The role of “non-traditional” physical activities in improving balance in older adults: A review
DOI:
https://doi.org/10.14198/jhse.2017.122.21Keywords:
Physical activity, Exercise, Older adults, Healthy ageing, BalanceAbstract
Recent research indicates that the number of people aged over 60 years is rising faster than any other age group which will put increased financial and social strains on all countries. One major focus of various health and social care agencies is not only to keep these older individuals healthy but also physically active and independent. Many older people lead inactive lives which together with the aging process lead to physiological changes which have potentially damaging effects on balance control and are risk factors for falls. Research shows that physical activity improves mental health, often stimulates social contacts and can help older people remain as independent as possible. This paper has attempted to review existing research on physical activities and exercise intervention used to improve balance in older adults. Using relevant databases and keywords, 68 studies that met the inclusion criteria were reviewed. Results indicate that many traditional activities can help to improve balance in older adults. However, further investigations need to be conducted into activities that are not generally considered appropriate for older people but may be enjoyable and have health benefits and may help to improve balance in this population.
Downloads
References
Anderson, R.L. & Fishback, E. (2010). Balance Specific Training in Water and on Land in Older Adults: A Pilot Study. International Journal of Aquatic Research and Education, 4, 300-311. https://doi.org/10.25035/ijare.04.03.08
Barnett, A., Smith, B., Lord, S.R., Williams, M. & Baumand, A. (2003). Community-Based Group Exercise Improves Balance and Reduces Falls in At-Risk Older People: A Randomised Controlled Trial. Age and Aging, 32, 407-414. https://doi.org/10.1093/ageing/32.4.407
Bates, A., Eccleston, P. & Kershaw, M. (2011). BEST at Home: A Pilot Evaluation of a Home-Based Strength and Balance Exercise Program. Health Promotion Journal of Australia, 22, 3, 234-7. https://doi.org/10.1071/HE11234
Berg. K. (1989). Balance and its Measure in the Elderly: A Review. Physiotherapy Canada, 41, 5. https://doi.org/10.3138/ptc.41.5.240
Berg, K.O. & Kairy, D. (2002). Balance Interventions to Prevent Falls. Generations, 26, 4, 75-78.
Bergamin, M., Ermolao, A., Tolomio, S., Berton, L., Sergi, G. & Zaccaria, M. (2013). Water-Versus Land-Based Exercise in Elderly Subjects: Effects on Physical Performance and Body Composition. Clinical Interventions in Aging, 8, 1109-17. https://doi.org/10.2147/CIA.S44198
Bird, M., Hill, K., Ball, M. & Williams, A.D. (2009). Effects of Resistance- and Flexibility- Exercise Interventions on Balance and Related Measures in Older Adults. Journal of Aging and Physical Activity, 17, 444-454. https://doi.org/10.1123/japa.17.4.444
Bird, M., Hill, K., Ball, M., Hetherington, S. & Williams, A.D. (2011). The Long-Term Benefits of a Multi-Component Exercise Intervention to Balance and Mobility in Healthy Older Adults. Archives of Gerontology and Geriatrics, 52, 2, 211-216. https://doi.org/10.1016/j.archger.2010.03.021
Bissonnette, D.R., Weir,P.L., Leigh, L. & Kenno, K. (2010). The Effects of a Whole-Body Advanced Vibration Exercise Program on Flexibility, Balance, and Strength in Seniors. Physical & Occupational Therapy in Geriatrics, 28, 3 225-234. https://doi.org/10.3109/02703181.2010.503913
Buatois, S., Gauchard, G.C., Aubry, C., Benetos, A. & Perrin, P. (2007). Current Physical Activity Improves Balance Control During Sensory Conflicting Conditions In Older Adults. International Journal of Sports Medicine, 28, 1, 53-8. https://doi.org/10.1055/s-2006-924054
Bulbulian, R. & Hargan, M.L. (2000). The Effect of Activity History and Current Activity on Static and Dynamic Postural Balance in Older Adults. Physiology & Behavior, 70, 319-325. https://doi.org/10.1016/S0031-9384(00)00272-9
Carlson, S.A., Kruger, J., Kohl,III, H.W. & Buchner, D.M. (2006). Cross-Sectional Relationship Between Physical Activity and Falls in Older Adults, United States 2003. Journal of Physical Activity and Health, 3, 390-404. https://doi.org/10.1123/jpah.3.4.390
Cromwell, R.L., Meyers, P.M., Meyers, P.E & Newton, R.A. (2007). Tae Kwon Do: An Effective Exercise for Improving Balance and Walking Ability in Older Adults. Journal of Gerontology: Biological Sciences & Medical Sciences, 62, 6, 641-6. https://doi.org/10.1093/gerona/62.6.641
DiBrezzo, R., Shadden, B.B., Raybon, B.H. & Powers, M. (2005). Exercise Intervention Designed to Improve Strength and Dynamic Balance Among Community-Dwelling Older Adults. Journal of Aging and Physical Activity, 13, 198-209. https://doi.org/10.1123/japa.13.2.198
Eyigor, S., Karapolat, H., Durmaz, B., Ibisoglu, U. & Cakir, S. (2009). A Randomized Controlled Trial of Turkish Folklore Dance on the Physical Performance, Balance, Depression and Quality of Life in Older Women. Archives of Gerontology and Geriatrics, 48, 1, 84 – 8. https://doi.org/10.1016/j.archger.2007.10.008
Gardner, M.M., Buchner, D.M., Robertson, M.C. & Campbell, A.J. (2001). Practical Implementation of an Exercise-Based Falls Prevention Programme. Age & Ageing, 30, 1, 77-83. https://doi.org/10.1093/ageing/30.1.77
Gomes da Silva Borges, E., Cader, S.A., Gomes de Souza Vale, R., Cruz, T.H.P., Mauro Cezar de Gurgel de Alencar Carvalho, Pinto, F.M. & Dantas, E.H.M. (2012). The Effect of Ballroom Dance on Balance and Functional Autonomy Among the Isolated Elderly. Archives of Gerentology and Geriatrics, 55, 492-496. https://doi.org/10.1016/j.archger.2011.09.004
Granacher, U., Muehlbauer, T., Bridenbaugh, S.A., Wolf, M., Gschwind, Y., Wolf, I., Mata, R. & Kressig, R.W. (2012). Effects of Salsa Dance Training on Balance and Strength Performance in Older Adults. Gerentology, 58, 4, 305-12. https://doi.org/10.1159/000334814
Hallage, T., Krause, M. P., Haile, L., Miculis, C. P., Nagle, E. F. & Reis, R. (2010). The Effects Of 12 Weeks Of Step Aerobics Training On Functional Fitness Of Elderly Women. Journal of Strength and Conditioning Research, 24, 8, 2261-2266. https://doi.org/10.1519/JSC.0b013e3181ddacc6
Hayashi, D., Goncalves, C.G., Parreira. R.B., Fernandes, K.B.P., Teixeira, D.C., Silva, R.A. & Probst, V.S. (2012). Postural Balance and Physical Activity in Daily Life (PADL) in Physically Independent Older Adults with Different Levels of Aerobic Exercise Capacity. Archives of Gerentology and Geriatrics, 55, 480-485. https://doi.org/10.1016/j.archger.2012.04.009
Hoeppner, S.C. & Rimmer, J.H. (2000). Postural Balance and Self-Reported Exercise in Older Adults. Adapted Physical Activity Quarterly, 17, 69-77. https://doi.org/10.1123/apaq.17.1.69
Hopkins, D. R., Murrah, B., Werner W. K. Hoeger,W.W.K. & Rhodes, R. C. (1990). Effect of Low-Impact Aerobic Dance on the Functional Fitness of Elderly Women. The Gerontologist, 30, 2, 189-192. https://doi.org/10.1093/geront/30.2.189
Hsu, H.C., Chou, S.W., Chen, C.P., Wong, A.M., Chen, C.K. & Hong, J.P. (2010). Effects of Swimming on Eye Hand Coordination and Balance in the Elderly. Journal of Nutrition, Health and Aging, 14, 8, 692-5. https://doi.org/10.1007/s12603-010-0134-6
Islam, M.M., Takeshima, N., Rogers, M.E., Koizumi, D. & Rogers, N.L. (2004). Relationship Between Balance, Functional Fitness, and Daily Physical Activity in Older Adults. Asian Journal of Exercise & Sports Science, 1, 1, 9- 18.
Jancey, J.M., Clarke, A., Howat, P., Maycock, B. & Lee. A.H. (2009). Perceptions of Physical Activity by Older Adults: A Qualitative Study. Health Education Journal, 68, 3, 196-206. https://doi.org/10.1177/0017896909339531
Judge, J.O., Lindsey, C., Underwood, M & Winsemius, D. (1993). Balance Improvements in Older Women: Effects of Exercise Training. Physical Therapy, 73, 4, 254-62. https://doi.org/10.1093/ptj/73.4.254
Kahle, N. & Tevald, M.A. (2014). Core Muscle Strengthening's Improvement of Balance Performance in Community-Dwelling Older Adults: A Pilot Study. Journal of Aging and Physical Activity, 22, 1, 65-73. https://doi.org/10.1123/japa.2012-0132
Kaneda, K., Sato, D., Wakabayashi, H., Hanai, A. & Nomura, T. (2008). A Comparison of the Effects of Different Water Exercise Programs on Balance Ability in Elderly People. Journal of Aging and Physical Activity, 16, 381-392. https://doi.org/10.1123/japa.16.4.381
Kattenstroth, J.C., Kalisch, T., Holt, S., Tegenthoff, M. & Dinse, H.R. (2013). Six Months of Dance Intervention Enhances Postural, Sensorimotor and Cognitive Performance in Elderly Without Affecting Cardio-Respiratory Functions. Frontiers in Aging Neuroscience, 26, 5, 5. https://doi.org/10.3389/fnagi.2013.00005
Keogh, J.W.L., Kilding, A., Pidgeon, L.A. & Gillis, D. (2009). Physical Benefits of Dancing for Healthy Older Adults: A Review. Journal of Aging and Physical activity, 17, 479-500. https://doi.org/10.1123/japa.17.4.479
King, A.C., Haskell, W.L., Taylor, B., Kraemer, H.C. & DeBusk, R.F. (1991). Group-vs Home-Based Exercise Training in Healthy Older Men and Women. Journal of the American Medical Association, 266, 11, 1535-1542. https://doi.org/10.1001/jama.1991.03470110081037
Kramer, B.J., Creekmur, B., Mitchell, M.N., Rose, D.J., Pynoos, J. & Rubenstein, L.Z. (2014). Community Fall Prevention Programs: Comparing Three InSTEP Models by Levels of Intensity. Journal of Aging andPhysical Activity, 22, 3, 372-9. https://doi.org/10.1123/JAPA.2012-0344
Lamoth, C.J.C. & van Heuvelen, M.J.G. (2012). Sports Activities are Reflected in the Local Stability and Regularity of Body Sway: Older Ice-Skaters Have Better Postural Control Than Inactive Elderly. Gait & Posture, 35, 489-493. https://doi.org/10.1016/j.gaitpost.2011.11.014
Liu, H. & Frank, A. (2010). Tai Chi as a Balance Improvement Exercise for Older Adults: A Systematic Review. Journal of Geriatric Physical Therapy, 33, 3, 103-109.
McKinley, P., Jacobson, A., Leroux, A. Bednarczyk, V. Rossignol, M. & Fung, J. (2008). Effect of a Community-Based Argentine Tango Dance Program on Functional Balance and Confidence in Older Adults. Journal of Aging and Physical Activity, 16, 4, 435-53. https://doi.org/10.1123/japa.16.4.435
Means, K.M., Rodell, D.E. & O'Sullivan, P.S. (2005). Balance, Mobility, and Falls Among Community-Dwelling Elderly Persons: Effects of a Rehabilitation Exercise Program. American Journal of Physical Medicine & Rehabilitation, 84, 4, 238-250. https://doi.org/10.1097/01.PHM.0000151944.22116.5A
Melzer, I., Benjuya, N. & Kaplanski, J. (2003). Effects of Regular Walking on Postural Stability in the Elderly. Gerontology, 49, 4, 240-5. https://doi.org/10.1159/000070404
Merom, D., Cosgrove, C., Venugopal, K. & Bauman, A. (2012). How Diverse was the Leisure Time Physical Activity of Older Australians Over the Past Decade? Journal of Science and Medicine in Sport, 15, 213-219. https://doi.org/10.1016/j.jsams.2012.11.108
Merom,D., Pye, V., Macniven, R., van der Ploeg, H., Milat,A., Sherrington, C., Lord, S. & Bauman, A. (2012). Prevalence and Correlates of Participation in Fall Prevention Exercise/Physical Activity by Older Adults. Preventitive Medicine, 55, 613-617. https://doi.org/10.1016/j.ypmed.2012.10.001
Merom, D., Cumming, R., Mathieu, E., Anstey, K.J., Rissel, C., Simpson, J.M., Morton, R.L., Cerin, E., Sherrington, C. & Lord, S.R. (2013). Can Social Dancing Prevent Falls in Older Adults? A Protocol of the Dance, Aging, Cognition, Economics (DAnCE) Fall Prevention Randomised Controlled Trial. BMC Public Health, 15, 13, 477. https://doi.org/10.1186/1471-2458-13-477
Nelson, M.E., Rejeski, W.J., Blair, S.N., Duncan, P.W., Judge, J.O., King, A.C., Macera, C.A. & Castaneda-Sceppa, C. (2007). Physical Activity and Public Health in Older Adults: Recommendation from the American College of Sports Medicine and the American Heart Association. Medicine & Science in Sports & Exercise, 39, 8, 1435-1445. https://doi.org/10.1249/mss.0b013e3180616aa2
Paillard, T., Lafont, C., Costes-Salon, M.c., Riviere, D. & Dupui, P. (2004). Effects of Brisk Walking on Static and Dynamic Balance, Locomotion, Body Composition and Aerobic Capacity in Ageing Healthy Active Men. International Journal of Sports Medicine, 25, 7, 539-46. https://doi.org/10.1055/s-2004-820948
Pau, M., Leban, B., Collu, G. & Migliaccio, G.M. (2014). Effect of Light and Vigorous Physical Activity on Balance and Gait of Older Adults. Archives of Gerontology and Geriatrics, 59, 3, 568-73. https://doi.org/10.1016/j.archger.2014.07.008
Perrin, P.P., Gauchard, G.C., Perrot, C. & Jeandel, C. (1999). Effects of Physical and Sporting Activities on Balance Control in Elderly People. British Journal of Sports Medicine, 33, 121-126. https://doi.org/10.1136/bjsm.33.2.121
Pluchino, A., Lee, S.Y., Asfour, S., Roos, B.A. & Signorile J.F. (2012). Pilot Study Comparing Changes in Postural Control After Training Using a Video Game Balance Board Program and 2 Standard Activity-Based Balance Intervention Programs. Archives of Physical Medicine & Rehabilitation, 93, 7, 1138-1146. https://doi.org/10.1016/j.apmr.2012.01.023
Robitaille, Y., Laforest, S., Fournier, M., Gauvin, L., Parisien, M., Corriveau, H., Trickey, F. & Damestoy, N. (2005). Moving Forward in Fall Prevention: An Intervention to Improve Balance Among Older Adults in Real-World Settings. American Journal of Public Health, 95,11,2049-2056. https://doi.org/10.2105/AJPH.2004.057612
Roma, M.F.B., Busse, A.L., Betoni, R.A., de Melo, A.C., Kong, J., Santarem, J.M. & Filho, W.J. (2013). Effects of Resistance Training and Aerobic Exercise in Elderly People Concerning Physical Fitness and Ability: A Prospective Clinical Trial. Einstein, 11, 2, 153-7. https://doi.org/10.1590/S1679-45082013000200003
Rose, D.J. (2008). Preventing Falls Among Older Adults: No "One Size Suits All" Intervention Strategy. Journal of Rehabilitation Research & Development, 45, 8, 1153-1166. https://doi.org/10.1682/JRRD.2008.03.0041
Seco, J., Abecia, L.C., Echevarria, E., Barbero, I., Torres-Unda, J., Rodriguez, V. & Calvo, J.I. (2013). A Long-Term Physical Activity Training Program Increases Strength and Flexibility and Improves Balance in Older Adults. Rehabilitation Nursing, 38, 1, 37-47. https://doi.org/10.1002/rnj.64
Sherrington, C., Teidemann, A., Fairhall,N., Close, J.C.T. & Lord, S.R. (2011). Exercise to prevent falls in older adults: an updated meta-analysis and best practice recommendations. NSW Public Health Bulletin, 22, 3-4. https://doi.org/10.1071/NB10056
Sherrington, C., Whitney, J.C., Lord, S.R., Herbert, R.D., Cumming, R.G. & Close, J.C.T. (2008). Effective Exercise for the Prevention of Falls: A Systematic Review and Meta-Analysis. Journal of the American Geriatrics Society, 56, 12, 2234-2243. https://doi.org/10.1111/j.1532-5415.2008.02014.x
Shigematsu, R., Chang, M., Yabushita, N., Sakai, T., Nakagaichi, M., Nho, H. & Tanaka, K. (2002). Dance-Based Aerobic Exercise May Improve Indices of Falling Risk in Older Women. Age and Ageing, 31, 4, 261-6. https://doi.org/10.1093/ageing/31.4.261
Silveira, P., van het Reve, E., Daniel, F., Casati, F., & de Bruin, E. D. (2013). Motivating and assisting physical exercise in independently living older adults: a pilot study. International Journal of Medical Informatics, 82(5), 325–334. https://doi.org/10.1016/j.ijmedinf.2012.11.015
Smith, S.T., Sherrington, C., Studenski, S., Schoene, D. & Lord, S.R. (2011). A Novel Dance Dance Revolution (DDR) System for In-Home Training of Stepping Ability: Basic Parameters of System Use by Older Adults. British Journal of Sports Medicine, 45, 441-445. https://doi.org/10.1136/bjsm.2009.066845
Studenski, S., Perera, S., Hile, E., Keller, V., Spadola-Bogard, J. & Garcia, J. (2010). Interactive Video Dance Games for Healthy Older Adults. The Journal of Nutrition, Health & Aging, 14, 10, 850-852. https://doi.org/10.1007/s12603-010-0119-5
Taggart, H. (2002). Effects of Tai Chi Exercise on Balance, Functional Mobility, and Fear of Falling Among Older Women. Applied Nursing Research, 15, 4, 235-242. https://doi.org/10.1053/apnr.2002.35975
Taylor-Piliae, R.E., Newell, K.A., Cherin, R., Lee, M.J., King, A.C. & Haskell, W.L. (2010). Effects of Tai Chi and Western Exercise on Physical and Cognitive Functioning in Healthy Community-Dwelling Older Adults. Journal of Aging and Physical Activity, 18, 3, 261-79. https://doi.org/10.1123/japa.18.3.261
Tiedemann, A., O'Rourke, S., Sesto, R., & Sherrington, C. (2013). A 12-Week Lyengar Yoga Program Improved Balance and Morbility in Older Community-Dwelling People: A Pilot Randomized Controlled Trial. The Journals of Gerentology, Biological Sciences and Medical Sciences, 68, 9, 1068-75. https://doi.org/10.1093/gerona/glt087
Toto, P.E., Raina, K. D., Holm, M.B., Schlenk, E.A., Rubinstein, E.N. & Rogers, J.C. (2012). Outcomes of a Multicomponent Physical Activity Program for Sedentary, Community-Dwelling Older Adults. Journal of Aging and Physical Activity, 20, 363-378. https://doi.org/10.1123/japa.20.3.363
Toulotte, C., Toursel, C. & Olivier, N. (2012). Wii Fit Training vs. Adapted Physical Activities: Which One is the Most Appropriate to Improve the Balance of Independent Senior Subjects? A Randomized Controlled Study. Clinical Rehabilitation, 26, 9, 827-835. https://doi.org/10.1177/0269215511434996
Tsang, W.W. & Hui-Chan, C.W (2004). Effects of Exercise on Joint Sense and Balance in Elderly Men: Tai Chi versus Golf. Medicine & Science in Sports & Exercise, 36, 4, 658-67. https://doi.org/10.1249/01.MSS.0000122077.87090.2E
Tsang, W.W. & Hui-Chan, C.W. (2010). Static and Dynamic Balance Control in Older Golfers. Journal of Aging and Physical Activity, 18, 1, 1-13. https://doi.org/10.1123/japa.18.1.1
Virag, A., Karoczi, C.K., Jakab, A., Vass, Z., Kovacs, E. & Gondos, T. (2014). Short-Term And Long-Term Effects of Nordic Walking Training on Balance, Functional Mobility, Muscle Strength and Aerobic Endurance among Hungarian Community-Living Older People: A Feasibility Study. Journal of Sports Medicine and Physical Fitness, Oct 10.
Wolf, B., Feys, H., De Weerdt, W., van der Meer, J., Noom, M. & Aufdemkampe, G. (2001). Effect of a Physical Therapeutic Intervention for Balance Problems in the Elderly: A Single-Blind, Randomized, Controlled Multicentre Trial. Clinical Rehabilitation, 15, 624-636. https://doi.org/10.1191/0269215501cr456oa
World Health Organisation (2010). Global Recommendation on Physical Activity for Health Available via http://www.who.int/dietphysicalactivity/publications/9789241599979/en/index.html. Accessed 4th February 2013.
Yang, X.J., Hill, K., Moore, K., Williams, S., Dowson, L., Borschmann, K., Simpson, J.A. & Dharmage, S.C. (2012). Effectiveness of a Targeted Exercise Intervention in Reversing Older People's Mild Balance Dysfunction: A Randomized Controlled Trial. Physical Therapy, 92, 1, 24-37. https://doi.org/10.2522/ptj.20100289
Yu, D.H. & Yang, H.X. (2012). The Effect of Tai Chi Intervention on Balance in Older Males. Journal of Sport and Health Science, 1, 57-60. https://doi.org/10.1016/j.jshs.2012.03.001
Zhang, J.G., Ishikawa-Takata, K., Yamazaki, H., Morita, T. & Ohta, T. (2008). Postural Stability and Physical Performance in Social Dancers. Gait & Posture, 27, 697-701. https://doi.org/10.1016/j.gaitpost.2007.09.004
Downloads
Statistics
Published
How to Cite
Issue
Section
License
Copyright (c) 2017 Journal of Human Sport and Exercise
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Each author warrants that his or her submission to the Work is original and that he or she has full power to enter into this agreement. Neither this Work nor a similar work has been published elsewhere in any language nor shall be submitted for publication elsewhere while under consideration by JHSE. Each author also accepts that the JHSE will not be held legally responsible for any claims of compensation.
Authors wishing to include figures or text passages that have already been published elsewhere are required to obtain permission from the copyright holder(s) and to include evidence that such permission has been granted when submitting their papers. Any material received without such evidence will be assumed to originate from the authors.
Please include at the end of the acknowledgements a declaration that the experiments comply with the current laws of the country in which they were performed. The editors reserve the right to reject manuscripts that do not comply with the abovementioned requirements. The author(s) will be held responsible for false statements or failure to fulfill the above-mentioned requirements.
This title is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International license (CC BY-NC-ND 4.0).
You are free to share, copy and redistribute the material in any medium or format. The licensor cannot revoke these freedoms as long as you follow the license terms under the following terms:
Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
NonCommercial — You may not use the material for commercial purposes.
NoDerivatives — If you remix, transform, or build upon the material, you may not distribute the modified material.
No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
Notices:
You do not have to comply with the license for elements of the material in the public domain or where your use is permitted by an applicable exception or limitation.
No warranties are given. The license may not give you all of the permissions necessary for your intended use. For example, other rights such as publicity, privacy, or moral rights may limit how you use the material.
Transfer of Copyright
In consideration of JHSE’s publication of the Work, the authors hereby transfer, assign, and otherwise convey all copyright ownership worldwide, in all languages, and in all forms of media now or hereafter known, including electronic media such as CD-ROM, Internet, and Intranet, to JHSE. If JHSE should decide for any reason not to publish an author’s submission to the Work, JHSE shall give prompt notice of its decision to the corresponding author, this agreement shall terminate, and neither the author nor JHSE shall be under any further liability or obligation.
Each author certifies that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article, except as disclosed on a separate attachment. All funding sources supporting the Work and all institutional or corporate affiliations of the authors are acknowledged in a footnote in the Work.
Each author certifies that his or her institution has approved the protocol for any investigation involving humans or animals and that all experimentation was conducted in conformity with ethical and humane principles of research.
Competing Interests
Biomedical journals typically require authors and reviewers to declare if they have any competing interests with regard to their research.
JHSE require authors to agree to Copyright Notice as part of the submission process.
