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MENSTRUAL HYGIENE TOUR

Posted on Leave a commentPosted in About Us, health, Latest News/Events, Menstrual Health, Menstrual Health Tour, MHT, Projects, Team

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This year, 2019, we are in partnership with RAM foundation, to embark on a nationwide Menstrual Hygiene Tour (MHT). The tour is geared towards engaging students (boys and girls) and the community in general on Menstrual and Reproductive Health Education. Our aim throughout this project is to teach best practices in order to maintain optimum health during the monthly menstrual cycle and to do away with shyness as a result of bleeding. We will also be giving away free sanitary pads to the students and other girls in the community during the course of this project.

 

MENSTRUAL HYGIENE TOUR
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CLITH NGO TEAMS UP WITH JERRY4LIBRARY PROJECT TO SURPRISE HOSPITALS IN GREATER ACCRA REGION

Posted on 3 CommentsPosted in Latest News/Events, Projects

Few hospitals in the Greater Accra Region of Ghana were full of smiles last week Thursday when a team of benevolent citizens paid surprise visits to them.

On the 23rd of August 2018, Managing Director and Co-Founder of CLITH NGO, Mr Eugene E. Tornyeavah joined a family of concerned philanthropists lead by Mrs. Akweley Plahar to visit 6 hospitals at random in the national capital and the harbour city of Ghana. They made it to both small and big facilities, as well as private and public owned health institutions who continue to brace the odds to deliver health service par excellence to the people of Ghana.

#Jerry4Library project is an ongoing family cum community library project spear headed by Mrs Akweley Plahar to boost reading culture in children in rural communities. As part of efforts to build this project, Mrs Plahar who was until recently a civil service diplomatic staff stationed in Ghana’s High Commission in India; called for support from friends, co-workers, family and civil society in the Diaspora to donate used books and reading materials.

In conversation with Administrators and Directors of the receiving institutions, Mrs Akweley Plahar and her twin sister Akuorkor cautioned the institutions to use the equipment and medical consumables to the benefit of people and not sell them or keep them in stores where they will gather dust. Among the items donated were wheel chairs, drip stands, medical consumables such as packs of cotton pads, gauze packs, infusion sets, boxes of syringes and needles, IV catheters and boxes of hand gloves. Hospitals and Clinics who benefited from the first round of the donation exercise included Oak Street Clinic and Laboratory in Teshie, LEKMA Hospital in Teshie, Family Health Hospital in Teshie, Tema General Hospital, New Crystal Hospital in Tema and Tema Polyclinic.

The receiving institutions were very happy with the surprise donations with most of them expressing how much it was an answered prayer to their call and desire for workable medical equipment to augment their lack and inadequate ones. On Facebook, many health workers expressed desire and need for some of those equipment to reach their doorsteps because they all lack them. Several requests were received from Hospitals in Winneba, Cape coast, Keta, Sogakope, Akatsi, Ada, Adaklu, Agbozume etc. Grievous of all was calls from Nkwanta South Hospital in northern Volta.

The team intends to make another surprise visit to the Volta region this week to donate the rest of the medical equipment in stock. It is worthy to note that purchase of these medical equipment and consumables was funded by two Ghanaian consuls in Mumbai and Kolkata, three astute Indian companies and some wonderful Ghanaians including the Managing Director of CLITH NGO who contribute Made-In-Ghana products which were sold in India and proceeds used to purchase the equipment. These were wonderfully purchased, shipped in and cleared by Mrs Plahar at a great cost. One would expect government to supply these things at ease to health institutions in the country, but that is seen only when we get lucky or elections loom. Government even took a step further to tax the philanthropists who made efforts to bring them in.

“CLITH NGO intends to reach out to Civil Society, individual donors and willing people to help raise funds to renovate, restock and refurbish some primary health delivery centers across rural Ghana starting with Nkwanta South Municipal hospital.” Says Dr Stephen Akiti, Board chairman of CLITH NGO.

By

@telikemeugene

telikemeugene@gmail.com

0205850427

World Heart and Stroke Day – Preventing Heart Diseases and Stroke through Good Nutrition

Posted on 1 CommentPosted in health

 

Cardiovascular diseases are the number one cause of death worldwide and this is projected to remain so, according to WHO. About 17.5 million people died from cardiovascular disease in 2005, representing 30 percent of all global deaths. Risk factors that may lead to heart disease and stroke include:

  • Raised blood pressure, cholesterol and glucose levels.
  • Smoking
  • Inadequate intake of fruit and vegetables.
  • Obesity

World Heart Day was created to inform people around the globe that heart disease and stroke are the world’s leading cause of death. According to WHO at least 80 percent of premature deaths from heart disease and stroke could be avoided if the main risk factors – which are tobacco, unhealthy diet and physical inactivity – are controlled.

Healthy lifestyle through good nutrition (Healthy Diet)

A healthy diet helps protect against malnutrition in all its forms, as well as noncommunicable diseases (NCDs), including diabetes, heart disease, stroke and cancer.

Unhealthy diet and lack of physical activity are leading global risks to health.

Healthy dietary practices start early in life – breastfeeding fosters healthy growth and improves cognitive development, and may have longer-term health benefits, like reducing the risk of becoming overweight or obese and developing NCDs (heart disease and stroke) later in life.

Energy intake (calories) should be in balance with energy expenditure. Evidence indicates that total fat should not exceed 30% of total energy intake to avoid unhealthy weight gain, with a shift in fat consumption away from saturated fats to unsaturated fats, and towards the elimination of industrial trans fats.

A healthy diet contains:

  • Fruits, vegetables, legumes (e.g. lentils, beans), nuts and whole grains (e.g. unprocessed maize, millet, oats, wheat, brown rice).
  • At least 400 g (5 portions) of fruits and vegetables a day. Potatoes, sweet potatoes, cassava and other starchy roots are not classified as fruits or vegetables.
  • Less than 10% of total energy intake from free sugars which is equivalent to 50 g (or around 12 level teaspoons) for a person of healthy body weight consuming approximately 2000 calories per day, but ideally less than 5% of total energy intake for additional health benefits. Most free sugars are added to foods or drinks by the manufacturer, cook or consumer, and can also be found in sugars naturally present in honey, syrups, fruit juices and fruit juice concentrates.
  • Less than 30% of total energy intake should come from fats. Unsaturated fats (e.g. found in fish, avocado, nuts, sunflower, canola and olive oils) are preferable to saturated fats (e.g. found in fatty meat, butter, palm and coconut oil, cream, cheese, ghee and lard). Industrial trans fats (found in processed food, fast food, snack food, fried food, frozen pizza, pies, cookies, margarines and spreads) are not part of a healthy diet.
  • Less than 5 g of salt (equivalent to approximately 1 teaspoon) per day and use iodized salt greatly impact positively on one’s health.

How Practical can this be done:

To improve fruit and vegetable consumption you can:

  • always include vegetables in your meals
  • eat fresh fruits and raw vegetables as snacks
  • eat fresh fruits and vegetables in season
  • eat a variety of choices of fruits and vegetables.

Fat intake can be reduced by:

  • changing how you cook – remove the fatty part of meat; use vegetable oil (not animal oil); and boil, steam or bake rather than fry;
  • avoiding processed foods containing trans fats; and
  • limiting the consumption of foods containing high amounts of saturated fats (e.g. cheese, ice cream, fatty meat).

You can reduce salt consumption by:

  • not adding salt, soy sauce or fish sauce during the preparation of food
  • not having salt on the table
  • limiting the consumption of salty snacks
  • choosing products with lower sodium content.
  • Some food manufacturers are reformulating recipes to reduce the salt content of their products, and it is helpful to check food labels to see how much sodium is in a product before purchasing or consuming it.
  • Potassium, which can mitigate the negative effects of elevated sodium consumption on blood pressure, can be increased with consumption of fresh fruits and vegetables.

The intake of free sugars should be reduced throughout the life course. Evidence indicates that in both adults and children, the intake of free sugars should be reduced to less than 10% of total energy intake, and that a reduction to less than 5% of total energy intake provides additional health benefits. Free sugars are all sugars added to foods or drinks by the manufacturer, cook or consumer, as well as sugars naturally present in honey, syrups, fruit juices and fruit juice concentrates.

Dietary modification is key in maintaining a very good heart health and general wellbeing.

 

Carl Makafui Agbittor

Nutritionist.

World Heart Day 2017: Share the Power – Know heart diseases

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This year’s theme for World Heart Day is ‘Share the Power’, encouraging people across the world to take care of their heart and inspire others to do the same.

Bad eating habits, inadequate intake of water, lack of physical activity, use of tobacco and alcohol etc., predispose one to heart conditions such as vessel clogging and hypertension, arrhythmia, high cholesterol and other cardiovascular diseases.

Anyone diagnosed with any of these heart conditions is evidently at a higher risk of a heart attack and Cerebrovascular accident. Heart problems are still very much one of the biggest burdens on the medical budget and the dangers of acquiring heart disease loom large over those who hold an unhealthy lifestyle close to their heart.

Unfortunately, some heart conditions are congenital. This means they are either present at birth or acquired during foetal development. These include Mitral, Aortic and Tricuspid Regurgitations and Stenosis, Hole-In-Heart, Mitral Valve Prolapse etc

World Health Organisation (WHO) founded World Heart Day in the year 2000 to be celebrated every 29th September – to sensitize and create awareness among people around the globe that heart diseases including CVA are the world’s leading causes of death, claiming 17.3 million lives each year.

To commemorate World Heart Day and also climax #CLITHSeptember, the medical team of CLITH will be out in the Church of Pentecost, Achimota Area – Taifa District, Accra tomorrow to screen few indicator of Heart Disease and also educate the congregation on risk factors of heart diseases and lifestyle modifications.

What is heart disease?

Disorders that affect the heart or blood vessels are called cardiovascular disorders. These disorders are usually divided into heart disease and peripheral blood vessel disorders. Heart disease affects the heart and blood vessels that supply the heart muscle. Disorders that affect blood vessels that supply the brain are called Cerebrovascular disorders e.g. stroke. Basically, heart disease encompasses diseased or occluded vessels, structural damage or malformations and blood clots.

When your heart begins to fail, it means it is no longer operating at its best and is unable to pump blood rhythmically.

This may be due to and not limited to some form of damage to the muscles of the heart, a chronic high blood pressure problem, faulty heart valves, a congenital malformation, and complications from rheumatic fever (causing rheumatic heart disease).

The trigger could also be coronary artery disease, which leaves your arteries clogged with cholesterol or plaque, blocking them partially or almost completely preventing normal blood flow.

According to WHO (World Health Organization) and the CDC, heart disease is the leading cause of death in the UK, USA, Canada and Australia. Unfortunately, data is not available for Ghana and Africa but the rate at which we see cases of heart disease in the hospitals is very high. The number of US adults diagnosed with heart disease stands at 26.6 million (11.3% of adult population).

Coronary heart disease or ischemic heart disease is the most common form of heart disease. Although the heart regulates and pumps blood to every part of the body, it also needs special vessels to supply itself, without which its functions will be deficient. These vessels are the coronary arteries. Coronary or ischemic heart disease occurs when there is a blockade or blood supply to the heart tissues is cut off. If you have this problem, your heart muscles are unable to receive the oxygen and blood they need for nourishment and proper functioning, leading to symptoms like chest pain, arrhythmia or irregular heartbeat, and even heart attacks.

Signs and Symptoms of Heart Disease include

  1. Pain: Sever chest pain is a common and widely known symptom of heart disease. Technically known as angina, it is a result of inadequate oxygen supply to the heart muscle and accumulation of waste products causing cramps. Strange as it may seem, women and men have different symptoms of pain ;
  • Where the pain is:Women usually complain of pain in the neck, jaw, abdomen, throat, or back unlike men, who have chest pain more often.
  • The trigger:For women, the pain may occur during rest or even while sleeping and not just during a physical activity. Mental stress is more likely to trigger pain in women. In men, physical activity worsens their pain. Pain usually goes away while at rest.
  • Feeling of pain:Women may feel a sharp burning chest pain, but men experience a squeezing sensation or pressure in the chest. The more plaque is build up in the vessel, the worse the pain.
  1. Palpitations: Rapid and irregular heartbeat are not noticeable in normal people. However, most people can feel their heartbeats when they lie on their left side. Under certain circumstances – for example, when exercising strenuously or having a dramatic emotional experience – healthy people may become aware of their heartbeat. Determining whether palpitations are abnormal depends on answers to a number of questions such as whether they started suddenly or gradually, whether something seems to trigger them, how fast the heart beats and whether and to what extent the beats seem irregular. Palpitations that occur with other symptoms such as shortness of breath, pain, weakness, fatigue, or fainting are more likely to result from an abnormal heart rhythm or a serious disorder.
  1. Fatigue: When the heart pumps inefficiently as it does in heart failure, blood flow to the muscles may be inadequate during physical activity causing feelings of weakness and fatigue. Symptoms are often subtle. People usually compensate by gradually reducing their activity level or they may blame the systems on increasing age.
  1. Shortness of breath: Also known as dyspnoea is a common symptom of heart failure. It results from fluid sipping into the air spaces of the lungs – A condition called pulmonary congestion or oedema. Ultimately the process is similar to drowning.
  1. Limitation of physical activity: Heart disease can limit a person’s ability to perform physical activity. One way to evaluate the severity of heart disease is to determine how limited this activity is.
  1. Light-headedness and fainting: If blood flow is inadequate because the heart rate or rhythm is abnormal, or because the heart cannot pump adequately, light-headedness, faintness, or fainting (syncope) may result. These symptoms can also result from brain or spinal cord disorders or they may have no serious cause. E.g. healthy soldiers may feel faint or may faint when standing still for long periods ( a phenomenon called parade ground syncope) because the leg muscles have to be active to help return blood to the heart. Strong emotion or pain which activates part of the nervous system also can cause fainting. Sitting or standing up too quickly can cause feeling of faintness or fainting because the change in position causes blood to pool in the legs resulting in the fall in blood pressure. Normally the body quickly adjust to maintain blood pressure. Inability to adjust quickly is called auto-static hypotension.
  1. Swelling, Numbness and changes in skin colour: Swelling is due to the accumulation of fluids (oedema) in tissues. It occurs when blood pools in the leg veins increasing pressure in the leg veins and forcing fluids out of the veins into tissues. Blood may pool because the heart cannot pump out all the blood it receives from the rest of the body (in heart failure) or because a deep vein in the leg is blocked (in deep vein thrombosis). Swelling in the legs or ankles and feet or in the abdomen may indicate heart failure or a venous disorder such as deep vein thrombosis. However such swelling is most commonly caused by standing or sitting in one position for too long or by age related changes in the leg veins. Swelling in the legs is also common in pregnancy. Swelling may also be due to liver or kidney disorders. If the blood supply is inadequate, the affected part of the body may feel numb. If blood supply is inadequate, if anaemia is present, or if the veins do not drain adequately, the skin may appear pale or bluish (or purplish).

Signs of a heart attack:

These warning signs will help you catch a heart attack before it happens or as it is starting.

  1. Pain in the jaw/neck/back: Pain or even discomfort in the jaw, back, or neck may be a sign of an impending heart attack.
  2. Pain in the chest: Discomfort or pain in the chest could be a sign of an oncoming heart attack.
  3. Pain in the shoulders/arms: Even painful arms or shoulders could be a sign of a heart issue. More than women, men are more likely to have pain in the left arm during a heart attack.
  4. Light-headedness/dizziness: If you feel faint, dizzy or weak, especially combined with other symptoms, this may be due to a heart attack. Women tend to experience this symptom more than men.
  5. Shortness of breath: Finding it hard to breathe? It may be because your heart is struggling to supply oxygen and blood.
  6. Nausea: Women may feel nauseous if and when they are experiencing a heart attack.
  7. Heartburn and indigestion: Another symptom more common in women than in men is the feeling of indigestion which is often ignored in the hope that it will eventually go away.
  8. Tiredness/fatigue: Feeling of extreme exhaustion and tiredness, especially if you have other signs accompanying this, may be due to a heart attack.
  9. Fluttering in the chest:Also known as palpitations, this fluttering in the chest can be caused by a heart attack or heart problem. However, since there are other harmless reasons for this like anxiety or dehydration, you are advised to get yourself checked to be sure.

Better to be safe than sorry! Getting timely medical attention is critical and may allow you to recover better and faster.

Anytime you are contemplating the early warning signs of heart failure, just remember your ‘FACES’.

F – Fatigue

A – Activity limitation

C – Congestion

E – Edema

S – Shortness of breath

Apart from these symptoms, some people also experience confusion, memory loss and disorientation. Lack of appetite is also a possible sign. Pain is just the beginning. Fortunately, problems like heart attack and heart failure do have red flags that can help you save your own life or someone else’s if you notice them in time.

In this case, if you or a loved one is experiencing heart failure or a heart attack, get emergency medical attention as fast as possible.

If you are alone, call an ambulance!

 

E. E. Tornyeavah @telikemeugen

 

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READY TO JOIN THE EHIE-AGBOZUME (VOLTA REGION) TRAIN?

Posted on Leave a commentPosted in About Us, health, Latest News/Events, Projects, Team

On the 2nd of September, 2016, last year at the invitation of opinion leaders of the community, CLITH championed a mobile clinic In Ehie, Agbozume in the Volta Region of Ghana to commence the “GALI” festival. Natives of all ages, young and old; male and female alike were carefully screened individually, diagnosed and treated of various health conditions. The reception was warm and cordial , it is for this reason that we are excited to return there this year, on the 23rd of September, 2017. Regardless of your age, status or location, CLITH intends to extend QUALITY HEALTH CARE. Do well to join the moving Train

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DOCTOR, I HAVE A “WATERY MOUTH”, ITS PAINFUL!

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DOCTOR, I HAVE A “WATERY MOUTH”, ITS PAINFUL!

Health has always been of great concern all over the world. A nation’s development depends largely on it. It has been said, that Health is wealth. This is true because medical care is expensive and the human body is the most priceless commodity on the market.

Amongst the growth, development and attention every person tries to acquire, medical care has been the least and hardest sought. Seemingly desired but seldom concerned.

It is not so comfortable expressing ignorance and neither is it exposing one’s body and privacy to another person, is it? When people sit in front of the Doctor, so many thoughts run amok through their minds. They perceive the outcome of their visits immediately they have their hands on the door knob or even in the waiting area. “Who is this Doctor and how can he or she help me? Is he or she nice to talk to? Why is he or she not smiling? Will he or she really listen and manage me well? Will I leave satisfied or regret this visit? What will he or she think of me when he or she sees my penis or sagging breast?”

 

Most people do have good reasons for not seeking medical attention. Although some are just ignorant, others suffer a true sense of anxiety, dilemma and fear. They either present a false state of their problem or serve the prescriber with a puzzle to solve. This is a defence mechanism to sometimes assess the nature of the Doctor they have fallen unto. They wonder if she would be nice and interested to know more or just take what they have presented without further probe. Unfortunately, many walk miles away more traumatized and mentally abused because of the Doctor or nurse’s lack of tenderness and care. But I thank God and I believe that if Eleanor was an Angel, she surely would have had a good report to tell The Heavens about me!

 

Friday,

21.7.17

@ 11:42 am.

 

PC

Painful watery mouth (recurrent for 5/12)

Before I could continue to do my Direct Questioning (ODQ), I was thrown into frenzy! I paused for while to be sure I was in my right senses, and hearing well what is being said (because the consulting room can be extremely tiring and exhausting sometimes). I kept getting the same feedback on every clarification. I paused my questioning and went straight to examination.

She opened her mouth at my command, but I could not see water or any kind of unusual fluid. I checked the throat, the mucosal membranes, beneath the tongue, almost everywhere but there was nothing I could see. Her speech and buccal movement was also not suggestive of pain in the mouth. So which mouth was exactly “watering” with the pain?

I don’t think my reaction was well cultured enough because I was growing out of patience. She looked totally indifferent of the situation and that almost spurred the anger already starting up within me. I tried everything nice and funny, but she was still not willing to open up. I nearly wrote her off to the next Doctor on duty, at least to punish her for her own game. But suddenly, I had that magic intuition that is always with the doctor.

 

Doctors can most of the times predict the actual complaint of a patient. Not only the complaint, we are also capable of reading ahead the patient’s emotions to know their state of mind!

What sat before me this day was total fear of being laughed at, because she had a hygiene related infection which is very common with women.

Her actual complain:

Vaginal discharge

Painful urination (recurrent 5/12)

ODQ:

Offensive discharge+, waist pain+, lower abdominal pain+, frequent micturition+, urgency+, fever•, vomiting•

Drug hx – nill

O/E:

A young lady, looks well, no pallor, no jaundice, afebrile and well dehydrated.

 

Fast forward……

Abdomen – abdomen is full, soft, moves with respiration, there is supra pubic tenderness. No renal angle tenderness

Laboratory results:

Urine R/E

Appearance – Amber

Protein – negative

Nitrite – negative

Leukocyte – ++++

Uribilinogen – negative

Bilirubin – Negative

Pus cells – 20/1

Epithelial cells – 15/1

Blood – ++ (not in menses)

 

Diagnoses:

Urinary Tract Infection (UTI)

 

She looked sad as I broke the news to her. In her eyes, she wished to be talk to, to be counselled on how she contracted UTI. She instantly stole my heart as Theodore in Alvin and the Chipmunks always does with his voice and innocent looking face. I held her hand, reassured and educated her on what UTI really is and the causes.

So what is UTI?

Urinary tract infection is an infection of the urinary tract usually caused by bacteria. The urinary system consists of the bladder, urethra, ureters and the kidneys. UTI is commonly diagnosed in women because of the anatomy of the vagina (closeness of the anus to the vagina and closeness of the urethra to the vagina)

CAUSES

  1. Wiping the anus from down to up. (Faecal matter from the anus contains millions of bacteria from the gastrointestinal tract. Any small amount bacteria that enters the vagina can cause the infection)
  2. Sexual intercourse; “fingering” with dirty fingernails and sometimes sleeping with a partner with sexually transmitted infections like Gonorrhoea.
  3. Wearing soaked sanitary pads for a long time
  4. Wearing dirty panties.
  5. Pregnancy; UTI is usually common in pregnancy. Almost every pregnant woman gets this infection before term. It can be mistaken for “offshore” complains such as fever, severe lower abdominal pain, headache, general body pain and severe waist pains with or without vaginal discharge. You cannot wait to hear painful and frequency of urination which are usually present in a non pregnant woman. The urine r/e and blood film for malaria parasites (which also sometimes come with similar complains) gives the differential diagnosis.

 

“And also do not forget to be drinking water frequently because it flushes out bacteria from the urinary system.” I ended with a fulfilled smile.

She admitted of being guilty on this and that, and promised to do well because of possible complications, which is another tale for another day.

 

(c) Eunice Godbless for CLITH NGO 2017

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EXERCISE

Posted on 4 CommentsPosted in health, Latest News/Events, Projects

Regardless of your age, race or gender, regular exercise is one important aspect of health that should not be taken for granted. Regular exercise is known to: control weight, help improve certain health conditions, help relaxation, help boost confidence and generally help improve health. Basically, regular exercise serves as a means of improving and living a healthy and comfortable life.

It is common for people to struggle with their weight; it maybe as a result of the consumption of certain food or lifestyle or probably as a results of certain genes. To a large extent, regular exercise can be helpful in controlling the weight gained through these processes. Regular exercise can be very helpful in burning calories; which in turn helps put your weight in check. The exercise you need to engage in to notice effective results, does not have to be strenuous. Simple activities that can be engaged in regularly, can also constitute an effective exercise routine. Hence, simple activities like taking the stairs or strolling can also be helpful.

Regular exercise can also be helpful in boosting high-density lipoprotein (HDL) and decreases unhealthy triglycerides. This helps in putting some conditions and health diseases in check, such as high blood pressure. It also helps in decreasing your risk of cardiovascular diseases. Other health conditions that can be managed or prevented through regular exercise includes: metabolic syndrome, type 2 diabetes, depression, arthritis and many more. The benefit of regular exercise also extends to improving relaxation, which in turn can be very helpful in improving sleep, especially those suffering from insomnia. Exercise increases the body’s core temperature; when the body temperature drops back to normal after an exercise routine, it relaxes the body, which enhances sleep.

The relaxation nature that exercise helps boost, also helps in the reduction of stress; this is done by the increase concentration of norepinephrine, during an exercise section. Norepinephrine is a chemical that can moderate the brain’s response to stress. Stress is also reduced as a result of the release of endorphins during exercise. Endorphins create feelings of happiness and euphoria; this also means that exercise can be helpful for people suffering from depression or anxiety.

Generally, in chasing good health by engaging in regular exercise routines, you also get an additional benefit of having great looks; as exercise puts you in great shape both mentally and physically. This to a large extent can help boost self-esteem and improve self-confidence.

The health benefits of regular exercise is quite extensive; it will take some time to exhaust all of them in details. So bear in mind that anytime you engage in any exercise routine, you are doing some real ‘good’ by improving your health and general wellbeing.

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