<p>Addressing the needs of adults with disabilities in exercise settings is an imperative yet challenging task. This population faces barriers to exercise including physical limitations, lack of accessibility, and few specially trained fitness professionals. In this systematic review following PRISMA guidelines, we examined disability-specific exercise studies (<i>N</i> = 46) conducted between 1999 and 2024 to identify factors to consider when designing exercise programs for this population. Six themes emerged as important considerations when providing exercise to individuals with a diverse range of disabilities (multiple sclerosis, Down syndrome, intellectual disability, mobility impairment, wheelchair user, amputee, fibromyalgia, and acquired brain injury): (a) individualize intensity to the participants’ needs and abilities; (b) offer modifications or alternative options; (c) parent/guardian/caregiver support; (d) offer special accommodations to facilitate involvement; (e) lack of current disability-specific exercise standards; and (f) other information relating to strategies to increase adherence. Outcomes underscore the need for non-adapted fitness professionals to address barriers persons with disabilities face in accessing and benefiting from exercise programs. This review serves as a step toward fostering inclusivity and dismantling fitness-related barriers.</p>