Rehabilitation and Therapy Commons^™

Associations Of Functional Connectivity And Walking Performance In Multiple Sclerosis, Rachel E. Bollaert, Kyle Poe, Elizabeth A. Hubbard, Robert W. Motl, Lara A. Pilutti, Curtis L. Johnson, Bradley P. Sutton

Exercise Science Faculty Research and Publications

Background

Persons with multiple sclerosis (MS) often demonstrate impaired walking performance, and neuroimaging methods such as resting state functional connectivity. (RSFC) may support a link between central nervous system damage and disruptions in walking.

Objectives

This study examined associations between RSFC in cortical networks and walking performance in persons with MS.

Methods

29 persons with MS underwent 3-T brain magnetic resonance imaging (MRI) and we computed RSFC among 68 Gy matter regions of interest in the brain. Participants completed the Timed 25-foot Walk as a measure of walking performance. We examined associations using partial Pearson product-moment correlation analyses (r …

Total Energy Expenditure And Body Composition Of Children With Developmental Disabilities, Michele L. Polfuss, Kathleen J. Sawin, Paula E. Papanek, Linda Bandini, Bethany Forseth, Andrea Moosreiner, Kimberley Zvara, Dale A. Schoeller

Exercise Science Faculty Research and Publications

Background

Obesity prevalence is increased in children with developmental disabilities, specifically in children with spina bifida and Down syndrome. Energy expenditure, a critical aspect of weight management, has been extensively studied in the typically developing population, but not adequately studied in children with developmental disabilities.

Objective

Determine energy expenditure, fat-free mass and body fat percentile and the impact of these findings on recommended caloric intake in children with spina bifida and Down syndrome.

Methods/Measures

This pilot study included 36 children, 18 with spina bifida, 9 with Down syndrome and 9 typically developing children. Half of the children with spina bifida …

Sex Differences In Mechanisms Of Recovery After Isometric And Dynamic Fatiguing Tasks, Jonathon Senefeld, Hugo M. Pereira, Nicholas Elliott, Tejin Yoon, Sandra K. Hunter

Exercise Science Faculty Research and Publications

Purpose The purpose of this study was to determine whether supraspinal mechanisms contribute to the sex difference in fatigability during and recovery from a dynamic and isometric fatiguing task with the knee extensors.

Methods: Transcranial magnetic stimulation and electrical stimulation were used to determine voluntary activation and contractile properties of the knee extensors in 14 men and 17 women (20.8 ± 1.9 yr) after a 1) 60-s sustained, maximal voluntary isometric contraction (MVIC), and 2) dynamic fatiguing task involving 120 maximal voluntary concentric contractions with a 20% MVIC load.

Results: There were no differences between men and women in the …

Physical Activity And Annual Medical Outlay In U.S. Colorectal, Breast And Prostate Cancer Survivors, Alice F. Yan, Yang Wang, Alexander V. Ng

Exercise Science Faculty Research and Publications

Multiple chronic conditions in cancer survivors are highly prevalent and may increase health care costs for both patients and the health care system. Studies of cancer survivors reveal positive effects of physical activity (PA) on reducing risk of cancer recurrence, other chronic conditions, and secondary cancer. Few nationally representative studies have examined how physical activity levels have affected survivors' annual economic burden in the United States.

Leisure-time physical activity data from the National Health Interview Survey was linked to health care expenditure data from the Medical Expenditure Panel Survey data (2008–2012). We calculated per-person annual total medical expenditures for identified …

Mechanisms For The Increased Fatigability Of The Lower Limb In People With Type 2 Diabetes, Jonathon Senefeld, Steven B. Magill, April L. Harkins, Alison R. Harmer, Sandra K. Hunter

Exercise Science Faculty Research and Publications

Fatiguing exercise is the basis of exercise training and a cornerstone of management of type 2 diabetes mellitus (T2D), however, little is known about the fatigability of limb muscles and the involved mechanisms in people with T2D. The purpose was to compare fatigability of knee extensor muscles between people with T2D and controls without diabetes and determine the neural and muscular mechanisms for a dynamic fatiguing task. Seventeen people with T2D (10 men, 7 women: 59.6{plus minus}9.0 years) and 21 age-, BMI- and physical activity-matched controls (11 men, 10 women: 59.5{plus minus}9.6 years) performed 120 high-velocity concentric contractions (1 contraction/3 …

Six-Minute Walk Test Performance In Persons With Multiple Sclerosis While Using Passive Or Powered Ankle-Foot Orthoses, Morgan K. Boes, Rachel E. Bollaert, Richard M. Kesler, Yvonne C. Learmonth, Mazharul Islam, Matthew N. Petrucci, Robert W. Motl, Elizabeth T. Hsiao-Wecksler

Exercise Science Faculty Research and Publications

Objective

To determine whether a powered ankle-foot orthosis (AFO) that provides dorsiflexor and plantar flexor assistance at the ankle can improve walking endurance of persons with multiple sclerosis (MS).

Design

Short-term intervention.

Setting

University research laboratory.

Participants

Participants (N=16) with a neurologist-confirmed diagnosis of MS and daily use of a prescribed custom unilateral passive AFO.

Interventions

Three 6-minute walk tests (6MWTs), 1 per footwear condition: shoes (no AFO), prescribed passive AFO, and portable powered AFO (PPAFO). Assistive devices were worn on the impaired limb.

Main Outcome Measures

Distance walked and metabolic cost of transport were recorded during each 6MWT and …

Validation Of The Godin Leisure-Time Exercise Questionnaire Classification Coding System Using Accelerometry In Multiple Sclerosis, Robert W. Motl, Rachel E. Bollaert, Brian M. Sandroff

Exercise Science Faculty Research and Publications

Objective: There have been recent efforts toward creating a health contribution score (HCS) from the Godin Leisure-Time Exercise Questionnaire (GLTEQ) that reflects public-health guidelines for levels of moderate-to-vigorous physical activity (MVPA). The HCS yields categories of insufficiently active (less substantial or low benefits), moderately active (some benefits), and active (substantial benefits). The present study examined the validity of the GLTEQ HCS and its categories as reflecting levels of MVPA in multiple sclerosis (MS). Method: The sample included 684 persons with MS. Participants wore an accelerometer on an elastic belt around the waist above the nondominant hip during the waking hours …

Girls In The Boat: Sex Differences In Rowing Performance And Participation, Kevin G. Keenan, Jonathon Senefeld, Sandra K. Hunter

Exercise Science Faculty Research and Publications

Men outperform women in many athletic endeavors due to physiological and anatomical differences (e.g. larger and faster muscle); however, the observed sex differences in elite athletic performance are typically larger than expected, and may reflect sex-related differences in opportunity or incentives. As collegiate rowing in the United States has been largely incentivized for women over the last 20 years, but not men, the purpose of this study was to examine sex differences in elite rowing performance over that timeframe. Finishing times from grand finale races for collegiate championship on-water performances (n = 480) and junior indoor performances (n = 1,280) …

Contraction Intensity And Sex Differences In Knee-Extensor Fatigability, Paul Ansdell, Kevin Thomas, Glyn Howatson, Sandra K. Hunter, Stuart Goodall

Exercise Science Faculty Research and Publications

Females are less fatigable than males during isometric contractions across various muscles and intensities. However, sex differences in knee-extensor fatigability remain relatively unexplored. Purpose: To determine the sex difference in performance fatigability for intermittent, isometric contractions of the knee-extensor muscles. Methods: Eighteen participants (10 males, 8 females) performed intermittent, isometric, knee-extensor contractions at 30% of their maximal voluntary force (MVC) for 30 min and in a separate session at 50% MVC until task-failure. During both fatiguing protocols a MVC was performed every 60 s and electromyography (EMG) was recorded during all contractions. Results: At task completion males had a larger …

Physiological Response To Firefighting Activities Of Various Work Cycles Using Extended Duration And Prototype Scba, Richard M. Kesler, Ipek Ensari, Rachel E. Bollaert, Robert W. Motl, Elizabeth T. Hsiao-Wecksler, Karl S. Rosengren, Bo Fernhall, Denise L. Smith, Gavin P. Horn

Exercise Science Faculty Research and Publications

Firefighters’ self-contained breathing apparatus (SCBA) protects the respiratory system during firefighting but increases the physiological burden. Extended duration SCBA (>30 min) have increased air supply, potentially increasing the duration of firefighting work cycles. To examine the effects of SCBA configuration and work cycle (length and rest), 30 firefighters completed seven trials using different SCBA and one or two bouts of simulated firefighting following work cycles common in the United States. Heart rate, core temperature, oxygen consumption, work output and self-reported perceptions were recorded during all activities. Varying SCBA resulted in few differences in these parameters. However, during a second …

Sex Differences In Spatial Accuracy Relate To The Neural Activation Of Antagonistic Muscles In Young Adults, Agostina Casamento-Moran, Sandra K. Hunter, Yen-Ting Chen, Min-Hyuk Kwon, Emily J. Fox, Basma Yacoubi, Evangelos A. Christou

Exercise Science Faculty Research and Publications

Sex is an important physiological variable of behavior, but its effect on motor control remains poorly understood. Some evidence suggests that women exhibit greater variability during constant contractions and poorer accuracy during goal-directed tasks. However, it remains unclear whether motor output variability or altered muscle activation impairs accuracy in women. Here, we examine sex differences in endpoint accuracy during ankle goal-directed movements and the activity of the antagonistic muscles. Ten women (23.1 ± 5.1 years) and 10 men (23 ± 3.7 years) aimed to match a target (9° in 180 ms) with ankle dorsiflexion. Participants performed 50 trials and we …

Physical Activity Modulates Corticospinal Excitability Of The Lower Limb In Young And Old Adults, Hamidollah Hassanlouei, Christopher W. Sundberg, Ashleigh E. Smith, Andrew Kuplic, Sandra K. Hunter

Exercise Science Faculty Research and Publications

Aging is associated with reduced neuromuscular function, which may be due in part to altered corticospinal excitability. Regular physical activity (PA) may ameliorate these age-related declines, but the influence of PA on corticospinal excitability is unknown. The purpose of this study was to determine the influence of age, sex, and PA on corticospinal excitability by comparing the stimulus-response curves of motor evoked potentials (MEP) in 28 young (22.4 ± 2.2 yr; 14 women and 14 men) and 50 old adults (70.2 ± 6.1 yr; 22 women and 28 men) who varied in activity levels. Transcranial magnetic stimulation was used to …

Cardio-Protection Afforded By Β-Blockade Is Maintained During Resistance Exercise, Alexander V. Ng, Jason M. Conviser, Shawn S. Rockey, D. Paul Thomas

Exercise Science Faculty Research and Publications

Objectives

Whether or not the cardio-protective effect of β-adrenergic blockade is retained during resistance exercise has not been systematically evaluated. Therefore the purpose of this study was to measure selected cardiorespiratory responses to isometric exercise involving hand-gripping, single-leg extension, or double-leg dead-lift, under placebo (control), β₁-selective (atenolol), and non-selective (propranolol) adrenergic blockade conditions.

Design

Eleven young male adults were evaluated in a randomized, double-blinded, repeated measures study design and performed all three exercise modalities at 30% of maximal voluntary contraction under placebo, atenolol and propranolol conditions.

Methods

Heart rate, systolic and diastolic blood pressure, rate-pressure product, oxygen uptake, …

Sex Differences In Neuromuscular Fatigability Of The Knee Extensors Post-Stroke, Meghan Kirking, Reivian B. Barillas, Philip A. Nelson, Sandra K. Hunter, Allison S. Hyngstrom

Exercise Science Faculty Research and Publications

Background and Purpose: Despite the implications of optimizing strength training post-stroke, little is known about the differences in fatigability between men and women with chronic stroke. The purpose of this study was to determine the sex differences in knee extensor muscle fatigability and potential mechanisms in individuals with stroke. Methods: Eighteen participants (10 men, eight women) with chronic stroke (≥6 months) and 23 (12 men, 11 women) nonstroke controls participated in the study. Participants performed an intermittent isometric contraction task (6 s contraction, 3 s rest) at 30% of maximal voluntary contraction (MVC) torque until failure to maintain the target …

Wellness And Multiple Sclerosis: The National Ms Society Establishes A Wellness Research Working Group And Research Priorities, Robert W. Motl, Ellen M. Mowry, Dawn M. Ehde, Nicholas G. Larocca, Kathy E. Smith, Kathleen Costello, Lynne Shinto, Alexander V. Ng, Amy B. Sullivan, Barbara Geisser, Kevin K. Mccully, Bo Fernhall, Malachy Bishop, Matthew Plow, Patrizia Casaccia, Nancy D. Chiaravalloti

Exercise Science Faculty Research and Publications

Background:

People with multiple sclerosis (MS) have identified “wellness” and associated behaviors as a high priority based on “social media listening” undertaken by the National MS Society (i.e. the Society).

Objective:

The Society recently convened a group that consisted of researchers with experience in MS and wellness-related research, Society staff members, and an individual with MS for developing recommendations regarding a wellness research agenda.

Method:

The members of the group engaged in focal reviews and discussions involving the state of science within three approaches for promoting wellness in MS, namely diet, exercise, and emotional wellness.

Results:

That process informed a …

Muscle Function And Fatigability Of Trunk Flexors In Males And Females, Rita Deering, Jonathon Senefeld, Tatyana Pashibin, Donald A. Neumann, Sandra K. Hunter

Exercise Science Faculty Research and Publications

Background

Optimal function of the abdominal muscles is necessary for several life functions including lifting and carrying tasks. Sex differences in strength and fatigability are established for many limb muscles and back extensor muscles, but it is unknown if sex differences exist for the abdominal muscles despite their functional importance.

Methods

Eighteen females (24.3 ± 4.8 years) and 15 males (24.1 ± 6.6 years) performed (1) isometric trunk flexion maximal voluntary contractions (MVCs) in a range of trunk positions to establish a torque-angle curve and (2) submaximal (50% MVC), intermittent isometric contraction (6 s on, 4 s off) until task …

Mechanical Demands Of The Hang Power Clean And Jump Shrug: A Joint-Level Perspective, Kristof Kipp, Philip Malloy, Jordan Smith, Matthew D. Giordanelli, Michael T. Kiely, Christopher Geiser, Timothy J. Suchomel

Exercise Science Faculty Research and Publications

The purpose of this study was to investigate the joint- and load-dependent changes in the mechanical demands of the lower extremity joints during the hang power clean (HPC) and the jump shrug (JS). Fifteen male lacrosse players were recruited from an NCAA DI team, and completed three sets of the HPC and JS at 30%, 50%, and 70% of their HPC 1-Repetition Maximum (1-RM HPC) in a counterbalanced and randomized order. Motion analysis and force plate technology were used to calculate the positive work, propulsive phase duration, and peak concentric power at the hip, knee, and ankle joints. Separate three-way …

Muscle-Specific Effective Mechanical Advantage And Joint Impulse In Weightlifting, Kristof Kipp, Chad Harris

Exercise Science Faculty Research and Publications

Lifting greater loads during weightlifting exercises may theoretically be achieved through increasing the magnitudes of net joint impulses or manipulating the joints’ effective mechanical advantage (EMA). The purpose of this study was to investigate muscle-specific EMA and joint impulse as well as impulse-momentum characteristics of the lifter-barbell system across a range of external loads during the execution of the clean. Collegiate-level weightlifters performed submaximal cleans at 65, 75, and 85% of their 1-repetition maximum (1-RM) while data from a motion analysis system and a force plate were used to calculate lifter-barbell system impulse and velocity, as well as net extensor …

Sex Differences In Elite Swimming With Advanced Age Are Less Than Marathon Running, Jonathon Senefeld, Michael J. Joyner, A. Stevens, Sandra K. Hunter

Exercise Science Faculty Research and Publications

The sex difference in marathon performance increases with finishing place and age of the runner but whether this occurs among swimmers is unknown. The purpose was to compare sex differences in swimming velocity across world record place (1st–10th), age group (25–89 years), and event distance. We also compared sex differences between freestyle swimming and marathon running. The world's top 10 swimming times of both sexes for World Championship freestyle stroke, backstroke, breaststroke, and butterfly events and the world's top 10 marathon times in 5-year age groups were obtained. Men were faster than women for freestyle (12.4 ± 4.2%), backstroke (12.8 …

Hip External Rotator Strength Is Associated With Better Dynamic Control Of The Lower Extremity During Landing Tasks, Philip Malloy, Alexander Morgan, Carolyn M. Meinerz, Christopher Geiser, Kristof Kipp

Exercise Science Faculty Research and Publications

Hip external rotator strength is associated with better dynamic control of the lower extremity during landing tasks. J Strength Cond Res 30(1): 282–291, 2016—The purpose of this study was to determine the association between hip strength and lower extremity kinematics and kinetics during unanticipated single-leg landing and cutting tasks in collegiate female soccer players. Twenty-three National Collegiate Athletic Association division I female soccer players were recruited for strength testing and biomechanical analysis. Maximal isometric hip abduction and external rotation strength were measured using a hand-held dynamometer and expressed as muscle torque (force × femoral length) and normalized to body weight. …

Body Composition Measurement In Children With Cerebral Palsy, Spina Bifida And Spinal Cord Injury: A Systematic Review Of The Literature, Michele L. Polfuss, Paula E. Papanek, Fallon Meyer-Wentland, Andrea Moosreiner, Lenore R. Wilkas, Kathleen J. Sawin

Exercise Science Faculty Research and Publications

Pediatric obesity is a major health concern that has an increased prevalence in children with special needs. In order to categorize a child’s weight, an assessment of body composition is needed. Obtaining an accurate body composition measurement in children with special needs has many challenges associated with it. This perplexing scenario limits the provider’s ability to screen, prevent and treat an abnormal weight status in this vulnerable population. This systematic review summarizes common methods of body composition measurements, their strengths and limitations and reviews the literature when measurements were used in children with cerebral palsy, spina bifida and spinal cord …

Impaired Hyperemic Response To Exercise Post Stroke, Matthew J. Durand, Spencer A. Murphy, Kathleen K. Schaefer, Sandra K. Hunter, Brian D. Schmit, David D. Gutterman, Allison S. Hyngstrom

Exercise Science Faculty Research and Publications

Individuals with chronic stroke have reduced perfusion of the paretic lower limb at rest; however, the hyperemic response to graded muscle contractions in this patient population has not been examined. This study quantified blood flow to the paretic and non-paretic lower limbs of subjects with chronic stroke after submaximal contractions of the knee extensor muscles and correlated those measures with limb function and activity. Ten subjects with chronic stroke and ten controls had blood flow through the superficial femoral artery quantified with ultrasonography before and immediately after 10 second contractions of the knee extensor muscles at 20, 40, 60, and …

Spinal And Supraspinal Motor Control Predictors Of Rate Of Torque Development, S. T. Johnson, Kristof Kipp, M. F. Norcross, M. A. Hoffman

Exercise Science Faculty Research and Publications

During explosive movements and potentially injurious situations, the ability to rapidly generate torque is critical. Previous research has suggested that different phases of rate of torque development (RTD) are differentiately controlled. However, the extent to which supraspinal and spinal mechanisms predict RTD at different time intervals is unknown. RTD of the plantarflexors across various phases of contraction (i.e., 0–25, 0–50, 0–100, 0–150, 0–200, and 0–250 ms) was measured in 37 participants. The following predictor variables were also measured: (a) gain of the resting soleus H-reflex recruitment curve; (b) gain of the resting homonymous post-activation depression recruitment curve; (c) gain of …

Age And Sex Differences In Steadiness Of Elbow Flexor Muscles With Imposed Cognitive Demand, Hugo M. Pereira, Vincent C. Spears, Bonnie Schlinder-Delap, Tejin Yoon, Kristy A. Nielson, Sandra K. Hunter

Exercise Science Faculty Research and Publications

Purpose: These studies determined (1) age and sex-related differences in steadiness of isometric contractions when high cognitive demand was imposed across a range of forces with the elbow flexor muscles (study 1) and, (2) sex differences in steadiness among older adults when low cognitive demand was imposed (study 2).

Methods: 36 young adults (18–25 years; 18 women) and 30 older adults (60–82 years; 17 women) performed isometric contractions at 5%, 30% and 40% of maximum voluntary contraction (MVC). Study 1 involved a high-cognitive demand session (serial subtractions by 13 during the contraction) and a control session …

Stroke-Related Effects On Maximal Dynamic Hip Flexor Fatigability And Functional Implications, Henry Kuhnen, Megan M. Rybar, Tanya Onushko, Ryan E. Doyel, Sandra K. Hunter, Brian D. Schmit, Allison S. Hyngstrom

Exercise Science Faculty Research and Publications

Introduction: Stroke-related changes in maximal dynamic hip flexor muscle fatigability may be more relevant functionally than isometric hip flexor fatigability. Methods: Ten chronic stroke survivors performed 5 sets of 30 hip flexion maximal dynamic voluntary contractions (MDVC). A maximal isometric voluntary contraction (MIVC) was performed before and after completion of the dynamic contractions. Both the paretic and nonparetic legs were tested. Results: Reduction in hip flexion MDVC torque in the paretic leg (44.7%) was larger than the nonparetic leg (31.7%). The paretic leg had a larger reduction in rectus femoris EMG (28.9%) between the first and last …

Use Of Audio Biofeedback To Reduce Tibial Impact Accelerations During Running, Claire M. Wood, Kristof Kipp

Exercise Science Faculty Research and Publications

Visual biofeedback of tibial peak positive acceleration (PPA) during running has been used successfully as a method of gait retraining to reduce PPAs. Audio biofeedback generated from PPA may present a novel, portable alternative. The purpose of this study was to investigate the feasibility of using PPA-generated audio biofeedback to reduce PPAs while running. Nine runners were fitted with a wireless accelerometer on their left tibia. PPAs were recorded and a custom LabVIEW program was used to emit a single beep once the PPA reached a preset threshold. The numerical difference between this threshold and peak PPA during running was …

Sex Differences In Human Fatigability: Mechanisms And Insight To Physiological Responses, Sandra K. Hunter

Exercise Science Faculty Research and Publications

Sex-related differences in physiology and anatomy are responsible for profound differences in neuromuscular performance and fatigability between men and women. Women are usually less fatigable than men for similar intensity isometric fatiguing contractions. This sex difference in fatigability, however, is task specific because different neuromuscular sites will be stressed when the requirements of the task are altered, and the stress on these sites can differ for men and women. Task variables that can alter the sex difference in fatigability include the type, intensity and speed of contraction, the muscle group assessed and the environmental conditions. Physiological mechanisms that are responsible …

The Stroke-Related Effects Of Hip Flexion Fatigue On Over Ground Walking, Megan M. Rybar, Eric R. Walker, Henry Kuhnen, Daniel R. Ouellette, Reivian Berrios, Sandra K. Hunter, Allison S. Hyngstrom

Exercise Science Faculty Research and Publications

Individuals post stroke often rely more on hip flexors for limb advancement during walking due to distal weakness but the effects of muscle fatigue in this group is not known. The purpose of this study was to quantify how stroke affects the influence of hip flexor fatigue on over ground walking kinematics and performance and muscle activation. Ten individuals with chronic stroke and 10 without stroke (controls) participated in the study. Maximal walking speed, walking distance, muscle electromyograms (EMG), and lower extremity joint kinematics were compared before and after dynamic, submaximal fatiguing contractions of the hip flexors (30% maximal load) …

Fatigue And Recovery From Dynamic Contractions In Men And Women Differ For Arm And Leg Muscles, Jonathon Senefeld, Tejin Yoon, Marie K. Hoeger Bement, Sandra K. Hunter

Exercise Science Faculty Research and Publications

Introduction: Whether there is a gender difference in fatigue and recovery from maximal velocity fatiguing contractions and across muscles is not understood. Methods: Sixteen men and 19 women performed 90 isotonic contractions at maximal voluntary shortening velocity (maximal velocity concentric contractions, MVCC) with the elbow flexor and knee extensor muscles (separate days) at a load equivalent to 20% maximal voluntary isometric contraction (MVIC). Results: Power (from MVCCs) decreased similarly for men and women for both muscles (P > 0.05). Men and women had similar declines in MVIC of elbow flexors, but men had greater reductions in knee extensor MVIC force and …

Fatigability And Recovery Of Arm Muscles With Advanced Age For Dynamic And Isometric Contractions, Tejin Yoon, Bonnie Schlinder-Delap, Sandra K. Hunter

Exercise Science Faculty Research and Publications

This study determined whether age-related mechanisms can increase fatigue of arm muscles during maximal velocity dynamic contractions, as it occurs in the lower limb. We compared elbow flexor fatigue of young (n = 10, 20.8 ± 2.7 years) and old men (n = 16, 73.8 ± 6.1 years) during and in recovery from a dynamic and an isometric postural fatiguing task. Each task was maintained until failure while supporting a load equivalent to 20% of maximal voluntary isometric contraction (MVIC) torque. Transcranial magnetic stimulation (TMS) was used to assess supraspinal fatigue (superimposed twitch, SIT) and muscle relaxation. Time …