modern day healthcare

Working with Clients with Breast Cancer

Polestar Educator Amy Dixon has an extensive fitness background spanning over 20 years, including experience working with breast cancer survivors. Through classes and private sessions, she helps survivors rehabilitate and reexperience positive movement experiences. Amy shares her experiences working with Cancer clients along with useful insights on what to expect teaching this population and how to make the sessions the best they can be.


23 years ago, I was working as a personal trainer while working through issues resulting from 2 herniated discs. I began working with a Pilates teacher and was amazed to discover that this practice alleviated my pain. Because of this, I was inspired to train to become a Pilates instructor myself and after a few years, I found Polestar and completed their Transition program. It was after Polestar that I was drawn to work with more complex clients, using Polestar’s principles to navigate their varying needs. Throughout my career, I have had the opportunity to work with a lot of people with breast cancer diagnoses. I have seen the full range of symptoms breast cancer sufferers experience, from diagnosis to post mastectomy. These symptoms include:

  • Decreased shoulder range of motion and strength
  • Fatigue
  • Pain
  • Poor posture
  • Peripheral neuropathy
  • Increased risk of premature osteoporosis
  • Increased risk of lymphedema and sarcopenia
  • Impaired ability to perform daily tasks

These issues are compounded with emotional stress and varying frames of mind, which can irritate the symptoms further. Post-surgery breast cancer patients tend to limit their movement to the point that they set back their recovery. Many also develop guarding habits, such as raising the arm on the affected side to protect against being touched or jostled, which can cause further mobility problems in the shoulder area. This is where Pilates can retrain some of these potentially adverse compensations to expedite recovery and avoid the adverse movement patterns from becoming habitual. For example, it is more difficult to restore shoulder mobility in patients who stay guarded in a sling for six to eight weeks than it is to begin the mobility process as soon as lesions are healed.

Clients with a positive outlook and a willingness to progress tend to have better results with this kind of focused movement. It can be scary for the client to move, so much encouragement and compassion are needed! Private sessions are ideal for this type of client in the beginning in order for them to feel more comfortable and to participate in Pilates without feeling self-conscious.

To reintroduce patients to everyday movement, it’s best to start with low-intensity Pilates routines that focus on the upper body. During cancer rehabilitation, the concepts of breathing, pelvic and lumbar spine alignment, rib cage placement, shoulder mobility and stability, and head and neck alignment can be applied to any Pilates movement. Bringing awareness to posture can be the first step in improving daily activities. Putting the body in a position where it moves and reacts more efficiently can take away unwanted stress and strain. Developing proper movement patterns will also allow the body to heal in a way that reduces the likelihood of compensatory injuries.

When dealing with cancer patients, you must be aware of their progress as well as keep in close communication with their physical therapist. It is important to know the types of issues they are dealing with, and by keeping good communication with their PT, you can ensure the proper contraindications are noted before creating a program for these clients. Watch for fatigue, swelling, limited range of motion, and pain while working with these clients.

Ultimately, our Pilates practice can greatly improve the mobility, range, and posture of survivors. Creating a positive movement experience is key.


For more information on Amy and her studio, click here.

Helping and Healing Through Pilates

Deborah Marcus entered the Pilates world in the 1980’s in New York City via teachers including Andre Bernard and Jean Claude West while pursuing a career as a dancer and choreographer.  She found her way to the Polestar Teacher Training in 2008 studying with Sherri Betz in Santa Cruz, CA., “It was an eye opening and transformative experience for which I am forever grateful!”.  Deborah is Currently a Polestar Educator and the owner of Movement Refinery Pilates Studio in San Mateo, CA. 

 An Offer Of Pilates to Help Heal The Trauma of Relationship Abuse by: Deborah Marcus, MFA, NCPT, Polestar Educator

What follows is a summary of my experience after teaching a one and a half hour workshop to two groups of CORA, (Community Overcoming Relationship Abuse), staff members in San Mateo, CA in October of 2018.  There was no charge for these workshops as my services are offered to this organization on a volunteer basis. The impetus to reach out to CORA emerged from a conversation with a friend who had recently retired as a police sergeant in a neighboring town.  Since retirement she had been working as a volunteer with CORA.  She spoke about the disconnect between the goals of the police and those of the CORA representative who invariably would show up at the scene of a domestic abuse crime.  The first was to arrest the abuser, the latter was to empower the victim to leave the abusive situation.  Often, the charges would be dropped by the victim against the abuser.  Until her own work with CORA, my friend did not understand the nature of CORA’s mission which is to provide safety, support and healing for those affected by intimate partner abuse.  The seed was sewn in my mind that perhaps there was a way for Pilates to be included in this healing.  It also was a way to bring this powerful work to individuals who may never otherwise walk into a Pilates studio. Workshop Objectives:
  • To introduce Staff participants to a brief history of Joseph Pilates with mention of his work during World War 1 with soldiers and prisoners of war who survived trauma on the front.
  • To give Staff participants an hour long movement experience where the Pilates Principles are introduced through Pilates Mat Exercises modified for clients who are seeking help to overcome recent or current relationship abuse trauma.
  • To give Staff participants a movement experience that they can envision as part of the CORA program curriculum development and implementation.Over the course of two late afternoon sessions in my studio, two groups of four female CORA staff members participated in the hour long Pilates class followed by a sharing session about their experiences during the class.  For all but one of the participants, this was the first Pilates class they had ever taken.
During the planning stage of these classes, the CORA administrator who scheduled the interested employees asked that I teach the classes in my studio and not in their office community room.  Although the class I taught did not use any Pilates apparatus, this opportunity allowed me to give a very brief demonstration during the sharing session of how the apparatus is used as an assistive and resistive support for the acquisition of movement patterns.  It is a long term dream of mine to create a small roster of Pilates teachers in my area who are committed to donating one hour each week to a CORA client or clients who are far enough along in their recovery to not be triggered by the body positions on the apparatus.  These clients would be  referred out for a private or small group studio Pilates class.  CORA requires all of their volunteers to take a 40 hour training in how to work with victims of trauma, which is offered twice each year.  I plan to take this training in 2019. The process of planning this mat class involved adopting a filter of empathy and sensitivity towards domestic trauma abuse victims.  As one of my clients who is an MD said, “We all have suffered our own trauma at some point in our lives.”  Although this is true, I have never personally experienced the level of trauma as that of a CORA client.  I reached out to a few friends and colleagues who have, as well as to Pilates teachers on “The Contemporary Pilates Haven” Facebook group who have had experience working with victims of domestic abuse.  Excellent advice came from all of these sources. One member of this Facebook group recommended the book, The Body Keeps The Score, by Bessel Van der Kolk M.D. This excellent read was particularly helpful in understanding the current neuroscience research involving trauma and pointed towards the successful use of Yoga and Pilates as tools whereby the individual can experience the self as finally being seen and heard, a state of being that often disappears from the psyche of the abused. In other words, just to be, as opposed to not be, (think Shakespeare), is an essential step for the individual to experience as she/he negotiates a path towards freedom. I had to design a Pilates Mat class that delayed supine, prone and quadruped positions on the mat as these positions would likely be triggers that could land the participant in a real moment of re-lived trauma crisis.  These positions would need to be introduced in a manner where the participant felt an organic sequencing that got them there with a sense of self efficacy and power. As opposed to a list of exercises to teach, here is where the six Polestar Pilates Principles of Movement helped me to design an appropriate class.  Breath, Axial Elongation and Core Control, Spine Articulation and Mobility, Head Neck and Shoulder Organization, Alignment and Weight Bearing of the Extremities, and Movement Integration. The class started sitting on stools where we mobilized the feet using blue mini balls, and breath and spine movement exploration using Therabands.  We progressed to standing for mobility and balance exercises in the spine and extremities using the wall and the floor for support, followed by supine, prone and quadruped exercises with feet against the wall.  We returned to standing in a circle with some group movement, folk dance style.  In one of the groups we also did an improvisation using the mirror exercise where, working in partners with palms held up and facing each other but without touching palms, the duo moves together as if looking in a mirror.  Many of us movement teachers may have done this sometime in our past, but none of the CORA staff members had ever done this exercise before.  They loved it! Aside from the stools, blue mini balls and Therabands, the only other small props I used were partially inflated squishy balls for proprioceptive feedback through the hands, and upper and lower back while doing exercises standing at the wall and in supine.  The use of balls for the wall exercises was important because it brought an element of play to the experience and would hopefully avoid a trigger experience of abuse. We addressed all of the Polestar Principles during this class, and as is so often the case, each exercise hit on many Principles simultaneously. During the discussion afterwards, I asked the staff members for feedback as to how, or even if, they thought what they had just experienced might be beneficial for their clients.  They all commented on the awareness of breath as a huge benefit for bringing the self into the present.  I had introduced the statement, “breath is a tool, not a rule” to the group as we explored mobility through all the movement planes, changing where to inhale and exhale.  They found this particularly on point as it facilitated each of them to feel positive change in their movement where there had initially been some discomfort.  They commented that this might be a first concrete step for many of their clients to feel less invisible.  After all, the successful change was generated by the self and not an outside force.  Not surprisingly, they also saw the value for their clients in the group and partner generated movement at the end of class as it provided community support. As of this writing, the CORA Safe House Curriculum Director has indicated that she would like to find a way to incorporate Pilates into the early evening programming.  Some of the therapists are considering ways to bring Pilates into their group sessions.  These are a group of dedicated, underpaid non-profit organization employees working to improve the lives of their clients.  Although no ongoing relationship between myself and CORA has been established, and it may take awhile to solidify some plans, I believe that we will find a way to make something work.  Stay tuned!
Polestar Educator Deborah Marcus is owner of Movement Refinery Pilates Studio in San Mateo CA.   
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What Are The Best Exercises for Scoliosis?

 Polestar Educator, Physical Therapist, and certified C2 Schroth therapist Lise Stolze offers further insight to Scoliosis and working with Scoliosis clients.  For all upcoming continuing education courses with Polestar visit: Polestar Continuing Education

Most asked questions scoliosis clients ask me about exercise:

  • Should I perform some exercises just on one side?
  • Should I choose exercises that rotate me to the opposite direction of the curve?
  • Should I do an extra set of movements to one side?
  • I just saw research that side plank exercises can reduce curve degrees…should I be doing these?
To answer these questions we must understand how scoliosis affects movement.

What is the Pathomechanism of Idiopathic Scoliosis? (the short version!)

I will be brief since this is a whole course in itself! We know that Idiopathic (no known cause) Scoliosis (IS) is a 3 dimensional spinal disorder that begins with anterior vertebral wedging due to RASO (relative anterior spinal overgrowth) during bone development. We also know that the rotational component of scoliosis exists as both inter-vertebral torsion (rotation of one vertebra relative to another) and intravertebral torsion (an internal rotational distortion within each vertebra), most notably at the apical vertebra (the vertebra most deviated laterally from the vertical axis that passes through the sacrum).1 This distortion contributes to less joint motion at the apex of the curve and more at the transition points of the curve. We see this to a greater degree in adults and to a lesser degree in adolescents who have a more flexible curve before bone maturity. This is apparent in a supine lateral flexion X-ray that assesses curve flexibility.

Three Goals for our Clients with Scoliosis

Movement educators can keep 3 goals in mind when choosing exercises for clients with IS:
  1. Achieve better postural alignment along the central axis
  2. Provide a safe fitness option to increase flexibility, strength and fluid movement
  3. Support sports, recreation and functional activities that enhance quality of life

We Can Improve Posture Through Exercise!

Better posture can be achieved by emphasizing the most fundamental principles of all intelligent movement disciplines:  axial elongation and breathing.  Scoliosis curve concavities are constantly under compression by gravity.  Axial elongation encourages a natural re-alignment of the spine by using neuromuscular activity to reduce multi-plane compression and collapse of the concave side of the scoliosis curves. Once the concavities (which include the ribs) are expanded, then breath can be used to further open the collapse through:
  1. Tactile cueing of the concavities
  2. Unilateral nostril breathing
  3. Guided imagery
The most effective position to learn decompression of the concavities is in a spinal neutral position, out of gravity. Once there is neuromuscular re-patterning, movement can then be transferred to functional positions against gravity like standing, sitting, walking, squatting and lifting where it is more difficult to maintain axial decompression. There are many neutral spine exercises in the Pilates and yoga environment that can be used in this initial phase of re-patterning.

The Side Plank Research Controversy

A research article was published in 2014 claiming that scoliosis curves can be reduced by doing side planks on the convex side of the curve, and was sensationalized in a WSJ article.2  But the research had many flaws3 and while interesting, it cannot make that claim.  Muscular activity on both the concave and convex side of a scoliosis curve is inefficient and exercises that address each side are optimal for IS, including the Side Plank. Consider benefits of the Side Plank based on curve type:
  1. Single Major Thoracic Curve: performing side plank on the convex thoracic side (concavity up) can help strengthen elongated muscles on this side by placing them in a relatively shortened position, and helps to open the concave side, working these muscles eccentrically.
  2. Double Curve, Primary Thoracic: the same can be true for the thoracic curve but now the lumbar curve may be more compressed and specific cueing and/or modification of the exercise must be considered.
  3. Double Curve, Primary Lumbar: performing side plank on the convex lumbar side may be beneficial, but the thoracic curve may be more compressed, and will require special cueing or modification.
  4. Single Curve – Lumbar or Thoraco-lumbar: performing side plank on the lumbar or thoraco-lumbar convex side may strengthen elongated muscles on this side by placing them in a relatively shortened position and helps to open the concave side, working these muscles eccentrically.
  5. Adult with Degenerative Scoliosis (Lumbar): receive the same benefits as Single Lumbar curve but if there is a lateral instability (listhesis), then this exercise may not be indicated.
In all curve types, performing the Side Plank on the concave side of the primary curve is much more challenging but also beneficial.  This brings us to the importance of performing a scoliosis assessment to determine the curve type.  In the case of adult degenerative scoliosis, an X-ray must be obtained and collaboration established with a health care practitioner who has a deep working knowledge of scoliosis evaluation and management.

Safe Exercises for Spine Mobility

Life takes us out of neutral spine…shouldn’t we train our scoliosis clients how to move their spine effectively out of neutral?  The answer is of course yes…. but which movements and how much?   This depends on your assessment of the client:  Are they in pain?  How much movement does the apex of each curve have?  What is the curve type?  What other muscle imbalances or injuries exist? What are their goals?  Considering that the scoliosis spine tends to move more at the transition points and less at the apices, we may want to limit end range movements and emphasize elongation in postural shapes that minimize compression of the curve concavities.  This will be more difficult for those with a double curve. So it is important to make critical decisions with your client based on your evaluation and their goals.

Recreation and Sports: Can it Be Done with Scoliosis?

Everyone with scoliosis should be free to enjoy activities that increase quality of life! What does you client love to do?  Sports activities such as dance and gymnastics involve many compressive spine positions for scoliosis….as do golf and tennis.  Each person must be evaluated for the risk that their chosen activity may have on their scoliosis.  Considerations for age, curve type, activity frequency, and muscle imbalances must be made. Clients should be educated about scoliosis spine mechanics and progressions to help them make an informed decision about the activity they choose.  A fitness or movement session with your client could focus on training to maintain axial elongation and openness of the concavities during sport. Just as likely and equally important, a session could simply focus your client back to their center line!

Education and the Need for Individualized Programs

Polestar founder Brent Anderson, PT, PhD, OCS reminds us of the importance of working within our own scope of practice. It is crucial to invest in your education to increase your effectiveness and level of safety with your scoliosis clients. Find a professional you can partner with, join a network of practitioners with like interests, and take courses to keep yourself current with scoliosis research. If you are the client, make sure that your Pilates teacher or therapist has the training to create safe and effective exercise programs for you and your needs.

For all Upcoming Continuing Education Courses: Continuing Education with Polestar


References: 1Dickson RA, Lawton JO, et al. The pathogenesis of idiopathic scoliosis. Biplanar spinal asymmetry. J Bone Joint Surg Br. 1984;66(1):8–15. 2 Fishman LM, Groessl EJ et al.  Serial case reporting yoga for idiopathic and degenerative scoliosis.  Global Advances in Health and Medicine.  2014;3(5):16-21.   3 Salvatore M, Zaina F, et al.  Letter to the editor: Serial case reporting yoga for idiopathic and degenerative scoliosis. Global Adv Health Med.2015;4(1):79-80.

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Lise Stolze, MPT, DSc PMA®-CPT, is a certified C2 Schroth therapist, Polestar Educator, and owner of Stolze Therapies in Denver, CO. She has co-created Pilates Adaptations for people with Scoliosis with Schroth Scoliosis Therapist and BSPTS educator Hagit Berdishevsky, PT, MSPT, DPT, Cert. MDT. Lise has been published with her research on Pilates and Low Back Pain. 

Be Your Own Architect!

Becky Phares, PMA®-CPT is a Polestar Pilates Graduate, Practitioner and contributor to the Polestar Life Weekly Blog.  With more than 10 years of teaching Becky teaches at her studio The Body Initiative Pilates Studio in Lafayette, Louisiana.  Find Becky and her Studio on Facebook: The Body Initiative Pilates Studio and Instagram @the_body_initiative_ .

Being Your Own Architect

“Everyone is the architect of his own happiness.”

-Joseph Pilates

If you are a Pilates instructor you have probably heard the quote from Joe in Your Health: “Everyone is the architect of his own happiness.” This to me means that we as humans have the control to make the necessary changes in our lives to create fulfillment.  When teaching class, I find myself referring to my clients as their own personal architects to help inspire the point; take control of your own joy, mental well being, and physical health. Hearing the word architecture in Pilates also makes me think of other characteristics this profession provides. In exercises like long stretch, I ask my clients to imagine that their body is like a house. When you are in the plank position your house is small and needs only a few supportive beams. When you are stretched out long you must add in more support so the roof doesn’t cave in. These cues make me think of one of Polestar’s favorite philosophies: as little as possible, as much as necessary. What better way to validate this connection than to interview an architect. So I sat down with my friend Kally to see if our ideologies mesh. BP: Describe your job in 1 sentence: Kally: I design custom homes from scratch. BP: What type of supportive systems are used in a home that you design? K: They are all wood framed houses so normally wooden beams, columns or structural walls. Sometimes when we want a long span of open space we use steel beams. BP: How do you determine how many beams to put up in your house to keep the roof from caving in? K: So over 20 feet and under normally requires some sort of wooden beam. Over 20 will require a bigger/stronger beam. BP: What would happen if you have to little support? K: Well the structure would fall, obviously. BP: What would happen if you have too much support? K: Too much… nothing would happen to the structure, but it would be a waste of resources. BP: What other things make your job fun but challenging? K: It’s fun because it’s creative and each family I design for is unique. It’s challenging for 2 reasons: 1. When the lots are small but people still want to build a big house on limited space. 2. Trying to accommodate everything they want but sometimes those things conflict with each other physically. For instance, you want a window in the bathroom, but the desired location of the bathroom is not on an exterior wall. So we either have to move the room, or not have windows. BP: Based on this interview I have supported the reasoning for why the quote, “as little as possible, as much as necessary” is important not only in Pilates and architecture but in life in general. Using too much stuff during a job wastes resources; using too little doesn’t create enough support. I have also realized that my job and Kally’s have more similarities than I once imagined. We both have to figure out what is best for our clients through creative and critical thinking. She describes her process of designing a house like putting together a jigsaw puzzle. Kally knows what they want, but it is not always a quick fix. Similarly, when a new client walks into my door, they may have a goal for their body, but I know it will take multiple sessions to make that goal a reality. Becky Phares, PMA®-CPT is a Polestar Pilates Graduate, Practitioner and contributor to the Polestar Life Weekly Blog.  With more than 10 years of teaching Becky teaches at her studio The Body Initiative Pilates Studio in Lafayette, Louisiana.  Find Becky and her Studio on Facebook: The body Initiative Pilates Studio and Instagram @the_body_initiative_ . Link our Blog? Subscribe to the Newsletter Polestar Life Weekly!

From Pilates to Neuroscience


We interviewed Polestar Educator Kate Strozak MSc, LMT, NCPT of Chicago,  Illinois.  Not only is Kate a leader in Pilates education in Chicago and the Mid-West she is also a Runity coach, Oov educator and JB-MFR trained.  Kate is a contributor for Polestar Life Weekly (check out her blogs on Neuroplasticity, Fascia, Healthcare and Pilates Chairs).  Watch Kate as a special guest on the #PilatesHour episode “Neuro-Concepts in Pilates”. 
Polestar: What do you love about teaching? KS: I love the challenge of helping anybody surpass their movement expectations and goals. It’s one thing to meet goals and another to exceed them. I also love the uniqueness of each individual and how there are beautiful similarities that we all share. We are complex systems of gliding tissues with this incredible spark of life. This keeps me in constant awe and amazement and makes me feel like it’s an honor and privilege to be able to collaborate with my clients and students. Polestar: What are your current inspirations? KS: Nature is my perpetual inspiration. Whenever I start to feel in need of inspiration or if I feel in need of balance or grounding, I head outside as fast as I can. Polestar: Why Pilates? KS: Pilates made movement accessible and fascinating to me. It’s my foundation to start from and return to for my personal movement inquiries or for my clients’ movement exploration. Polestar: What do you hope to convey in your teaching? KS: I hope to empower my clients to revel in their movement, health, and fitness. I aim to be a resource and a collaborator, not a teacher or practitioner. Polestar: Where would you love to vacation? KS: I love to hike and would love an extended trip to visit a few countries in Africa. But I would go anywhere…I love to travel. Polestar: Do you have a favorite quote? KS: “The definition of insanity is doing the same thing over and over again and expecting different results.” Polestar: Describe your movement style? KS: Explorative, Playful, and Varied. Polestar: Do you have a favorite apparatus? KS: The mat. I think of that apparatus being there as a tool to help me better access my own body’s capabilities. But if I had to choose an apparatus I’d go with the cadillac for purposes of hanging and flips . Polestar: What are you currently reading? KS: H is for Hawk by Helen Macdonald, and Fascia: The Tensional Network of the Human Body by Leon Chaitow.

“The Constant” in Pilates

Becky Phares, PMA®-CPT is a Polestar Pilates Graduate, Practitioner and contributor to the Polestar Life Weekly Blog.  With more than 10 years of teaching Becky teaches at her studio The Body Initiative Pilates Studio in Lafayette, Louisiana.  Find Becky and her Studio on Facebook: The body Initiative Pilates Studio and Instagram @the_body_initiative_ .

“The Constant”

I have a new theme… “The Constant” . This term shows itself in multiple different ways throughout society. The dictionary defines it as occurring continuously over a period of time or unchanged through time and space. In math constants are parts of algebraic expressions that do not change. In science it is referred to as properties that do not change. If you were to google the word constant you may come up with: a constant burden, constant bickering or constant chatter. Constant is even a name given to babies; in 2016 it was ranked #16,656 for popularity for girls and #13,558 for boys. But what in the world does that have to do with Pilates? Well, it shows up EVERYWHERE in our system. Let’s take a look: In the exercise the hundred, the shape of your spine and legs stay constant as your arms pump. In foot work your spine stays in a constant shape as your hips and knees flex and extend, even though it is moving with the carriage. In rolling like a ball, the whole shape of the body is constant even though the shape changes orientation. But why is it important? I feel that this gives some of my clients feedback if I give them “the constant.” For example during long stretch the spine and pelvis stay constant. The first part of long stretch, the plank position, is fairly easy to keep the shape. However, once you stretch your body back and your arms forward, your spine and pelvis want to change. Because of where gravity is sitting, I get a lot of people who like to create a bigger, lordotic curve in this exercise. It’s understandable because the body goes in the path of least resistance. So could an instructor benefit from cueing the constant? Absolutely! It could help the client understand that the shape does not change even though the spine is in a greater challenge. The constant may change orientation, like tendon stretch and thigh stretch. Sometimes the constant stays in the same orientation but moves along with the carriage such as in stomach massage and feet in straps. Other times the constant stays absolutely stable in space and time but progresses in difficulty because of outside forces, such as leg pull front and chest lift. **see pictures below So is this a new theory? Absolutely not! I’m just sharing different terms that I am currently using with my clients. I like this word/concept because regular people walking through my door easily comprehend it. Other relatable terms are dissociation and stability. We all use what works for each individual client. Try this on and see if it works for you.

**The constant is shown in white**

Exercises that the constant changes orientation to gravity:

Thigh Stretch
Thigh Stretch
Tendon Stretch
Tendon Stretch

Exercises that the constant stays in the same orientation to gravity but moves with the carriage:

Feet in Straps
Feet in Straps
Stomach Massage

Exercises that the constant stays the same in space but grow more difficult through the series:

Leg Pull Front
Chest Lift
Find Becky and her Studio on Facebook: The body Initiative Pilates Studio and Instagram @the_body_initiative_ . Like our Blog? Subscribe to the Newsletter and be the first in the know!