Rehabilitation and Therapy Commons^™

Energy Flow Differences In Throwing Arm Joints Between Javelin And Weighted Balls In Male Javelin Throwers, Hans-Peter Köhler, Kristof Kipp, Nikola Prvulović, Maren Witt

Exercise Science Faculty Research and Publications

Introduction: To enhance release velocity during competition, javelin throwers incorporate implements of varying mass into their training regimens. Previous research has demonstrated that, although velocity contributes quadratically to the computation of kinetic energy, heavier implements generate substantially greater kinetic energy at the moment of release, despite markedly lower release velocities. The primary objective of the present investigation was to analyze energy transfer within the throwing arm to gain deeper insight into the biomechanical mechanisms underlying the use of implements with different masses.

Methods: The three-dimensional coordinates of 16 reflective markers were recorded for 6 athletes during throws using 6 different …

Mechanisms For The Age-Related Increase In Fatigability Of The Elbow Flexor Muscles In Healthy Adults, Blaine E. Arney, Andrew Kuplic, Mitchell D. Adam, Christopher W. Sundberg, Sandra Hunter

Exercise Science Faculty Research and Publications

The mechanisms for the age-related increase in fatigability of the elbow flexor muscles during dynamic contractions are unknown. The purpose of this study was to determine the contribution of supraspinal and contractile mechanisms for the age-related increase in fatigability of the elbow flexor muscles. Twenty-eight young (23.2 ± 2.6 years; 14 females) and 32 older adults (72.6 ± 5.6 years; 15 females) performed 80 maximal velocity contractions at 20% of maximal isometric strength. Voluntary activation and muscle contractile properties were assessed before and immediately following the fatiguing exercise using transcranial magnetic stimulation (TMS) and electrical stimulation. Fatigability (% reduction in …

Sex-Based Differences In The Representation Of Top Youth Athletes, Jessica J. James, Sandra K. Hunter, Elizabeth P. Bueckers, Michael J. Joyner, Jonathon W. Senefeld

Exercise Science Faculty Research and Publications

Although emerging research demonstrates that male athletes outperform female athletes before puberty, the effect of these sex-related advantages on ordinal ranking of top performances remains unclear.

Objectives

Among overall top performances of youth track and swimming athletes, we aimed to determine 1) the proportional number of male compared with female athletes represented and 2) at what age females are no longer represented.

Methods

Finishing times and sex of the top 10 and top 100 performances of youth runners and swimmers between 5 and 18 yr were abstracted from online U.S.-based databases for four running (100 m–800 m) and six freestyle …

Walking Performance Is Worse In Black Than White People With Multiple Sclerosis, Robert W. Motl, Deborah Backus, Jeffrey R. Hebert, Alexander V. Ng, Kevin K. Mccully, Whitney N. Neal, Hollie Schmidt, Robert Mcburney, Prudence Plummer, Francois Bethoux, John Lowman, Gary R. Cutter

Exercise Science Faculty Research and Publications

Background

There is emerging evidence for poor health outcomes among Black people with MS, and Black people with MS may have worse walking performance than White counterparts.

Purpose

The current study examined if Black participants with MS had slower walking speed (timed 25-foot walk, T25FW) and shorter walking distance (six-minute walk, 6MW) than White participants, and if these differences were accounted for by demographic variables, physical activity, disease/clinical characteristics, and Social Determinants of Health (SDOH).

Method

The analysis included samples of Black (N = 105) and White (N = 246) participants with MS who completed the T25FW and 6MW, underwent …

Prediction Of Snatch And Clean And Jerk Performance From Physical Performance Measures In Elite Male Weightlifters, Ingo Sandau, Kristof Kipp

Exercise Science Faculty Research and Publications

This study aimed to build a valid model to predict maximal weightlifting competition performance using ordinary least squares linear regression (OLR) and penalized (Ridge) linear regression (penLR) in 29 elite male weightlifters. One repetition maximum (1RM) or 3RM test results of assistant exercises were used as predictors. Maximal performance data of competition and assistant exercises were collected during a macrocycle in preparation for a competition. One repetition maximum snatch pull, 3RM back squat, 1RM overhead press, and body mass were used to predict the 1RM snatch; and 1RM clean pull, 3RM front squat, 1RM overhead press, and body mass were …

Effect Of Trauma Type And Trauma Burden On Self-Efficacy For Physical Exercise In Military Veterans, Kaley E. Davis, Meghan M. Bennett, Cecilia J. Hillard, Jeffrey Whittle, Zeno Franco, Rachel E. Bollaert, Jacklynn M. Fitzgerald

Exercise Science Faculty Research and Publications

Introduction

United States (U.S.) military veterans experience significant physical health problems. Lifestyle modifications, such as increasing daily physical activity, are often considered the first course of action in treatment for the general public. However, veterans report low levels of physical activity, often due to perceived barriers to engaging in exercise. Trauma exposure type and cumulative trauma burden may be differentially associated with exercise attitudes and behaviors.

Methods

We surveyed U.S. military veterans on perceived self-efficacy to overcome barriers to engaging in exercise and physical activity levels. Additionally, we explored the relationship between the type of traumatic event exposure and cumulative …

Relative Muscular Effort In The Older Adults During The Sit-To-Stand Task: Monitoring Neuromuscular Reserve And Movement Limitations, Nayun Ahn, Michael H. Haischer, Cara L. Lewis, Kristof Kipp

Exercise Science Faculty Research and Publications

Background

Due to lower maximum strength, older adults purportedly need to exert greater muscular effort to stand up from a chair. This study investigated joint-specific muscular effort during a sit-to-stand by calculating relative-muscular-effort and investigating differences between healthy older and young adults.

Methods

Fifteen older (age: 69.9 ± 3.5 years) and 15 young (age: 22.2 ± 2.6 years) adults performed five self-paced sit-to-stand trials. Kinematic and kinetic data were collected and used to calculate inverse dynamics net joint moment. Peak isometric knee and hip extensor torques were measured and used as inputs to regression models that predicted angle- and velocity-dependent …

Performance Of Artificial Neural Network Compared To Multi-Linear Regression In Prediction Of Countermovement Jump Height, Amirhossein Emamian, Alireza Hashemi Oskouei, Kristof Kipp, Rasoul Azreh

Exercise Science Faculty Research and Publications

Previous research has used primarily linear regression models to predict jump height and establish contributors of performance. The purpose of this study was to compare the performance of artificial neural network (ANN) and multi-linear regression (MLR) in prediction of countermovement jump (CMJ) height and investigating the contribution of kinematic variables to CMJ performance. Thirty-four healthy young male athletes performed a total of 204 CMJ while eight kinematic variables (the hip, knee, and ankle angles at the begging of the concentric phase of CMJ, the hip and knee take-off angles, and the shoulder, hip, and knee maximum angular velocities) were used …

Validation Of Scores From A Telephone Administered Multiple Sclerosis Walking Scale-12 In Persons With Multiple Sclerosis, Robert W. Motl, Prudence Plummer, Deborah Backus, Jeffrey R. Hebert, Whitney N. Neal, Alexander V. Ng, John Lowman, Francois Bethoux, Hollie Schmidt, Robert Mcburney, Kevin K. Mccully, Gary R. Cutter

Exercise Science Faculty Research and Publications

Background

The Multiple Sclerosis Walking Scale-12 (MSWS-12) has typically been delivered through paper-and-pencil or computer-based administration.

Purpose

This study examined the validity of inferences from scores derived via a telephone administration of the MSWS-12 applied as part of screening of participants with walking dysfunction into a clinical trial of exercise training in MS.

Method

The MSWS-12 was administered on two occasions separated by approximately 2 weeks through the telephone and then in-person (i.e., computer-based administration). Participants further completed the Patient Determined Disease Steps (PDDS) scale, timed 25-foot walk (T25FW), six-minute walk (6MW), Modified Fatigue Impact Scale (MFIS), and Multiple Sclerosis …

Effects Of Photobiomodulation Therapy On Muscle Function In Individuals With Multiple Sclerosis, Mitra Rouhani, Miguel Tolentino, Jeri-Anne Lyons, Alexander V. Ng

Exercise Science Faculty Research and Publications

Background

In people with multiple sclerosis (pwMS), muscle fatigue and weakness are common issues that can interfere with daily activities. Photobiomodulation therapy (PBMT), comprising light in a 600–1100 nm bandwidth, is a low-level laser therapy thought to improve muscle performance in non-disease populations, in part, by improving mitochondrial function and thus, might be beneficial in pwMS. Given this potential, we aimed to investigate the effects of PBMT on muscle performance in pwMS, both in the short-term and over an extended period.

Methods

This study consisted of two parts with a randomized double-blind crossover design. In study I, muscle function was …

Heart Rate Variability Is Reduced In Covid-19 Survivors And Associated With Physical Activity And Fatigue, Michael H. Haischer, Lauren E. Opielinski, Lindsey M. Mirkes, Toni D. Uhrich, Rachel E. Bollaert, Michael E. Danduran, Marie K. Hoeger Bement, Linda B. Piacentine, Paula E. Papanek, Sandra K. Hunter

Exercise Science Faculty Research and Publications

Reduced heart rate variability (HRV) and fatigue are common after COVID-19 infection and both are potentially influenced by physical activity (PA). We compared resting HRV, PA from accelerometers and questionnaires, and self-reported fatigue in 41 COVID-19 survivors (~8 months postinfection, 38 ± 17 years) with 41 matched controls. Differences in HRV were observed on acceleration capacity (p = 0.041), deceleration capacity (p = 0.032), high-frequency peak frequency (p = 0.019), absolute low-frequency power (p = 0.042), relative very low-frequency power (p = 0.012), SD2 (from Poincare plot; p = 0.047), and DFA2 (slope of long-term …

Middle-Range Scores From The Patient Determined Disease Steps Scale Reflect Varying Levels Of Walking Dysfunction In Multiple Sclerosis, Robert W. Motl, Whitney Neal, Deborah Backus, Jeffrey Hebert, Kevin K. Mccully, Francois Bethoux, Prudence Plummer, Alexander V. Ng, John Lowman, Hollie Schmidt, Robert Mcburney, Gary R. Cutter

Exercise Science Faculty Research and Publications

Background

Multiple sclerosis (MS) is a leading cause of neurological disability among young and middle-aged adults worldwide, and disability is measured using a variety of approaches, including patient reported outcome measures (PROMs) such as the Patient Determined Disease Steps (PDDS) scale. There is limited evidence for the validity of inferences from the middle-range of scores on the PDDS (i.e., 3 “gait disability” – 6 “bilateral support”), but that range of scores seemingly represents moderate disability characterized by varying levels of walking dysfunction.

Purpose

The current study examined whether the middle-range of scores from the PDDS reflect varying levels of walking …

Sex Differences In Fatigability And Recovery Following A 5 Km Running Time Trial In Recreationally Active Adults, Maria Solleiro Pons, Sandra K. Hunter, Paul Ansdell

Exercise Science Faculty Research and Publications

Females demonstrate greater fatigue resistance compared to males in tasks ranging from single-limb contractions to whole-body exercise, including running. Many of the studies investigating sex differences in fatigability following running, however, occur after long duration, low-intensity tasks and it is unknown whether there is a sex difference in fatigability following high-intensity running. This study compared fatigability and recovery following a 5 km running time trial in young males and females. Sixteen recreationally active participants (8 males, 8 females, age: 23 ± 4 years) completed a familiarisation and experimental trial. Knee-extensor maximal voluntary contractions (MVCs) were performed before and up to …

Underrepresentation Of Women In Exercise Science And Physiology Research Is Associated With Authorship Gender, Jessica J. James, Emilie A. Klevenow, Mira A. Atkinson, Emma E. Vosters, Elizabeth P. Bueckers, Meagan E. Quinn, Samantha L. Kindy, Azara P. Mason, Sophia K. Nelson, Kennedy A. H. Rainwater, Petra V. Taylor, Elena P. Zippel, Sandra K. Hunter

Exercise Science Faculty Research and Publications

Historically, low representation of women participants in exercise science and physiology studies has led to a lack of understanding in the response of women to exercise and therapeutic interventions. We hypothesized that 1) the number of women authors, participants, and editorial board members increased over 30 years (1991–2021) and 2) larger representation of women as editors and authors is associated with more women participants. Gender (man/woman) of editorial board members (n = 394), authors (n = 5,735), and participants (n = 2,984,883) of 972 original research articles with human participants published in 1991 and 2021 …

The Biological Basis Of Sex Differences In Athletic Performance: Consensus Statement For The American College Of Sports Medicine, Sandra K. Hunter, Siddhartha S. Angadi, Aditi Bhargava, Joanna Harper, Angelica Lindén Hirschberg, Benjamin D. Levine, Kerrie L. Moreau, Natalie J. Nokoff, Nina S. Stachenfeld, Stéphane Bermon

Exercise Science Faculty Research and Publications

Biological sex is a primary determinant of athletic performance because of fundamental sex differences in anatomy and physiology dictated by sex chromosomes and sex hormones. Adult men are typically stronger, more powerful, and faster than women of similar age and training status. Thus, for athletic events and sports relying on endurance, muscle strength, speed, and power, males typically outperform females by 10%–30% depending on the requirements of the event. These sex differences in performance emerge with the onset of puberty and coincide with the increase in endogenous sex steroid hormones, in particular testosterone in males, which increases 30-fold by adulthood, …

Muscle-Specific Contributions To Vertical Ground Reaction Force Profiles During Countermovement Jumps: Case Studies In College Basketball Players, Kristof Kipp, Hoon Kim

Exercise Science Faculty Research and Publications

The purpose of this study was to determine muscle-specific contributions to various types of vertical ground reaction force (vGRF) profiles in collegiate basketball players. Players from a men's (n = 5; height: 1.84 ± 0.14 m; mass: 92.8 ± 11.4 kg) and a women's (n = 5; 1.71 ± 0.09 m; mass: 80.1 ± 17.6 kg) basketball team completed 3–5 countermovement jumps (CMJ) while motion capture and force plate data were recorded. Muscle-specific contributions to vGRF were calculated through vGRF decomposition analysis. Profiles of vGRF were analyzed based on the presence of unimodal or bimodal peaks during the …

Running To The Beat: Does Listening To Music Affect Running Cadence And Lower Extremity Biomechanics?, Carolyn Meinerz, Jessica M. Fritz, Janelle A. Cross, Cody C. Dziuk, Kristof Kipp, Carole Vetter

Exercise Science Faculty Research and Publications

Background

Gait retraining can be effective in altering lower extremity biomechanics and reducing risk of injury. In attempts to alter running gait, previous studies used metronomes to manipulate cadence.

Research question

The aim of this study was to determine if manipulating running cadence via music could alter lower extremity biomechanics.

Methods

Eighteen runners ran at a self-selected speed (SS) and ran to music where the beats per minute (bpm) of the songs was increased by 5% (+5%) and 10% (+10%). Kinematic and kinetic data were collected with a motion capture system and a triaxial accelerometer. A one-way repeated measures analysis …

Localized Pain And Fatigue During Recovery From Submaximal Resistance Exercise In People With Fibromyalgia, Giovanni Berardi, Christine Eble, Sandra K. Hunter, Marie K. Hoeger Bement

Exercise Science Faculty Research and Publications

Objective

Exercise is recommended as a main treatment in fibromyalgia. However, many people have limited exercise tolerance and report exacerbated pain and fatigue during and following a bout of exercise. This study examined the local and systemic changes in perceived pain and fatigue during exercise and through the 3-day recovery following isometric and concentric exercises in people with and without fibromyalgia.

Methods

Forty-seven participants with a physician diagnosis of fibromyalgia (44 women; mean age [SD] = 51.3 [12.3] years; mean body mass index [SD] = 30.2 [6.9]) and 47 controls (44 women; mean age [SD] = 52.5 [14.7] years; mean …

Physical Function Across The Lifespan In Adults With Multiple Sclerosis: An Application Of The Short Physical Performance Battery, Brenda Jeng, Petra Šilić, Rachel E. Bollaert, Brian M. Sandroff, Robert W. Motl

Exercise Science Faculty Research and Publications

Background

Multiple sclerosis (MS) typically has its onset in early and middle adulthood, but the population is steadily becoming more dominated by older adults. One of the primary consequences of both MS and aging involves declines of lower extremity physical function and mobility. This cross-sectional study compared physical function status based on Short Physical Performance Battery (SPPB) summary and component scores between persons with MS and healthy controls across 6 age groups. We further examined associations between SPPB summary scores and component scores as well as associations between summary scores and measures of physical and cognitive function for identifying the …

Sex Differences In The Speed–Duration Relationship Of Elite Runners Across The Lifespan, Timothy J. Fulton, Christopher W. Sundberg, Blaine E. Arney, Sandra K. Hunter

Exercise Science Faculty Research and Publications

Purpose

To determine if the speed–duration relationship is altered with age and sex of elite Master’s runners.

Methods

The world’s top 10 performances for men and women in three events (800, 1500, and 5000 m) across six age groups (18–34 yr, 40–49 yr, 50–59 yr, 60–69 yr, 70–79 yr, and 80–89 yr) were analyzed from public data to establish theoretical models of the speed–duration relationship. Critical speed (CS) and the curvature constant (D′) were estimated by fitting the average speeds and performance times with a two-parameter hyperbolic model.

Results

Critical speed expressed relative to the 18- to 34-yr-olds, …

Case Studies In Physiology: Male To Female Transgender Swimmer In College Athletics, Jonathon Senefeld, Sandra K. Hunter, Doriane Coleman, Michael J. Joyner

Exercise Science Faculty Research and Publications

There is current scientific and legal controversy about sports competition eligibility regulations for transgender athletes. In this case study, we quantified performances by an elite, transgender woman (male sex, female gender identity) college swimmer who competed in both the men’s and women’s National Collegiate Athletic Association (NCAA) categories. We also contextualized her performances with respect to world-record performances and contemporary elite college swimmers. These data demonstrate that the declines in freestyle swimming performances of a transgender woman after about 2 yr of reported feminizing gender-affirming hormone treatment (0.5% for the 100 to 7.3% for the 1,650 yard distance) are smaller …

Primary Results Of A Phase-Iii, Randomized Controlled Trial Of The Behavioral Intervention For Increasing Physical Activity In Multiple Sclerosis Project, Robert W. Motl, Ariel Kidwell, Brian M. Sandroff, Lara A. Pilutti, Gary R. Cutter, Roberto Aldunate, Rachel E. Bollaert

Exercise Science Faculty Research and Publications

Background

We undertook a phase-III, randomized controlled trial (RCT) that examined the effectiveness of a behavioral intervention based on social cognitive theory (SCT) and delivered through the Internet using e-learning approaches for immediate and sustained increases in physical activity among persons with multiple sclerosis (MS).

Method

The study followed a parallel group RCT design. Persons with MS (N = 318) were randomized into either behavioral intervention (n = 159) or attention/social contact control (n = 159) conditions. The conditions were administered over a 6-month period by persons who were uninvolved in screening, recruitment, random assignment, and outcome …

Randomized Controlled Trial Of The Behavioral Intervention For Increasing Physical Activity In Multiple Sclerosis Project: Secondary, Patient-Reported Outcomes, Robert W. Motl, Brian M. Sandroff, Lara A. Pilutti, Gary R. Cutter, Roberto Aldunate, Ariel Kidwell, Rachel E. Bollaert

Exercise Science Faculty Research and Publications

Background

We undertook a randomized controlled trial (RCT) that investigated the effectiveness of a theory-based, Internet-delivered, behavioral intervention focusing on physical activity promotion for immediate and sustained improvements in secondary, patient-reported outcomes (PROs) of function, symptoms, and quality of life (QOL) in multiple sclerosis (MS).

Method

Persons with MS (N = 318) were recruited from throughout the United States and randomized into behavioral intervention (n = 159) or attention/social contact control (n = 159) conditions. The conditions were administered over a 6-month period by persons who were uninvolved in screening, recruitment, random assignment, and outcome assessment. There …

Depression, Anxiety, And Physical Activity In Older Adults With Multiple Sclerosis, Rachel E. Bollaert, C. Danielle Jones, Petra Silic, Robert W. Motl

Exercise Science Faculty Research and Publications

This study examined levels of depression and anxiety symptoms (Hospital Anxiety and Depression Scale scores), and self-reported (Godin Leisure-Time Exercise Questionnaire), and accelerometer-measured physical activity in older adults with multiple sclerosis (n = 40) compared with age- and sex-matched healthy controls (n = 40). We observed differences in depression, anxiety, and physical activity between groups and further observed that minutes/day of moderate to vigorous physical activity partially accounted for group differences in depression scores. We provide preliminary support for research examining approaches for increasing moderate to vigorous physical activity and possibly reducing depression symptoms in older adults with …

From The Editor, Sandra K. Hunter

Exercise Science Faculty Research and Publications

No abstract provided.

“It’S About Being Healthy”; A Novel Approach To The Socio-Ecological Model Using Family Perspectives Within The Latinx Community, Bethany Korom, Meghan Malloy, Caroline Remmers, Mari Cevilla, Kelly Dione, Paula E. Papanek, Jeffrey Condit, David Nelson

Exercise Science Faculty Research and Publications

Background

The Latinx community is at risk for obesity, type 2 diabetes, and other chronic illnesses. Culturally appropriate, community facing physical activity (P.A.) and nutrition programs may provide the basis for families to improve their health status. Our objectives are as follows: 1. To investigate synergistic factors within this type of program that play a role in creating an environment for participants to learn and practice healthy behaviors. 2. To apply factors into a novel model of components that support health and wellness. 3. To design an intervention for future implementation and evaluation.

Methods

A two-year P.A. and nutrition program, …

Neural And Muscular Contributions To The Age-Related Loss In Power Of The Knee Extensors In Men And Women, David Wrucke, Andrew Kuplic, Mitchell Adam, Sandra K. Hunter, Christopher W. Sundberg

Exercise Science Faculty Research and Publications

The mechanisms for the loss in limb muscle power in old (60-79 years) and very old (≥80 years) adults and whether the mechanisms differ between men and women are not well-understood. We compared maximal power of the knee extensor muscles between young, old, and very old men and women and identified the neural and muscular factors contributing to the age-related loss of power. 31 young (22.9±3.0 years, 15 women), 83 old (70.4±4.9 years, 39 women), and 16 very old adults (85.8±4.2 years, 9 women) performed maximal isokinetic contractions at 14 different velocities (30- 450°/s) to identify peak power. Voluntary activation …

Who Was Wearing A Mask In 2021? Update On Gender-, Age-, And Location-Related Differences During The Covid-19 Pandemic, Michael H. Haischer, Rachel Beilfuss, Meggie Rose Hart, Lauren Opielinski, Emma Schmit, David Wrucke, Helena Zhao, Toni D. Uhrich, Sandra K. Hunter

Exercise Science Faculty Research and Publications

Previous observational work from 2020 demonstrated gender-, age-, and location-related differences in mask-wearing behavior, despite the efficacy and public health messaging that emphasized face coverings in combatting the spread of COVID-19. In 2021, COVID-19 vaccinations and a corresponding change in public health policy became new considerations in deciding personal protective behaviors. To provide an update on mask wearers and resistors approximately one year after our initial study, we observed shoppers (n = 6,118) entering retail stores using the same experimental methodology. Approximately 26% of individuals wore a mask. Mask wearing has decreased across demographic groups compared to 2020. Aligning …

Cognitive Challenge As A Probe To Expose Sex- And Age-Related Differences During Static Contractions, Hugo M. Pereira, Sandra K. Hunter

Exercise Science Faculty Research and Publications

Despite activities of daily living being frequently performed simultaneously with a cognitive task, motor function is often investigated in isolation, which can hinder the applicability of findings. This brief review presents evidence that 1) performing a cognitive challenge simultaneously with a motor task can negatively impact force steadiness and fatigability of limb muscles during a static contraction, 2) the negative impact on old adults (>65 years old), particularly older women is greater than young when a cognitive challenge is simultaneously performed with a static motor task, 3) age-related mechanisms potentially explain impairments in motor performance in the presence of …

Moderate-To-Vigorous Physical Activity Is Related With Retinal Neuronal And Axonal Integrity In Persons With Multiple Sclerosis, Jeongwoon Kim, Rachel E. Bollaert, Jonathan Cerna, Brynn C. Adamson, Connor M. Robbs, Naiman A. Khan, Robert W. Motl

Exercise Science Faculty Research and Publications

Background

Moderate-to-vigorous physical activity (MVPA) may confer benefits for axonal and/or neuronal integrity in adults with multiple sclerosis (MS).

Purpose

Examine the association between device-measured MVPA with optical coherence tomography (OCT) metrics of retinal nerve fiber layer (RNFL) thickness and total macular volume (TMV) in persons with and without MS.

Methods

Adults with MS (N = 41), along with sex-matched healthy control (HC) participants (N = 79), underwent measurements of retinal morphology via OCT and wore an accelerometer for a period of 7 days as a measure of MVPA.

Results

Persons with MS had significantly lower MVPA, RNFL thickness, and …