Login to MyKarger

New to MyKarger? Click here to sign up.



Login with Facebook

Forgot your password?

Authors, Editors, Reviewers

For Manuscript Submission, Check or Review Login please go to Submission Websites List.

Submission Websites List

Institutional Login
(Shibboleth or OpenAthens)

For the academic login, please select your country in the dropdown list. You will be redirected to verify your credentials.

Regenerative and Technological Section / Systematic Review

Free Access

Feasibility and Effectiveness of Intervention Programmes Integrating Functional Exercise into Daily Life of Older Adults: A Systematic Review

Weber M.a · Belala N.a · Clemson L.b · Boulton E.c · Hawley-Hague H.c · Becker C.d · Schwenk M.a, d

Author affiliations

aNetwork Aging Research (NAR), Heidelberg University, Heidelberg, Germany; bThe University of Sydney, Sydney, NSW, Australia; cSchool of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, and Manchester Academic Health Care Centre, Manchester, UK; dDepartment of Geriatric Rehabilitation, Robert-Bosch Hospital, Stuttgart, Germany

Corresponding Author

Michael Schwenk, PhD

Network Aging Research, Heidelberg University

Bergheimer Strasse 20

DE-69115 Heidelberg (Germany)

E-Mail schwenk@nar.uni-heidelberg.de

Related Articles for ""

Gerontology 2018;64:172-187

Do you have an account?

Login Information





Contact Information











I have read the Karger Terms and Conditions and agree.



Abstract

Background: Traditionally, exercise programmes for improving functional performance and reducing falls are organised as structured sessions. An alternative approach of integrating functional exercises into everyday tasks has emerged in recent years. Objectives: Summarising the current evidence for the feasibility and effectiveness of interventions integrating functional exercise into daily life. Methods: A systematic literature search was conducted including articles based on the following criteria: (1) individuals ≥60 years; (2) intervention studies of randomised controlled trials (RCTs) and non-randomised studies (NRS); (3) using a lifestyle-integrated approach; (4) using functional exercises to improve strength, balance, or physical functioning; and (5) reporting outcomes on feasibility and/or effectiveness. Methodological quality of RCTs was evaluated using the PEDro scale. Results: Of 4,415 articles identified from 6 databases, 14 (6 RCTs) met the inclusion criteria. RCT quality was moderate to good. Intervention concepts included (1) the Lifestyle-integrated Functional Exercise (LiFE) programme integrating exercises into everyday activities and (2) combined programmes using integrated and structured training. Three RCTs evaluated LiFE in community dwellers and reported significantly improved balance, strength, and functional performance compared with controls receiving either no intervention, or low-intensity exercise, or structured exercise. Two of these RCTs reported a significant reduction in fall rate compared with controls receiving either no intervention or low-intensity exercise. Three RCTs compared combined programmes with usual care in institutionalised settings and reported improvements for some (balance, functional performance), but not all (strength, falls) outcomes. NRS showed behavioural change related to LiFE and feasibility in more impaired populations. One NRS comparing a combined home-based programme to a gym-based programme reported greater sustainability of effects in the combined programme. Conclusions: This review provides evidence for the effectiveness of integrated training for improving motor performances in older adults. Single studies suggest advantages of integrated compared with structured training. Combined programmes are positively evaluated in institutionalised settings, while little evidence exists in other populations. In summary, the approach of integrating functional exercise into daily life represents a promising alternative or complement to structured exercise programmes. However, more RCTs are needed to evaluate this concept in different target populations and the potential for inducing behavioural change.

© 2017 S. Karger AG, Basel


References

  1. Gillespie LD, et al: Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev 2012;9: CD007146.
  2. Sherrington C, et al: Exercise to prevent falls in older adults: an updated meta-analysis and best practice recommendations. NSW Public Health Bull 2011;22:78-83.
  3. Sherrington C, et al: Effective exercise for the prevention of falls: a systematic review and meta-anaylsis. J Am Geriatr Soc 2008;56:2234-2243.
  4. Campbell AJ, Robertson MC: Otago Exercise Programme to Prevent Falls in Older Adults. Wellington, ACC, 2003.
  5. Skelton D, et al: Tailored group exercise (Falls Management Exercise - FaME) reduces falls in community-dwelling older frequent fallers (an RCT). Age Ageing 2005;34:636-639.
  6. Becker C, et al: Effectiveness of a multifaceted intervention on falls in nursing home residents. J Am Geriatr Soc 2003;51:306-313.
  7. Clemson L, et al: The effectiveness of a community-based program for reducing the incidence of falls in the elderly: a randomized controlled trial. J Am Geriatr Soc 2004;52:1487-1494.
  8. Hauer K, et al: Exercise training for rehabilitation and secondary prevention of falls in geriatric patients with a history of injurious falls. J Am Geriatr Soc 2001;49:10-20.
  9. Li F, et al: Tai Chi and fall reductions in older adults: a randomized controlled trial. J Gerontol A Biol Sci Med Sci 2005;60:187-194.
  10. Liu-Ambrose T, et al: Balance confidence improves with resistance and or agility training. Gerontology 2004;50:373-382.
  11. Latham NK, et al: A randomized, controlled trial of quadriceps resistance exercise and vitamin D in frail older people: The Frailty Interventions Trial in Elderly Subjects (FITNESS). J Am Geriatr Soc 2003;51:291-299.
  12. Lin MR, et al: A randomized, controlled trial of fall prevention programs and quality of life in older fallers. J Am Geriatr Soc 2007;55:499-506.
  13. Liu-Ambrose T, et al: Otago home-based strength and balance retraining improves executive functioning in older fallers: a randomized controlled trial. J Am Geriatr Soc 2008;56:1821-1830.
  14. Ciolac EG: Exercise training as a preventive tool for age-related disorders: a brief review. Clinics (Sao Paulo) 2013;68:710-717.
  15. Hawley-Hague H, et al: Multiple levels of influence on older adults' attendance and adherence to community exercise classes. Gerontologist 2013;54:599-610.
  16. Nyman SR, Victor CR: Older people's participation in and engagement with falls prevention interventions in community settings: an augment to the Cochrane systematic review. Age Ageing 2011;41:16-23.
  17. Merom D, et al: Prevalence and correlates of participation in fall prevention exercise/physical activity by older adults. Prevente Med 2012;55:613-617.
  18. Boulton E: Promoting physical activity amongst older adults: what if we asked them what they want? Two studies to consider the effects of involving older adults in the design, delivery, implementation and promotion of interventions to promote physical activity amongst their age group. University of Manchester, 2014.
  19. Costello E, et al: Motivators, barriers and beliefs regarding physical activity in the older adult population. J Geriatr Physiother 2011;34:138-147.
  20. Schutzer KA, Graves S: Barriers and motivations to exercise in older adults. Prevent Med 2004;39:1056-1061.
  21. Chao D, Capri GF, Farmer D: Exercise adherence among older adults: challenges and strategies. Controlled Clinical Trials 2000;21:212-217.
  22. Burton NW, Khan A, Brown WJ: How, where and with whom? Physical activity context preferences of three adult groups at risk of inactivity. Br J Sports Med 2012;46:1125-1131.
  23. Cohen-Mansfield J, Marx MS, Guralnik JM: Motivators and barriers to exercise in an older community-dwelling population. J Aging Phys Act 2003;11:242-253.
  24. Burton E, Lewin G, Boldy D: Physical activity levels of older people receiving a home care service. J Aging Phys Act 2013;21:140-154.
  25. Clemson L, et al: LiFE Pilot Study: a randomised trial of balance and strength training embedded in daily life activity to reduce falls in older adults. Aust Occup Ther J 2010;57:42-50.
  26. Clemson L, et al: Integration of balance and strength training into daily life activity to reduce rate of falls in older people (the LiFE study): randomised parallel trial. BMJ 2012;345:e4547.
  27. Bravata DM, et al: Using pedometers to increase physical activity and improve health. A systematic review. JAMA 2007;298:2296-2304.
  28. Dunn AL, Andersen RE, Jakicic JM: Lifestyle physical activity interventions. History, short- and long-term effects, and recommendations. Am J Prev Med 1998;15:398-412.
  29. Liu C, et al: Systematic review of functional training on muscle strength, physical functioning, and activities of daily living in older adults. Eur Rev Aging Phys Act 2014;11:95-106.
  30. Chou CH, Hwang CL, Wu YT: Effect of exercise on physical function, daily living activities, and quality of life in the frail older adults: a meta-analysis. Arch Phys Med Rehab 2012;93:237-244.
  31. Clemson L, Munro J: Conceptual model of habit reforming to improve balance and prevent falls; in Pachana NA (ed): Encyclopedia of Geropsychology. Singapore, Springer Singapore, 2016, pp 1-10.
  32. Moher D, et al: Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 2009;151:264-269.
  33. Hariohm K, Prakash V, Saravankumar J: Quantity and quality of randomized controlled trials published by Indian physiotherapists. Perspect Clin Res 2015;6:91.
  34. Higgins JP, et al: The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ 2011;343:d5928.
  35. Burton E, et al: Effectiveness of a lifestyle exercise program for older people receiving a restorative home care service: a pragmatic randomized controlled trial. Clin Interv Aging 2013;8:1591-1601.
  36. Burton E, et al: Long-term benefits of a lifestyle exercise program for older people receiving a restorative home care service: a pragmatic randomized controlled trial. Healthy Aging Clin Care Elderly 2014;6:1-9.
  37. Grönstedt H, et al: Effects of individually tailored physical and daily activities in nursing home residents on activities of daily living, physical performance and physical activity level: a randomized controlled trial. Gerontology 2013;59:220-229.
  38. Kerse N, et al: Does a functional activity programme improve function, quality of life, and falls for residents in long term care? Cluster randomised controlled trial. BMJ 2008;337:a1445.
  39. Peri K, et al: Does functionally based activity make a difference to health status and mobility? A randomised controlled trial in residential care facilities (The Promoting Independent Living Study; PILS). Age Ageing 2008;37:57-63.
  40. Burton E, Lewin G, Clemson L: Determining the feasibility of a lifestyle activity program for inclusion in a restorative home care service: a pilot study. Act Adapt Aging 2014;38:79-93.
  41. Fleig L, et al: Health behavior change theory meets fall prevention: feasibility of a habit-based and strength exercise intervention for older adults. Psychol Sport Exerc 2016;22:114-122.
  42. Keay L, et al: Feasibility and acceptability of orientation and mobility instructors delivering the LiFE falls prevention program to older people with vision impairment. Int J Orient Mobil 2015;7:22-33.
  43. Opdenacker J, et al: Effectiveness of a lifestyle intervention and a structured exercise intervention in older adults. Prev Med 2008;46:518-524.
  44. Opdenacker J, Delecluse C, Boen F: The longitudinal effects of a lifestyle physical activity intervention and a structured exercise intervention on physical self-perceptions and self-esteem in older adults. J Sport Exerc Psychol 2009;31:743-760.
  45. Opdenacker J, Delecluse C, Boen F: A 2-year follow-up of a lifestyle physical activity versus a structured exercise intervention in older adults. J Am Geriatr Soc 2011;59:1602-1611.
  46. Van Roie E, et al: Effectiveness of a lifestyle physical activity versus a structured exercise intervention in older adults. J Aging Phys Act 2010;18:335-352.
  47. Clemson L, Munro J, Singh MAF: Lifestyle-integrated Functional Exercise (LiFE) Program to Prevent Falls: Trainer's Manual. Sydney, Sydney University Press, 2014.
  48. Clemson L, Munro J, Fiatrone Singh M: Lifestyle-integrated Functional Exercise (LiFE) Program to Prevent Falls: Participants Manual. Sydney, Sydney University Press, 2014.
  49. Lally P, Gardner B: Promoting habit formation. Health Psychol Rev 2013;7:137-158.
  50. Gibbs JC, et al: Measuring the implementation of a group-based Lifestyle-integrated Function Exercise(Mi-LiFE) intervention delivered in primary care for older adults aged 75 years or older: a pilot feasibility study protocol. Pilot Feasibility Studies 2015;1:20.
  51. Pitrou I, et al: Reporting of safety results in published reports of randomized controlled trials. Arch Intern Med 2009;169:1756-1761.
  52. Chodzko-Zajko WJ, et al: Exercise and physical activity for older adults. Med Sci Sports Exerc 2009;41:1510-1530.
  53. Sherrington C, et al: Exercise to prevent falls in older adults: an updated systematic review and meta-analysis Br J Sports Med DOI: 10.1136/bjsports-2016-096547.
  54. Gardner B, et al: Putting habit into practice, and practice into habit: a process evaluation and exploration of the acceptability of a habit-based dietary behaviour change intervention. Int J Behav Nutr Phys Act 2014;11:135.
  55. Lally P, Wardle J, Gardner B: Experiences of habit formation: a qualitative study. Psychol Health Med 2011;16:484-489.
  56. Judah G, Gardner B, Aunger R: Forming a flossing habit: an exploratory study of the psychological determinants of habit formation. Br J Health Psychol 2012;18:338-353.
  57. Schüz B, Sniehotta FF, Schwarzer R: Stage-specific effects of an action control intervention on dental flossing. Health Educ Res 2007;22:332-341.
  58. Ehde DM, Dillworth TM, Turner JA: Cognitive-behavioral therapy for individuals with chronic pain: efficacy, innovations, and directions for research. Am Psychol 2014;69:153.
  59. French DP, et al: Which behaviour change techniques are most effective at increasing older adults' self-efficacy and physical activity behaviour? A systematic review. Ann Behav Med 2014;48:225-234.

Article / Publication Details

First-Page Preview
Abstract of Regenerative and Technological Section / Systematic Review

Received: March 11, 2017
Accepted: August 03, 2017
Published online: September 15, 2017
Issue release date: February 2018

Number of Print Pages: 16
Number of Figures: 1
Number of Tables: 3

ISSN: 0304-324X (Print)
eISSN: 1423-0003 (Online)

For additional information: https://www.karger.com/GER

References

  1. Gillespie LD, et al: Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev 2012;9: CD007146.
  2. Sherrington C, et al: Exercise to prevent falls in older adults: an updated meta-analysis and best practice recommendations. NSW Public Health Bull 2011;22:78-83.
  3. Sherrington C, et al: Effective exercise for the prevention of falls: a systematic review and meta-anaylsis. J Am Geriatr Soc 2008;56:2234-2243.
  4. Campbell AJ, Robertson MC: Otago Exercise Programme to Prevent Falls in Older Adults. Wellington, ACC, 2003.
  5. Skelton D, et al: Tailored group exercise (Falls Management Exercise - FaME) reduces falls in community-dwelling older frequent fallers (an RCT). Age Ageing 2005;34:636-639.
  6. Becker C, et al: Effectiveness of a multifaceted intervention on falls in nursing home residents. J Am Geriatr Soc 2003;51:306-313.
  7. Clemson L, et al: The effectiveness of a community-based program for reducing the incidence of falls in the elderly: a randomized controlled trial. J Am Geriatr Soc 2004;52:1487-1494.
  8. Hauer K, et al: Exercise training for rehabilitation and secondary prevention of falls in geriatric patients with a history of injurious falls. J Am Geriatr Soc 2001;49:10-20.
  9. Li F, et al: Tai Chi and fall reductions in older adults: a randomized controlled trial. J Gerontol A Biol Sci Med Sci 2005;60:187-194.
  10. Liu-Ambrose T, et al: Balance confidence improves with resistance and or agility training. Gerontology 2004;50:373-382.
  11. Latham NK, et al: A randomized, controlled trial of quadriceps resistance exercise and vitamin D in frail older people: The Frailty Interventions Trial in Elderly Subjects (FITNESS). J Am Geriatr Soc 2003;51:291-299.
  12. Lin MR, et al: A randomized, controlled trial of fall prevention programs and quality of life in older fallers. J Am Geriatr Soc 2007;55:499-506.
  13. Liu-Ambrose T, et al: Otago home-based strength and balance retraining improves executive functioning in older fallers: a randomized controlled trial. J Am Geriatr Soc 2008;56:1821-1830.
  14. Ciolac EG: Exercise training as a preventive tool for age-related disorders: a brief review. Clinics (Sao Paulo) 2013;68:710-717.
  15. Hawley-Hague H, et al: Multiple levels of influence on older adults' attendance and adherence to community exercise classes. Gerontologist 2013;54:599-610.
  16. Nyman SR, Victor CR: Older people's participation in and engagement with falls prevention interventions in community settings: an augment to the Cochrane systematic review. Age Ageing 2011;41:16-23.
  17. Merom D, et al: Prevalence and correlates of participation in fall prevention exercise/physical activity by older adults. Prevente Med 2012;55:613-617.
  18. Boulton E: Promoting physical activity amongst older adults: what if we asked them what they want? Two studies to consider the effects of involving older adults in the design, delivery, implementation and promotion of interventions to promote physical activity amongst their age group. University of Manchester, 2014.
  19. Costello E, et al: Motivators, barriers and beliefs regarding physical activity in the older adult population. J Geriatr Physiother 2011;34:138-147.
  20. Schutzer KA, Graves S: Barriers and motivations to exercise in older adults. Prevent Med 2004;39:1056-1061.
  21. Chao D, Capri GF, Farmer D: Exercise adherence among older adults: challenges and strategies. Controlled Clinical Trials 2000;21:212-217.
  22. Burton NW, Khan A, Brown WJ: How, where and with whom? Physical activity context preferences of three adult groups at risk of inactivity. Br J Sports Med 2012;46:1125-1131.
  23. Cohen-Mansfield J, Marx MS, Guralnik JM: Motivators and barriers to exercise in an older community-dwelling population. J Aging Phys Act 2003;11:242-253.
  24. Burton E, Lewin G, Boldy D: Physical activity levels of older people receiving a home care service. J Aging Phys Act 2013;21:140-154.
  25. Clemson L, et al: LiFE Pilot Study: a randomised trial of balance and strength training embedded in daily life activity to reduce falls in older adults. Aust Occup Ther J 2010;57:42-50.
  26. Clemson L, et al: Integration of balance and strength training into daily life activity to reduce rate of falls in older people (the LiFE study): randomised parallel trial. BMJ 2012;345:e4547.
  27. Bravata DM, et al: Using pedometers to increase physical activity and improve health. A systematic review. JAMA 2007;298:2296-2304.
  28. Dunn AL, Andersen RE, Jakicic JM: Lifestyle physical activity interventions. History, short- and long-term effects, and recommendations. Am J Prev Med 1998;15:398-412.
  29. Liu C, et al: Systematic review of functional training on muscle strength, physical functioning, and activities of daily living in older adults. Eur Rev Aging Phys Act 2014;11:95-106.
  30. Chou CH, Hwang CL, Wu YT: Effect of exercise on physical function, daily living activities, and quality of life in the frail older adults: a meta-analysis. Arch Phys Med Rehab 2012;93:237-244.
  31. Clemson L, Munro J: Conceptual model of habit reforming to improve balance and prevent falls; in Pachana NA (ed): Encyclopedia of Geropsychology. Singapore, Springer Singapore, 2016, pp 1-10.
  32. Moher D, et al: Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 2009;151:264-269.
  33. Hariohm K, Prakash V, Saravankumar J: Quantity and quality of randomized controlled trials published by Indian physiotherapists. Perspect Clin Res 2015;6:91.
  34. Higgins JP, et al: The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ 2011;343:d5928.
  35. Burton E, et al: Effectiveness of a lifestyle exercise program for older people receiving a restorative home care service: a pragmatic randomized controlled trial. Clin Interv Aging 2013;8:1591-1601.
  36. Burton E, et al: Long-term benefits of a lifestyle exercise program for older people receiving a restorative home care service: a pragmatic randomized controlled trial. Healthy Aging Clin Care Elderly 2014;6:1-9.
  37. Grönstedt H, et al: Effects of individually tailored physical and daily activities in nursing home residents on activities of daily living, physical performance and physical activity level: a randomized controlled trial. Gerontology 2013;59:220-229.
  38. Kerse N, et al: Does a functional activity programme improve function, quality of life, and falls for residents in long term care? Cluster randomised controlled trial. BMJ 2008;337:a1445.
  39. Peri K, et al: Does functionally based activity make a difference to health status and mobility? A randomised controlled trial in residential care facilities (The Promoting Independent Living Study; PILS). Age Ageing 2008;37:57-63.
  40. Burton E, Lewin G, Clemson L: Determining the feasibility of a lifestyle activity program for inclusion in a restorative home care service: a pilot study. Act Adapt Aging 2014;38:79-93.
  41. Fleig L, et al: Health behavior change theory meets fall prevention: feasibility of a habit-based and strength exercise intervention for older adults. Psychol Sport Exerc 2016;22:114-122.
  42. Keay L, et al: Feasibility and acceptability of orientation and mobility instructors delivering the LiFE falls prevention program to older people with vision impairment. Int J Orient Mobil 2015;7:22-33.
  43. Opdenacker J, et al: Effectiveness of a lifestyle intervention and a structured exercise intervention in older adults. Prev Med 2008;46:518-524.
  44. Opdenacker J, Delecluse C, Boen F: The longitudinal effects of a lifestyle physical activity intervention and a structured exercise intervention on physical self-perceptions and self-esteem in older adults. J Sport Exerc Psychol 2009;31:743-760.
  45. Opdenacker J, Delecluse C, Boen F: A 2-year follow-up of a lifestyle physical activity versus a structured exercise intervention in older adults. J Am Geriatr Soc 2011;59:1602-1611.
  46. Van Roie E, et al: Effectiveness of a lifestyle physical activity versus a structured exercise intervention in older adults. J Aging Phys Act 2010;18:335-352.
  47. Clemson L, Munro J, Singh MAF: Lifestyle-integrated Functional Exercise (LiFE) Program to Prevent Falls: Trainer's Manual. Sydney, Sydney University Press, 2014.
  48. Clemson L, Munro J, Fiatrone Singh M: Lifestyle-integrated Functional Exercise (LiFE) Program to Prevent Falls: Participants Manual. Sydney, Sydney University Press, 2014.
  49. Lally P, Gardner B: Promoting habit formation. Health Psychol Rev 2013;7:137-158.
  50. Gibbs JC, et al: Measuring the implementation of a group-based Lifestyle-integrated Function Exercise(Mi-LiFE) intervention delivered in primary care for older adults aged 75 years or older: a pilot feasibility study protocol. Pilot Feasibility Studies 2015;1:20.
  51. Pitrou I, et al: Reporting of safety results in published reports of randomized controlled trials. Arch Intern Med 2009;169:1756-1761.
  52. Chodzko-Zajko WJ, et al: Exercise and physical activity for older adults. Med Sci Sports Exerc 2009;41:1510-1530.
  53. Sherrington C, et al: Exercise to prevent falls in older adults: an updated systematic review and meta-analysis Br J Sports Med DOI: 10.1136/bjsports-2016-096547.
  54. Gardner B, et al: Putting habit into practice, and practice into habit: a process evaluation and exploration of the acceptability of a habit-based dietary behaviour change intervention. Int J Behav Nutr Phys Act 2014;11:135.
  55. Lally P, Wardle J, Gardner B: Experiences of habit formation: a qualitative study. Psychol Health Med 2011;16:484-489.
  56. Judah G, Gardner B, Aunger R: Forming a flossing habit: an exploratory study of the psychological determinants of habit formation. Br J Health Psychol 2012;18:338-353.
  57. Schüz B, Sniehotta FF, Schwarzer R: Stage-specific effects of an action control intervention on dental flossing. Health Educ Res 2007;22:332-341.
  58. Ehde DM, Dillworth TM, Turner JA: Cognitive-behavioral therapy for individuals with chronic pain: efficacy, innovations, and directions for research. Am Psychol 2014;69:153.
  59. French DP, et al: Which behaviour change techniques are most effective at increasing older adults' self-efficacy and physical activity behaviour? A systematic review. Ann Behav Med 2014;48:225-234.

Copyright / Drug Dosage / Disclaimer

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.