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Psychophysiology of Spaceflight and Aviation

In space, the absence of gravity alone causes unique physiological stress. Significant biomedical changes, across multiple organ systems, such as body fluid redistribution, diminished musculoskeletal strength, changes in cardiac function and sensorimotor control have been reported. The time course of development of these disorders and severity of symptoms experienced by individuals varies widely. Space motion sickness (SMS) is an example of maladaptation to microgravity, which occurs early in the mission and can have profound effects on physical health and crew performance. Disturbances in sleep quality, perception, emotional equilibrium and mood have also been reported, with impact to health and performance varying widely across individuals. And lastly, post-flight orthostatic intolerance, low blood pressure experienced after returning to Earth, is also of serious concern. Both the Russian and American space programs have a varied list of human errors and mistakes, which adversely impacted mission goals. Continued probability of human exposure to microgravity for extended time periods provides a rationale for the study of the effects of stress. The primary focus of this research group is directed toward examining individual differences in: (a) prediction of susceptibility to these disorders, (b) assessment of symptom severity, (c) evaluation of the effectiveness of countermeasures, and (d) developing and testing a physiological training method, Autogenic-Feedback Training Exercise (AFTE) as a countermeasure with multiple applications. The present paper reports on the results of a series of human flight experiments with AFTE aboard the Space Shuttle and Mir Space Station, and during emergency flight scenarios on Earth.

Cowings, Patricia↗

Countermeasures for Maintenance of Cardiovascular and Muscle Function in Space Flight

In this session, Session FA2, the discussion focuses on the following topics: Effects of Repeated Long Duration +2Gz Load on Man's Cardiovascular Function; Certain Approaches to the Development of On-Board Automated Training System; Cardiac, Arterial, and Venous Adaptation to Og during 6 Month MIR-Spaceflights with and without "Thigh Cuffs" (93-95); Space Cycle(TM) Induced Physiologic Responses; Muscular Deconditioning During Long-term Spaceflight Exercise Recommendations to Optimize Crew Performance; Structure And Function of Knee Extensors After Long-Duration Spaceflight in Man, Effects of Countermeasure Exercise Training; Force and power characteristics of an exercise ergometer designed for use in space; and The simulating of overgravity conditions for astronauts' motor apparatus at the conditions of the training for orbital flights.

Source record↗

An Integrated Musculoskeletal Countermeasure Battery for Long-Duration Lunar Missions

During extended periods of skeletal unloading, losses in strength and density of the proximal femur will occur. In long-duration spaceflight, resistive exercise is used to replace the normal loads exerted on the spine and hip. At the present time, there is no conclusive evidence that hip bone loss has been prevented in this scenario. Our group has recently developed and clinically evaluated a multifunctional exercise system, the Combined Countermeasure Device (CCD). The CCD comprises a low-footprint Stuart Platform for lower-body resistance exercise and balance training, and a cardiovascular exercise bicycle. A consideration for resistance exercise was targeting of the hip abductor and adductor muscles, which attach directly at the hip and which should subject it to the largest loads. In our training study, we found that CCD exercise increased hip adductor and abductor strength, and modeling results suggest that this exercise exerts forces on the hip of approx. 4-6 body weights at 1g, compared to forces of approx.2.5 body weight y squatting exercise. In our current study, we hypothesize that abductor and adductor exercise will increase the density and strength of the proximal femur.

Lang, T. F.↗

Risk Assessment and Control through Countermeasure System Iplementation for Long-term Crew Exposure to Microgravity

Experience with the International Space Station (ISS) program demonstrates the degree to which engineering design and operational solutions must protect crewmembers from health risks due to long-term exposure to the microgravity environment. Risks to safety and health due to degradation in the microgravity environment include crew inability to complete emergency or nominal activities, increased risk of injury, and inability to complete safe return to the ground due to reduced strength or embrittled bones. These risks without controls slowly increase in probability for the length of the mission and become more significant for increasing mission durations. Countermeasures to microgravity include hardware systems that place a crewmember s body under elevated stress to produce an effect similar to daily exposure to gravity. The ISS countermeasure system is predominately composed of customized exercise machines. Historical treatment of microgravity countermeasure systems as medical research experiments unintentionally reduced the foreseen importance and therefore the capability of the systems to function in a long-term operational role. Long-term hazardous effects and steadily increasing operational risks due to non-functional countermeasure equipment require a more rigorous design approach and incorporation of redundancy into seemingly non- mission-critical hardware systems. Variations in the rate of health degradation and responsiveness to countermeasures among the crew population drastically increase the challenge for design requirements development and verification of the appropriate risk control strategy. The long-term nature of the hazards and severe limits on logistical re-supply mass, volume and frequency complicates assessment of hardware availability and verification of an adequate maintenance and sparing plan. Design achievement of medically defined performance requirements by microgravity countermeasure systems and incorporation of adequate failure tolerance significantly reduces these risks. Future implementation of on-site monitoring hardware for critical health parameters such as bone mineral density would allow greater responsiveness, efficiency, and optimized design of the countermeasures system.

Gernand, Jeremy M.↗

Methodologies to determine forces on bones and muscles of body segments during exercise, employing compact sensors suitable for use in crowded space vehicles

Work under this grant was carried out by the author and by a graduate research assistant. An instrumented bicycle ergometer was implemented focusing on the stated objective: to estimate the forces exerted by each muscle of the feet, calf, and thigh of an individual while bicycling. The sensors used were light and compact. These were probes to measure muscle EMG activity, miniature accelerometers, miniature load sensors, and small encoders to measure angular positions of the pedal. A methodology was developed and implemented to completely describe the kinematics of the limbs using data from the sensors. This work has been published as a Master's Thesis by the Graduate student supported by the grant. The instrumented ergometer along with the sensors and instrumentation were tested during a KC-135 Zero-Gravity flight in July, 1994. A complete description of the system and the tests performed have been published as a report submitted to NASA Johnson Space Center. The data collected during the KC-135 flight is currently being processed so that a kinematic description of the bicycling experiment will be soon determined. A methodology to estimate the muscle forces has been formulated based on previous work. The methodology involves the use of optimization concepts so that the individual muscle forces that represent variables in dynamic equations of motion may be estimated. Optimization of a criteria (goal) function such as minimization of energy will be used along with constraint equations defined by rigid body equations of motion. Use of optimization principles is necessary, because the equations of motion alone constitute an indeterminate system of equations with respect to the large amount of muscle forces which constitute the variables in these equations. The number of variables is reduced somewhat by using forces measured by the load cells installed on the pedal. These load cells measure pressure and shear forces on the foot. The author and his collaborators at NASA and at the University of Alabama, Tuscaloosa, are continuing the work of reducing the experimental data from the KC-135 flight, and the implementation of the optimization methods to estimate muscle forces. As soon as results from these efforts are available, they will be published in reputable journals. Results of this work will impact studies addressing bone density loss and development of countermeasures to minimize bone loss in zero gravity conditions. By analyzing muscle forces on Earth and in Space during exercise, scientists could eventually formulate new exercises and machines to help maintain bone density. On Earth, this work will impact studies concerning arthritis, and will provide the means to study possible exercise countermeasures to minimize arthritis problems.

Figueroa, Fernando↗

Bone Metabolism on ISS Missions

Spaceflight-induced bone loss is associated with increased bone resorption (1, 2), and either unchanged or decreased rates of bone formation. Resistive exercise had been proposed as a countermeasure, and data from bed rest supported this concept (3). An interim resistive exercise device (iRED) was flown for early ISS crews. Unfortunately, the iRED provided no greater bone protection than on missions where only aerobic and muscular endurance exercises were available (4, 5). In 2008, the Advanced Resistive Exercise Device (ARED), a more robust device with much greater resistance capability, (6, 7) was launched to the ISS. Astronauts who had access to ARED, coupled with adequate energy intake and vitamin D status, returned from ISS missions with bone mineral densities virtually unchanged from preflight (7). Bone biochemical markers showed that while the resistive exercise and adequate energy consumption did not mitigate the increased bone resorption, bone formation was increased (7, 8). The typical drop in circulating parathyroid hormone did not occur in ARED crewmembers. In 2014, an updated look at the densitometry data was published. This study confirmed the initial findings with a much larger set of data. In 42 astronauts (33 male, 9 female), the bone mineral density response to flight was the same for men and women (9), and those with access to the ARED did not have the typical decrease in bone mineral density that was observed in early ISS crewmembers with access to the iRED (Figure 1) (7). Biochemical markers of bone formation and resorption responded similarly in men and women. These data are encouraging, and represent the first in-flight evidence in the history of human space flight that diet and exercise can maintain bone mineral density on long-duration missions. However, the maintenance of bone mineral density through bone remodeling, that is, increases in both resorption and formation, may yield a bone with strength characteristics different from those that existed before space flight. Studies to assess bone strength after flight are underway at NASA, to better understand the results of bone remodeling. Studies are also underway to evaluate optimized exercise protocols and nutritional countermeasures. Regardless, there is clear evidence of progress being made to protect bone during spaceflight.

Smith, S. M.↗

Integrated Resistance and Aerobic Training Study - Sprint

Space flight causes reductions in fitness/health: (1) Cardiovascular -- reduced VO2max, cardiac output (2) Bone -- reduced bone mineral density (3) Muscle -- reduced mass, strength and endurance. Exercise is the primary countermeasure to protect against these changes and was made operational before completely mature. Research continues to identify most effective/efficient exercise programs. Crew medical tests (cardio, muscle, bone) do not yield sufficient information to fine tune the effectiveness of exercise programs, thus there is a need for more detailed testing aimed at identifying the most effective training program. The objective of this program was to obtain detailed information about crew physical fitness pre-and post-flight and evaluate new evidence based exercise prescription with higher intensity, lower duration and frequency.

Ploutz-Snyder, Lori↗

Exercise-training protocols for astronauts in microgravity

Based on physical working requirements for astronauts during intra- and extravehicular activity and on the findings from bed-rest studies that utilized exercise training as a countermeasure for the reduction of aerobic power, deterioration of muscular strength and endurance, decrements in mood and cognitive performance, and possibly for bone loss, two exercise protocols are proposed. One assumes that, during microgravity, astronaut exercise physiological functions should be maintained at 100 percent of ground-based levels. The other assumes that maximal aerobic power in flight can be reduced by 10 percent of the ground-based level.

Greenleaf, J. E.↗

Temporal Changes in Astronauts’ Muscle and Cardiorespiratory Physiology Pre-, In-, and Post-Spaceflight

NASA’s vision for future exploration missions depends on the ability to protect astronauts’ health and safety for performance of Extravehicular Activity (EVA), and to allow astronauts to safely egress from vehicles in a variety of landing scenarios (e.g. water landing upon return to Earth and undefined planetary/lunar landings). Prolonged exposure to spaceflight results in diminished tolerance to prolonged physical activity, decreased cardiac and sensorimotor function, and loss of bone mineral density, muscle mass, and muscle strength. For over 50 years exercise has been the primary countermeasure against these physiologic decrements during spaceflight, and while the resulting protection is adequate for ISS missions (i.e., Soyuz landing, microgravity EVAs), there is little information regarding time-course changes in muscle and aerobic performance. As spaceflight progresses towards longer exploration missions and vehicles with less robust exercise capabilities compared to ISS, countermeasures will need to be combined and optimized to protect crew health and performance across all organ systems over the course of exploration missions up to 3 years in duration. This will require a more detailed understanding of the dynamic effects of spaceflight on human performance. Thus, the focus of this study is quantifying decrements in physical performance over different mission durations, and to provide detailed information on the physiological rational for “why” and “when” observed changes in performance occur. The research proposed will temporally profile changes in astronauts’ cardiorespiratory fitness, muscle mass, strength, and endurance over spaceflight missions of 2 months, 6 months, and up to 1 year in duration. Additionally, an extrapolation model will provide predictions for changes associated with exploration missions 2-3 years in duration. To accomplish these objectives astronauts will be asked to participate in pre, in, post-flight measurement of muscle performance, muscle size, cardiorespiratory fitness and submaximal performance capabilities, as well as non-invasive assessment of cerebral and muscle oxygenation and perfusion (Table 1). Additionally, ambulatory and in-flight exercise, nutrition, and sleep will be monitored using a variety of commercial technologies and in-flight assessment tools. Significance: Our detailed testing protocol will provide valuable information for describing how and when spaceflight-induced muscle and aerobic based adaptations occur over the course of spaceflight missions up to and beyond 1 year. This information will be vital in the assessment as to whether humans can be physically ready for deep space exploration such as Mars missions with current technology, or if additional mitigation strategies are necessary.

Downs, M. E.↗

Physiological Adaptations and Countermeasures Associated with Long-Duration Space Flights

On earth, the presence of gravity imposes weight-bearing gradients on tissues which influence the functions of multiple integrative systems. On the other hand, conditions of actual or simulated microgravity can modify and/or nullify these gradients and subsequently alter structure and function. The purpose of this symposium is to discuss the results from short-term Shuttle flights, long term Skylab or Mir missions, or long-term ground based experiments which indicate or suggest that performance has been or could be compromised in space missions of long durations (>one year) or with space tasks (e.g. building space stations) with the goal of identifying countermeasures that could minimize or eliminate the expected anatomical and physiological consequences. After an overview by C. Tipton from the U. Arizona, the countermeasures necessary for the fluid shifts and select functions of the cardiovascular system will be discussed by A. Hargens from NASA Ames Research Center. He will be followed by K. Baldwin of the U. California at Irvine who will discuss the countermeasures needed to prevent the changes that alter the structure, function and control of skeletal muscles. Since changes in bone mass with microgravity are a major concern of NASA, V. Schneider from NASA Headquarters will present data and the countermeasures for bone. Although the results are limited, the changes in the endocrine and immune system deserve mentioning and C. Tipton will assume this responsibility. V. Convertino from the Air Force School of Aerospace Medicine has the challenge of discussing the role, importance, and the specificity of exercise as an effective countermeasure while I. Kozlovskaya from Moscow will elaborate on the Russian experiences with past countermeasures and provide a viewpoint on future ones. After the brief (25 min.) presentations, the speakers will assemble as a panel to discuss the issues raised and the concerns of the audience.

Tipton, C. M.↗

Human Physiological Responses to Cycle Ergometer Leg Exercise During +Gz Acceleration

Spaceflight and bed-rest deconditioning decrease maximal oxygen uptake (aerobic power), strength, endurance capacity, and orthostatic tolerance. In addition to extensive use of muscular exercise conditioning as a countermeasure for the reduction in aerobic power (VO(sub 2max)), stimuli from some form of +Gz acceleration conditioning may be necessary to attenuate the orthostatic intolerance component of this deconditioning. Hypothesis: There will be no significant difference in the physiological responses (oxygen uptake, heart rate, ventilation, or respiratory exchange ratio) during supine exercise with moderate +Gz acceleration.

Chou, J. L.↗

Jumping in simulated and true microgravity: response to maximal efforts with three landing types

BACKGROUND: Exercise is a promising countermeasure to the physiological deconditioning experienced in microgravity, but has not proven effective in eliminating the ongoing loss of bone mineral, most likely due to the lack of high-impact forces and loading rates during in-flight activity. We wanted to determine lower-extremity response to high-impact jumping exercises in true and simulated microgravity and establish if 1-G force magnitudes can be achieved in a weightless environment. METHODS: Jumping experiments were performed in a ground-based zero-gravity simulator (ZGS) in 1 G, and during parabolic flight with a gravity-replacement system. There were 12 subjects who participated in the study, with 4 subjects common to both conditions. Force, loading rates, jump height, and kinematics were analyzed during jumps with three distinct landings: two-footed toe-heel, one-footed toe-heel, and flat-footed. Gravity replacement loads of 45%, 60%, 75%, and 100% bodyweight were used in the ZGS; because of time constraints, these loads were limited to 60% and 75% bodyweight in parabolic flight. RESULTS: Average peak ground-reaction forces during landing ranged between 1902+/-607 and 2631+/-663 N in the ZGS and between 1683+/-807 and 2683+/-1174 N in the KC-135. No significant differences were found between the simulated and true microgravity conditions, but neither condition achieved the magnitudes found in 1 G. CONCLUSION: Data support the hypothesis that jumping exercises can impart high-impact forces during weightlessness and that the custom-designed ZGS will replicate what is experienced in true microgravity.

short duration↗

Parabolic Flight Investigation for Advanced Exercise Concept Hardware Hybrid Ultimate Lifting Kit (HULK)

Long-duration space flight poses many hazards to the health of the crew. Among those hazards is the physiological deconditioning of the musculoskeletal and cardiovascular systems due to prolonged exposure to microgravity. To combat this erosion of physical condition space flight may take on the crew, the Human Research Program (HRP) is charged with developing Advanced Exercise Concepts to maintain astronaut health and fitness during long-term missions, while keeping device mass, power, and volume to a minimum. The goal of this effort is to preserve the physical capability of the crew to perform mission critical tasks in transit and during planetary surface operations. The HULK is a pneumatic-based exercise system, which provides both resistive and aerobic modes to protect against human deconditioning in microgravity. Its design targeted the International Space Station (ISS) Advanced Resistive Exercise Device (ARED) high level performance characteristics and provides up to 600 foot pounds resitive loading with the capability to allow for eccentric to concentric (E:C) ratios of higher than 1:1 through a DC motor assist component. The device's rowing mode allows for high cadence aerobic activity. The HULK parabolic flight campaign, conducted through the NASA Flight Opportunities Program at Ellington Field, resulted in the creation of device specific data sets including low fidelity motion capture, accelerometry and both inline and ground reaction forces. These data provide a critical link in understanding how to vibration isolate the device in both ISS and space transit applications. Secondarily, the study of human exercise and associated body kinematics in microgravity allows for more complete understanding of human to machine interface designs to allow for maximum functionality of the device in microgravity.

countermeasures↗

Increased Treadmill Running and Lower-Body Resistance Training Intensity May Attenuate Aerobic Capacity Loss During Spaceflight

BACKGROUND: In-flight exercise training is the primary countermeasure to mitigate spaceflight-induced decrements in strength and aerobic capacity. Despite high-quality exercise capabilities and prescriptions aboard the International Space Station (ISS), most astronauts experience strength and aerobic capacity loss; however, significant individual variability exists. Recent findings suggest that greater in-flight running (i.e., distance per session) and lower-body resistance exercise intensity (i.e., load relative to body weight) help preserve strength. Whether similar variables contribute to the preservation of aerobic capacity during spaceflight is unknown. METHODS: A NASA database of exercise performance metrics was used to identify long-duration (≥ 90 days) ISS crew who completed pre- and post-flight aerobic capacity testing (VO2peak, cycle ergometry, n = 44). “Responders” (R) were classified as those that maintained or improved VO2peak (n = 13; 1.4 ± 3.3%), and “non-responders” (NR) were those with the most severe decrements (n = 13; -20.0 ± 3.4%) from pre- to post-flight. In-flight exercise records (cycling, treadmill, resistance exercise) were aggregated across flight weeks. Independent t-tests or Mann-Whitney U tests were used to compare training variables (i.e., frequency, time, intensity, volume) between R and NR. RESULTS: Consistent with the variables contributing to strength protection, in-flight running distance (R: 5.0 ± 0.7; NR: 4.2 ± 1.0 km/session, p = 0.020) and lower-body resistance exercise intensity (R: 110.9 ± 27.3; NR: 91.7 ± 16.5% body weight, p = 0.040) were greater in R than NR. Active running time was also greater in R than NR (R: 101.1 ± 20.4; NR: 82.3 ± 23.5 min/wk; p = 0.039). However, no group differences in cycling frequency, intensity, or time, as well as upper body or core resistance exercise intensity, volume, or frequency were observed. CONCLUSIONS: Although physiologically distinct stimuli, the exercise training variables contributing to the preservation of both strength and aerobic capacity during microgravity exposure appear to be consistent. Increased running time and distance, but not cycling, combined with higher-intensity lower-body resistance exercise, may help mitigate losses in both aerobic capacity and strength during long-duration spaceflight.

Alyssa N Varanoske↗

Workshop on Exercise Prescription for Long-Duration Space Flight

The National Aeronautics and Space Administration has a dedicated history of ensuring human safety and productivity in flight. Working and living in space long term represents the challenge of the future. Our concern is in determining the effects on the human body of living in space. Space flight provides a powerful stimulus for adaptation, such as cardiovascular and musculoskeletal deconditioning. Extended-duration space flight will influence a great many systems in the human body. We must understand the process by which this adaptation occurs. The NASA is agressively involved in developing programs which will act as a foundation for this new field of space medicine. The hallmark of these programs deals with prevention of deconditioning, currently referred to as countermeasures to zero g. Exercise appears to be most effective in preventing the cardiovascular and musculoskeletal degradation of microgravity.

Harris, Bernard A., Jr.↗

Standing Without Gravity: the Use of Lower Body Negative Pressure for Research and Reconditioning in Spaceflight

Weightlessness during spaceflight causes cephalad redistribution of intravascular and extravascular fluid, provoking cardiovascular and autonomic nervous system adaptations. The resulting functional state is appropriate for weightlessness but can result in orthostatic hypotension and intolerance during and after return to a persistent acceleration or gravitational environment. Lower body negative pressure (LBNP) applies subambient air pressure to the legs and lower abdomen inside a volume sealed at the waist, and decompression by 40‐50 mmHg reverses the spaceflight‐induced cephalad shift. LBNP has been used both to test the state of cardiovascular system during spaceflight and as a countermeasure by all space‐faring nations. Two configurations have thus far been used in spaceflight since the first LBNP flew on the first Soviet Salyut station in 1971. The Soviet and Russian configuration, used in four Salyut stations, the Mir space station and the Russian segment of the International Space Station, has no saddle to support the body so during decompression the feet press against the bottom of the collapsible chamber which shortens and applies force against the feet proportional to the decompression level. Thus, activation of the skeletal musculature partially counteracts vascular and venous pooling in the enclosed body segments, stimulating the orthostatic compensatory mechanisms as they would be standing on Earth. In the American configuration, used aboard Skylab and the Space Shuttle, a saddle supported the astronaut so the feet did not contact the bottom of the chamber, and vascular engorgement was not countered by muscular contraction. This minimized skeletal muscle involvement, unmasked vascular compensatory mechanisms for research purposes, and allowed measurements of changes in leg volume and muscle sympathetic nerve activity. Both variants have demonstrated research and therapeutic value in appropriately designed protocols. LBNP continues to be used for research and countermeasures on ISS, and future versions may explore the value of exercise during LBNP as an integrated countermeasure. This paperwill review the history and development of LBNP for spaceflight research and therapeutic purposes.

Charles, John B.↗

Psychophysiology in microgravity and the role of exercise

The Space Transportation-Shuttle (STS) Program has greatly expanded our capabilities in space by allowing for missions to be flown more frequently, less expensively, and to encompass a greater range of goals than ever before. However, the scope of the United State's role and involvement in space is currently at the edge of a new and exciting era. The National Aeronautics and Space Administration (NASA) has plans for placing an orbiting space station (Space Station Freedom) into operation before the year 2000. Space Station Freedom promises to redefine the extent of our involvement in space even further than the STS program. Space Station crewmembers will be expected to spend extended periods of time (approximately 30 to 180 days) in space exposed to an extremely diverse and adverse environment (e.g., the major adversity being the chronic microgravity condition). Consequently, the detrimental effects of exposure to the microgravity environment is of primary importance to the biomedical community responsible for the health and well-being of the crewmembers. Space flight and microgravity exposure present a unique set of stressors for the crewmember; weightlessness, danger, isolation/confinement, irregular work-rest cycles, separation from family/friends, and mission/ground crew interrelationships. A great deal is beginning to be known about the physiological changes associated with microgravity exposure, however, limited objective psychological findings exist. Examination of this latter area will become of critical concern as NASA prepares to place crewmembers on the longer space missions that will be required on Space Station Freedom. Psychological factors, such as interpersonal relations will become increasingly important issues, especially as crews become more heterogeneous in the way of experience, professional background, and assigned duties. In an attempt to minimize the detrimental physiological effects of prolonged space flight and microgravity exposure, the United States and Russian space agencies have taken steps to implement various countermeasure programs. One of the principle countermeasures used by both nations is exercise during space flight. The purpose is to present a brief overview of the major research findings examining the psychophysiological changes associated with microgravity exposure, and to address the potential role of exercise as a countermeasure in affecting these psychophysiological changes.

Shaw, J. M.↗

Cardiovascular responses during orthostasis - Effect of an increase in maximal O2 uptake

A study is described which tests the hypothesis that changes in aerobic activity (increases in maximum oxygen uptake) will reduce the effectiveness of cardiovascular reflexes to regulate blood pressure during orthostasis. The hypothesis was tested by measuring heart rate, blood pressure and blood volume responses in eight healthy male subjects before and after an eight-day endurance regimen. The results of the study suggest that the physiologic responses to orthostasis are dependent upon the rate of plasma volume loss and pooling, and are associated with training-induced hypervolemia. It is indicated that endurance type exercise training enhances cardiovascular adjustments during tilt. The implications of these results for the use of exercise training as a countermeasure and/or therapeutic method for the prevention of cardiovascular instability during orthostatic stress are discussed.

Convertino, V. A.↗