyle.
Opportunities for exercise and activity end for a lot of individuals when they age out of the school system at 22, said Laurie Woodard, an associate professor of family medicine at the University of South Florida.
"The sad fact is that they are socially isolated and have limited outlets," Woodard said.
The Goodwill Industries-Suncoast job training program, one of a few local opportunities for developmentally disabled adults, found that poor food choices and a lack of exercise sapped the energy of some of its workers and often added pounds.
So Goodwill leaders added exercise breaks and nutrition education to the daily six-hour shifts of hanging and tagging donated clothes for Goodwill's chain of thrift stores.
"We're teaching them that they are part of the (health) puzzle and that they have a choice," said Cyndi Adams, supervisor of Goodwill's Pinellas Park job center.
The Goodwill workers sign up for two weekly, 30-minute activities, such as Nintendo Wii country line dancing, meditation, yoga, or walks to a nearby flea market. Donated stair climber and elliptical machines were set up to use during breaks from work that is manual but not very physical.
"Actually, I do feel a lot healthier," said Goodwill worker Eric Pushkar, 38. "Now I'm not tired when I take longer walks."
A Florida Disabilities Council grant paid for some clients to attend Weight Watchers classes and personal trainer sessions at the YMCA. Since its launch in August 2011, the effort, called the Get Fit Club, has seen 31 participants collectively drop 167 pounds.
"I feel hungry all the time, but if I feel hungry, I drink water," said Kristine McCarthy, 27, who has lost more than 25 pounds this year. "I feel good and nice and healthy and feel like I can walk more."
Intellectually disabled adults struggle with diet and exercise differently than the general population. For starters, they may need regular prompting from caregivers about daily activities such as dressing, eating or bathing; many will never be able to live independently.
Medical conditions, such as seizure disorders or palsies, may dissuade these adults or their caregivers from regular exercise, says the American Academy of Orthopaedic Surgeons.
For example, lax ligaments and muscle tone associated with Down syndrome can increase risk for neck injury, requiring the need to pay more attention to specific exercises.
Woodard and others know that the concern about weight places additional responsibilities on caregivers, who often are overwhelmed by the day-to-day needs. Sometimes it's easier to let the developmentally disabled adult spend all day playing video games.
But Woodard said there's value in challenging these adults to be more active in programs such as the Special Olympics or All People's Life Center in Tampa.
"They're used to people not expecting a whole lot," Woodard said.
Goodwill leaders say they try to avoid telling their adult clients what to do about food choices or exercise. Workers at the Pinellas Park training center vary in age from 22 to 65, and they dislike being told to stop salting their food like anybody else, Adams said.
Exercise is approached more like job training, with repetitive instruction, she said.
YMCA personal trainer Shannon Foster said respect is central to her workouts with the Goodwill clients. She meets with four to six participants at a time, rotating through the gym's cardio and strength training machines and other exercises.
Joey Gifford, 28, doesn't speak but diligently tosses a medicine ball the best he can with Escher or April Myers, 23. Foster's command to stand on tiptoes works, too, though Gifford lifts just one foot at a time.
Six weeks ago, Peter Brock, 34, couldn't master any of the calisthenics Foster introduced. Now Brock smiles, shouts and pumps his fist after completing 10 grueling pushups.
Their abilities vary and they face physical challenges, Foster said. But each one is moving and improving his or her mobility.
"I don't even want them to think mentally that they can't do this," Foster said.
Escher said she knows she can handle all the exercises Foster tosses at her, even her least-favorite activity: basketball. It's more exhausting than her job at Goodwill, which requires her to hang 100 pieces of clothing an hour on a rack for $3 an hour up to minimum wage.
"Exercising is harder," she said.
As in any work environment, physical breaks can improve employee productivity, esteem and behavior. The activities improve morale at Goodwill – for workers and their supervisors, said Diane Stuchko, a skills trainer for six years.
"Taking a break from this job — or any job — keeps them motivated," she said.
That's why Goodwill decided it will extend its Get Fit Club beyond August, when the grant expires.
Exercise classes, walking outings and nutrition education will continue, and the agency is applying for grants to help cover trips to the YMCA and Weight Watchers, Goodwill spokeswoman Chris Ward said.
Goodwill worker Pushkar is glad the fitness breaks are staying. He works a second job, and the newfound energy has helped him keep pace with co-workers, he said.
"It makes working a lot quicker. I don't stand around," Pushkar said. "Before I was falling behind, now I'm a lot faster and staying on task."