Nuclear Test Heart – Stroke Prevention Testing & Screening Near Me

Stroke Prevention  as well as Screening near me
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5 Preventive Health Screenings for these Diseases:

 

 

Carotid Artery Disease – Nuclear Test Heart

An ultrasound is executed to evaluate the carotid arteries (a pair of capillary in the neck that supplies blood to your brain) for the develop of fatty plaque. Nuclear test heart.  This build up, called atherosclerosis, is among the leading causes of stroke.

Carotid (kuh-ROT-id) ultrasound is a secure, pain free treatment that uses sound waves to analyze the blood flow through the carotid arteries. Nuclear test heart.

Your  2 carotid arteries  lie on each side of your neck. They deliver blood from your heart to your  mind.

Carotid ultrasound  examinations for blocked or  tightened carotid arteries, which can increase the  threat of stroke. Nuclear test heart.  The results can help your doctor identify a therapy to lower your stroke risk.

Ischemic stroke. A carotid ultrasound is  carried out to test for  tightened carotid arteries, which  boost the  threat of stroke.

Carotid arteries are typically tightened by a accumulation of plaque – composed of fat, cholesterol, calcium and also other substances that flow in the bloodstream. Early diagnosis as well as therapy of a narrowed carotid artery can lower stroke risk.

Your medical professional will recommend carotid ultrasound if you have transient ischemic assaults (TIAs) or certain kinds of stroke and also may suggest a carotid ultrasound if you have medical conditions that boost the risk of stroke, including:

  • High blood pressure.
  • Diabetes mellitus.
  • High cholesterol.
  • Family history of stroke or heart problem
  • Recent short-term ischemic assault (TIA) or stroke.
  • Uncommon noise in carotid arteries (bruit), discovered by your physician making use of a stethoscope.
  • Coronary artery  illness.

To evaluate for narrowed or blocked capillary in various other locations of the body, you might require added tests, including:

Abdominal ultrasound. Nuclear test heart.  You may have an stomach ultrasound to test for conditions affecting the capillary or body organs in your abdominal area.

Ankle-brachial index examination. This examination steps as well as contrasts the high blood pressure between your ankle joint and your arm. The test reveals minimized or obstructed blood circulation to your legs.

Cardiac stress test. Nuclear test heart.  This examination demonstrates how well your heart does when under stress and anxiety, such as during workout. Outcomes can show bad blood circulation to the heart.

Nuclear test heart.  Your doctor may also order imaging examinations to identify coronary artery disease.

 Various other  uses carotid ultrasound.
Your  physician may  buy a carotid ultrasound to:.

 Assess blood  circulation  via the artery after  surgical treatment to remove plaques (carotid endarterectomy).

Evaluate the positioning as well as efficiency of a stent, a mesh tube used to boost blood circulation via an artery.

Situate a collection of clotted blood (hematoma) that may prevent blood circulation.

 Find other carotid artery abnormalities that may  interrupt blood  circulation.

 

 

Peripheral Arterial Disease (PAD) – Nuclear Test Heart

Nuclear test heart.  An Ankle-Brachial Index (ABI) test is carried out using high blood pressure cuffs on the arms and legs. It is very important to evaluate for PAD because it raises the danger of coronary artery condition, cardiovascular disease, or stroke.

 Outer artery  illness (also called  outer arterial  condition) is a  usual  problem in which narrowed arteries  decrease blood  circulation to the arms or legs.

In  outer artery  illness (PAD), the legs or arms–  typically the legs–  do not  obtain  adequate blood  circulation to  stay on par with  need. Nuclear test heart.  This may cause leg pain when strolling (claudication) and also various other symptoms.

Outer artery condition is usually a sign of a accumulation of fatty down payments in the arteries (atherosclerosis). Atherosclerosis triggers constricting of the arteries that can reduce blood circulation in the legs and also, often, the arms.

Peripheral artery disease treatment  consists of  working out, eating a  healthy and balanced diet and not  cigarette smoking or  making use of tobacco.

 Signs.
 Many individuals with  outer artery disease have  moderate or no  signs. Some  individuals have leg pain when walking (claudication).

Claudication  signs include muscle  discomfort or cramping in the legs or arms that begins during exercise  and also ends with rest. Nuclear test heart.  The pain is most generally felt in the calf bone. The discomfort ranges from light to extreme. Serious leg pain may make it tough to stroll or do various other sorts of physical activity.

Other peripheral artery  condition  signs  might include:

  • Temperature in the reduced leg or foot, specifically when compared to the other side.
  • Leg tingling or weak point.
  • No pulse or a weak pulse in the legs or feet.
  • Excruciating cramping in one or both of the hips, thighs or calf bone muscles after certain tasks, such as strolling or climbing up staircases.
  • Shiny skin on the legs. Nuclear test heart.
  • Skin color changes on the legs.
  • Slower growth of the toe nails.
  • Sores on the toes, feet or legs that will not {heal| recover,
  • Discomfort when making use of the arms, such as aching and also cramping when weaving, creating or doing other hand-operated tasks.
  • Impotence.
  •  Loss of hair or slower hair  development on the legs.

If peripheral artery  condition gets worse,  discomfort  might  take place  throughout  remainder or when lying down. The  discomfort  might interrupt sleep. Hanging the legs over the edge of the bed or  strolling may  briefly  eliminate the  discomfort.

 Reasons.
Growth of atherosclerosis. Nuclear test heart.  Outer artery illness is often caused by a build-up of fatty, cholesterol-containing deposits (plaques) on artery wall surfaces. This procedure is called atherosclerosis. It decreases blood circulation via the arteries.

Atherosclerosis  impacts arteries throughout the body. When it  happens in the arteries supplying blood to the limbs, it causes peripheral artery  illness.

 Much less  typical  sources of  outer artery disease  consist of:

  • Blood vessel swelling.
  • Injury to the arms or legs.
  • Adjustments in the muscles or ligaments.
  • Radiation direct exposure.
  • Risk elements.
  •  Cigarette smoking or having  diabetic issues  considerably increases the  threat of  establishing  outer artery disease.

 

Other  points that  boost the  danger of peripheral artery  illness include:.

  • A family history of peripheral artery condition, cardiovascular disease or stroke.
  • Hypertension.
  • High cholesterol. Nuclear test heart.
  • High degrees of an amino acid called homocysteine, which boost the risk for coronary artery condition.
  • Increasing age, especially after 65 (or after 50 if you have threat elements for atherosclerosis).
  •  Excessive weight (a body mass index over 30).

 

 Difficulties.
Problems of outer artery illness brought on by atherosclerosis include:

Nuclear test heart.   In this condition, an injury or infection  triggers tissue to die.  Signs and symptoms  consist of open sores on the  arm or legs that don’t heal. 

Stroke as well as cardiac arrest. Plaque build up in the arteries can likewise influence the capillary in the heart and also mind.

 Avoidance.
 The very best way  to stop leg pain  because of peripheral artery disease is to maintain a healthy lifestyle.

That means:.

  • Do not smoke.
  • Control blood glucose.
  • Consume foods that are reduced in saturated fat.
  • Obtain routine workout – but consult your care supplier concerning what kind and also how much is best for you.
  • Keep a healthy weight
  • Manage blood pressure and cholesterol.

 

Stomach Aortic Aneurysm (AAA) – Nuclear Test Heart

Nuclear test heart.  An ultrasound is done to screen the abdominal aorta for the existence of an enlargement or aneurysm. AAA can lead to a ruptured aortic artery, which is a significant clinical emergency situation.

An abdominal aortic aneurysm is an enlarged  location in the lower part of the major vessel that  provides blood to the body (aorta). Nuclear test heart.  The aorta ranges from the heart through the center of the breast and also abdomen.

The aorta is the largest blood vessel in the body, so a fractured abdominal aortic aneurysm can cause lethal bleeding.

 Depending upon the  dimension of the aneurysm  and also  just how  quick it’s growing,  therapy  differs from watchful waiting to  emergency situation  surgical treatment.

 Signs.
 Abdominal aortic aneurysms  typically grow slowly without  visible  signs and symptoms, making them difficult to  discover. Some aneurysms  never ever rupture. 

If you have an expanding stomach aortic aneurysm, you might notice:

  • Deep, constant pain in the stomach area or side of the stomach (abdomen).
  • Back pain.
  • A pulse near the belly button.

 Reasons.
Aneurysms can develop anywhere along the aorta, but  many aortic aneurysms  take place in the part of the aorta that’s in the belly  location (abdomen).

A number of points can play a role in the growth of an stomach aortic aneurysm, consisting of:

  • Solidifying of the arteries (atherosclerosis). Atherosclerosis occurs when fat as well as other substances accumulate on the lining of a blood vessel.
  • Hypertension. High blood pressure can damage as well as damage the aorta’s walls.
  • Blood vessel diseases. These are  conditions that  create blood vessels to  end up being inflamed.
    Infection in the aorta. Hardly ever, a bacterial or fungal infection might create an stomach aortic aneurysms.
  • Injury. As an example, being harmed in a auto crash can cause an stomach aortic aneurysms.
  •  Danger  variables.

Abdominal aortic aneurysm risk elements consist of:

Cigarette use. Nuclear test heart.  Smoking cigarettes is the greatest threat aspect for aortic aneurysms. Smoking can weaken the wall surfaces of the aorta, raising the danger of aortic aneurysm and aneurysm tear. The longer and a lot more you smoke or chew cigarette, the better the chances of developing an aortic aneurysm. Medical professionals advise a one-time stomach ultrasound to display for an abdominal aortic aneurysm in males ages 65 to 75 who are current or former cigarette smokers.

Age. Abdominal aortic aneurysms occur frequently in individuals age 65 as well as older.

Being male. Nuclear test heart.  Guy create abdominal aortic aneurysms a lot more often than women do.
Being white. People who are white are at  greater risk of abdominal aortic aneurysms.

Family history. Having a family history of  stomach aortic aneurysms  raises the  danger of having the  problem.

 Various other aneurysms. Having an aneurysm in another  huge blood vessel, such as the artery behind the knee or the aorta in the  breast (thoracic aortic aneurysm),  may  raise the risk of an abdominal aortic aneurysm.

Nuclear test heart.  If you’re at risk of an aortic aneurysm, your medical professional might suggest other actions, such as drugs to reduce your blood pressure as well as alleviate tension on damaged arteries.

 Problems.
Rips in several of the layers of the wall surface of the aorta (aortic breakdown) or a fractured aneurysm are the main complications. A rupture can create lethal internal blood loss. In general, the bigger the aneurysm and also the faster it expands, the better the risk of rupture.

Symptoms and signs that an aortic aneurysm has ruptured can include:

  • Sudden, intense as well as consistent abdominal or pain in the back, which can be referred to as a tearing experience.
  • Reduced blood pressure.
  • Fast pulse.
  • Aortic aneurysms  likewise  boost the  threat of  creating  embolism in the area. If a  embolism  break out from the inside wall of an aneurysm  and also blocks a blood vessel  somewhere else in your body, it can cause  discomfort or block blood  circulation to the legs, toes, kidneys or abdominal  body organs.

 

Prevention.
To prevent an aortic aneurysm or maintain an aortic aneurysm from worsening, do the following:

  • Do not smoke or use cigarette products. Stopped cigarette smoking or chewing cigarette and prevent secondhand smoke. If you require assistance giving up, talk to your doctor regarding drugs and also treatments that may aid. Nuclear test heart.
  • Eat a healthy diet plan. Focus on eating a selection of fruits and vegetables, entire grains, poultry, fish, as well as low-fat milk items. Stay clear of saturated and trans fats as well as limit salt.
  • Maintain your blood pressure and also cholesterol controlled. If your doctor has actually recommended medications, take them as advised.
  •   Obtain  normal exercise. Try to  obtain at least 150  mins a week of  modest  cardiovascular activity. 

 

Atrial Fibrillation (AFib) – Nuclear Test Heart

A 6-lead electrocardiogram (EKG) is carried out by placing sensors on the arms as well as legs to evaluate for Atrial Fibrillation.  Nuclear test heart. AFib can cause blood clots, stroke, as well as heart failure, and other heart-related difficulties.

Atrial fibrillation (A-fib) is an uneven as well as usually really fast heart rhythm (arrhythmia) that can result in embolism in the heart. A-fib boosts the risk of stroke, heart failure and also other heart-related problems.

During atrial fibrillation, the heart’s top chambers (the atria) beat chaotically and also irregularly – out of sync with the lower chambers (the ventricles) of the heart. For many people, A-fib might have no signs and symptoms. Nuclear test heart.  A-fib might cause a quickly, pounding heart beat (palpitations), shortness of breath or weak point.

Episodes of atrial fibrillation may come and go, or they may be relentless. Although A-fib itself typically isn’t deadly, it’s a significant clinical problem that needs appropriate therapy to stop stroke.

Treatment for atrial fibrillation may include  medicines, therapy to reset the heart rhythm  as well as catheter procedures to  obstruct  defective heart signals.

A  individual with atrial fibrillation  might  likewise have a related heart rhythm problem called atrial flutter.  Atrial flutter is a different arrhythmia, the  therapy is  fairly  comparable to atrial fibrillation. 

 Signs and symptoms.
Some  individuals with atrial fibrillation (A-fib) don’t notice  any kind of symptoms. Nuclear test heart.  Those who do have atrial fibrillation signs might have symptoms and signs such as:.

  • Feelings of a quickly, fluttering or battering heartbeat (palpitations).
  • Upper body pain.
  • Dizziness.
  • Exhaustion.
  • Lightheadedness.
  • Lowered capability to exercise.
  • Lack of breath.
  • Weakness.

 

Atrial fibrillation might be:

Periodic (paroxysmal atrial fibrillation). Some people with periodic A-fib requirement therapy.

Consistent. With this sort of atrial fibrillation, the heart rhythm doesn’t return to typical on its own. If a individual has A-fib symptoms, cardioversion or treatment with medications may be made use of to bring back as well as preserve a typical heart rhythm.

Long-lasting persistent. This kind of atrial fibrillation is constant as well as lasts longer than 12 months.
Long term. Nuclear test heart.  In this kind of atrial fibrillation, the irregular heart rhythm can not be brought back. Drugs are needed to manage the heart price and also to stop blood clots.

Causes.
To  comprehend the causes of A-fib, it may be  valuable to  recognize  just how the heart  normally beats.

The regular heart has 4 chambers – 2 top chambers ( room) and two reduced chambers (ventricles). It generates the signal that starts each heartbeat.

In a routine heart rhythm:

  • The signal takes a trip from the sinus node with both upper heart chambers ( room).
  • The signal travels through a pathway between the top and also lower chambers called the atrioventricular (AV) node.
  • The movement of the signal triggers your heart to squeeze (contract), sending blood to your heart and also body.
  • In atrial fibrillation, the signals in the  top chambers of the heart are  disorderly. As a result, the upper chambers shake (quiver). The AV node is then  pounded with signals trying to  get across the  reduced heart chambers (ventricles). This  creates a fast  and also irregular heart rhythm. 

 

The heart  price in atrial fibrillation may range from 100 to 175 beats a minute. The  regular range for a heart rate is 60 to 100 beats a minute.

Causes of atrial fibrillation.
 Issues with the heart’s  framework are the most common  reason for atrial fibrillation. Nuclear test heart.  Possible root causes of atrial fibrillation consist of:.

  • Coronary artery disease.
  • Heart attack.
  • Heart defect that you’re born with ( hereditary heart defect).
  • Heart shutoff issues.
  • Hypertension.
  • Lung conditions.
  • Physical stress because of surgery, pneumonia or other illnesses.
  • Previous heart surgical treatment.
  • Problem with the heart’s all natural pacemaker ( ill sinus syndrome).
  • Rest apnea.
  • Thyroid illness such as an overactive thyroid (hyperthyroidism) and also various other metabolic discrepancies.
  • Use of energizers, consisting of certain medicines, caffeine, cigarette as well as alcohol.
  • Viral infections.

Some people who have atrial fibrillation have no  well-known heart problems or heart damage.

Threat elements. Nuclear test heart.
Things that can  raise the  threat of atrial fibrillation (A-fib)  consist of:.

Age. The older a person is, the  higher the  danger of  creating atrial fibrillation.

Heart disease. Anyone with heart disease– such as heart shutoff issues, congenital heart disease, congestive heart failure, coronary artery illness, or a background of cardiovascular disease or heart surgical treatment– has an enhanced threat of atrial fibrillation.

High blood pressure. Having high blood pressure, specifically if it’s not well controlled with way of living adjustments or drugs, can enhance the threat of atrial fibrillation.

Thyroid disease. In some people, thyroid problems might activate heart rhythm issues (arrhythmias), consisting of atrial fibrillation.

Various other chronic health and wellness problems. People with certain chronic conditions such as diabetes, metabolic disorder, chronic kidney illness, lung illness or rest apnea have actually an enhanced threat of atrial fibrillation.

Consuming alcohol. For some people, drinking alcohol can set off an episode of atrial fibrillation. Binge drinking further rises the danger.

Obesity.  Nuclear test heart.  People who have weight problems are at higher threat of developing atrial fibrillation.

Family history. An boosted danger of atrial fibrillation occurs in some families.

Difficulties.
Blood clots are a dangerous complication of atrial fibrillation that can  result in stroke.

In atrial fibrillation, the  disorderly heart rhythm can  trigger blood to collect in the heart’s  top chambers (atria)  and also form clots. Nuclear test heart.  If a embolism in the left top chamber (left room) breaks without the heart area, it can take a trip to the mind and trigger a stroke.

The  threat of stroke from atrial fibrillation  boosts as you  age. Other  health and wellness conditions  likewise  might  boost your  threat of a stroke due to A-fib, including:.

  • Hypertension.
  • Diabetes.
  • Cardiac arrest.
  • Some valvular heart problem.
  • Blood  slimmers are commonly  recommended to prevent blood clots  and also strokes in people with atrial fibrillation.

Prevention.
Healthy and balanced way of living options can decrease the danger of heart problem and also may avoid atrial fibrillation. Nuclear test heart.  Below are some basic heart-healthy suggestions:

  • Eat a healthy diet plan.
  • Obtain routine exercise and preserve a healthy and balanced weight.
  • Don’t smoke.
    Stay clear of or restrict alcohol and caffeine.
  •  Handle  tension, as intense  anxiety  and also  temper can cause heart rhythm  troubles.

 

Osteoporosis Risk – Nuclear Test Heart

An ultrasound is  carried out to  determine the shin bone for  uncommon bone mass density. Nuclear test heart.  This can aid analyze the danger of weakening of bones, a illness where bones come to be weak and breakable.

Weakening of bones creates bones to become weak and also brittle – so fragile that a loss or perhaps moderate anxieties such as flexing over or coughing can cause a fracture. Osteoporosis-related fractures most typically take place in the hip, wrist or spinal column.

Weakening of bones influences males and females of all races. White and Asian females, specifically older ladies who are previous menopause, are at greatest threat. Medicines, healthy diet and weight bearing workout can aid prevent bone loss or strengthen currently weak bones.

 Signs and symptoms.
There generally are no signs in the early stages of bone loss. But once your bones have been compromised by weakening of bones, you may have symptoms and signs that consist of:.

  • Back pain, triggered by a broken or collapsed vertebra.
  • Loss of elevation gradually.
  • A stooped position.
  • A bone that  damages  far more  quickly than expected.

Causes.
Comparing the  inside of a healthy bone with one that has become porous from  weakening of bones.
Osteoporosis  deteriorates bone.

How  most likely you are to  establish  weakening of bones depends  partially on how much bone mass you  achieved in your  young people. Peak bone mass is partly  acquired  as well as  differs  likewise by ethnic group. The higher your  optimal bone mass, the  even more bone you have “in the  financial institution”  and also the  much less likely you are to develop osteoporosis as you age.

 Danger  elements.
A variety of variables can raise the probability that you’ll develop osteoporosis– including your age, race, way of life choices, and medical conditions and also treatments. Nuclear test heart.

Unchangeable risks.
Some danger factors for weakening of bones run out your control, consisting of:

  • Your sex. Ladies are a lot more most likely to establish weakening of bones than are men.
  • Age. The older you obtain, the greater your risk of osteoporosis.
  • Race. You’re at greatest risk of weakening of bones if you’re white or of Asian descent.
  • Family history. Having a parent or sibling with osteoporosis places you at greater danger, especially if your mommy or papa fractured a hip.
  • Body frame size. Men and women that have small body frames have a tendency to have a greater risk due to the fact that they might have much less bone mass to draw from as they age.
  •  Hormonal agent  degrees.

Osteoporosis is much more typical in people that have way too much or too little of certain hormonal agents in their bodies. Examples consist of:

 The fall in estrogen levels in  females at menopause is one of the  toughest  threat  aspects for developing osteoporosis.  Therapies for prostate  cancer cells that reduce testosterone  degrees in men and  therapies for  bust  cancer cells that  minimize estrogen levels in  ladies are likely to  speed up bone loss. 

 Nutritional  elements.
Osteoporosis is  most likely to  take place in  individuals  that have:

Low calcium intake. A long lasting absence of calcium plays a role in the advancement of weakening of bones. Reduced calcium intake adds to reduced bone thickness, very early bone loss as well as an enhanced risk of cracks.

Eating disorders. Drastically restricting food consumption as well as being undernourished weakens bone in both males and females.

Lasting use of dental or infused corticosteroid medications, such as prednisone and also cortisone, disrupts the bone-rebuilding procedure. Nuclear test heart.  Weakening of bones has also been connected with medications used to combat or protect against:

  • Seizures.
  • Stomach reflux.
  • Cancer cells.
  • Transplant rejection.
  • Medical  problems.

The  threat of osteoporosis is  greater in  individuals  that have  specific  clinical problems,  consisting of:.

  • Celiac disease.
  • Inflammatory digestive tract disease.
  • Kidney or liver illness.
  • Cancer cells.
  • Several myeloma.
  • Rheumatoid joint inflammation
  •  Way of living choices.

Some bad habits can raise your danger of weakening of bones. Examples include:

Inactive way of living. Individuals who spend a great deal of time sitting have a higher risk of weakening of bones than do those who are extra energetic. Any type of weight bearing exercise and tasks that advertise equilibrium and also good position are beneficial for your bones, however walking, running, leaping, dancing as well as weight training seem especially valuable.
 Extreme alcohol  usage. Nuclear test heart.  Regular consumption of greater than two alcoholic drinks a day raises the threat of weakening of bones.

Tobacco usage. The exact function tobacco plays in osteoporosis isn’t clear, however it has actually been shown that tobacco use contributes to weak bones.

Problems.
How  weakening of bones can cause vertebrae to crumple  as well as collapse.
Compression  cracks.

In some cases,  back fractures can  take place even if you  have not fallen. The bones that make up your  back (vertebrae) can  compromise to the point of  falling down, which can  lead to back pain, lost height and a  stooped  onward  stance.

Prevention.
 Great  nourishment  and also  routine  workout are  vital for keeping your bones healthy throughout your life.

Calcium.
Men and women between the ages of 18  as well as 50 need 1,000 milligrams of calcium a day. This  everyday  quantity  enhances to 1,200 milligrams when women  transform 50  and also men turn 70.

Good resources of calcium consist of:

  • Low-fat milk products.
  • Dark environment-friendly leafy {vegetables| veggies
  • Tinned salmon or sardines with bones.
  • Soy items, such as tofu.
  • Calcium-fortified  grains and orange juice.

 

The Health and Medicine Division of the National Academies of Sciences, Engineering,  and also Medicine  suggests that  overall calcium intake, from supplements and  diet plan  integrated,  must be no more than 2,000 milligrams daily for  individuals older than 50.

Vitamin D.
Vitamin D  enhances the body’s  capability to  take in calcium  and also  boosts bone health in other ways. Nuclear test heart.  People can obtain some of their vitamin D from sunlight, yet this might not be a excellent source if you live in a high latitude, if you’re housebound, or if you frequently make use of sunscreen or prevent the sunlight because of the danger of skin cancer.

 Nutritional sources of vitamin D  consist of cod liver oil, trout  and also salmon.  Numerous  sorts of milk  as well as cereal  have actually been fortified with vitamin D.

Most people need  a minimum of 600  worldwide  systems (IU) of vitamin D a day. That  referral  raises to 800 IU a day after age 70.

People without various other resources of vitamin D and also specifically with restricted sun direct exposure could require a supplement. The majority of multivitamin products include in between 600 and also 800 IU of vitamin D. Up to 4,000 IU of vitamin D a day is safe for most people.

 Workout.
Workout can assist you construct strong bones and sluggish bone loss. Nuclear test heart.  Exercise will profit your bones no matter when you begin, however you’ll acquire the most benefits if you start working out on a regular basis when you’re young and also continue to work out throughout your life.

Weight-bearing workouts– such as strolling, running, running, stair climbing, missing rope, snowboarding as well as impact-producing sports– affect mainly the bones in your legs, hips and lower back. Equilibrium workouts such as tai chi can decrease your risk of falling especially as you obtain older.

 

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