HEATHER, athlete and personal trainer: Gym class, also known as physical education, is one of the most important aspects of a child’s curriculum, and yet we are continually de-emphasizing it in classrooms across the country. In many cases, we have eliminated it entirely and in others, we allow kids to move for 45 minutes to one hour per week. Yes, you read correctly. We encourage and even mandate within a curriculum that a child be active for that short of a time. And we mistakenly think that the child will reap some grandiose benefit from this limited activity. What if we had a child participate in a physics or geometry class for less than an hour per week and expected him or her to be a master of the subject? Obviously 99% of those who participated would be far less than an expert in their field. So then, how can we expect our youth to receive any tangible benefits from a physical education class, let alone yield any lifetime health behavior changes?

Children of all ages need to move and be active both in school and at home. Kids are born to talk, move, jump, run and hop. Physical education is not about learning a sport, it is about teaching children movement and activities that they can use throughout their lives.

I am not going to bore you with the health facts that we are inundated with on a daily basis. You know we are one of the fattest nations in the world. We know that Type 2 diabetes has risen significantly in our children. We know the physical and mental health benefits of exercise. If the schools can’t or won’t provide the environment, get involved with your children and get them moving.

Get off the instant messenger on your computer, step away from the television set and go out and do something physical with your kids. You set the example. It is your responsibility to teach your children the active pursuit of health.

BARBARA, arts, educational & cultural consultant: Your young person has a lot to think about, sort out and talk about. Their "his" mones, "her" mones and hormones are adding to the "I’ve gotta be me, whoever that is" equation.

The teen years are an awkward time for some and a seemingly awful time for others. Those wonder years just aren’t so wonderful. But, with over 10 years of junior high school teaching behind me, I know peer pressure really matters. And teen idols matter.

Except for the rare teen, parental opinion is not high on a teen’s list, so you have to try some new tactics. Give them reasons that matter to them and remember, like ice cream flavors, not all young adults are alike.

My friend Elsie L., from the Main Line, had this to offer:

Gym gives you an opportunity to exercise and develop the body you want. For instance, Britney Spears and Beyonce are two people teenagers want to be like. Emphasize that to look like them, it will help to start in high school. Besides, some guys love athletic girls and vice versa.

Fashions tend to play an important role in young people’s lives, especially if they can look like their peers. By focusing on this somewhat frivolous aspect to us adults, many teenagers would gladly go to the gym class. If they thought that gym would make or keep their thighs firm for mini-skirts and tight jeans, then they might see the value.

Then there’s the realistic approach which promotes the health benefits one can gain from good habits formed early. The rewards are better agility, improved strength and energy.

Another ploy is to point out that gym is a graduation requirement, and you don’t want it to ruin your class rank.

Aside from these and other mind altering strategies, some schools offer alternatives to the traditional gym class, including, basketball, volleyball, co-ed gym, relaxed dress-codes, dance, fencing, and more. The educators who think outside the box may have the solution.

Finally, if all else fails, you might want to resort to bribery. Just kidding!

ELLEN, the anti-athlete: A young friend, who is a sophomore in high school, appears to do anything possible to avoid gym class. Yet, she’s happy to go over to her local gym to workout.

What is that?

Is it just that we hate activities because teachers make us do them?

Going to the gym is all the rage and rather expensive, if you ask me. Yet a generation ago when I was in school, we hid out in the showers so we didn’t have to play volleyball or we feigned illness to avoid climbing the rope. I hate to sound like a crone, but we really did walk to school or take a city bus. We probably hiked the equivalent of a mile from the stop to the school building and from the stop to home. EVERY DAY. My kids want a ride to the grocery store, well within walking distance, to buy snacks! It’s just not cool in our neighborhood to walk to the store. In some neighborhoods, it’s not safe or it’s too far to conveniently walk.

Heather’s right. We have epidemic obesity and diabetes. We have young women alternately starving or overweight. Whatever happened to the notion that school is there to help you learn about your body and its strengths just like it helps you sharpen your mind? Why is it that in high schools you often find two extremes: the jock and the nerd?

It is important, particularly for young women, to make physical fitness and athleticism something “cool” to do. I am not sure how to do it given the high school curriculum and the younger generation’s penchant for challenging authority. On this topic, I clearly have more questions than answers.

HEATHER, athlete and personal trainer: While breast cancer surgery results in significant trauma to the body, the days of limited rehabilitation and restrictions of all exercise are gone. In fact, it is imperative that your physical therapy begins almost immediately post surgery. Without exercise, three common problems can occur - frozen shoulder, back pain, and lymphedema.

Because there is a removal of tissue and incisions are made in the breast and chest regions, there is a chance for the development of scar tissue. The more scar tissue your body produces that you do not manage to break up through exercise, the greater the risk for the development of a frozen shoulder. Your physical therapist will give you exercises to do while in the hospital and for the initial stages of your recovery. They will include movements to increase range of motion and flexibility, and as you recover, you will begin to incorporate strengthening exercises as well.

The next area you must focus on is your back. Your body will attempt to protect itself by slumping your shoulders thus putting your body in a poor postural position. This, in turn, leads to back pain. Not only must you continue working on the flexibility in your chest area, but you need to focus on strengthening your rhomboids, traps, and lats. Exercises such as the row, lat pulldown, and pullover will help develop these areas. Also remember that posture is 80% awareness and 20% strength so take the time to recognize poor positioning and correct it.

Finally, some treatments require the removal of lymph glands which are the filtration system for your body. To limit lymphedema, try to stay away from excess pressure on the effected area, keep your arm elevated to prevent swelling, and be vigilant in expanding your range of motion in that area. Your first six weeks post surgery will be spent minimizing scar tissue with range of motion exercises. After you have received clearance from your physician, the strengthening phase will begin. Remember to provide progressive resistance to your workouts and don’t be afraid to challenge your body by reincorporating exercises you were doing pre operatively. If you are unsure of how to proceed, feel free to drop me a line or enlist the support of another health or fitness professional.

BARBARA, arts, educational & cultural consultant: Most experts agree that good nutrition and proper exercise help breast cancer patients on the road to physical and emotional recovery. For many, good nutrition and exercise was part of their routine for years before diagnosis of cancer.

Terry Hanlon, a two-time breast cancer survivor of Upper Moreland, discussed her experience with post operative exercise.

At age 40, Terry had always been a healthy eater. She had no pain, no lump and she wasn’t overweight. Yet, upon her first mammogram, cancer was found. After her lumpectomy, the muscles in her arm and lymph nodes began to atrophy. A physician recommended the use of exercise. Terry’s dad fashioned an exercise machine which allowed her to stretch and pull. As a result, Terry increased her strength and range of motion, while reducing her pain. Her doctors and physical therapists determined that exercise was a valuable tool in her recovery.

Seven years later, a new cancer was found in Terry’s breast. This time, she began to exercise almost immediately after surgery. With the support of family and friends, Terry beat the odds. Today, she is cancer-free and involved in the Reach to Recovery program, a support group for women diagnosed with breast cancer.

Experts believe exercise and proper nutrition may reduce the risk of breast cancer. Thanks to people like Terry and dedicated professionals, there is more information available today for the cancer patient. For more information, go to www.cancer.org.

ELLEN, the anti-athlete: When Annie Toglia found out she had breast cancer in 1996, she tried to keep it a secret.

Today, she is reaching out all over the world with a message to breast cancer survivors: Make fitness part of your recovery.

She’s written a book that contains exercises and continually counsels breast cancer survivors from her Web site.

A former personal fitness trainer who is also trained as a dancer, Toglia has survived Stage IV breast cancer. She decided early on that she was going to beat the disease and fitness would be part of her arsenal. Sixteen surgeries later, the 40-something resident of West Chester County in New York calls her recovery nothing short of “miraculous.”

“The miracle happened so I could bring this book to the world,” she said. Her book, called “Staying Abreast, Rehabilitation Exercises for Breast Cancer Surgery” ($65) by Annie Toglia, MES, ACSM, CSCS, can be ordered through the Web site. It shows exercises and gives survivors tips on the special issues they experience: weight gain during chemotherapy, a new center of gravity after the loss of a breast, and posture issues, among others. The information, along with the Web site, empowers women to ask their doctors for more than the standard level of care, according to Toglia.

The book only tells part of the Toglia survival story. Her Web site and conversation tells the rest. She had to quit working and went broke. She’s still trying to figure out a way to use her “gift” of a survival tale and to support herself financially. Grit and optimism got her this far; contact with other survivors pushes her on.

Toglia’s message is echoing not only in the lives of patients but also in the medical community where fitness has not been an important part of recovery programs, she said.

She describes the experience many breast cancer survivors have when presented after surgery with an impersonal and uninspiring piece of paper detailing exercises:

“Here’s a person, laying in bed and I’m probably going to have to have chemo and gain 20 pounds and lose my hair. Here’s this piece of paper. I think I’ll go home and do some exercises?” she asks incredulously.

Women need the medical community to get more proactive in using fitness to promote healing, she said. Occupational therapists and physical therapists need more training; doctors need more awareness; the health care system needs to make quality physical therapy available to post-surgical patients to avoid debilitating side effects such as frozen shoulder and lymphedema, an abnormal swelling of the hand or arm that can be permanent and can be associated with infection.

Toglia recently has done seminars for doctors, nurses and other health professionals in her campaign to enlist their support for post-surgical treatment. Her latest mission is to get the book to women before they have the surgery, when they are feeling well and optimistic, rather than waiting until they are recovering from surgery and the inevitable feelings of loss.

Her doctor told her when she had her surgery that there are two kinds of breast cancer surgery patients: One gets up and walks around after surgery; the other lies in bed. “And she’s likely to stay there,” Toglia said. The latter patient’s recovery is likely to be slower and more difficult.

Toglia was up walking around with her IV in the hospital and she credits her “breast cancer posse,” a group of new friends in the cancer recovery community, as the inspiration for her stamina in the face of a deadly diagnosis. She is trying to boil down the book into a pamphlet for those who can’t afford the 100-plus tome’s hefty price and she’s strategizing how to form a nonprofit organization that can supply hospitals with information from her book.

A conversation with Toglia leaves you breathless. Breast cancer took away her life, she said. Clearly, Toglia has taken it back and delivers on her quest to give the rest of us “little packages of hope.”

For more on Toglia’s life story and current activities, go to her Web site, www.stayingabreast.com. You can e-mail her from that location.

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