Vysoký krvný tlak nebolí, ale môže mať smrteľné následky

Prečo by mali pacienti s hypertenziou dodržiavať liečbu? Oddialia ňou hroziace komplikácie, predĺžia si dĺžku život, môžu žiť aktívne a zlepšia si celkovú kvalitu života. V opačnom prípade môže mať nedodržanie liečby fatálne následky.

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Zaujímavosti a fakty 

  • Celosvetovo trpí vysokým krvným tlakom 20- 50% dospelej populácie, čo je najmenej miliarda dospelých ľudí.
  • Systolický krvný tlak („horný“) sa považuje za dôležitejší ako diastolický, keďže je nezávislým rizikovým faktorom  cievnych mozgových príhod, srdcového i obličkového zlyhávania.
  • Podľa najnovších výsledkov Framinghamskej štúdie sa hypertenzia rozvinie takmer u všetkých ľudí, ktorí žijú dostatočne dlho. Zároveň ale v primitívnych kultúrach tlak vekom nestúpa, čo potvrdzuje významný vplyv moderného životného štýlu.
  • Až 54 % prípadov cievnej mozgovej príhody a 47 % srdcových infarktov vzniká ako dôsledok hypertenzie.
  • Ľudia s hypertenziou majú 2,5krát vyššie riziko rozvoja cukrovky.
  • Z dlhodobých výskumov vyplýva, že zníženie systolického tlaku o 10 mmHg a diastolického o 5mmHg znižuje riziko mozgovej mŕtvice o 36%, riziko srdcového zlyhania o 38%, úmrtnosti na kardiovaskulárne príčiny o 16 % a riziko celkovej úmrtnosti o 10%.
  • Vysoký krvný tlak nebolí ani ho nijak necítiť, preto by si mal každý dospelý kontrolovať tlak aspoň raz ročne.
  • Až u tretiny až polovice pacientov s vysokým tlakom sa napriek liečbe nedarí dosiahnuť hodnoty tlaku nižšie ako 140/90 mmHg.
  • U väčšiny pacientov s hypertenziou nestačí na dostatočnú kontrolu tlaku jeden liek, ale musia užívať kombináciu dvoch až troch antihypertenzív

Krvný tlak 

Je to tlak, ktorým krv pôsobí na vnútornú stranu ciev. Neustále prirodzene kolíše v priebehu srdcového cyklu, pri zmene fyzickej námahy, rôznych emóciách, ako aj ako reakcia na rôzne látky (kofeín, nikotín, soľ...). Počas cyklu srdca je najvyšší tlak v okamihu, keď sa srdcový sval stiahne a krv vypudí zo srdca do tepien celého tela – hovoríme o systolickom tlaku. Pri uvoľnení srdcového svalu, kedy sa plní krvou pritekajúcou zo žíl, je tlak najnižší – nazýva sa diastolický tlak. 

Hypotenzia

Príliš nízky krvný tlak – hypotenzia - sa vyskytuje pomerne často a u väčšiny ľudí nespôsobuje vážnejšie problémy. Chorobný význam má v prípade, keď vedie k porušeniu prietoku krvi vnútornými orgánmi. Najcitlivejší na krvné zásobenie je mozog, preto sa ako prvé príznaky hypotenzie objavujú poruchy centrálnej nervovej sústavy - najmä spavosť, únava, závraty, poruchy videnia, hučanie v ušiach, celková nevoľnosť až krátkodobé poruchy vedomia. Závažné prípady neprekrvenia mozgu môžu viesť až k mozgovej mŕtvici.

Častým prejavom hypotenzie je porucha prekrvenia končatín, ktorá sa prejavuje chladom a bledosťou. Pokiaľ sú nedokrvením zasiahnuté obličky, prejaví sa to zníženým vylučovaním moču. Hypotenziu zhoršuje dlhé státie, náhle postavenie sa, príjem väčšieho množstva potravy a strava bohatá na sacharidy, horúce prostredie, dvíhanie ťažkých predmetov, užívanie alkoholu a liekov. 

Hypertenzia

Vysoký krvný tlak – hypertenzia - vzniká ako dôsledok zužovania alebo tuhnutia ciev. O hypertenzii hovoríme, pokiaľ je hodnota systolického tlaku vyššia ako 140 mmHg a hodnota diastolického vyššia ako 90 mmHg. Pri hypertenzii je tlak krvi na vnútornú stranu tepny príliš vysoký, čo môže viesť k narušeniu alebo poškodeniu tepien (napr. k rozvoju aterosklerózy – kôrnateniu tepien).

Typy hypertenzie

  1. primárna (esenciálna)– zvýšený tlak nie je dôsledkom iného ochorenia; tvorí viac ako 90 % všetkých prípadov
  2. sekundárna– ako dôsledok iného ochorenia, tvorí menej ako 10 % prípadov

„Hypertenzia bieleho plášťa“ – objavuje sa ako reakcia na stres či strach pri návšteve lekára. Hodnota krvného tlaku pri meraní v ambulancii je ≥ 140/90 mmHg, kým pri 24-hodinovom meraní je v priemere nižšia ako 125/80 mmHg.

Rizikové faktory hypertenzie

Medzi faktory, ktoré zvyšujú riziko vzniku a tiež zhoršujú prognózu hypertenzie, patria:

  • Obezita– najmä v oblasti brucha (abdominálna obezita, tzn. obvod pása ˃ 102 cm u mužov a ˃ 88 cm u žien)
  • Vysokývek– vyššie riziko hypertenzie hrozí po 45. roku veku, ešte významnejšie u mužov starších ako 55 rokov a žien nad 65 rokov
  • Nevhodný spôsob života– najmä fajčenie, ale aj stres, nedostatok pohybu, nevhodné zloženie stravy
  • Dedičné faktory– riziko je vyššie u ľudí, ktorých priami príbuzní trpia vysokým krvným tlakom, keďže môžu mať dedičnú predispozíciu na jeho rozvoj, rovnako ľudia, ktorí majú v rodinnej anamnéze predčasné kardiovaskulárne ochorenie – u mužov mladších ako 55 rokov a žien mladších ako 65 rokov
  • Zvýšený cholesterol– rizikovým faktorom pre vznik hypertenzie je celkový cholesterol > 6,5 mmol/l, LDL cholesterol ˃ 4,0 mmol/l a HDL cholesterol ˂ 1,0 mmol/l u mužov a < 1,2 mmol/l u žien
  • Iné ochorenia– niektoré majú vysoký krvný tlak ako príznak alebo dôsledok – napr. ochorenie obličiek, mozgovocievne a kardiovaskulárne ochorenia, ochorenia žliaz s vnútorným vylučovaním... Hovoríme o sekundárnej hypertenzii a tvorí asi 5 – 10 % všetkých prípadov vysokého tlaku.

Komplikácie hypertenzie

Vysoký krvný tlak môže spôsobiť rôzne komplikácie. Pokiaľ je tlak na vnútornú stranu ciev zvýšený dlhodobo, poškodzuje sa ich výstelka, steny ciev hrubnú a znižuje sa ich poddajnosť, čo môže viesť k vzniku a rýchlejšiemu postupu aterosklerózy -  kôrnateniu tepien. Ateroskleróza a zmeny stavby tepien, ktoré hypertenzia urýchľuje, môžu viesť k prasknutiu tepny a krvácaniu - cievnej mozgovej príhode či srdcovému infarktu. Spomedzi orgánov zaťažuje vysoký krvný tlak najmä srdce, mozog, cievy, ako aj obličky a oči. Pacienti s hypertenziou majú tiež 2,5-krát vyššie riziko rozvoja cukrovky.

Diagnostika hypertenzie

Diagnóza arteriálna hypertenzia sa určí vtedy, ak je tlak opakovane vyšší alebo rovný 140/90 mmHg minimálne pri dvoch rôznych návštevách lekára. Pri určení diagnózy sa používa viacero metód: 

Opakované meranie krvného tlaku

Pri meraní by mal byť pacient v duševnom i fyzickom pokoji. Keďže samotné meranie krvný tlak zvyšuje (tzv. „efekt bieleho plášťa“), meranie sa viackrát opakuje, aby sa určil čo najpresnejší výsledok. Obyčajne sa tlak odmeria 3x počas jednej návštevy lekára a za výsledný tlak krvi považujeme priemernú hodnotu druhého a tretieho merania. U starších pacientov a diabetikov sa niekedy odporúča merať tlak v stoji.  

24-hodinové monitorovanie krvného tlaku 

Sledovanie krvného tlaku počas 24 hodín sa odporúča najmä v týchto prípadoch:

  • pokiaľ sú v rámci jedného alebo viacerých meraní zistené významné rozdiely v hodnote krvného tlaku, 
  • ak sa objavia výrazné rozdiely medzi ambulantným a domácim meraním,
  • ak je vysoký tlak nameraný u človeka s nízkym kardiovaskulárnym rizikom,
  • u ľudí rezistentných na liečbu alebo pre potreby výskumu.

Odobratie anamnézy – najmä rodinná anamnéza kardiovaskulárnych ochorení

Laboratórne vyšetrenia – vyšetrenie moču a krvi, cholesterolu, obličkovej funkcie...

Iné vyšetrenia - niekedy sa ako súčasť diagnostiky hypertenzie môže vykonať EKG, ultrazvukové vyšetrenie tepien, vyšetrenie bielkoviny v moči, vyšetrenie očného pozadia a pod. Pri komplikovanej hypertenzii sa môžu vyšetrovať funkcie mozgu, srdca a obličiek.

Liečba hypertenzie

Primárna hypertenzia, ktorá nie je dôsledkom iného ochorenia, je obyčajne celoživotné ochorenie, a preto si vyžaduje aj celoživotnú liečbu. Cieľom liečby je:

  • dosiahnuť hodnoty krvného tlaku do 140/90
  • maximálne znížiť celkové dlhodobé riziko kardiovaskulárnej chorobnosti a úmrtnosti
  • redukcia všetkých odstrániteľných rizikových faktorov – fajčenie, cholesterol, hodnoty cukru, liečba pridružených ochorení;

Nefarmakologická liečba

Všetkým pacientom s vysokým krvným tlakom je odporúčaných niekoľko režimových opatrení:

  • Pravidelné meranie krvného tlaku a spolupráca s lekárom;
  • Zanechanie fajčenia – je hlavným rizikovým faktorom vzniku srdcovocievnych ochorení, zvyšuje riziko náhlej smrti, postihnutia tepien, poškodzuje cievne steny. Po zanechaní fajčenia sa riziko ochorení srdca a ciev rýchlo znižuje;
  • Zníženie telesnej hmotnosti u ľudí s nadváhou alebo obezitou;
  • Zníženie konzumácie alkoholu;
  • Zvýšenie telesnej aktivity – aspoň 30-45 minút 3-4x do týždňa znižuje krvný tlak, ako aj srdcovú frekvenciu, spotrebu kyslíka pre srdce, záťaž pre srdce i hmotnosť, ktorá je tiež rizikovým faktorom vysokého tlaku;
  • Zníženie príjmu soli;
  • Zvýšenie konzumácie ovocia a zeleniny, zníženie príjmu tukov;
  • Obmedzenie užívania liekov, ktoré môžu zvýšiť zadržiavanie vody a sodíka v organizme

Farmakologická liečba

Lieky proti vysokému krvnému tlaku sa rozdeľujú do niekoľkých skupín podľa svojho mechanizmu účinku. Typy liečby sa ďalej líšia podľa toho, či pacient užíva jeden liek alebo viacero súčasne.

Monoterapia

Užívanie jedného lieku – monoterapia umožňuje dosiahnuť cieľové hodnoty tlaku len u obmedzeného počtu pacientov - je úspešná asi u 20-40 % z nich. Preto sa užívanie jedného lieku odporúča len pri počiatočnej liečbe u pacientov s hypertenziou 1. stupňa a nízkym kardiovaskulárnym rizikom (sTK < 150 mmHg) alebo u veľmi starých pacientov (> 80 rokov), alebo u krehkých pacientov.

Kombinovaná liečba

Lieky proti hypertenzii sa často kombinujúaby sa posilnil ich účinok a znížil sa výskyt nežiaducich účinkov. Ideálne je, ak sa lieky vyberú pacientovi „na mieru“ – podľa výskytu ďalších ochorení a iných faktorov. Bohužiaľ, ak pacienti potrebujú viacero liekov, zvyčajne ich neužívajú správne. Stáva sa, že niektoré prestanú brať, zmenia si dávkovanie alebo úplne prestanú brať lieky aj počas niekoľkých dní či týždňov. Liečba artériovej hypertenzie musí byť dlhodobá, väčšinou je celoživotná. Riešením by mohli byť takzvanéfixné kombinácie - spojenie dvoch alebo troch liekov do jednej tablety. Majú niekoľko výhod: znižuje sa tým počet tabliet, ktoré musí pacient denne užiť, zvyšuje sa tak ochota pacientov liečiť sa a zároveň sa zlepšuje kontrola tlaku krvi - stúpa efektivita liečby. Zároveň klesá počet nežiaducich vedľajších účinkov, pretože obsiahnuté lieky vo vhodnej fixnej kombinácii navzájom priaznivo ovplyvňujú svoje vedľajšie efekty. Preto aj nové odporúčania ESC/ESH 2018 pre manažment artériovej hypertenzie uprednostňujú začať liečbu dvoj-kombináciou, pokiaľ možno fixnou dvoj kombináciou liečiv a hneď v druhom kroku liečby, keď dvoj-kombinácia nestačí, využiť troj-kombináciu liečiv, najlepšie v 1 tablete, ktorá zabezpečí 24-hodinovú kontrolu krvného tlaku, kardiovaskulárnu ochranu a lepšiu compliance k liečbe.

Kombinovaná liečba

Na dosiahnutie cieľových hodnôt tlaku krvi je u väčšiny pacientov potrebné použiť kombináciu liekov. V súčasnosti existuje viacero účinných a dobre znášaných kombinácií antihypertenzív. 

Pri úvodnej liečbe sa obyčajne používa fixná kombinácia dvoch liekov v nízkych dávkach (ACEi + BKK alebo DIU) s možnosťou zvýšiť dávku, ak je to potrebné. Kombinácia 2 liekov v nízkych dávkach oproti monoterapii sa uprednostňuje u pacientov v 2. alebo 3. štádiu hypertenzie, ktorých riziko hypertenzie a rozvoja kardiovaskulárnych ochorení je vysoké. Fixná kombinácia dvoch liekov má jednoduché dávkovanie a lepšiu compliance pacienta (= akceptácia, prijatie, ochota dodržiavať liečbu). 

Pri nekomplikovanej hypertenzii a u starších pacientov má byť liečba začatá postupne, no u vysokorizikových pacientov by sa mala kombinovaná terapia použiť už v úvode liečby a vyššie dávky dosahovať rýchlejšie. U niektorých pacientov sa cieľový tlak krvi nepodarí dosiahnuť ani kombináciou dvoch liekov a vtedy sa odporúča kombinácia troch alebo aj štyroch rôznych antihypertenzív.

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    The flexor muscular tissues are on the inside of the forearm and
    start on the elbow. These muscle tissue work by flexing your
    wrist and transferring your hand downward towards
    the inside of your arm. With reasonable loads, you'll find a way to increase the reps to
    10 to twenty reps per set and add round four to 10 sets
    to your weekly workouts. There are three main benefits to using the cable machine to work your triceps.


    The distinctive mixture of passion for my area and
    the continual quest for development fuels my drive to break new floor.
    For most parts yes – stance matters like when doing squats or bench presses;
    it sets every little thing else up right… And grips?
    They change things too – pronated (palms down) versus neutral can shift
    how muscular tissues work collectively during an train.
    The traps are vital in turning the top, lifting the shoulders, and rotating the arm.

    The pecs are engaged while utilizing the battle ropes while moving the ropes side
    to facet or up and down. Make sure to maintain your back straight and
    core tight for safety and effectiveness whereas performing this
    move, creating a robust basis for overhead presses and improving posture.
    For shoulder rehabilitation do these exercises two instances a day.

    The barbell row is a incredible exercise for your whole upper again, and relying on how
    much you bend over, you can target completely different components of your traps.
    To hit your middle traps, keep your higher physique close to horizontal
    to the ground. The extra upright you stand, the more you interact your higher traps.
    Next, think about the thickness of the ropes, with
    thicker ropes offering extra resistance for strength-focused
    exercises and thinner ropes being suitable for pace and endurance coaching.


    From the importance of consulting a healthcare supplier to the debate between DIY and store-bought pulleys, we have
    lined a spread of topics to guide you in making informed choices.
    So, earlier than you begin swinging that shoulder pulley, ensure to consult
    a bodily therapist, orthopedic surgeon, or chiropractor that focuses
    on sports activities medication. Their experience can guide you through the
    secure and efficient use of this tool, helping you obtain your rehabilitation goals whereas minimizing the danger of additional injury.
    Furthermore, a bodily therapist can answer any questions you would possibly have
    about your situation and the best strategies for treatment.
    This personalized attention may be invaluable, especially when you're navigating the
    complexities of shoulder strengthening workout routines
    and other types of bodily remedy. If you’re looking for a shoulder workout you can do
    at house or the fitness center, strive the circuit below.

    Start with 5-10 minutes of dynamic shoulder stretches like arm circles, shoulder
    rolls, and shoulder mobility exercises to extend coronary heart price and put together the shoulder joints for the exercise.

    It mimics the pure rowing motion, but as an alternative of pulling up (which can improve shoulder injury risk), you pull straight toward your body/face.
    You can study every little thing about totally
    different battle rope lengths, thicknesses, and supplies in our Battle Ropes Buyer’s Information. All questions associated to purchasing battle ropes are answered in that article.
    The solely thing we will suggest is that if you'd like the most durable battle rope, then go for a battle rope manufactured from polydac.

    This exercise could be done as pictured below or
    with a single weight stack with a bar attachment.
    Deadlifts on the cable machine may help you to enhance your
    kind as the burden is equally constant all through the motion. This exercise is ideal for a
    deep stretch of the shoulders and lats which might expose any lack in range
    of movement. The cable pullover might help to increase the again, chest
    and serratus anterior power and dimension. The most typical offender when doing face pulls incorrectly is solely not understanding what you are alleged to be working.


    Remember to breathe out as you press up and breathe in the
    method in which down. Attach both the handles on the bottom of a cable machine and place an incline bench in between. Return back to the beginning
    position and stretch your shoulders at the finish.
    You simply have to maintain your elbows slightly bend and convey your arms above the shoulder height.
    Cable machine is a good modality to deliver variations into your workout program.

    You can use different angles and positions to coach your muscles.


    Right Here in this article, you will discover some superior cable workout routines for shoulders that may particularly target every part of your
    delts, i.e., the front, lateral and rear delts. The one-arm cable lateral elevate is an isolated shoulder train that targets the deltoids whereas
    growing stability in each the wrists and
    the core. Cable machine workouts are great for the shoulder as a
    result of they keep the muscle tissue in rigidity all through the complete vary
    of motion, which helps construct strength and form the delt muscular tissues.
    You might remember them from health club class, but ropes have been a well-liked health software in gyms
    across the country for years.
    With a cable machine, you’ll be getting fixed tension throughout every exercise.
    Continuous engagement is essential, as analysis has shown that larger time beneath rigidity leads to greater muscle protein synthesis.

    A actually useful a half of doing all of your shoulder and back workout with a cable machine is that we will very quickly adjust the load we use
    when we are coaching. The alternating overhead
    press can be carried out in a few alternative ways.
    You can alternate between each arms during one set or do only one arm at a time.

    The weights are labeled, so you understand precisely how a lot you’re lifting.
    Another advantage is that cables put more demand on stability through the exercise, just like if you train with dumbbells
    or barbells. This may be higher for shoulder well being as you interact
    the smaller muscle tissue that assist stabilize your shoulder joint.
    Let's discover this comprehensive information to using a shoulder pulley for bodily therapy and home
    exercises, from professional recommendation to DIY vs.
    store-bought choices and superior exercise progressions.

    Not permitting any motion of your elbow will place greater emphasis on your tricep muscle.
    When you choose a careful approach, there are a few explanation why your restoration might
    not be as fast as you need to. There is inadequate blood move to the rotator cuff tendons the place they hook up with the humerus.

    As A Result Of of wear and pressure, we are subsequently more more doubtless to get a rotator cuff
    harm as we become older.
    DMoose retailer is offering discounts to help you achieve your health targets without
    breaking the financial institution. The cable creates a relentless
    rigidity that enhances muscle engagement and promotes muscle growth.

    Cable shrug is an exercise that provides you neck and shoulder stability by instantly
    targeting the trapezius muscle tissue. As the resistance in this exercise is controlled, there shall be much less pressure
    on the joints in comparability with free weights workouts.
    Cable underhand front raises and targets
    front deltoids while involving the biceps to some extent.

    They typically resort to countless crunches or planks,
    leaving them gazing on the floor with out substantial progress.

    Repeatedly swinging the ropes in various patterns elevates
    the guts fee and forces the core to take care of rigidity and stability.
    This teaches you to tighten your core whereas your
    limbs are shifting on the field whereas additionally difficult your fatigue.

    The more muscle you have, the more successfully your body will burn off
    the relaxation of the unwanted fat. When you're employed the ropes appropriately, you’ll find yourself burning tons of energy and
    fats in each exercise session. Battle ropes supply a great possibility when you’re attempting
    to maintain burning fat with every exercise. You can purchase
    your battle rope in three completely different lengths starting from ft.
    You can easily change this move up and make it kind of tough with every development.

    This move also actually focuses on stabilizing muscles around your shoulder so you possibly can move them extra easily after you’re done.
    Your endurance will benefit from working the ropes as properly whenever you structure your exercise appropriately.

    Then take a look at our tricep extension vs cranium crusher comparison information. By the finest way, the BEHIND-THE-NECK SHOULDER PRESS, a deltoid
    train, was shown within the German research to be remarkably efficient at hitting
    the lengthy head. We suspect this happens extra
    at lockouts when the triceps take over a lot of the work and the long heads
    fully contract. To flip this shoulder builder into a real triceps
    grower, strive doing these in an influence rack or
    on a Smith machine arrange so that you solely transfer by way of the top third of typical reps.

    Under-performing rear delts prevent you from gaining strength with overhead pressing and bench urgent.
    You can work your upper physique muscle tissue rather well through the use of battle ropes.

    The high and low battle rope waves are the identical actions as the battle rope waves.

    Whether Or Not you are a seasoned pro or just starting out, we provide professional tips and dependable advice that will
    assist you create the last word gym expertise in the
    consolation of your individual residence. At Garage Gym Pro, we're devoted to being your trusted source for all
    things related to garage gyms and residential fitness.
    This is a great one to work on endurance, attempt pacing your self and work
    for as much as seconds earlier than taking a relaxation. Energy slams are a
    hard exercise and can only be tolerated in short bursts with loads of rest.
    This is just like the side-to-side exercise; nonetheless,
    with the slams, you need to create more energy, which can fatigue you extra rapidly.
    Your torso may rotate slightly with this motion,
    however your toes should keep planted and your hips
    square always. Low waves are the alternative of high waves, with your torso
    angled forwards toward the ground.
    Depending in your rep and set scheme you can use the battle ropes for conditioning, mobility and even strength work.
    Although, there are tons of of combos one
    can carry out with the battle ropes, the battle ropes motion we're spotlighting at present is the surface circle wave exercise.
    The cable upright row is a really efficient exercise for focusing on the aspect delts and higher traps.

    You can both use a straight bar, cambered bar, or rope attachment
    to carry out this train.
    With a dumbbell, there is not any resistance on the deltoid within the bottom position. With a cable machine, there's resistance on the deltoid
    within the backside position. We've additionally
    delved into the progression of workouts beyond the essential pulley movements, emphasizing the position of resistance coaching in achieving performance objectives.

    Think About a mini model of the standard cable machine
    that fits proper into your own home, ideal for
    house exercises. These muscles work together to
    keep the pinnacle of your higher arm bone (humerus) firmly throughout the shallow socket of your shoulder blade.
    For everyone, shoulders are important to assist stabilize all other upper-body actions.
    The Bent-Over Cable Row is one other pulling movement however it’s going to target
    your again, not your shoulders. Cables offer you some unique advantages including constant rigidity and a better vary
    of movement.
    If you want to take HIIT classes to the subsequent
    degree and really push your self, then incorporate battle ropes for amazing outcomes.
    It is those heavy ropes that probably live in the nook of the health
    club referred to as battle ropes. For commercial gyms,
    50ft battle ropes are the best and most common.
    For everybody else, it is a cool option for taking the
    legs out of the equation and focusing simply on the higher physique (although
    the glutes will still be activated for stability).
    Under are 20 superior battle rope exercises to include into your
    battle rope exercises. Battle ropes are finest used
    to lose fats (burn calories), construct up core power & stability, and
    enhance explosive power and muscular endurance.
    In truth, when it comes to these aspects of fitness,
    the battle rope (aka battling rope) is arguably the best coaching tools on the market.
    I have seen many people having a big shoulder from the front view.
    Nonetheless, if I see them from the side or behind, then their shoulders look small.

    Research present that cable shoulder press done with a single hand increases core activation as a
    end result of the indirect and abs work together to stabilize the body
    throughout unilateral motion.

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