Stroke Prevention – Stroke Prevention Testing & Screening Near Me

Stroke Prevention  and also Screening near me
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5 Preventive Health Screenings for these Diseases:

 

 

Carotid Artery Disease – Stroke Prevention

An ultrasound is performed to screen the carotid arteries (a set of blood vessels in the neck that provides blood to your mind) for the develop of fatty plaque. Stroke prevention.  This buildup, called atherosclerosis, is just one of the leading root causes of stroke.

Carotid (kuh-ROT-id) ultrasound is a secure, pain free procedure that makes use of sound waves to examine the blood flow with the carotid arteries. Stroke prevention.

Your  2 carotid arteries are located on each side of your neck. They  provide blood from your heart to your brain.

Carotid ultrasound  examinations for  obstructed or narrowed carotid arteries, which can  enhance the risk of stroke. Stroke prevention.  The results can aid your medical professional determine a therapy to lower your stroke danger.

Ischemic stroke. A carotid ultrasound is  executed to  examine for narrowed carotid arteries, which  enhance the  threat of stroke.

Carotid arteries are typically narrowed by a buildup of plaque – composed of fat, cholesterol, calcium and also other substances that circulate in the bloodstream. Early medical diagnosis and also therapy of a narrowed carotid artery can lower stroke threat.

Your medical professional will certainly recommend carotid ultrasound if you have short term ischemic assaults (TIAs) or certain types of stroke as well as may recommend a carotid ultrasound if you have medical conditions that boost the danger of stroke, including:

  • High blood pressure.
  • Diabetic issues.
  • High cholesterol.
  • Family history of stroke or heart disease
  • Recent short-term ischemic attack (TIA) or stroke.
  • Unusual sound in carotid arteries (bruit), identified by your medical professional utilizing a stethoscope.
  • Coronary artery disease.

To screen for narrowed or blocked capillary in other areas of the body, you might need additional tests, including:

 Stomach ultrasound. Stroke prevention.  You may have an abdominal ultrasound to check for problems influencing the capillary or body organs in your abdominal area.

Ankle-brachial index examination. This examination measures and compares the high blood pressure between your ankle and also your arm. The examination shows minimized or blocked blood circulation to your legs.

Heart stress test. Stroke prevention.  This test demonstrates how well your heart carries out when under anxiety, such as during workout. Outcomes can show inadequate blood flow to the heart.

Stroke prevention.  Your medical professional may likewise purchase imaging examinations to spot coronary artery disease.

Other uses of carotid ultrasound.
Your  physician  might  get a carotid ultrasound to:.

 Review blood flow  via the artery after  surgical procedure to remove plaques (carotid endarterectomy).

Examine the placement and performance of a stent, a mesh tube made use of to enhance blood flow through an artery.

Find a collection of thickened blood (hematoma) that may prevent blood circulation.

 Identify  various other carotid artery  problems that may  interfere with blood  circulation.

 

 

Outer Arterial Disease (PAD) – Stroke Prevention

Stroke prevention.  An Ankle-Brachial Index (ABI) test is performed making use of blood pressure cuffs on the arms as well as legs. It is very important to evaluate for PAD due to the fact that it raises the threat of coronary artery condition, heart attack, or stroke.

Peripheral artery disease ( additionally called peripheral arterial  illness) is a  usual  problem in which  tightened arteries  lower blood flow to the arms or legs.

In peripheral artery  condition (PAD), the legs or arms–  generally the legs– don’t  get  adequate blood  circulation to  stay up to date with  need. Stroke prevention.  This might create leg discomfort when walking (claudication) and various other symptoms.

Outer artery disease is generally a sign of a accumulation of fatty deposits in the arteries (atherosclerosis). Atherosclerosis triggers narrowing of the arteries that can decrease blood circulation in the legs and also, sometimes, the arms.

Peripheral artery  illness  therapy  consists of  working out, eating a healthy  diet regimen  and also not  cigarette smoking or  making use of tobacco.

 Signs and symptoms.
 Lots of people with  outer artery  illness have  moderate or no symptoms. Some people have leg  discomfort when walking (claudication).

Claudication symptoms include  muscle mass pain or cramping in the legs or arms that begins  throughout exercise and  finishes with rest. Stroke prevention.  The pain is most generally felt in the calf. The discomfort varies from mild to extreme. Severe leg pain may make it difficult to walk or do various other sorts of exercise.

 Various other  outer artery disease  signs and symptoms may include:

  • Temperature in the reduced leg or foot, especially when compared to the opposite side.
  • Leg tingling or weak point.
  • No pulse or a weak pulse in the legs or feet.
  • Uncomfortable cramping in one or both of the hips, thighs or calf muscle mass after certain tasks, such as walking or climbing stairs.
  • Shiny skin on the legs. Stroke prevention.
  • Skin shade modifications on the legs.
  • Slower growth of the toenails.
  • Sores on the toes, feet or legs that won’t {heal| recover,
  • Pain when making use of the arms, such as hurting and cramping when weaving, writing or doing various other manual jobs.
  • Impotence.
  •  Loss of hair or slower hair growth on the legs.

If  outer artery disease  becomes worse,  discomfort may  happen  throughout rest or when  relaxing. The pain  might  disrupt  rest. Hanging the legs over the edge of the bed or walking may temporarily  soothe the  discomfort.

 Reasons.
Growth of atherosclerosis. Stroke prevention.  Peripheral artery disease is typically caused by a accumulation of fatty, cholesterol-containing down payments (plaques) on artery walls. This process is called atherosclerosis. It reduces blood circulation via the arteries.

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

 Much less  typical  reasons for peripheral artery  condition include:

  • Capillary inflammation.
  • Injury to the arms or legs.
  • Adjustments in the muscular tissues or ligaments.
  • Radiation exposure.
  • Threat elements.
  •  Cigarette smoking or having  diabetic issues  considerably  enhances the  danger of developing  outer artery disease.

 

Other things that  boost the  danger of  outer artery  condition  consist of:.

  • A family history of outer artery illness, heart problem or stroke.
  • High blood pressure.
  • High cholesterol. Stroke prevention.
  • High degrees of an amino acid called homocysteine, which increase the risk for coronary artery disease.
  • Enhancing age, especially after 65 (or after 50 if you have danger variables for atherosclerosis).
  • Obesity (a body mass index over 30).

 

 Difficulties.
Difficulties of peripheral artery illness triggered by atherosclerosis include:

Stroke prevention.   In this condition, an injury or infection causes tissue to  pass away.  Signs  consist of open sores on the  arm or legs that  do not  recover. 

Stroke and also cardiovascular disease. Plaque accumulation in the arteries can additionally affect the blood vessels in the heart as well as mind.

 Avoidance.
 The most effective  means  to stop leg pain  as a result of  outer artery disease is to maintain a healthy lifestyle.

That  implies:.

  • Do not smoke.
  • Control blood sugar.
  • Consume foods that are low in saturated fat.
  • Obtain regular workout – however check with your care supplier about what type and how much is finest for you.
  • Keep a healthy and balanced weight
  •  Handle blood pressure and cholesterol.

 

Stomach Aortic Aneurysm (AAA) – Stroke Prevention

Stroke prevention.  An ultrasound is carried out to evaluate the stomach aorta for the visibility of an enhancement or aneurysm. AAA can lead to a fractured aortic artery, which is a significant medical emergency situation.

An  stomach aortic aneurysm is an enlarged  location in the  reduced part of the major vessel that supplies blood to the body (aorta). Stroke prevention.  The aorta runs from the heart with the center of the breast and abdominal area.

The aorta is the biggest blood vessel in the body, so a fractured abdominal aortic aneurysm can trigger deadly blood loss.

 Depending upon the size of the aneurysm  as well as  exactly how  quick it’s  expanding, treatment  differs from watchful waiting to  emergency situation surgery.

 Signs and symptoms.
  Stomach aortic aneurysms  usually grow  gradually without noticeable  signs, making them  tough to  find. Some aneurysms never rupture. 

If you have an expanding abdominal aortic aneurysm, you could notice:

  • Deep, continuous discomfort in the stubborn belly location or side of the stomach ( abdominal area).
  • Neck and back pain.
  • A pulse near the belly button.

Causes.
Aneurysms can develop anywhere along the aorta, but  many aortic aneurysms  happen in the part of the aorta that’s in the belly area (abdomen).

Several points can play a role in the advancement of an abdominal aortic aneurysm, consisting of:

  • Solidifying of the arteries (atherosclerosis). Atherosclerosis takes place when fat as well as various other compounds accumulate on the lining of a capillary.
  • Hypertension. Hypertension can damage and damage the aorta’s walls.
  • Blood vessel  illness. These are diseases that  create  capillary to become inflamed.
    Infection in the aorta. Rarely, a microbial or fungal infection might create an abdominal aortic aneurysms.
  • Trauma. Being hurt in a cars and truck crash can trigger an stomach aortic aneurysms.
  • Risk  elements.

Abdominal aortic aneurysm threat factors include:

Cigarette usage. Stroke prevention.  Smoking cigarettes is the greatest risk variable for aortic aneurysms. Smoking can compromise the walls of the aorta, increasing the danger of aortic aneurysm and aneurysm rupture. The longer and also much more you smoke or eat tobacco, the higher the opportunities of establishing an aortic aneurysm. Doctors advise a single abdominal 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 most often in individuals age 65 and also older.

Being  man. Stroke prevention.  Guy create stomach aortic aneurysms far more usually than females do.
Being white. People who are white  go to higher  danger of  stomach aortic aneurysms.

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

Other aneurysms. Having an aneurysm in another  big  capillary, such as the artery behind the knee or the aorta in the chest (thoracic aortic aneurysm),  could  boost the risk of an  stomach aortic aneurysm.

Stroke prevention.  If you’re at risk of an aortic aneurysm, your doctor could suggest various other actions, such as medications to reduce your high blood pressure and relieve stress on damaged arteries.

 Problems.
Rips in several of the layers of the wall of the aorta (aortic breakdown) or a fractured aneurysm are the main difficulties. A tear can trigger deadly interior blood loss. As a whole, the bigger the aneurysm as well as the much faster it expands, the better the threat of rupture.

Signs and symptoms that an aortic aneurysm has actually burst can include:

  • Abrupt, extreme as well as persistent abdominal or neck and back pain, which can be called a tearing sensation.
  • Low blood pressure.
  • Quick pulse.
  • Aortic aneurysms also  enhance the  danger of  creating  embolism in the area. If a blood clot breaks loose from the inside wall of an aneurysm and  obstructs a blood vessel elsewhere in your body, it can cause pain or block blood flow to the legs, toes, kidneys or  stomach organs.

 

 Avoidance.
To stop an aortic aneurysm or maintain an aortic aneurysm from worsening, do the following:

  • Do not smoke or utilize cigarette items. Stopped smoking cigarettes or chewing tobacco and also avoid secondhand smoke. If you need aid giving up, talk with your doctor about drugs and also therapies that might assist. Stroke prevention.
  • Consume a healthy and balanced diet. Focus on eating a variety of fruits and vegetables, whole grains, fowl, fish, and low-fat milk items. Avoid saturated as well as trans fats and also limitation salt.
  • Keep your high blood pressure and also cholesterol in control. If your doctor has actually prescribed medications, take them as instructed.
  •  Get  routine exercise.  Attempt to  obtain at least 150  mins a week of moderate  cardio activity. 

 

Atrial Fibrillation (AFib) – Stroke Prevention

A 6-lead electrocardiogram (EKG) is executed by placing sensors on the arms as well as legs to screen for Atrial Fibrillation.  Stroke prevention. AFib can lead to embolism, stroke, as well as cardiac arrest, and also other heart-related problems.

Atrial fibrillation (A-fib) is an irregular and also usually very rapid heart rhythm (arrhythmia) that can bring about embolism in the heart. A-fib rises the threat of stroke, heart failure and various other heart-related difficulties.

During atrial fibrillation, the heart’s top chambers (the atria) beat chaotically as well as off-and-on – out of sync with the lower chambers (the ventricles) of the heart. For many people, A-fib may have no signs. Stroke prevention.  A-fib may create a quick, pounding heartbeat (palpitations), lack of breath or weak point.

Episodes of atrial fibrillation may reoccur, or they may be persistent. A-fib itself typically isn’t lethal, it’s a major clinical condition that needs appropriate treatment to prevent stroke.

 Therapy for atrial fibrillation  might include medications,  treatment to reset the heart rhythm and catheter procedures to block faulty heart signals.

A  individual with atrial fibrillation may also have a related heart rhythm  issue called atrial flutter. Although atrial flutter is a different arrhythmia, the  therapy is  rather  comparable to atrial fibrillation. 

 Signs and symptoms.
Some people with atrial fibrillation (A-fib) don’t notice  any type of  signs. Stroke prevention.  Those that do have atrial fibrillation signs and symptoms may have symptoms and signs such as:.

  • Sensations of a fast, trembling or battering heartbeat (palpitations).
  • Chest pain.
  • Lightheadedness.
  • Tiredness.
  • Impaired thinking.
  • Decreased ability to workout.
  • Lack of breath.
  •  Weak point.

 

Atrial fibrillation may be:

Periodic (paroxysmal atrial fibrillation). A-fib symptoms reoccur, typically lasting for a couple of minutes to hours. In some cases signs and symptoms happen for as long as a week and episodes can occur consistently. Some people with occasional A-fib requirement treatment.

Persistent. With this kind of atrial fibrillation, the heart rhythm doesn’t return to normal on its own. If a person has A-fib signs and symptoms, cardioversion or therapy with medicines might be utilized to bring back and also keep a regular heart rhythm.

Enduring relentless. This kind of atrial fibrillation is continuous and also lasts longer than 12 months.
Irreversible. Stroke prevention.  In this sort of atrial fibrillation, the uneven heart rhythm can not be brought back. Drugs are required to regulate the heart rate and also to prevent embolism.

Causes.
To understand the  sources of A-fib, it  might be helpful to  understand  just how the heart  generally beats.

The regular heart has four chambers – two upper chambers (atria) and 2 lower chambers (ventricles). It creates the signal that begins each heartbeat.

In a routine heart rhythm:

  • The signal takes a trip from the sinus node via the two upper heart chambers (atria).
  • The signal goes through a path in between the top and lower chambers called the atrioventricular (AV) node.
  • The motion of the signal triggers your heart to press (contract), sending out blood to your heart and body.
  •  In atrial fibrillation, the signals in the upper chambers of the heart are chaotic. The AV node is  after that bombarded with signals trying to get  via to the lower heart chambers (ventricles). 

 

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

Causes of atrial fibrillation.
 Troubles with the heart’s  framework are the most  usual  source of atrial fibrillation. Stroke prevention.  Possible root causes of atrial fibrillation include:.

  • Coronary artery illness.
  • Cardiovascular disease.
  • Heart flaw that you’re born with (congenital heart defect).
  • Heart valve issues.
  • High blood pressure.
  • Lung illness.
  • Physical tension as a result of surgery, pneumonia or other illnesses.
  • Previous heart surgical procedure.
  • Trouble with the heart’s natural pacemaker ( unwell sinus syndrome).
  • Rest apnea.
  • Thyroid disease such as an over active thyroid (hyperthyroidism) and also various other metabolic discrepancies.
  • Use of energizers, including specific medications, high levels of caffeine, tobacco as well as alcohol.
  • Viral infections.

Some  individuals  that have atrial fibrillation have no  well-known heart problems or heart  damages.

Danger aspects. Stroke prevention.
 Points that can increase the  threat of atrial fibrillation (A-fib)  consist of:.

Age. The older a  individual is, the greater the  danger of  establishing atrial fibrillation.

Heart problem. Anyone with cardiovascular disease– such as heart shutoff troubles, congenital heart disease, congestive heart failure, coronary artery disease, or a history of cardiovascular disease or heart surgical treatment– has actually an increased risk of atrial fibrillation.

Hypertension. Having high blood pressure, particularly if it’s not well managed with way of living changes or medicines, can enhance the threat of atrial fibrillation.

Thyroid condition. In some people, thyroid troubles may cause heart rhythm problems (arrhythmias), including atrial fibrillation.

Various other chronic health and wellness conditions. People with particular persistent conditions such as diabetes mellitus, metabolic disorder, persistent kidney disease, lung condition or sleep apnea have an boosted danger of atrial fibrillation.

Drinking alcohol. For some people, consuming alcohol can set off an episode of atrial fibrillation. Binge alcohol consumption additional boosts the risk.

Excessive weight.  Stroke prevention.  Individuals that have weight problems are at greater risk of creating atrial fibrillation.

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

Issues.
Blood clots are a  unsafe  issue of atrial fibrillation that can lead to stroke.

In atrial fibrillation, the  disorderly heart rhythm can  create blood to collect in the heart’s  top chambers (atria)  as well as  kind  embolisms. Stroke prevention.  If a blood clot in the left upper chamber (left room) breaks without the heart area, it can travel to the brain and cause a stroke.

The  danger of stroke from atrial fibrillation  boosts as you  age. Other  wellness  problems also may  boost your  danger of a stroke  because of A-fib, including:.

  • High blood pressure.
  • Diabetic issues.
  • Heart failure.
  • Some valvular cardiovascular disease.
  • Blood thinners are  frequently  suggested to prevent  embolism  as well as strokes in  individuals with atrial fibrillation.

 Avoidance.
Healthy lifestyle selections can decrease the danger of heart disease as well as may avoid atrial fibrillation. Stroke prevention.  Here are some basic heart-healthy ideas:

  • Consume a healthy diet plan.
  • Obtain regular exercise and also keep a healthy and balanced weight.
  • Don’t smoke.
    Avoid or restrict alcohol and high levels of caffeine.
  •  Handle  tension, as intense  anxiety  as well as  rage can cause heart rhythm  troubles.

 

Osteoporosis Risk – Stroke Prevention

An ultrasound is  done to  determine the shin bone for  uncommon bone mass  thickness. Stroke prevention.  This can aid evaluate the danger of weakening of bones, a condition where bones become weak and also brittle.

Weakening of bones causes bones to come to be weak and weak – so breakable that a autumn or even mild stress and anxieties such as flexing over or coughing can cause a crack. Osteoporosis-related fractures most commonly occur in the hip, wrist or spinal column.

Weakening of bones impacts males and females of all races. White and also Asian females, especially older females that are previous menopause, are at highest possible threat. Drugs, healthy diet as well as weight bearing exercise can assist avoid bone loss or strengthen currently weak bones.

Symptoms.
There usually are no signs and symptoms in the onset of bone loss. Once your bones have actually been damaged by weakening of bones, you might have indicators and symptoms that include:

  • Pain in the back, triggered by a broken or fell down vertebra.
  • Loss of height gradually.
  • A stooped posture.
  • A bone that breaks  far more easily than expected.

Causes.
 Contrasting the interior of a  healthy and balanced bone with one that has  ended up being porous from osteoporosis.
 Weakening of bones  deteriorates bone.

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

Risk  variables.
A number of variables can increase the likelihood that you’ll establish osteoporosis– including your age, race, way of life choices, and clinical problems and therapies. Stroke prevention.

Unchangeable  threats.
Some risk aspects for weakening of bones are out of your control, consisting of:

  • Your sex. Ladies are far more likely to establish osteoporosis than are men.
  • Age. The older you obtain, the greater your risk of weakening of bones.
  • Race. You’re at biggest risk of osteoporosis if you’re white or of Asian descent.
  • Family history. Having a moms and dad or sibling with weakening of bones places you at better risk, specifically if your mommy or father fractured a hip.
  • Body frame dimension. Men and women that have tiny body structures often tend to have a higher danger because they may have less bone mass to draw from as they age.
  • Hormone levels.

Osteoporosis is much more common in individuals who have too much or too little of particular hormonal agents in their bodies. Examples include:

Sex  hormonal agents.  Reduced sex hormone  degrees  have a tendency to  damage bone. The fall in estrogen  degrees in  females at menopause  is among the strongest  threat  elements for  establishing osteoporosis. Treatments for prostate  cancer cells that  decrease testosterone levels in  males and  therapies for  bust cancer that reduce estrogen levels in  ladies are  most likely to  increase bone loss. 

Dietary  elements.
Osteoporosis is more likely to  happen in people  that have:

Reduced calcium consumption. A long lasting absence of calcium plays a role in the growth of weakening of bones. Reduced calcium consumption contributes to diminished bone thickness, early bone loss and an increased danger of fractures.

Eating disorders. Drastically limiting food consumption as well as being underweight compromises bone in both men and women.

Long lasting use of dental or infused corticosteroid medications, such as prednisone and also cortisone, interferes with the bone-rebuilding process. Stroke prevention.  Osteoporosis has actually also been related to drugs used to deal with or protect against:

  • Seizures.
  • Stomach reflux.
  • Cancer.
  • Transplant denial.
  • Medical conditions.

The risk of osteoporosis is  greater in  individuals  that have certain medical  issues,  consisting of:.

  • Gastric condition.
  • Inflammatory bowel disease.
  • Kidney or liver illness.
  • Cancer cells.
  • Several myeloma.
  • Rheumatoid joint inflammation
  •  Way of life choices.

Some bad habits can increase your risk of weakening of bones. Examples consist of:

Sedentary way of living. People that spend a lot of time resting have a higher danger of osteoporosis than do those who are much more active. Any type of weight bearing exercise and activities that promote equilibrium as well as good pose are valuable for your bones, however walking, running, jumping, dancing and also weightlifting seem specifically valuable.
 Extreme alcohol  usage. Stroke prevention.  Regular intake of greater than 2 alcoholic drinks a day enhances the risk of osteoporosis.

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

Complications.
 Just how osteoporosis can  trigger vertebrae to crumple and collapse.
Compression fractures.

 Sometimes,  spine fractures can  take place even if you haven’t  dropped. The bones that  compose your spine (vertebrae) can  deteriorate to the point of collapsing, which can  cause  neck and back pain, lost height  as well as a hunched forward  pose.

Prevention.
 Excellent nutrition  as well as  normal exercise are  vital for keeping your bones healthy throughout your life.

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

Good resources of calcium include:

  • Low-fat dairy products.
  • Dark green leafy {vegetables| veggies
  • Canned salmon or sardines with bones.
  • Soy items, such as tofu.
  • Calcium-fortified cereals  and also orange juice.

 

The Health  as well as Medicine Division of the National Academies of Sciences, Engineering, and Medicine  suggests that  overall calcium intake, from supplements and  diet plan combined,  need to  disappear than 2,000 milligrams daily for  individuals older than 50.

Vitamin D.
Vitamin D  enhances the body’s  capability to absorb calcium  and also  enhances bone  health and wellness in  various other  means. Stroke prevention.  Individuals can obtain some of their vitamin D from sunlight, yet this could not be a excellent resource if you live in a high latitude, if you’re housebound, or if you on a regular basis utilize sun block or avoid the sun due to the danger of skin cancer.

Dietary sources of vitamin D include cod liver oil, trout  as well as salmon.  Numerous  sorts of milk  and also  grain have been  strengthened with vitamin D.

Most people  require at least 600  worldwide units (IU) of vitamin D a day. That  suggestion  boosts to 800 IU a day after age 70.

People without other sources of vitamin D and also particularly with minimal sunlight exposure may need a supplement. Most multivitamin items include between 600 and 800 IU of vitamin D. Up to 4,000 IU of vitamin D a day is risk free for most individuals.

Exercise.
Exercise can help you build solid bones and also slow moving bone loss. Stroke prevention.  Exercise will certainly benefit your bones anytime you start, yet you’ll get one of the most advantages if you start exercising consistently when you’re young as well as continue to work out throughout your life.

Weight-bearing exercises– such as walking, running, running, staircase climbing, missing rope, winter sports and also impact-producing sporting activities– affect mostly the bones in your legs, hips and reduced spine. Balance exercises such as tai chi can decrease your danger of falling specifically as you get older.

 

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