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NASA NTRS2025

Astronaut Physiological Deconditioning and Exercise Prescription Countermeasures in Spaceflight

The human skeletal muscular and cardiovascular systems are adapted to the upright posture of Earth’s gravitational environment. Astronauts experience an altered gravity environment in spaceflight that leads to a number of physiological changes and decrements to these systems that can decrease overall crew performance. Countermeasures, including prescribed exercise during spaceflight, is vital for astronauts to maintain optimal health and performance. The degree of physiological deconditioning is dependent on a multitude of factors such as sex, age, mission duration, fitness level, and gravity environments experienced. Deconditioning begins immediately upon entering an altered gravity environment and physiological decrements of the skeletal muscular and cardiovascular systems are measurable among astronauts within a few days. Thus, to maintain their physical fitness, ability to perform mission duties, and be able to egress vehicles when needed, it is imperative that astronauts participate in exercise during all phases of flight. This is especially important for long duration flights where deconditioning effects can be more deleterious. The NASA Office of the Chief Health and Medical Officer 3001 Standards Team develops requirements utilized by commercial and international partners to better understand spaceflight-induced physiological changes and countermeasures and expected outcomes with or without exercise.

exercise physiology↗
NASA NTRS2016

Biomechanical Modeling of the Deadlift Exercise to Improve the Efficacy of Resistive Exercise Microgravity Countermeasures

During long-duration spaceflight missions, astronauts exposure to microgravity without adequate countermeasures can result in losses of muscular strength and endurance, as well as loss of bone mass. As a countermeasure to this challenge, astronauts engage in resistive exercise during spaceflight to maintain their musculoskeletal function. The Hybrid Ultimate Lifting Kit (HULK) has been designed as a prototype exercise device for an exploration-class vehicle; the HULK features a much smaller footprint than previous devices such as the Advanced Resistive Exercise Device (ARED) on the International Space Station (ISS), which makes the HULK suitable for extended spaceflight missions in vehicles with limited volume. As current ISS exercise countermeasure equipment represents an improvement over previous generations of such devices, the ARED is being employed as a benchmark of functional performance. This project involves the development of a biomechanical model of the deadlift exercise, and is novel in that it is the first exercise analyzed in this context to include the upper limbs in the loading path, in contrast to the squat, single-leg squat, and heel raise exercises also being modeled by our team. OpenSim software is employed to develop these biomechanical models of humans performing resistive exercises to assess and improve the new exercise device designs. Analyses include determining differences in joint and muscle forces when using different loading strategies with the device, comparing and contrasting with the ARED benchmark, and determining whether the loading is sufficient to maintain musculoskeletal health. During data collection, the number of repetitions, load, cadence, stance, and grip width are controlled in order to facilitate comparisons between loading configurations. To date, data have been collected for two human subjects performing the deadlift exercise on the HULK device using two different loading conditions. Recorded data include motion capture, electromyography (EMG), ground reaction forces, device load cell data, photos and videos, and anthropometric data. Work is ongoing to perform biomechanical analyses including inverse kinematics and inverse dynamics to compare different versions of the deadlift model in order to determine which provides an appropriate level of detail to study this exercise. This work is supported by the National Space Biomedical Research Institute through NCC 9-58.

physical exercise↗
NASA NTRS2007

Myotonometry as a Surrogate Measure of Muscle Strength

Space flight-induced muscle atrophy/neuromuscular degradation and the consequent decrements in crew-member performance are of increasing concern as mission duration lengthens, and planetary exploration after extended space flight is planned. Pre- to post-flight strength measures have demonstrated that specific countermeasures, such as resistive exercise, are effective at countering microgravity-induced muscle atrophy and preventing decrements in muscle strength. However, in-flight assessment/monitoring of exercise countermeasure effectiveness will be essential during exploration class missions due to their duration. The ability to modify an exercise countermeasure prescription based on such real-time information will allow each individual crew member to perform the optimal amount and type of exercise countermeasure to maintain performance. In addition, such measures can be used to determine if a crew member is physically capable of performing a particular mission-related task during exploration class missions. The challenges faced in acquiring such data are those common to all space operations, namely the requirement for light-weight, low power, mechanically reliable technologies that make valid measurements in microgravity, in this case of muscle strength/neuromuscular function. Here we describe a simple, light-weight, low power, non-invasive device, known as the Myotonometer, that measures tissue stiffness as an indirect measure of muscle contractile state and muscle force production. Repeat myotonometer measurements made at the same location on the surface of the rectis femoris muscle (as determined using a 3D locator device, SEM plus or minus 0.34 mm) were shown to be reproducible over time at both maximal voluntary contraction (MVC) and at rest in a total of 17 sedentary subjects assessed three times over a period of seven days. In addition, graded voluntary isometric force production (i.e. 20%, 40%, 60%, 80% & 100% of MVC) during knee extension was shown to be significantly (p less than 0.01) correlated with contemporaneous myotonometer measurements made on the rectis femoris muscle in a total of 16 healthy subjects (8 males, 8 females). Further-more, this device has been operationally tested during parabolic flight demonstrating its suitability for use in a microgravity environment. Our data indicates that the Myotonometer is a viable surrogate measure of muscle contractile state/tone and of muscle strength/force production. Additional studies are required to assess the suitability of this technique for assessing these measures in de-conditioned subjects such as crew-members.

Ang, B. S.↗
NASA NTRS2013

The Digital Astronaut Project Computational Bone Remodeling Model (Beta Version) Bone Summit Summary Report

Under the conditions of microgravity, astronauts lose bone mass at a rate of 1% to 2% a month, particularly in the lower extremities such as the proximal femur [1-3]. The most commonly used countermeasure against bone loss in microgravity has been prescribed exercise [4]. However, data has shown that existing exercise countermeasures are not as effective as desired for preventing bone loss in long duration, 4 to 6 months, spaceflight [1,3,5,6]. This spaceflight related bone loss may cause early onset of osteoporosis to place the astronauts at greater risk of fracture later in their lives. Consequently, NASA seeks to have improved understanding of the mechanisms of bone demineralization in microgravity in order to appropriately quantify this risk, and to establish appropriate countermeasures [7]. In this light, NASA's Digital Astronaut Project (DAP) is working with the NASA Bone Discipline Lead to implement well-validated computational models to help predict and assess bone loss during spaceflight, and enhance exercise countermeasure development. More specifically, computational modeling is proposed as a way to augment bone research and exercise countermeasure development to target weight-bearing skeletal sites that are most susceptible to bone loss in microgravity, and thus at higher risk for fracture. Given that hip fractures can be debilitating, the initial model development focused on the femoral neck. Future efforts will focus on including other key load bearing bone sites such as the greater trochanter, lower lumbar, proximal femur and calcaneus. The DAP has currently established an initial model (Beta Version) of bone loss due to skeletal unloading in femoral neck region. The model calculates changes in mineralized volume fraction of bone in this segment and relates it to changes in bone mineral density (vBMD) measured by Quantitative Computed Tomography (QCT). The model is governed by equations describing changes in bone volume fraction (BVF), and rates of changes in bone cell populations that remove and replace bone in packets within the bone region. The DAP bone model is unique in several respects. In particular in takes former models of volume fraction changes one step higher in fidelity and separates BVF into separate equations for mineralized and osteoid volume fractions governed by a mineralization rate. This more closely follows the physiology of the remodeling unit cycles where bone is first resorbed and then followed by the action of osteoblasts to lay down collagen matrix which eventually becomes mineralized. In another respect, the modules allow the functional description of the time rate of change of other parameters and variables in the model during a computational simulation. More detailed description of the model, preliminary validation results, current limitation and caveats, and planned advancements are provided in sections 2 through 5. The DAP bone model is being developed primarily as a research tool, and not as a clinical tool like QCT. Even if it transitions to a clinical tool, it is not intended to replace QCT or any other clinical tool. Moreover, the DAP bone model does not predict bone fracture. Its purpose is to provide valuable additional data via "forward prediction" simulations for during and after spaceflight missions to gain insight on, (1) mechanisms of bone demineralization in microgravity, and (2) the volumetric changes at the various bone sites in response to in-flight and post-flight exercise countermeasures. This data can then be used as input to the Keyak [8] (or equivalent) FE analysis method to gain insight on how bone strength may change during and after flight. This information can also be useful to help optimize exercise countermeasure protocols to minimize changes in bone strength during flight, and improve regain of bone strength post-flight. To achieve this goal, the bone model will be integrated with DAP's exercise countermeasure models to simulate the effect of exercise prescriptions on preserving bone. More specifically, the model will accept loading history due to muscle and joint force on bone and produce quantified remodeling within the bone region under influence of the applied stress. Furthermore, because they tend to respond differently, the bone remodeling model includes both trabecular bone and cortical bone.

Pennline, James↗
NASA NTRS2016

Biomechanical Modeling of the Deadlift Exercise on the HULK Device to Improve the Efficacy of Resistive Exercise Microgravity Countermeasures

Extended spaceflight typically results in the loss of muscular strength and bone density due to exposure to microgravity. Resistive exercise countermeasures have been developed to maintain musculoskeletal health during spaceflight. The Advanced Resistive Exercise Device (ARED) is the "gold standard" of available devices; however, its footprint and volume are too large for use in space capsules employed in exploration missions. The Hybrid Ultimate Lifting Kit (HULK) device, with its smaller footprint, is a prototype exercise device for exploration missions. This work models the deadlift exercise being performed on the HULK device using biomechanical simulation, with the long-term goal to improve and optimize astronauts' exercise prescriptions, to maximize the benefit of exercise while minimizing time and effort invested.

Countermeasures↗
NASA NTRS2015

Human Research Program Advanced Exercise Concepts (AEC) Overview

Exercise countermeasures provide benefits that are crucial for successful human spaceflight, to mitigate the spaceflight physiological deconditioning which occurs during exposure to microgravity. The NASA Human Research Program (HRP) within the Human Exploration and Operations Mission Directorate (HEOMD) is managing next generation Advanced Exercise Concepts (AEC) requirements development and candidate technology maturation to Technology Readiness Level (TRL) 7 (ground prototyping and flight demonstration) for all exploration mission profiles from Multi Purpose Crew Vehicle (MPCV) Exploration Missions (up to 21 day duration) to Mars Transit (up to 1000 day duration) missions. These validated and optimized exercise countermeasures systems will be provided to the ISS Program and MPCV Program for subsequent flight development and operations. The International Space Station (ISS) currently has three major pieces of operational exercise countermeasures hardware: the Advanced Resistive Exercise Device (ARED), the second-generation (T2) treadmill, and the cycle ergometer with vibration isolation system (CEVIS). This suite of exercise countermeasures hardware serves as a benchmark and is a vast improvement over previous generations of countermeasures hardware, providing both aerobic and resistive exercise for the crew. However, vehicle and resource constraints for future exploration missions beyond low Earth orbit will require that the exercise countermeasures hardware mass, volume, and power be minimized, while preserving the current ISS capabilities or even enhancing these exercise capabilities directed at mission specific physiological functional performance and medical standards requirements. Further, mission-specific considerations such as preservation of sensorimotor function, autonomous and adaptable operation, integration with medical data systems, rehabilitation, and in-flight monitoring and feedback are being developed for integration with the exercise countermeasures systems. Numerous technologies have been considered and evaluated against HRP-approved functional device requirements for these extreme mission profiles, and include wearable sensors, exoskeletons, flywheel, pneumatic, and closed-loop microprocessor controlled motor driven systems. Each technology has unique advantages and disadvantages. The Advanced Exercise Concepts project oversees development of candidate next generation exercise countermeasures hardware, performs trade studies of current and state of the art exercise technologies, manages and supports candidate systems physiological evaluations with human test subjects on the ground, in flight analogs and flight. The near term goal is evaluation of candidate systems in flight, culminating in an integrated candidate next generation exercise countermeasures suite on the ISS which coalesces research findings from HRP disciplines in the areas of exercise performance for muscle, bone, cardiovascular, sensorimotor, behavioral health, and nutrition for optimal benefit to the crew.

Countermeasures↗
NASA NTRS2010

Treadmill Exercise Within LBNP as an Integrated Coutermeasure to Microgravity

An integrated exercise countermeasure for microgravity is needed to protect multiple physiologic systems and save crew time. Such a countermeasure should protect orthostatic tolerance, upright ambulatory capability (including sprinting), aerobic capacity, muscle strength/endurance, and other physiologic parameters relevant to human performance. We developed a novel physiologic countermeasure, treadmill exercise within LBNP, for preventing cardiovascular and musculoskeletal deconditioning associated with prolonged bed rest and spaceflight. We evaluated 40 min of daily LBNP treadmill exercise by a battery of physiologic parameters relevant to maintaining exercise performance and health of both women and men during bed-rest (simulated microgravity) studies lasting from 5 to 60 days. For 30 day studies, we employed identical twins with one twin as the control and the other twin as the exerciser to improve comparative power. During the WISE 60-day HDT study, the treadmill exercise within LBNP was performed 3-4 days each week and resistive exercise was performed 2-3 days each week. Our treadmill within LBNP protocol maintained plasma volume and sprint speed (30 day HDT bed-rest studies of identical twins), orthostatic tolerance to a degree, upright exercise capacity, muscle strength and endurance, and some bone parameters during 30 day (twin studies) and 60 day (WISE-2005) bed-rest simulations of microgravity. When combining treadmill exercise within LBNP and resistive exercise (WISE), cardiac mass increased significantly in the exercise (EX) group during bed rest relative to controls (CON). Upright peak VO2, and knee extensor strength and endurance decreased significantly in CON subjects; but these parameters were preserved in the EX group. In the 60 day WISE study, each LBNP exercise session was followed immediately by 10 minutes of static LBNP, and the last such session occurred three days before the end of bed rest. Still, orthostatic tolerance was better maintained in the EX group than in the CON group. Therefore, these collective peer-reviewed results document that our treadmill exercise within LBNP countermeasure safely and efficiently protects multiple physiologic systems in women and men during bed-rest studies of up to 60 days. Supported by NASA grants NNJ04HF71G and NAG 9-1425, NIH grant GCRC M01 RR00827 and by WISE support from ESA, NASA, CSA, and CNES.

Lee, Stuart↗
NASA NTRS1999

Computer Aided Modeling to Determine the Effectiveness of Resistive Exercises as Countermeasures for Bone Mineral Density Loss

Due to the loss of gravitational loading, astronauts have a tendency to lose bone mineral density in their lumbar spine and lower extremities on orbit. NASA requires astronauts to perform exercises during space flight to help reduce the amount of demineralization. To test these exercises on earth, 17 week bed rest studies are conducted that consist of specific diet and exercise regimes. Developing a finite element model of these exercises will help to quantify the stress distribution imposed by of each of these exercises. To help develop this model, MRI images are acquired from individuals participating in the bed rest studies. The MRIs can be used to create a subject specific model of each individual for testing. The MRIs are processed in the Magnetic Resonance Imaging Data Transfer System program to develop a three-dimensional finite element model of the femur for evaluation. Modifications were made to the MRIDTS that simplified the model creation process. These modifications made it possible to construct two separate models of different portions of a bone simultaneously and then later connect them manually. This helped alleviate the warping problem associated with the drastic changes in geometry found in some body parts, such as the joints. The code was also modified to incorporate material properties of various bone components into the model. Interior meshing was also incorporated into the program to allow for both the cortical shell and the entire bone to be modeled. A prototype model of the right femur of an adult female is being constructed and tested to determine the feasibility of finite element analysis as a tool for evaluating exercise effectiveness. The model is being run through the ANSYS finite element program on the Alabama Super Computer Network. After the model is validated, models of bedrest subjects can be generated to investigate exercise countermeasures.

Murphy, Benjamin M.↗
NASA NTRS2012

The Metabolic Cost of a High Intensity Exercise Program During Bed Rest

Background: Given that disuse-related skeletal muscle atrophy may be exacerbated by an imbalance between energy intake and output, the amount of energy required to complete exercise countermeasures is an important consideration in the well being of subject health during bed rest and spaceflight. Objective: To evaluate the energy cost of a high intensity exercise program performed during short duration bed rest. Methods: 9 subjects (8 male and 1 female; 34.5 +/- 8.2 years) underwent 14 days of bed rest and exercise countermeasures. Exercise energy expenditure and excess post exercise oxygen consumption (EPOC) were collected once in each of 5 different exercise protocols (30 second, 2 minute and 4 minute intervals, continuous aerobic and a variety of resistance exercises) during bed rest. Body mass, basal metabolic rate (BMR), upper and lower leg muscle, subcutaneous, and intramuscular adipose tissue (IMAT) volumes were assessed before and at the end of bed rest. Results: There were no significant differences in body mass (pre: 75.1 +/- 10.5 kg; post: 75.2 +/- 10.1 kg), BMR (pre: 1649 +/- 216 kcal; post: 1657 +/- 177 kcal), muscle subcutaneous, or IMAT volumes (Table 2) after 14 days of bed rest and exercise. Body mass was maintained with an average daily intake of 2710 +/- 262 kcal (36.2 +/- 2.1 kcal/kg/day), while average daily energy expenditure was 2579 +/-311 kcal (34.5 +/- 3.6 kcal/kg/day). Exercise energy expenditure was significantly greater as a result of continuous aerobic exercise than all other exercise protocols.

Hackney, Kyle↗
NASA NTRS2017

Practical Applications of Cables and Ropes in the ISS Countermeasures System

National Aeronautics and Space Administration (NASA) uses exercise countermeasures on the International Space Station (ISS) to maintain crew health and combat the negative effects of long-duration spaceflight on the human body. Most ISS exercise countermeasures system (CMS) equipment rely heavily on the use of textile and wire ropes to transmit resistive loads and provide stability in a microgravity environment. For a variety of reasons, including challenges in simulating microgravity environments for testing and limits on time available for life cycle testing, the textiles and wire ropes have contributed significantly to on-orbit planned and unplanned maintenance time. As a result, continued ground testing and on-orbit experience since the first expedition on the ISS in 2000 provide valuable data and lessons learned in materials selection, applications, and design techniques to increase service life of these ropes. This paper will present a review of the development and failure history of textile and wire ropes for four exercise countermeasure systems-the Treadmill with Vibration Isolation and Stabilization (TVIS) System, Cycle Ergometer with Vibration Isolation and Stabilization (CEVIS) System, Interim Resistive Exercise Device (IRED), and the Advanced Resistive Exercise Device (ARED)-to identify lessons learned in order to improve future systems. These lessons learned, paired with thorough testing on the ground, offer a forward path towards reduced maintenance time and up-mass for future space missions.

Svetlik, Randall G.↗
NASA NTRS2009

An Evidence-Based Approach To Exercise Prescriptions on ISS

This presentation describes current exercise countermeasures and exercise equipment for astronauts onboard the ISS. Additionally, a strategy for evaluating evidence supporting spaceflight exercise is described and a new exercise prescription is proposed. The current exercise regimen is not fully effective as the ISS exercise hardware does not allow for sufficient exercise intensity, the exercise prescription is adequate and crew members are noncompliant with the prescription. New ISS hardware is proposed, Advanced Resistance Exercise Device (ARED), which allows additional exercises, is instrumented for data acquisition and offers improved loading. The new T2 hardware offers a better harness and subject loading system, is instrumented to allow ground reaction force data, and offers improved speed. A strategy for developing a spaceflight exercise prescription is described and involves identifying exercise training programs that have been shown to maximize adaptive benefits of people exercising in both 0 and 1 g environments. Exercise intensity emerged as an important factor in maintaining physiologic adaptations in the spaceflight environment and interval training is suggested. New ISS exercise hardware should allow for exercise at intensities high enough to elicit adaptive responses. Additionally, new exercise prescriptions should incorporate higher intensity exercises and seek to optimize intensity, duration and frequency for greater efficiency.

Ploutz-Snyder, Lori↗
NASA NTRS2006

ISS Utilization for Exploration-Class Missions

Exercise countermeasures are the most commonly utilized approach for maintaining the health and performance of astronauts during spaceflight missions. However, International Space Station (ISS) exercise countermeasure hardware reliability and prescriptions are not at a point of departure to support exploration-class missions. The JSC Exercise Countermeasures Project (ECP) plans to use ISS as a research and hardware evaluation platform to define and validate improved exercise hardware, prescriptions, and monitoring strategies to support crewmember operations on the Moon and Mars. The ECP will partner with JSC's Space Medicine Division to standardize elements of ISS exercise prescriptions to better understand their efficacy and to propose modified prescriptions for implementation that may be used in the crew exploration vehicle and/or lunar habitat. In addition, evaluations of the ISS treadmill harness will be conducted to define and improve fit and function, and assess the next generation medical monitoring devices such as the portable unit for metabolic analysis and the muscle atrophy research and exercise system for completion of periodic fitness evaluations during lunar and Mars travel. Finally, biomechanical data from ISS crew exercise sessions will be obtained to better understand loading and restraint systems, and identify the physiologic requirements during ISS extravehicular activities that may be analogous to extended excursions from the lunar habitat. It is essential to optimize exercise prescriptions, hardware, and monitoring strategies for exploration initiatives using ISS as a platform before the planned retirement of the Shuttle in 2010 and the declining NASA emphasis on ISS to maximize knowledge before embarking on travel to the Moon and Mars.

FIncke, R.↗
NASA NTRS2012

Bed Rest is an Analog to Study the Physiological Changes of Spaceflight and to Evaluate Countermeasures

The UTMB/NASA Flight Analog Research Unit is an inpatient unit with a bionutrition kitchen and unique testing areas for studying subjects subjected to 6 degree head-down complete bed rest for prolonged periods as an analog for zero gravity. Bed rest allows study of physiological changes and performance of functional tasks representative of critical interplanetary mission operations and measures of the efficacy of countermeasures designed to protect against the resulting deleterious effects. METHODS/STUDY POPULATION: Subjects are healthy adults 24-55 years old; 60 75 in tall; body mass index 18.5-30; and bone mineral density normal by DXA scan. Over 100 subjects have been studied in 7 campaigns since 2004. The iRAT countermeasure combines high intensity interval aerobic exercises on alternating days with continuous aerobic exercise. Resistance exercise is performed 3 days per week. Subjects are tested on an integrated suite of functional and interdisciplinary physiological tests before and after 70 days of total bed rest. RESULTS/ANTICIPATED RESULTS: It is anticipated that post-bed rest functional performance will be predicted by a weighted combination of sensorimotor, cardiovascular and muscle physiological factors. Control subjects who do not participate in the exercise countermeasure will have significantly greater decreases in these parameters. DISCUSSION/SIGNIFICANCE OF IMPACT: Astronauts experience alterations in multiple physiological systems due to exposure to the microgravity, leading to disruption in the ability to perform functional tasks after reintroduction to a gravitational environment. Current flight exercise countermeasures are not fully protective of cardiovascular, muscle and bone health. There is a need to refine and optimize countermeasures to mitigate health risks associated with long-term space missions.

Pfannenstiel, P.↗
NASA NTRS2006

WISE-2005 Protective Effect of Exercise within LBNP Countermeasure Detected by Heart Rate Response to Low Levels of LBNP

Sixteen women were studied before, during and after a 60 day, continu ous 6" head-down bed-rest (HDBR). Subjects were randomly assigned to two groups: Control (no countermeasures) and Exercise+LBNP (supine ru nning within an LBNP chamber for 40-min followed by 10-min passive L BNP for 3-4 days/week, plus flywheel resistive training of the legs e very third day). Cardiovascular responses were observed before bed re st, on day 50 of HDBR and R+8 after bed rest. Subjects were supine in the LBNP device with suction applied at 0, -10, -20 and -30 mmHg LBN P for 2-min per stage. In the pre-bed rest testing, there was no diff erence in HR between the groups at rest or at -30 mmHg. On HDBR day 50, HR was elevated at supine rest for the Con not the Ex group, whil e at -30 mmHg HR was elevated above pre-HDBR for both groups, but the magnitude of increase from Pre- to HDBR day 50 was less for the Ex g roup than for the Con group. The change in HR on HDBR day 50 is an im portant indicator as it was less than 24-hours after the Exercise+LBN P countermeasure on day 49. After bed rest, no specific countermeasu res were provided in the first week, so HR responses on day R+8 refle cted the effects of bed rest with or without countermeasure plus any recovery from simply returning to the upright posture. Relative to th e Pre-bed rest responses, HR on day R+8 had recovered in the Ex group but was still elevated in the Con group. These results indicate that the cardiovascular response to LBNP is preserved to a greater degre e during bed rest by the countermeasures, and further that the cardio vascular response returned to pre-bed rest much more rapidly in the E xercise+LBNP group than hi the group that received no cardiovascular countermeasures.

Hughson, R. L.↗
NASA NTRS2011

Orbital Fitness: An Overview of Space Shuttle Cardiopulmonary Exercise Physiology Findings

Limited observations regarding the cardiopulmonary responses to aerobic exercise had been conducted during short-duration spaceflight before the Space Shuttle program. This presentation focuses on the findings regarding changes observed in the cardiopulmonary exercise responses during and following Shuttle flights. During flight, maximum oxygen uptake (VO2max) remained unchanged as did the maximum work rate achievable during cycle exercise testing conducted during the last full flight day. Immediately following flight, the ubiquitous finding, confirmed by investigations conducted during the Spacelab Life Sciences missions 1 and 2 and by NASA Detailed Supplemental Objective studies, indicated that VO2max was reduced; however, the reduction in VO2max was transient and returned to preflight levels within 7 days following return. Studies regarding the influence of aerobic exercise countermeasures performed during flight on postflight performance were mostly limited to the examination of the heart rate (HR) response to submaximal exercise testing on landing day. These studies revealed that exercise HR was elevated in individuals who performed little to no exercise during their missions as compared to individuals who performed regular exercise. In addition, astronauts who performed little to no aerobic exercise during flight demonstrated an increased HR and lowered pulse pressure response to the standard stand test on landing day, indicating a decrease in orthostatic function in these individuals. With regard to exercise modality, four devices were examined during the Shuttle era: two treadmills, a cycle ergometer, and a rowing device. Although there were limited investigations regarding the use of these devices for exercise training aboard the Shuttle, there was no clear consensus reached regarding which proved to be a "superior" device. Each device had a unique operational or physiologic limitation associated with its use. In conclusion, exercise research conducted during the Shuttle Program demonstrated that attenuation of postflight deconditioning was possible through use of exercise countermeasures and the Shuttle served as a test bed for equipment destined for use on the International Space Station. Learning Objective: Overview of the Space Shuttle Program research results related to aerobic capacity and performance, including what was learned from research and effectiveness of exercise countermeasures.

Moore, Alan D.↗
NASA NTRS2014

The Digital Astronaut Project Bone Remodeling Model

Under the conditions of microgravity, astronauts lose bone mass at a rate of 1% to 2% a month, particularly in the lower extremities such as the proximal femur: (1) The most commonly used countermeasure against bone loss has been prescribed exercise, (2) However, current exercise countermeasures do not completely eliminate bone loss in long duration, 4 to 6 months, spaceflight, (3,4) leaving the astronaut susceptible to early onset osteoporosis and a greater risk of fracture later in their lives. The introduction of the Advanced Resistive Exercise Device, coupled with improved nutrition, has further minimized the 4 to 6 month bone loss. But further work is needed to implement optimal exercise prescriptions, and (5) In this light, NASA's Digital Astronaut Project (DAP) is working with NASA physiologists to implement well-validated computational models that can help understand the mechanisms of bone demineralization in microgravity, and enhance exercise countermeasure development.

Femoral Neck↗
NASA NTRS2016

Post-Flight Back Pain Following International Space Station Missions: Evaluation of Spaceflight Risk Factors

INTRODUCTION Back pain during spaceflight has often been attributed to the lengthening of the spinal column due to the absence of gravity during both short and long-duration missions. Upon landing and re-adaptation to gravity, the spinal column reverts back to its original length thereby causing some individuals to experience pain and muscular spasms, while others experience no ill effects. With International Space Station (ISS) missions, cases of back pain and injury are more common post-flight, but little is known about the potential risk factors. Thus, the purpose of this project was to perform an initial evaluation of reported post-flight back pain and injury cases to relevant spaceflight risk factors in United States astronauts that have completed an ISS mission. METHODS All US astronauts who completed an ISS mission between Expeditions (EXP) 1 and 41 (2000-2015) were included in this evaluation. Forty-five astronauts (36 males and 9 females) completed 50 ISS missions during the study time period, as 5 astronauts completed 2 ISS missions. Researchers queried medical records of the 45 astronauts for occurrences of back pain and injury. A case was defined as any reported event of back pain or injury to the cervical, thoracic, lumbar, sacral, or coccyx spine regions. Data sources for the cases included the Flight Medicine Clinic's electronic medical record; Astronaut Strength, Conditioning and Rehabilitation electronic documentation; the Private Medical Conference tool; and the Space Medicine Operations Team records. Post-flight cases were classified as an early case if reported within 45 days of landing (R + 45) or a late case if reported from R + 46 to R + 365 days after landing (R + 1y). Risk factors in the astronaut population for back pain include age, sex, prior military service, and prior history of back pain. Additionally, spaceflight specific risk factors such as type of landing vehicle and onboard exercise countermeasures were included to evaluate their contribution to post-flight cases. Prior history of back pain included back pain recorded in the medical record within 3 years prior to launch. Landing vehicle was included in the model to discern if more astronauts experienced back pain or injury following a Shuttle or Soyuz landing. Onboard exercise countermeasures were noted for those astronauts who had a mission following 2009 deployment of the Advanced Resistive Exercise Device (aRED) (EXP 19 to 41). T-test and chi-squared tests were performed to evaluate the association between each individual risk factor and post-flight case. Logistic regression was used to evaluate the combined contribution of all the risk factors on post-flight cases. Separate models were calculated for cases reported by R + 45 and R + 1y. RESULTS During the study time period, there were 13 post-flight cases reported by R + 45 and an additional 5 reported by R + 1y. Most of these cases have been reported since EXP 19 with 10 cases by R + 45 and 4 by R + 1y. Individual risk factors of age, sex, landing vehicle, and prior military service were not significantly associated with post-flight cases identified at R + 45 or R + 1y (p greater than 0.05). Having back pain or injury within 3 years prior to launch significantly increased the likelihood of becoming a case by R + 1y (p = 0.041), but not at R+45 (p=0.204). Additionally, astronauts who experienced onboard exercise countermeasures that included aRED had a significantly increased risk of becoming a case at R + 45 (p = 0.024) and R + 1y (p=0.003). Multiple logistic regression evaluating all the risk factors for cases identified no significant risk factors at either the R + 45 or R + 1y time period (p greater than 0.05). Overall model fit was poor for both the R + 45 (R(exp 2) = 0.132) and R + 1y (R(exp 2) = 0.186) cases showing that there are risk factors not represented in our model. CONCLUSIONS Regardless of cause, post-flight cases are reported more often since aRED was deployed in 2009. This may reflect improved documentation or unidentified risk factors. No spaceflight risk factor explains the data fully. Post-flight cases are probably due to multi-faceted factors that are not easily elucidated in the medical data.

Laughlin, M. S.↗
NASA NTRS2006

WIse-2005: Combined Aerobic and Resistive Exercise May Help Mitigate Bone Loss During 60-D Simulated Microgravity in Women

Exercise can attenuate bone loss associated with disuse during bed rest (BR), an analog of space flight. Previous studies have examined the efficacy of aerobic or resistive exercise countermeasures, but not in combination. We sought to determine the effect of a combined resistive and aerobic exercise regimen on bone metabolism during BR. After a 20-d ambulatory adaptation to confinement and diet, 16 women participated in a 60-d head-down-tilt BR. Control subjects (CN, n=8) performed no countermeasures. Exercise subjects, (EX, n=8) participated in exercise alternating daily between supine treadmill exercise within lower body negative pressure and resistive fly-wheel exercise (6-d wk(sup -1)). In the last week of BR, bone resorption was greater (p less than 79 plus or minus 44%, mean plus or minus SD) and EX groups (64 50%). N-telopeptide also increased (CN: 51 plus or minus 34%; EX: 43 plus or minus 56%). However, bone-specific alkaline phosphatase, a bone formation marker, tended to be higher in EX (26 plus or minus 18%) than in CN (8 plus or minus 33%) groups. The combination of resistive and aerobic exercise does not prevent bone resorption, but may promote formation, potentially mitigating the net bone loss associated with simulated microgravity. This study was supported by CNES, CSA, ESA, NASA, and NASA grant NNJ04HF71G to ARH. MEDES (French Institute for Space Medicine and Physiology) organized the study.

Smith, Scott M.↗