WISE 2005: Aerobic and resistive countermeasures prevent paraspinal muscle deconditioning during 60-day bed rest in women

Corticospinal excitability after 5-day Dry Immersion in women

In light of the development of manned astronautics and the increasing participation of women in space flights, the question of female body adaptation to microgravity conditions becomes relevant. Currently, one of the important directions in this issue is to study the effects of support withdrawal as a factor of weightlessness on the human sensorimotor system. Dry Immersion is one of the well-known ground-based models, which adequately reproduces the main physiological effects of space flight. The aim of this study was to evaluate the changes in motor evoked potentials of the lower leg gravity-dependent muscles in women after a 5-day Dry Immersion. We analyzed evoked responses to transcranial and trans-spinal magnetic stimulation. In this method, areas of interest (the motor cortex and lumbosacral thickening of the spinal cord) are stimulated with an electromagnetic stimulus. The experiment was conducted with the participation of 16 healthy female volunteers with a natural menstrual cycle. The thresholds, amplitudes, and latencies of motor potentials evoked by magnetic stimulation were assessed. We showed that 5-day exposure to support withdrawal leads to a decrease in motor-evoked potential thresholds and central motor conduction time, although changes in motor response amplitudes were ambiguous. The data obtained correspond to the results of previous research on Dry Immersion effects on the sensorimotor system in men.

Environmental enrichment through virtual reality as multisensory stimulation to mitigate the negative effects of prolonged bed rest

Prolonged bed rest causes a multitude of deleterious physiological changes in the human body that require interventions even during immobilization to prevent or minimize these negative effects. In addition to other interventions such as physical and nutritional therapy, non-physical interventions such as cognitive training, motor imagery, and action observation have demonstrated efficacy in mitigating or improving not only cognitive but also motor outcomes in bedridden patients. Recent technological advances have opened new opportunities to implement such non-physical interventions in semi- or fully-immersive environments to enable the development of bed rest countermeasures. Extended Reality (XR), which covers augmented reality (AR), mixed reality (MR), and virtual reality (VR), can enhance the training process by further engaging the kinesthetic, visual, and auditory senses. XR-based enriched environments offer a promising research avenue to investigate the effects of multisensory stimulation on motor rehabilitation and to counteract dysfunctional brain mechanisms that occur during prolonged bed rest. This review discussed the use of enriched environment applications in bedridden patients as a promising tool to improve patient rehabilitation outcomes and suggested their integration into existing treatment protocols to improve patient care. Finally, the neurobiological mechanisms associated with the positive cognitive and motor effects of an enriched environment are highlighted.

The State of the Organs of the Female Reproductive System after a 5-Day "Dry" Immersion

The impact of weightlessness on the female reproductive system remains poorly understood, although deep space exploration is impossible without the development of effective measures to protect women's health. The purpose of this work was to study the effect of a 5-day "dry" immersion on the state of the reproductive system of female subjects. On the fourth day of the menstrual cycle after immersion, we observed an increase in inhibin B of 35% (p < 0.05) and a decrease in luteinizing hormone of 12% (p < 0.05) and progesterone of 52% (p < 0.05) compared with the same day before immersion. The size of the uterus and the thickness of the endometrium did not change. On the ninth day of the menstrual cycle after immersion, the average diameters of the antral follicles and the dominant follicle were, respectively, 14% and 22% (p < 0.05) higher than before. The duration of the menstrual cycle did not change. The obtained results may indicate that the stay in the 5-day "dry" immersion, on the one hand, can stimulate the growth of the dominant follicle, but, on the other hand, can cause functional insufficiency of the corpus lutea.

Impact of different ground-based microgravity models on human sensorimotor system

This review includes current and updated information about various ground-based microgravity models and their impact on the human sensorimotor system. All known models of microgravity are imperfect in a simulation of the physiological effects of microgravity but have their advantages and disadvantages. This review points out that understanding the role of gravity in motion control requires consideration of data from different environments and in various contexts. The compiled information can be helpful to researchers to effectively plan experiments using ground-based models of the effects of space flight, depending on the problem posed.

Striated Muscle Evaluation Based on Velocity and Amortization Ratio of Mechanical Impulse Propagation in Simulated Microgravity Environment

Long-duration space flight missions impose extreme physiological stress and/or changes, such as musculoskeletal function degradation, on the crew due to the microgravity exposure. A great deal of research studies have been conducted in order to understand these physiological stress influences and to provide countermeasures to minimize the observed negative effects of weightlessness exposure on musculoskeletal function. Among others, studies and experiments have been conducted in DI analogue Earth-based facilities in order to reproduce the weightlessness negative effects on the human body. This paper presents a complex muscular analysis of mechanical wave propagation in striated muscle, using MusTone, a device developed in-house at the Institute of Space Science, Romania. The data were collected during a 21-day DI campaign in order to investigate muscle fibers’ behavior in longitudinal direction, after applying a mechanical impulse, taking into account two particular parameters, namely propagation velocity and amortization ratio. The parameters were determined based on the wave-propagation data collected from five points (one impact point, two distal direction points, and two proximal direction points) along the muscle fiber. By statistically analyzing propagation velocity and amortization ratio parameters, the study revealed that muscle deconditioning is time dependent, the amortization ratio is more significant in the distal direction, and the lower fibers are affected the most.

The impact of altering participant MRI scanning position on back muscle volume measurements

Objectives

Muscle volume may reflect both strength and functional capability and hence is a parameter often measured to assess the effect of various interventions. The aim of the current study was to determine the sensitivity of muscle volume calculations on participant postural position and hence gauge possible errors that may arise in longitudinal studies, especially those where an intervention leads to large muscle changes and potentially the degree of spinal curvature.

Methods

Twenty healthy participants (22-49 years, 10 male and 10 female), were recruited and MRI images acquired with them lying in four different positions; neutral spine (P1), decreased lordosis (P2), increased lordosis (P3) and neutral spine repeated (P4). Images were analysed in Simpleware ScanIP, and lumbar muscle volume and Cobb's angle, as an indicator of spine curvature, determined.

Results

After comparing volume determinations, no statistically significant differences were found for P1 - P2 and P1 - P4, whereas significant changes were determined for P2 - P3 and P1 - P3. P2 and P3 represent the two extremes of spinal curvature with a difference in Cobb's angle of 17°. However, the mean difference between volume determinations was only 29 cm³. These results suggest the differences in muscle volume determinations are generally greater with increasing differences in curvature between measurements, but that overall the effects are small.

Conclusions

Thus, generally, spinal muscle volume determinations are robust in terms of participant positioning.

Advances in knowledge

Differences in muscle volume calculations appear to become larger the greater the difference in spinal curvature between positions. Thus, spinal curvature should not have a major impact on the results of spinal muscle volume determinations following interventions in longitudinal studies.

Effects of Various Muscle Disuse States and Countermeasures on Muscle Molecular Signaling

Skeletal muscle is capable of changing its structural parameters, metabolic rate and functional characteristics within a wide range when adapting to various loading regimens and states of the organism. Prolonged muscle inactivation leads to serious negative consequences that affect the quality of life and work capacity of people. This review examines various conditions that lead to decreased levels of muscle loading and activity and describes the key molecular mechanisms of muscle responses to these conditions. It also details the theoretical foundations of various methods preventing adverse muscle changes caused by decreased motor activity and describes these methods. A number of recent studies presented in this review make it possible to determine the molecular basis of the countermeasure methods used in rehabilitation and space medicine for many years, as well as to identify promising new approaches to rehabilitation and to form a holistic understanding of the mechanisms of gravity force control over the muscular system.

NAIAD-2020: Characteristics of Motor Evoked Potentials After 3-Day Exposure to Dry Immersion in Women

As female astronauts participate in space flight more and more frequently, there is a demand for research on how the female body adapts to the microgravity environment. In particular, there is very little research on how the neuromuscular system reacts to gravitational unloading in women. We aimed to estimate changes in motor evoked potentials (MEPs) in the lower leg muscles in women after 3-day exposure to Dry Immersion (DI), which is one of the most widely used ground models of microgravity. Six healthy female volunteers (mean age 30.17 ± 5.5 years) with a natural menstrual cycle participated in this experiment. MEPs were recorded from the gastrocnemius and soleus muscles twice before DI, on the day of DI completion, and 3 days after DI, during the recovery period. To evoke motor responses, transcranial and trans-spinal magnetic stimulation was applied. We showed that changes in MEP characteristics after DI exposure were different depending on the stimulation site, but were similar for both muscles. For trans-spinal stimulation, MEP thresholds decreased compared to baseline values, and amplitudes, on the contrary, increased, resembling the phenomenon of hypogravitational hyperreflexia. This finding is in line with data observed in other experiments on both male and female participants. MEPs to transcranial stimulation had an opposing dynamic, which may have resulted from the small group size and large inter-subject variability, or from hormonal fluctuations during the menstrual cycle. Central motor conduction time remained unchanged, suggesting that pyramidal tract conductibility was not affected by DI exposure. More research is needed to explore the underlying mechanisms.

Early Deconditioning of Human Skeletal Muscles and the Effects of a Thigh Cuff Countermeasure

Muscle deconditioning is a major consequence of a wide range of conditions from spaceflight to a sedentary lifestyle, and occurs as a result of muscle inactivity, leading to a rapid decrease in muscle strength, mass, and oxidative capacity. The early changes that appear in the first days of inactivity must be studied to determine effective methods for the prevention of muscle deconditioning. To evaluate the mechanisms of muscle early changes and the vascular effect of a thigh cuff, a five-day dry immersion (DI) experiment was conducted by the French Space Agency at the MEDES Space Clinic (Rangueil, Toulouse). Eighteen healthy males were recruited and divided into a control group and a thigh cuff group, who wore a thigh cuff at 30 mmHg. All participants underwent five days of DI. Prior to and at the end of the DI, the lower limb maximal strength was measured and muscle biopsies were collected from the vastus lateralis muscle. Five days of DI resulted in muscle deconditioning in both groups. The maximal voluntary isometric contraction of knee extension decreased significantly. The muscle fiber cross-sectional area decreased significantly by 21.8%, and the protein balance seems to be impaired, as shown by the reduced activation of the mTOR pathway. Measurements of skinned muscle fibers supported these results and potential changes in oxidative capacity were highlighted by a decrease in PGC1-α levels. The use of the thigh cuff did not prevent muscle deconditioning or impact muscle function. These results suggest that the major effects of muscle deconditioning occur during the first few days of inactivity, and countermeasures against muscle deconditioning should target this time period. These results are also relevant for the understanding of muscle weakness induced by muscle diseases, aging, and patients in intensive care.

The First Female Dry Immersion (NAIAD-2020): Design and Specifics of a 3-Day Study

This article describes procedures and some results of the first study of females undergoing 3-day Dry Immersion. The experiment “NAIAD-2020” was carried out at the Institute of Biomedical Problems (Moscow, Russia) with the participation of six healthy women volunteers (age 30.17 ± 5.5 years, height 1.66 ± 0.1 m, weight 62.05 ± 8.4 kg, BMI 22.39 ± 2.2 kg/m²) with a natural menstrual cycle. During the study, a standard protocol was used, the same as for men, with a minimum period of time spent outside the immersion bath. Before, during and after Immersion, 22 experiments were carried out aimed at studying the neurophysiological, functional, metabolic and psychophysiological functions of the body, the results of which will be presented in future publications. The total time outside the bath for women did not exceed that for men. Systolic and diastolic pressure did not significantly change during the immersion. In the first 24 h after the end of the immersion, heart rate was significantly higher than the background values [F(4,20) = 14.67; P < 0.0001]. Changes in body temperature and water balance were consistent with the patterns found in men. No significant changes in height and weight were found during immersion. All women reported general discomfort and pain in the abdomen and back. The results of this study did not find significant risks to women’s health and showed the feasibility of using this model of the effects of space flight in women of reproductive age.

Sharp Changes in Muscle Tone in Humans Under Simulated Microgravity

A decrease in muscle tone induced by space flight requires a standardized assessment of changes to control the state of the neuromuscular system. This study is a step toward the development of a unified protocol, aimed at determining the initial effect of the presence or withdrawal of support on muscle tone, the effects of a 2-h supportlessness in Dry Immersion (DI) experiments, and the changes in muscle tone depending on the site of measurement. To perform measurements of changes in muscle tone, we used a MyotonPRO device. The list of muscles that we assessed includes: trunk – mm. deltoideus posterior, trapezius, erector spinae; leg – mm. biceps femoris, rectus femoris, tibialis anterior, soleus, gastrocnemius; foot – m. flexor digitorum brevis, tendo Achillis, aponeurosis plantaris. The study involved 12 healthy volunteers (6 men, 6 women) without musculoskeletal disorders and aged 32.8 ± 1.6 years. At the start of DI, there was a significant decrease in muscle tone of the following muscles: mm. tibialis anterior (−10.9%), soleus (−9.6%), erector spinae (−14.4%), and the tendo Achillis (−15.3%). The decrease continued to intensify over the next 2 h. In contrast, the gastrocnemius muscle demonstrated an increase in muscle tone (+7.5%) 2 h after the start of DI compared to the immediate in-bath baseline. Muscle tone values were found to be site-dependent and varied in different projections of mm. erector spinae and soleus. In previous experiments, we observed a high sensitivity of the myotonometry technique, which was confirmed in this study. To make it possible to compare data from different studies, a standardized protocol for measuring muscle tone for general use in gravitational physiology needs to be developed.

Whey protein supplementation with vibration exercise ameliorates lumbar paraspinal muscle atrophy in prolonged bed rest

We examined the impact of adding protein supplementation to exercise (resistive vibration exercise) as a countermeasure against changes in the spine during spaceflight simulation. We found that adding the protein supplementation reduced spine muscle atrophy more than exercise alone. Neither countermeasure approach prevented changes in the disks in the spine or impacted back pain reports.

Quantitative ultrasound imaging monitoring progressive disuse osteopenia and mechanical stimulation mitigation in calcaneus region through a 90-day bed rest human study

Background

Osteoporosis parallels aging and functional mechanical unloading (e.g., space flight and bed rest), jeopardizing mineral density, microstructure, and integrity of bone and leading to an increased risk of fracture. A way to combat this deterioration is to harness the sensitivity of bone to mechanical signals.

Objective

This study evaluates the longitudinal effect of a dynamic mechanical loading through the heel on human bone in vivo during 90-day bed rest, monitored by quantitative ultrasound (QUS) imaging and dual-energy X-ray absorptiometry (DXA) in localized regions of interests, i.e., calcaneus.

Methods

A total of 29 bed rest individuals were evaluated (11 control and 18 treatment) with a brief (10-minute) daily low-intensity (0.3g), high-frequency (30Hz) dynamic mechanical stimulation countermeasure through vibrational inhibition bone erosion (VIBE). Both QUS and DXA detected longitudinal bone density and quality changes.

Results

Ultrasound velocity (UV) decreased in the control group and increased in the group treated with low-intensity loading. The UV increased by 1.9% and 1.6% at 60- and 90-day bed rest (p=0.01) in VIBE over control groups. A trend was found in broadband ultrasound attenuation (BUA), with a VIBE benefit of 1.8% at day 60 and 0.5% at day 90 in comparison with control (p=0.5). Bone mineral density (BMD) assessed by DXA decreased -4.50% for control individuals and -2.18% for VIBE individuals, showing a moderate effect of the mechanical intervention (p=0.19). Significant correlations between QUS and DXA were observed, with a combined BUA and UV vs. BMD: r²=0.70.

Conclusion

These results indicated that low-intensity, high-frequency loading has the potential to mitigate regional bone loss induced by long-term bed rest and that QUS imaging may be able to assess the subtle changes in bone alteration.

Translational potential of this article

Quantitative ultrasound has shown the efficacy of noninvasively assessing bone mass and structural properties in cadaver and isolated trabecular bone samples. While its ability in measuring in vivo bone quality and density is still unclear, a scanning confocal ultrasound imaging is developed and can perform an instant assessment for the subtle changes of such bone loss. This ultrasound imaging modality can potentially be used in the clinical assessment of bone mass. Moreover, physical stimulation has shown the ability to prevent bone loss induced by functional disuse and estrogen deficiency in animal models. However, its treatment capability is unclear. This study has shown that low-magnitude mechanical signals, introduced using low-intensity vibration (LIV), can mitigate regional bone loss caused by functional disuse. Thus localized mechanical treatment, and the quantitative ultrasound imaging have shown translational potential to noninvasively attenuate bone loss, and assess bone mass in the clinic, e.g., in an extreme condition such as long-term space mission, and long-term bedrest such as in case of spinal cord injury.

Effect of Time on Human Muscle Outcomes During Simulated Microgravity Exposure Without Countermeasures-Systematic Review

Background: Space Agencies are planning human missions beyond Low Earth Orbit. Consideration of how physiological system adaptation with microgravity (μG) will be managed during these mission scenarios is required. Exercise countermeasures (CM) could be used more sparingly to decrease limited resource costs, including periods of no exercise. This study provides a complete overview of the current evidence, making recommendations on the length of time humans exposed to simulated μG might safely perform no exercise considering muscles only. Methods: Electronic databases were searched for astronaut or space simulation bed rest studies, as the most valid terrestrial simulation, from start of records to July 2017. Studies were assessed with the Quality in Prognostic Studies and bed rest analog studies assessed for transferability to astronauts using the Aerospace Medicine Systematic Review Group Tool for Assessing Bed Rest Methods. Effect sizes, based on no CM groups, were used to assess muscle outcomes over time. Outcomes included were contractile work capacity, muscle cross sectional area, muscle activity, muscle thickness, muscle volume, maximal voluntary contraction force during one repetition maximum, peak power, performance based outcomes, power, and torque/strength. Results: Seventy-five bed rest μG simulation studies were included, many with high risk of confounding factors and participation bias. Most muscle outcomes deteriorated over time with no countermeasures. Moderate effects were apparent by 7-15 days and large by 28-56 days. Moderate effects (>0.6) became apparent in the following order, power and MVC during one repetition maximum (7 days), followed by volume, cross sectional area, torques and strengths, contractile work capacity, thickness and endurance (14 days), then muscle activity (15 days). Large effects (>1.2) became apparent in the following order, volume, cross sectional area (28 days) torques and strengths, thickness (35 days) and peak power (56 days). Conclusions: Moderate effects on a range of muscle parameters may occur within 7-14 days of unloading, with large effects within 35 days. Combined with muscle performance requirements for mission tasks, these data, may support the design of CM programmes to maximize efficiency without compromising crew safety and mission success when incorporated with data from additional physiological systems that also need consideration.

High-Intensity Exercise Mitigates Cardiovascular Deconditioning During Long-Duration Bed Rest

Head-down-tilt bed rest (HDT) mimics the changes in hemodynamics and autonomic cardiovascular control induced by weightlessness. However, the time course and reciprocal interplay of these adaptations, and the effective exercise protocol as a countermeasure need further clarification. The overarching aim of this work (as part of a European Space Agency sponsored long-term bed rest study) was therefore to evaluate the time course of cardiovascular hemodynamics and autonomic control during prolonged HDT and to assess whether high-intensity, short-duration exercise could mitigate these effects. A total of n = 23 healthy, young, male participants were randomly allocated to two groups: training (TRAIN, n = 12) and non-training (CTRL, n = 11) before undergoing a 60-day HDT. The TRAIN group underwent a resistance training protocol using reactive jumps (5–6 times per week), whereas the CTRL group did not perform countermeasures. Finger blood pressure (BP), heart rate (HR), and stroke volume were collected beat-by-beat for 10 min in both sitting and supine positions 7 days before HDT (BDC−7) and 10 days after HDT (R+10), as well as on the 2nd (HDT2), 28th (HDT28), and 56th (HDT56) day of HDT. We investigated (1) the isolated effects of long-term HDT by comparing all the supine positions (including BDC−7 and R+10 at 0 degrees), and (2) the reactivity of the autonomic response before and after long-term HDT using a specific postural stimulus (i.e., supine vs. sitting). Two-factorial linear mixed models were used to assess the time course of HDT and the effect of the countermeasure. Starting from HDT28 onwards, HR increased (p < 0.02) and parasympathetic tone decreased exclusively in the CTRL group (p < 0.0001). Moreover, after 60-day HDT, CTRL participants showed significant impairments in increasing cardiac sympathovagal balance and controlling BP levels during postural shift (supine to sitting), whereas TRAIN participants did not. Results show that a 10-day recovery did not compensate for the cardiovascular and autonomic deconditioning following 60-day HDT. This has to be considered when designing rehabilitation programs—not only for astronauts but also in general public healthcare. High-intensity, short-duration exercise training effectively minimized these impairments and should therefore deserve consideration as a cardiovascular deconditioning countermeasure for spaceflight.

Exercise and non-pharmacological treatment of POTS

Recent research has demonstrated that cardiovascular deconditioning (i.e., cardiac atrophy and hypovolemia) contributes significantly to the Postural Orthostatic Tachycardia Syndrome (POTS) and its functional disability. Therefore, physical reconditioning with exercise training and volume expansion via increased salt and fluid intake should be initiated early in the course of treatment for patients with POTS if possible. The use of horizontal exercise (e.g., rowing, swimming, recumbent bike, etc.) at the beginning is a critical strategy, allowing patients to exercise while avoiding the upright posture that elicits their POTS symptoms. As patients become increasingly fit, the duration and intensity of exercise should be progressively increased, and upright exercise can be gradually added as tolerated. Supervised training is preferable to maximize functional capacity. Other non-pharmacological interventions, which include: 1) chronic volume expansion via sleeping in the head-up position; 2) reduction in venous pooling during orthostasis by lower body compression garments extending at least to the xiphoid or with an abdominal binder; and 3) physical countermeasure maneuvers, such as squeezing a rubber ball, leg crossing, muscle pumping, squatting, negative-pressure breathing, etc., may also be effective in preventing orthostatic intolerance and managing acute clinical symptoms in POTS patients. However, randomized clinical trials are needed to evaluate the efficacies of these non-pharmacological treatments of POTS.

Bed Rest, Exercise Countermeasure and Reconditioning Effects on the Human Resting Muscle Tone System

The human resting muscle tone (HRMT) system provides structural and functional support to skeletal muscle and associated myofascial structures (tendons, fascia) in normal life. Little information is available on changes to the HRMT in bed rest. A set of dynamic oscillation mechanosignals ([Hz], [N/m], log decrement, [ms]) collected and computed by a hand-held digital palpation device (MyotonPRO) were used to study changes in tone and in key biomechanical and viscoelastic properties in global and postural skeletal muscle tendons and fascia from a non-exercise control (CTR) and an exercise (JUMP) group performing reactive jumps on a customized sledge system during a 60 days head-down tilt bed rest (RSL Study 2015–2016). A set of baseline and differential natural oscillation signal patterns were identified as key determinants in resting muscle and myofascial structures from back, thigh, calf, patellar and Achilles tendon, and plantar fascia. The greatest changes were found in thigh and calf muscle and tendon, with little change in the shoulder muscles. Functional tests (one leg jumps, electromyography) showed only trends in relevant leg muscle groups. Increased anti-Collagen-I immunoreactivity found in CTR soleus biopsy cryosections was absent from JUMP. Results allow for a muscle health status definition after chronic disuse in bed rest without and with countermeasure, and following reconditioning. Findings improve our understanding of structural and functional responses of the HRMT to disuse and exercise, may help to guide treatment in various clinical settings (e.g., muscle tone disorders, neuro-rehabilitation), and promote monitoring of muscle health and training status in personalized sport and space medicine.

Exercise and Transversus Abdominis Muscle Atrophy after 60-d Bed Rest

PURPOSE

This study aimed to investigate atrophy in the deep abdominal muscles, spinal extensors, and the effect of high-load resistive exercise with and without whole-body vibration after 60 d of strict bed rest.

METHODS

Twenty-four subjects underwent 60 d of head-down tilt bed rest and performed either resistive vibration exercise (RVE), resistive exercise only (RE), or no exercise control (2nd Berlin BedRest Study). The thickness of the transversus abdominis, internal oblique, and erector spinae muscles and the area of the multifidus muscle were measured bilaterally via real-time ultrasound. Intention-to-treat analysis was implemented, and P values were adjusted by the false discovery rate method.

RESULTS

At the end of the bed rest, transversus abdominis thickness was reduced by 18.3% in the inactive group (P = 0.00011) with no significant change in the RVE (-4.0%; P = 0.014 vs control) or RE (-5.0%; P = 0.10 vs control) groups. In the inactive subjects, internal oblique thickness reduced by 10.6% (P = 0.0025) and by 7% (P > 0.05) in each of the training groups. The lengthening of the lumbar spine was greatest on day 1 (+7.4%, P = 0.004) and day 2 (+6.3%, P = 0.004; day 54: +4.1%, P = 0.023). A 4.7% reduction of multifidus area was observed on day 1 of bed rest (P = 0.0049) and a 4.2% reduction of erector spinae thickness was observed on day 2 (P = 0.0011). Extensor atrophy and spinal lengthening was not affected by exercise. No significant difference was seen between RVE and RE.

CONCLUSION

Bed rest leads to atrophy of the transversus abdominis and internal oblique muscles. The exercise program, which implemented lower-limb and back extension exercises against shoulder restraints, was able to reduce atrophy seen in transversus abdominis in bed rest.

Pain and Vertebral Dysfunction in Dry Immersion: A Model of Microgravity Simulation Different from Bed Rest Studies

BACKGROUND

Astronauts frequently experience back pain during and after spaceflight. The aim of this study was to utilize clinical methods to identify potential vertebral somatic dysfunction (VD) in subjects exposed to dry immersion (DI), a model of microgravity simulation.

METHOD

The experiment was performed in a space research clinic, respecting all the ethical rules, with subjects completing three days of dry immersion (n = 11). Assessments of VD, spine height, and back pain were made before and after simulated microgravity.

RESULTS

Back pain was present in DI with great global discomfort during the entire protocol. A low positive correlation was found (Pearson r = 0.44; P < 0.001) between VD before DI and pain developed in the DI experiment.

CONCLUSIONS

There is a specific location of pain in both models of simulation. Our analysis leads to relativizing constraints on musculoskeletal system in function of simulation models. This study was the first to examine manual palpation of the spine in a space experience. Additionally, osteopathic view may be used to select those individuals who have less risk of developing back pain.

Microgravity-Induced Transcriptome Adaptation in Mouse Paraspinal longissimus dorsi Muscle Highlights Insulin Resistance-Linked Genes

Microgravity as well as chronic muscle disuse are two causes of low back pain originated at least in part from paraspinal muscle deconditioning. At present no study investigated the complexity of the molecular changes in human or mouse paraspinal muscles exposed to microgravity. The aim of this study was to evaluate longissimus dorsi adaptation to microgravity at both morphological and global gene expression level. C57BL/N6 male mice were flown aboard the BION-M1 biosatellite for 30 days (BF) or housed in a replicate flight habitat on ground (BG). Myofiber cross sectional area and myosin heavy chain subtype patterns were respectively not or slightly altered in longissimus dorsi of BF mice. Global gene expression analysis identified 89 transcripts differentially regulated in longissimus dorsi of BF vs. BG mice. Microgravity-induced gene expression changes of lipocalin 2 (Lcn2), sestrin 1(Sesn1), phosphatidylinositol 3-kinase, regulatory subunit polypeptide 1 (p85 alpha) (Pik3r1), v-maf musculoaponeurotic fibrosarcoma oncogene family protein B (Mafb), protein kinase C delta (Prkcd), Muscle Atrophy F-box (MAFbx/Atrogin-1/Fbxo32), and Muscle RING Finger 1 (MuRF-1) were further validated by real time qPCR analysis. In conclusion, our study highlighted the regulation of transcripts mainly linked to insulin sensitivity and metabolism in longissimus dorsi following 30 days of microgravity exposure. The apparent absence of robust signs of back muscle atrophy in space-flown mice, despite the overexpression of Atrogin-1 and MuRF-1, opens new questions on the possible role of microgravity-sensitive genes in the regulation of peripheral insulin resistance following unloading and its consequences on paraspinal skeletal muscle physiology.

Towards human exploration of space: the THESEUS review series on muscle and bone research priorities

Without effective countermeasures, the musculoskeletal system is altered by the microgravity environment of long-duration spaceflight, resulting in atrophy of bone and muscle tissue, as well as in deficits in the function of cartilage, tendons, and vertebral disks. While inflight countermeasures implemented on the International Space Station have evidenced reduction of bone and muscle loss on low-Earth orbit missions of several months in length, important knowledge gaps must be addressed in order to develop effective strategies for managing human musculoskeletal health on exploration class missions well beyond Earth orbit. Analog environments, such as bed rest and/or isolation environments, may be employed in conjunction with large sample sizes to understand sex differences in countermeasure effectiveness, as well as interaction of exercise with pharmacologic, nutritional, immune system, sleep and psychological countermeasures. Studies of musculoskeletal biomechanics, involving both human subject and computer simulation studies, are essential to developing strategies to avoid bone fractures or other injuries to connective tissue during exercise and extravehicular activities. Animal models may be employed to understand effects of the space environment that cannot be modeled using human analog studies. These include studies of radiation effects on bone and muscle, unraveling the effects of genetics on bone and muscle loss, and characterizing the process of fracture healing in the mechanically unloaded and immuno-compromised spaceflight environment. In addition to setting the stage for evidence-based management of musculoskeletal health in long-duration space missions, the body of knowledge acquired in the process of addressing this array of scientific problems will lend insight into the understanding of terrestrial health conditions such as age-related osteoporosis and sarcopenia.

Lumbar Spine Paraspinal Muscle and Intervertebral Disc Height Changes in Astronauts After Long-Duration Spaceflight on the International Space Station

STUDY DESIGN

Prospective case series.

OBJECTIVE

Evaluate lumbar paraspinal muscle (PSM) cross-sectional area and intervertebral disc (IVD) height changes induced by a 6-month space mission on the International Space Station. The long-term objective of this project is to promote spine health and prevent spinal injury during space missions and here on Earth.

SUMMARY OF BACKGROUND DATA

National Aeronautics and Space Administration (NASA) crewmembers have a 4.3 times higher risk of herniated IVDs, compared with the general and military aviator populations. The highest risk occurs during the first year after a mission. Microgravity exposure during long-duration spaceflights results in approximately 5 cm lengthening of body height, spinal pain, and skeletal deconditioning. How the PSMs and IVDs respond during spaceflight is not well described.

METHODS

Six NASA crewmembers were imaged supine with a 3 Tesla magnetic resonance imaging. Imaging was conducted preflight, immediately postflight, and then 33 to 67 days after landing. Functional cross-sectional area (FCSA) measurements of the PSMs were performed at the L3-4 level. FCSA was measured by grayscale thresholding within the posterior lumbar extensors to isolate lean muscle on T2-weighted scans. IVD heights were measured at the anterior, middle, and posterior sections of all lumbar levels. Repeated measures analysis of variance was used to determine significance at P < 0.05, followed by post-hoc testing.

RESULTS

Paraspinal lean muscle mass, as indicated by the FCSA, decreased from 86% of the total PSM cross-sectional area down to 72%, immediately after the mission. Recovery of 68% of the postflight loss occurred during the next 6 weeks, still leaving a significantly lower lean muscle fractional content compared with preflight values. In contrast, lumbar IVD heights were not appreciably different at any time point.

CONCLUSION

The data reveal lumbar spine PSM atrophy after long-duration spaceflight. Some FCSA recovery was seen with 46 days postflight in a terrestrial environment, but it remained incomplete compared with preflight levels.

LEVEL OF EVIDENCE

4.