Heart Sounds Assessment – Stroke Prevention Testing & Screening Near Me

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

 

 

Carotid Artery Disease – Heart Sounds Assessment

An ultrasound is done 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. Heart sounds assessment.  This buildup, called atherosclerosis, is among the leading reasons for stroke.

Carotid (kuh-ROT-id) ultrasound is a safe, pain free procedure that utilizes sound waves to analyze the blood circulation through the carotid arteries. Heart sounds assessment.

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

Carotid ultrasound tests for  obstructed or narrowed carotid arteries, which can  raise the  danger of stroke. Heart sounds assessment.  The results can assist your medical professional establish a therapy to decrease your stroke threat.

Ischemic stroke. A carotid ultrasound is performed to  evaluate for  tightened carotid arteries, which  raise the  danger of stroke.

Carotid arteries are generally tightened by a build-up of plaque – made up of fat, cholesterol, calcium and other materials that flow in the blood stream. Early medical diagnosis as well as treatment of a tightened carotid artery can lower stroke risk.

Your medical professional will advise carotid ultrasound if you have short term ischemic attacks (TIAs) or particular kinds of stroke as well as might suggest a carotid ultrasound if you have medical conditions that boost the danger of stroke, including:

  • Hypertension.
  • Diabetes mellitus.
  • High cholesterol.
  • Family history of stroke or heart problem
  • Current transient ischemic strike (TIA) or stroke.
  • Abnormal sound in carotid arteries (bruit), found by your physician utilizing a stethoscope.
  • Coronary artery disease.

To evaluate for narrowed or obstructed capillary in various other locations of the body, you may require added examinations, consisting of:

Abdominal ultrasound. Heart sounds assessment.  You might have an abdominal ultrasound to test for conditions impacting the blood vessels or body organs in your abdominal location.

Ankle-brachial index examination. This test measures and also contrasts the high blood pressure in between your ankle joint and your arm. The examination reveals minimized or blocked blood circulation to your legs.

Heart stress test. Heart sounds assessment.  This test shows how well your heart carries out when under tension, such as during workout. Results can suggest poor blood flow to the heart.

Heart sounds assessment.  Your medical professional might also purchase imaging examinations to spot coronary artery disease.

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

 Examine blood  circulation  via the artery after  surgical procedure to  eliminate plaques (carotid endarterectomy).

Evaluate the positioning and performance of a stent, a mesh tube made use of to boost blood circulation via an artery.

Locate a collection of clotted blood (hematoma) that might avoid blood circulation.

 Discover other carotid artery  problems that may  interfere with blood  circulation.

 

 

Peripheral Arterial Disease (PAD) – Heart Sounds Assessment

Heart sounds assessment.  An Ankle-Brachial Index (ABI) test is executed utilizing high blood pressure cuffs on the arms as well as legs. It is necessary to evaluate for PAD since it raises the risk of coronary artery illness, cardiac arrest, or stroke.

 Outer artery disease (also called peripheral arterial  condition) is a  usual  problem in which  tightened arteries  lower blood  circulation to the arms or legs.

In  outer artery  condition (PAD), the legs or arms–  generally the legs–  do not  get enough blood flow to  stay up to date with  need. Heart sounds assessment.  This may trigger leg discomfort when strolling (claudication) and other signs.

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

 Outer artery disease  therapy includes  working out,  consuming a healthy diet  as well as not  cigarette smoking or using tobacco.

 Signs and symptoms.
 Many individuals with  outer artery  condition have  moderate or no symptoms. Some  individuals have leg pain when  strolling (claudication).

Claudication signs and symptoms consist of muscle discomfort or cramping in the legs or arms that begins during workout and finishes with rest. Serious leg discomfort might make it tough to stroll or do various other kinds of physical task.

Other peripheral artery disease  signs and symptoms  might include:

  • Coldness in the reduced leg or foot, specifically when compared to the opposite.
  • Leg tingling or weakness.
  • No pulse or a weak pulse in the legs or feet.
  • Unpleasant cramping in one or both of the hips, upper legs or calf bone muscle mass after particular tasks, such as strolling or climbing up staircases.
  • Shiny skin on the legs. Heart sounds assessment.
  • Skin color modifications on the legs.
  • Slower development of the toe nails.
  • Sores on the toes, feet or legs that will not {heal| recover,
  • Pain when utilizing the arms, such as aching and constraining when weaving, composing or doing other manual tasks.
  • Impotence.
  • Hair loss or slower hair growth on the legs.

If  outer artery  condition  worsens,  discomfort  might  take place during rest or when lying down. The pain  might interrupt sleep. Hanging the legs over the edge of the bed or walking  might  briefly  soothe the pain.

 Reasons.
Development of atherosclerosis. Heart sounds assessment.  Outer artery illness is frequently triggered by a buildup of fatty, cholesterol-containing down payments (plaques) on artery wall surfaces. This procedure is called atherosclerosis. It lowers blood circulation through the arteries.

Atherosclerosis  impacts arteries throughout the body. When it occurs in the arteries  providing blood to the  arm or legs, it causes  outer artery  condition.

 Much less common  root causes of  outer artery  condition include:

  • Capillary swelling.
  • Injury to the arms or legs.
  • Modifications in the muscle mass or tendons.
  • Radiation exposure.
  • Danger aspects.
  • Smoking or having  diabetic issues  significantly  boosts the  danger of  creating peripheral artery disease.

 

Other  points that increase the risk of peripheral artery disease include:.

  • A family history of peripheral artery condition, heart disease or stroke.
  • Hypertension.
  • High cholesterol. Heart sounds assessment.
  • High levels of an amino acid called homocysteine, which boost the threat for coronary artery illness.
  • Increasing age, specifically after 65 (or after 50 if you have risk variables for atherosclerosis).
  • Obesity (a body mass index over 30).

 

 Issues.
Problems of peripheral artery condition caused by atherosclerosis include:

Heart sounds assessment.  Vital arm or leg anemia. In this condition, an injury or infection creates tissue to die. Symptoms include open sores on the arm or legs that don’t recover.

Treatment may include amputation of the affected  arm or leg. 

Stroke as well as heart attack. Plaque accumulation in the arteries can also affect the capillary in the heart and also brain.

Prevention.
The best  means to prevent leg pain  because of peripheral artery  condition is to  keep a healthy  way of life.

That  suggests:.

  • Don’t smoke.
  • Control blood sugar.
  • Eat foods that are low in hydrogenated fat.
  • Obtain routine exercise – but get in touch with your care service provider about what kind as well as how much is best for you.
  • Preserve a healthy and balanced weight
  •  Take care of blood pressure  as well as cholesterol.

 

Abdominal Aortic Aneurysm (AAA) – Heart Sounds Assessment

Heart sounds assessment.  An ultrasound is performed to evaluate the abdominal aorta for the existence of an enlargement or aneurysm. AAA can lead to a ruptured aortic artery, which is a severe medical emergency situation.

An abdominal aortic aneurysm is an  bigger  location in the lower part of the major vessel that supplies blood to the body (aorta). Heart sounds assessment.  The aorta ranges from the heart with the facility of the chest as well as abdominal area.

The aorta is the biggest capillary in the body, so a ruptured stomach aortic aneurysm can cause dangerous blood loss.

 Relying on the  dimension of the aneurysm  as well as  just how  quick it’s growing, treatment  differs from watchful waiting to emergency surgery.

 Signs.
 Abdominal aortic aneurysms  frequently  expand  gradually without  visible symptoms, making them  challenging to detect. Some aneurysms never  burst. 

If you have an increasing the size of abdominal aortic aneurysm, you may notice:

  • Deep, consistent discomfort in the stubborn belly location or side of the stomach ( abdominal area).
  • Back pain.
  • A pulse near the belly button.

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

Several points can play a role in the advancement of an stomach aortic aneurysm, including:

  • Hardening of the arteries (atherosclerosis). Atherosclerosis takes place when fat as well as other substances build up on the cellular lining of a capillary.
  • High blood pressure. High blood pressure can harm and also deteriorate the aorta’s wall surfaces.
  • Blood vessel  illness. These are  conditions that  trigger  capillary to  end up being  irritated.
    Infection in the aorta. Hardly ever, a microbial or fungal infection could create an stomach aortic aneurysms.
  • Trauma. As an example, being hurt in a car accident can cause an abdominal aortic aneurysms.
  •  Danger  elements.

Stomach aortic aneurysm risk aspects consist of:

Smoking cigarettes is the best risk variable for aortic aneurysms. Smoking cigarettes can weaken the walls of the aorta, boosting the risk of aortic aneurysm as well as aneurysm tear.

Age. Abdominal aortic aneurysms occur usually in people age 65 and also older.

Being  man. Heart sounds assessment.  Guy create abdominal aortic aneurysms much more usually than ladies do.
Being white.  Individuals  that are white are at  greater  danger of abdominal aortic aneurysms.

Family history. Having a family history of abdominal aortic aneurysms  raises the  threat of having the  problem.

 Various other aneurysms. Having an aneurysm in another  big blood vessel, such as the artery behind the knee or the aorta in the chest (thoracic aortic aneurysm),  may  enhance the  threat of an abdominal aortic aneurysm.

Heart sounds assessment.  If you’re at risk of an aortic aneurysm, your medical professional might suggest other measures, such as medications to lower your blood pressure and alleviate stress on damaged arteries.

 Problems.
Splits in one or more of the layers of the wall surface of the aorta (aortic dissection) or a burst aneurysm are the major problems. A tear can create dangerous internal bleeding. In general, the larger the aneurysm and the much faster it grows, the higher the danger of tear.

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

  • Sudden, extreme and persistent stomach or pain in the back, which can be described as a tearing experience.
  • Reduced blood pressure.
  • Rapid pulse.
  • Aortic aneurysms  likewise increase the risk of developing  embolism in the area. If a  embolism breaks loose from the  within  wall surface of an aneurysm  as well as  obstructs a blood vessel  in other places in your body, it can cause  discomfort or block blood flow to the legs, toes, kidneys or abdominal organs.

 

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

  • Do not smoke or make use of cigarette products. Stopped smoking cigarettes or eating tobacco and prevent secondhand smoke. If you need assistance giving up, talk with your medical professional about medicines and therapies that may help. Heart sounds assessment.
  • Eat a healthy and balanced diet. Focus on consuming a variety of fruits and vegetables, whole grains, poultry, fish, as well as low-fat dairy products. Stay clear of saturated and also trans fats and limit salt.
  • Keep your blood pressure and also cholesterol controlled. If your doctor has actually suggested medications, take them as instructed.
  •   Obtain regular  workout. Try to  obtain at  the very least 150  mins a week of moderate aerobic activity. 

 

Atrial Fibrillation (AFib) – Heart Sounds Assessment

A 6-lead electrocardiogram (EKG) is carried out by placing sensing units on the arms as well as legs to evaluate for Atrial Fibrillation.  Heart sounds assessment. AFib can bring about embolism, stroke, as well as heart failure, and various other heart-related problems.

Atrial fibrillation (A-fib) is an irregular as well as usually really quick heart rhythm (arrhythmia) that can cause embolism in the heart. A-fib boosts the danger of stroke, heart failure as well as various other heart-related difficulties.

Throughout atrial fibrillation, the heart’s upper chambers (the atria) beat chaotically and also off-and-on – out of sync with the lower chambers (the ventricles) of the heart. For many individuals, A-fib may have no signs. Heart sounds assessment.  A-fib may create a fast, pounding heart beat (palpitations), shortness of breath or weak point.

Episodes of atrial fibrillation might reoccur, or they might be persistent. A-fib itself generally isn’t dangerous, it’s a major medical condition that needs correct treatment to avoid stroke.

Treatment for atrial fibrillation may  consist of  medicines,  treatment to reset the heart rhythm  as well as catheter  treatments to block faulty heart signals.

A person with atrial fibrillation  might also have a related heart rhythm problem called atrial flutter.  Atrial flutter is a different arrhythmia, the  therapy is  fairly similar to atrial fibrillation. 

 Signs and symptoms.
Some people with atrial fibrillation (A-fib)  do not  see  any type of  signs and symptoms. Heart sounds assessment.  Those who do have atrial fibrillation symptoms might have signs and symptoms such as:.

  • Sensations of a quickly, fluttering or battering heart beat (palpitations).
  • Chest pain.
  • Dizziness.
  • Exhaustion.
  • Impaired thinking.
  • Decreased capability to workout.
  • Lack of breath.
  •  Weak point.

 

Atrial fibrillation might be:

Periodic (paroxysmal atrial fibrillation). A-fib signs and symptoms reoccur, typically lasting for a couple of minutes to hours. Often signs happen for as long as a week and also episodes can take place repetitively. Some individuals with periodic A-fib demand therapy.

Persistent. With this type of atrial fibrillation, the heart rhythm does not return to normal by itself. If a person has A-fib symptoms, cardioversion or therapy with medicines may be utilized to bring back and maintain a normal heart rhythm.

Long-lasting persistent. This kind of atrial fibrillation is continual and lasts longer than 12 months.
Irreversible. Heart sounds assessment.  In this type of atrial fibrillation, the uneven heart rhythm can not be recovered. Medicines are needed to control the heart rate as well as to avoid blood clots.

 Reasons.
To  comprehend the  reasons for A-fib, it  might be  valuable to  recognize  exactly how the heart  usually  defeats.

The common heart has four chambers – two upper chambers (atria) as well as 2 reduced chambers (ventricles). It creates the signal that starts each heart beat.

In a routine heart rhythm:

  • The signal takes a trip from the sinus node through the two top heart chambers (atria).
  • The signal goes through a path between the upper as well as lower chambers called the atrioventricular (AV) node.
  • The movement of the signal causes your heart to squeeze (contract), sending blood to your heart and body.
  • In atrial fibrillation, the signals in the upper chambers of the heart are chaotic.  Consequently, the upper chambers shake (quiver). The AV node is then  pounded with signals trying to  get across the lower heart chambers (ventricles). This  creates a  quick  as well as  uneven heart rhythm. 

 

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

Causes of atrial fibrillation.
 Issues with the heart’s structure are the most  usual  reason for atrial fibrillation. Heart sounds assessment.  Possible reasons for atrial fibrillation consist of:.

  • Coronary artery condition.
  • Cardiovascular disease.
  • Heart issue that you’re born with (congenital heart defect).
  • Heart valve problems.
  • Hypertension.
  • Lung diseases.
  • Physical stress and anxiety due to surgical procedure, pneumonia or various other ailments.
  • Previous heart surgical treatment.
  • Issue with the heart’s natural pacemaker (sick sinus syndrome).
  • Rest apnea.
  • Thyroid condition such as an overactive thyroid (hyperthyroidism) and other metabolic imbalances.
  • Use of stimulants, including specific medications, high levels of caffeine, tobacco as well as alcohol.
  • Viral infections.

Some  individuals who have atrial fibrillation have no known heart  troubles or heart damage.

Danger variables. Heart sounds assessment.
 Points that can  raise the risk of atrial fibrillation (A-fib)  consist of:.

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

Heart disease. Any individual with heart disease– such as heart shutoff problems, congenital heart disease, congestive heart failure, coronary artery disease, or a background of cardiovascular disease or heart surgical procedure– has an increased risk of atrial fibrillation.

Hypertension. Having high blood pressure, particularly if it’s not well controlled with way of life modifications or medicines, can boost the risk of atrial fibrillation.

Thyroid condition. In some individuals, thyroid issues might cause heart rhythm problems (arrhythmias), including atrial fibrillation.

Various other persistent wellness problems. People with certain persistent conditions such as diabetes mellitus, metabolic syndrome, persistent kidney disease, lung disease or sleep apnea have actually an enhanced danger of atrial fibrillation.

Consuming alcohol. For some people, drinking alcohol can activate an episode of atrial fibrillation. Binge alcohol consumption additional boosts the risk.

Weight problems.  Heart sounds assessment.  People who have weight problems go to higher threat of creating atrial fibrillation.

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

Complications.
Blood clots are a dangerous  problem of atrial fibrillation that can  cause stroke.

In atrial fibrillation, the chaotic heart rhythm can  create blood to  accumulate in the heart’s upper chambers (atria)  and also  kind  embolisms. Heart sounds assessment.  If a blood clot in the left top chamber (left room) breaks without the heart area, it can take a trip to the mind and also trigger a stroke.

The  danger of stroke from atrial fibrillation  raises as you  get older. Other health conditions  likewise may increase your risk of a stroke  as a result of A-fib,  consisting of:.

  • High blood pressure.
  • Diabetic issues.
  • Cardiac arrest.
  • Some valvular heart disease.
  • Blood thinners are  typically  recommended  to avoid  embolism  as well as strokes in people with atrial fibrillation.

 Avoidance.
Healthy way of life selections can minimize the danger of heart disease and might stop atrial fibrillation. Heart sounds assessment.  Below are some basic heart-healthy suggestions:

  • Consume a nutritious diet plan.
  • Obtain routine exercise and keep a healthy weight.
  • Don’t smoke.
    Stay clear of or restrict alcohol and also high levels of caffeine.
  •  Take care of  tension, as intense  tension  as well as anger can  trigger heart rhythm  issues.

 

Weakening of bones Risk – Heart Sounds Assessment

An ultrasound is  done to  determine the shin bone for  irregular bone mass  thickness. Heart sounds assessment.  This can aid examine the danger of weakening of bones, a disease where bones come to be weak and also brittle.

Osteoporosis causes bones to end up being weak as well as weak – so breakable that a autumn or perhaps light stresses such as bending over or coughing can trigger a fracture. Osteoporosis-related cracks most typically happen in the hip, wrist or spine.

Osteoporosis influences men and women of all races. White and also Asian women, specifically older females who are past menopause, are at highest possible danger. Medications, healthy diet regimen and weight bearing workout can help avoid bone loss or enhance already weak bones.

 Signs.
There normally are no symptoms in the beginning of bone loss. But once your bones have actually been deteriorated by osteoporosis, you might have symptoms and signs that consist of:.

  • Pain in the back, caused by a broken or broke down vertebra.
  • Loss of elevation with time.
  • A stooped position.
  • A bone that  damages  a lot more  quickly than expected.

 Reasons.
Comparing the  inside of a  healthy and balanced bone with one that  has actually  ended up being porous from  weakening of bones.
 Weakening of bones  damages bone.

How  most likely you are to  establish osteoporosis depends partly on how much bone mass you  obtained in your  young people. Peak bone mass is partly inherited  and also  differs  likewise by ethnic group. The higher your  height bone mass, the more bone you have “in the bank” and the less likely you are to  establish  weakening of bones as you age.

 Danger  variables.
A variety of variables can raise the possibility that you’ll establish weakening of bones– including your age, race, lifestyle selections, and also medical conditions and also therapies. Heart sounds assessment.

Unchangeable  dangers.
Some risk variables for osteoporosis are out of your control, including:

  • Your sex. Ladies are far more most likely to create weakening of bones than are guys.
  • Age. The older you get, the greater your risk of osteoporosis.
  • Race. You’re at greatest threat of weakening of bones if you’re white or of Asian descent.
  • Family history. Having a parent or brother or sister with osteoporosis puts you at higher danger, especially if your mom or daddy fractured a hip.
  • Body framework dimension. Males and female who have tiny body structures have a tendency to have a higher threat since they could have much less bone mass to draw from as they age.
  •  Hormonal agent levels.

Osteoporosis is extra typical in people who have way too much or inadequate of certain hormones in their bodies. Examples include:

Sex hormones.  Decreased sex  hormonal agent  degrees  often tend to  deteriorate bone. The fall in estrogen levels in  females at menopause is one of the strongest  threat  variables for  creating osteoporosis.  Therapies for prostate cancer that  minimize testosterone levels in  males and treatments for breast  cancer cells that  minimize estrogen levels in  ladies are  most likely to  speed up bone loss. 

Dietary  variables.
Osteoporosis is  most likely to  take place in  individuals who have:

Reduced calcium consumption. A long lasting lack of calcium plays a role in the growth of weakening of bones. Low calcium consumption adds to decreased bone density, early bone loss as well as an increased threat of cracks.

Eating disorders. Severely restricting food consumption as well as being underweight damages bone in both males and females.

Long-term use of oral or injected corticosteroid medicines, such as prednisone and also cortisone, disrupts the bone-rebuilding procedure. Heart sounds assessment.  Weakening of bones has likewise been related to drugs used to deal with or protect against:

  • Seizures.
  • Gastric reflux.
  • Cancer cells.
  • Transplant being rejected.
  • Medical conditions.

The  threat of  weakening of bones is higher in people  that have certain medical problems,  consisting of:.

  • Gastric condition.
  • Inflammatory digestive tract condition.
  • Kidney or liver condition.
  • Cancer cells.
  • Several myeloma.
  • Rheumatoid arthritis
  •  Way of life  options.

Some bad habits can enhance your danger of osteoporosis. Instances include:

Less active lifestyle. People who invest a lot of time resting have a greater danger of weakening of bones than do those who are much more active. Any kind of weight bearing exercise and also tasks that advertise equilibrium as well as good stance are helpful for your bones, yet strolling, running, leaping, dance and weight-lifting appear particularly useful.
 Too much alcohol consumption. Heart sounds assessment.  Normal usage of greater than two alcoholic drinks a day raises the danger of osteoporosis.

Cigarette use. The exact duty cigarette plays in weakening of bones isn’t clear, yet it has been revealed that cigarette use adds to weak bones.

Difficulties.
 Just how  weakening of bones can  create vertebrae to crumple  as well as collapse.
Compression  cracks.

In some cases, spinal fractures can  happen even if you haven’t fallen. The bones that  compose your  spinal column (vertebrae) can  compromise to the point of collapsing, which can result in  pain in the back, lost height  and also a hunched  ahead  pose.

Prevention.
 Excellent nutrition  as well as  normal  workout are essential for  maintaining your bones  healthy and balanced throughout your life.

Calcium.
Men and women  in between the ages of 18 and 50  demand 1,000 milligrams of calcium a day. This  everyday amount increases to 1,200 milligrams when  females  transform 50  as well as  males turn 70.

Good sources of calcium include:

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

 

The Health  and also Medicine Division of the National Academies of Sciences, Engineering,  as well as Medicine  suggests that  complete calcium intake, from supplements and diet combined,  need to 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  enhances bone  health and wellness in  various other ways. Heart sounds assessment.  Individuals can get a few of their vitamin D from sunshine, however this may not be a good source if you stay in a high latitude, if you’re housebound, or if you on a regular basis use sunscreen or prevent the sunlight due to the risk of skin cancer cells.

Dietary sources of vitamin D  consist of cod liver oil, trout and salmon. Many  kinds of milk  and also  grain  have actually been fortified with vitamin D.

Most people need  at the very least 600  worldwide units (IU) of vitamin D a day. That  referral  raises to 800 IU a day after age 70.

People without other sources of vitamin D as well as especially with limited sun exposure may need a supplement. Many multivitamin products have in between 600 as well as 800 IU of vitamin D. Up to 4,000 IU of vitamin D a day is safe for the majority of people.

Exercise.
Exercise can aid you build strong bones and slow bone loss. Heart sounds assessment.  Workout will benefit your bones anytime you start, however you’ll acquire one of the most benefits if you begin working out frequently when you’re young as well as remain to exercise throughout your life.

Weight-bearing workouts– such as walking, jogging, running, stairway climbing, avoiding rope, snowboarding as well as impact-producing sporting activities– affect generally the bones in your legs, hips and lower spine. Balance exercises such as tai chi can lower your risk of falling especially as you get older.

 

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