Physiological and Functional Alterations after Spaceflight and Bed Rest

NASA SPRINT exercise program efficacy for vastus lateralis and soleus skeletal muscle health during 70 days of simulated microgravity

The efficacy of the NASA SPRINT exercise countermeasures program for quadriceps (vastus lateralis) and triceps surae (soleus) skeletal muscle health was investigated during 70 days of simulated microgravity. Individuals completed 6° head-down-tilt bedrest (BR, n = 9), bedrest with resistance and aerobic exercise (BRE, n = 9), or bedrest with resistance and aerobic exercise and low-dose testosterone (BRE + T, n = 8). All groups were periodically tested for muscle (n = 9 times) and aerobic (n = 4 times) power during bedrest. In BR, surprisingly, the typical bedrest-induced decrements in vastus lateralis myofiber size and power were either blunted (myosin heavy chain, MHC I) or eliminated (MHC IIa), along with no change (P > 0.05) in %MHC distribution and blunted quadriceps atrophy. In BRE, MHC I (vastus lateralis and soleus) and IIa (vastus lateralis) contractile performance was maintained (P > 0.05) or increased (P < 0.05). Vastus lateralis hybrid fiber percentage was reduced (P < 0.05) and energy metabolism enzymes and capillarization were generally maintained (P > 0.05), while not all of these positive responses were observed in the soleus. Exercise offsets 100% of quadriceps and approximately two-thirds of soleus whole muscle mass loss. Testosterone (BRE + T) did not provide any benefit over exercise alone for either muscle and for some myocellular parameters appeared detrimental. In summary, the periodic testing likely provided a partial exercise countermeasure for the quadriceps in the bedrest group, which is a novel finding given the extremely low exercise dose. The SPRINT exercise program appears to be viable for the quadriceps; however, refinement is needed to completely protect triceps surae myocellular and whole muscle health for astronauts on long-duration spaceflights.NEW & NOTEWORTHY This study provides unique exercise countermeasures development information for astronauts on long-duration spaceflights. The NASA SPRINT program was protective for quadriceps myocellular and whole muscle health, whereas the triceps surae (soleus) was only partially protected as has been shown with other programs. The bedrest control group data may provide beneficial information for overall exercise dose and targeting fast-twitch muscle fibers. Other unique approaches for the triceps surae are needed to supplement existing exercise programs.

Myths and Methodologies: Understanding the health impact of head down bedrest for the benefit of older adults and astronauts. Study protocol of the Canadian Bedrest Study

Weightlessness during spaceflight can harm various bodily systems, including bone density, muscle mass, strength and cognitive functions. Exercise appears to somewhat counteract these effects. A terrestrial model for this is head-down bedrest (HDBR), simulating gravity loss. This mirrors challenges faced by older adults in extended bedrest and space environments. The first Canadian study, backed by the Canadian Space Agency, Canadian Institutes of Health Research, and Canadian Frailty Network, aims to explore these issues. The study seeks to: (1) scrutinize the impact of 14-day HDBR on physiological, psychological and neurocognitive systems, and (2) assess the benefits of exercise during HDBR. Eight teams developed distinct protocols, harmonized in three videoconferences, at the McGill University Health Center. Over 26 days, 23 participants aged 55-65 underwent baseline measurements, 14 days of -6° HDBR, and 7 days of recovery. Half did prescribed exercise thrice daily combining resistance and endurance exercise for a total duration of 1 h. Assessments included demographics, cardiorespiratory fitness, bone health, body composition, quality of life, mental health, cognition, muscle health and biomarkers. This study has yielded some published outcomes, with more forthcoming. Findings will enrich our comprehension of HDBR effects, guiding future strategies for astronaut well-being and aiding bedrest-bound older adults. By outlining evidence-based interventions, this research supports both space travellers and those enduring prolonged bedrest.

Development of a ground-based sensorimotor disorientation analog to replicate astronaut postflight experience

The perceptual and motor coordination problems experienced following return from spaceflight reflect the sensory adaptation to altered gravity. The purpose of this study was to develop a ground-based analog that replicates similar sensorimotor impairment using a standard measures test battery and subjective feedback from experienced crewmembers. This Sensorimotor Disorientation Analog (SDA) included varying levels of sensorimotor disorientation through combined vestibular, visual, and proprioceptive disruptions. The SDA was evaluated on five previously flown astronauts to compare with their postflight experience and functional motor performance immediately (Return (R)+0 days) and +24 h (R+1) after landing. The SDA consisted of galvanic vestibular stimulation (GVS), visual disruption goggles, and a weighted suit to alter proprioceptive feedback and replicate perceived heaviness postflight. Astronauts reported that GVS alone replicated ∼50-90% of their postflight performance with the weighted suit fine-tuning the experience to replicate an additional 10%-40% of their experience. Astronauts did not report feeling that the disruption goggles represented either the visual disruptions or illusory sensations that they experienced, nor did they impact motor performance in postflight tasks similarly. Based on these results, we recommend an SDA including the GVS and the weighted suit. These results provide a more realistic and portable SDA framework to provide transient spaceflight-relevant sensorimotor disruptions for use in countermeasure testing and as a pre-flight training tool.

An experimentally informed computational model of neurovestibular adaptation to altered gravity

Transitions to altered gravity environments result in acute sensorimotor impairment for astronauts, leading to serious mission and safety risks in the crucial first moments in a new setting. Our understanding of the time course and severity of impairment in the early stages of adaptation remains limited and confounded by unmonitored head movements, which are likely to impact the rate of adaptation. Here, we aimed to address this gap by using a human centrifuge to simulate the first hour of hypergravity (1.5g) exposure and the subsequent 1g readaptation period, with precisely controlled head tilt activity. We quantified head tilt overestimation via subjective visual vertical and found ∼30% tilt overestimation that did not decrease over the course of 1 h of exposure to the simulated gravity environment. These findings extended the floor of the vestibular adaptation window (with controlled vestibular cueing) to 1 h of exposure to altered gravity. We then used the empirical data to inform a computational model of neurovestibular adaptation to changes in the magnitude of gravity, which can offer insight into the adaptation process and, with further tuning, can be used to predict the temporal dynamics of vestibular-mediated misperceptions in altered gravity.

Daily artificial gravity partially mitigates vestibular processing changes associated with head-down tilt bedrest

Microgravity alters vestibular signaling and reduces body loading, driving sensory reweighting. The unloading effects can be modelled using head-down tilt bedrest (HDT). Artificial gravity (AG) has been hypothesized to serve as an integrated countermeasure for the declines associated with HDT and spaceflight. Here, we examined the efficacy of 30 min of daily AG to counteract brain and behavior changes from 60 days of HDT. Two groups received 30 min of AG delivered via short-arm centrifuge daily (n = 8 per condition), either in one continuous bout, or in 6 bouts of 5 min. To improve statistical power, we combined these groups (AG; n = 16). Another group served as controls in HDT with no AG (CTRL; n = 8). We examined how HDT and AG affect vestibular processing by collecting fMRI scans during vestibular stimulation. We collected these data prior to, during, and post-HDT. We assessed brain activation initially in 12 regions of interest (ROIs) and then conducted an exploratory whole brain analysis. The AG group showed no changes in activation during vestibular stimulation in a cerebellar ROI, whereas the CTRL group showed decreased activation specific to HDT. Those that received AG and showed little pre- to post-HDT changes in left vestibular cortex activation had better post-HDT balance performance. Whole brain analyses identified increased pre- to during-HDT activation in CTRLs in the right precentral gyrus and right inferior frontal gyrus, whereas AG maintained pre-HDT activation levels. These results indicate that AG could mitigate activation changes in vestibular processing that is associated with better balance performance.

Dynamic changes in perivascular space morphology predict signs of spaceflight-associated neuro-ocular syndrome in bed rest

During long-duration spaceflight, astronauts experience headward fluid shifts and expansion of the cerebral perivascular spaces (PVS). A major limitation to our understanding of the changes in brain structure and physiology induced by spaceflight stems from the logistical difficulties of studying astronauts. The current study aimed to determine whether PVS changes also occur on Earth with the spaceflight analog head-down tilt bed rest (HDBR). We examined how the number and morphology of magnetic resonance imaging-visible PVS (MV-PVS) are affected by HDBR with and without elevated carbon dioxide (CO2). These environments mimic the headward fluid shifts, body unloading, and elevated CO2 observed aboard the International Space Station. Additionally, we sought to understand how changes in MV-PVS are associated with signs of Spaceflight Associated Neuro-ocular Syndrome (SANS), ocular structural alterations that can occur with spaceflight. Participants were separated into two bed rest campaigns: HDBR (60 days) and HDBR + CO2 (30 days with elevated ambient CO2). Both groups completed multiple magnetic resonance image acquisitions before, during, and post-bed rest. We found that at the group level, neither spaceflight analog affected MV-PVS quantity or morphology. However, when taking into account SANS status, persons exhibiting signs of SANS showed little or no MV-PVS changes, whereas their No-SANS counterparts showed MV-PVS morphological changes during the HDBR + CO2 campaign. These findings highlight spaceflight analogs as models for inducing changes in MV-PVS and implicate MV-PVS dynamic compliance as a mechanism underlying SANS. These findings may lead to countermeasures to mitigate health risks associated with human spaceflight.

Simulated microgravity improves maturation of cardiomyocytes derived from human induced pluripotent stem cells

Cardiomyocytes derived from human induced pluripotent stem cells (hiPSC-CMs) possess tremendous potential for basic research and translational application. However, these cells structurally and functionally resemble fetal cardiomyocytes, which is a major limitation of these cells. Microgravity can significantly alter cell behavior and function. Here we investigated the effect of simulated microgravity on hiPSC-CM maturation. Following culture under simulated microgravity in a random positioning machine for 7 days, 3D hiPSC-CMs had increased mitochondrial content as detected by a mitochondrial protein and mitochondrial DNA to nuclear DNA ratio. The cells also had increased mitochondrial membrane potential. Consistently, simulated microgravity increased mitochondrial respiration in 3D hiPSC-CMs, as indicated by higher levels of maximal respiration and ATP content, suggesting improved metabolic maturation in simulated microgravity cultures compared with cultures under normal gravity. Cells from simulated microgravity cultures also had improved Ca2+ transient parameters, a functional characteristic of more mature cardiomyocytes. In addition, these cells had improved structural properties associated with more mature cardiomyocytes, including increased sarcomere length, z-disc length, nuclear diameter, and nuclear eccentricity. These findings indicate that microgravity enhances the maturation of hiPSC-CMs at the structural, metabolic, and functional levels.

The impact of bed rest on human skeletal muscle metabolism

Insulin sensitivity and metabolic flexibility decrease in response to bed rest, but the temporal and causal adaptations in human skeletal muscle metabolism are not fully defined. Here, we use an integrative approach to assess human skeletal muscle metabolism during bed rest and provide a multi-system analysis of how skeletal muscle and the circulatory system adapt to short- and long-term bed rest (German Clinical Trials: DRKS00015677). We uncover that intracellular glycogen accumulation after short-term bed rest accompanies a rapid reduction in systemic insulin sensitivity and less GLUT4 localization at the muscle cell membrane, preventing further intracellular glycogen deposition after long-term bed rest. We provide evidence of a temporal link between the accumulation of intracellular triglycerides, lipotoxic ceramides, and sphingomyelins and an altered skeletal muscle mitochondrial structure and function after long-term bed rest. An intracellular nutrient overload therefore represents a crucial determinant for rapid skeletal muscle insulin insensitivity and mitochondrial alterations after prolonged bed rest.

Retinal venular vessel diameters are smaller during ten days of bed rest

Older individuals experience cardiovascular dysfunction during extended bedridden hospital or care home stays. Bed rest is also used as a model to simulate accelerated vascular deconditioning occurring during spaceflight. This study investigates changes in retinal microcirculation during a ten-day bed rest protocol. Ten healthy young males (22.9 ± 4.7 years; body mass index: 23.6 ± 2.5 kg·m-2) participated in a strictly controlled repeated-measures bed rest study lasting ten days. High-resolution images were obtained using a hand-held fundus camera at baseline, daily during the 10 days of bed rest, and 1 day after re-ambulation. Retinal vessel analysis was performed using a semi-automated software system to obtain metrics for retinal arteriolar and venular diameters, central retinal artery equivalent and central retinal vein equivalent, respectively. Data analysis employed a mixed linear model. At the end of the bed rest period, a significant decrease in retinal venular diameter was observed, indicated by a significantly lower central retinal vein equivalent (from 226.1 µm, CI 8.90, to 211.4 µm, CI 8.28, p = .026), while no significant changes in central retinal artery equivalent were noted. Prolonged bed rest confinement resulted in a significant (up to 6.5%) reduction in retinal venular diameter. These findings suggest that the changes in retinal venular diameter during bedrest may be attributed to plasma volume losses and reflect overall (cardio)-vascular deconditioning.

Cognitive and balance functions of astronauts after spaceflight are comparable to those of individuals with bilateral vestibulopathy

Introduction

This study compares the balance control and cognitive responses of subjects with bilateral vestibulopathy (BVP) to those of astronauts immediately after they return from long-duration spaceflight on board the International Space Station.

Methods

Twenty-eight astronauts and thirty subjects with BVP performed five tests using the same procedures: sit-to-stand, walk-and-turn, tandem walk, duration judgment, and reaction time.

Results

Compared to the astronauts' preflight responses, the BVP subjects' responses were impaired in all five tests. However, the BVP subjects' performance during the walk-and-turn and the tandem walk tests were comparable to the astronauts' performance on the day they returned from space. Moreover, the BVP subjects' time perception and reaction time were comparable to those of the astronauts during spaceflight. The BVP subjects performed the sit-to-stand test at a level that fell between the astronauts' performance on the day of landing and 1 day later.

Discussion

These results indicate that the alterations in dynamic balance control, time perception, and reaction time that astronauts experience after spaceflight are likely driven by central vestibular adaptations. Vestibular and somatosensory training in orbit and vestibular rehabilitation after spaceflight could be effective countermeasures for mitigating these post-flight performance decrements.

Artificial gravity during a spaceflight analog alters brain sensory connectivity

Spaceflight has numerous untoward effects on human physiology. Various countermeasures are under investigation including artificial gravity (AG). Here, we investigated whether AG alters resting-state brain functional connectivity changes during head-down tilt bed rest (HDBR), a spaceflight analog. Participants underwent 60 days of HDBR. Two groups received daily AG administered either continuously (cAG) or intermittently (iAG). A control group received no AG. We assessed resting-state functional connectivity before, during, and after HDBR. We also measured balance and mobility changes from pre- to post-HDBR. We examined how functional connectivity changes throughout HDBR and whether AG is associated with differential effects. We found differential connectivity changes by group between posterior parietal cortex and multiple somatosensory regions. The control group exhibited increased functional connectivity between these regions throughout HDBR whereas the cAG group showed decreased functional connectivity. This finding suggests that AG alters somatosensory reweighting during HDBR. We also observed brain-behavioral correlations that differed significantly by group. Control group participants who showed increased connectivity between the putamen and somatosensory cortex exhibited greater mobility declines post-HDBR. For the cAG group, increased connectivity between these regions was associated with little to no mobility declines post-HDBR. This suggests that when somatosensory stimulation is provided via AG, functional connectivity increases between the putamen and somatosensory cortex are compensatory in nature, resulting in reduced mobility declines. Given these findings, AG may be an effective countermeasure for the reduced somatosensory stimulation that occurs in both microgravity and HDBR.

New frontiers in the measurement of energy metabolism

This perspective highlights three key areas of current and future energy metabolism research: intergenerational health, climate change, and interplanetary exploration. We describe the recent advances in determining estimated energy requirements for a large subset of the general population using the gold standard method for free-living total daily energy expenditure estimates, the doubly labeled water method. The global rise in overweight and obesity demands particular attention to energy requirements in pregnancy and early life, as accumulating evidence contributes to our understanding of intergenerational health transmission and the potential for epigenetic programming in utero. We also acknowledge some gaps in necessary guidelines and understandings of energy requirements for underrepresented populations (i.e., individuals from low and middle-income countries) or those who undergo major physiological changes in new environment (e.g., astronauts). The rising prevalence of excess weight gain, together with climate change, cumulate into a global syndemic exposing vulnerable populations to both malnutrition and the effects of unpredictable and severe weather events, emphasizing the need for varied energetic data accounting for rapid physiological and socioeconomic changes. Finally, we relate how specific estimated energy requirements are needed to account for the energetic challenges specific to extended space travel and ensure the success of interplanetary exploration.

Effects of Long-duration Microgravity and Gravitational Transitions on Fine Motor Skills

OBJECTIVE

Assess the effects of long-duration microgravity and gravitational transitions on fine motor skills using a tablet-based test battery of four fine motor tasks: Pointing, Dragging, Shape Tracing, and Pinch-Rotate.

BACKGROUND

While there have been some studies on fine motor skills in microgravity, few have measured the fine motor skills that are core components of interaction with computer-based devices, and none have measured performance systematically, to include preflight, inflight, and postflight space mission time periods.

METHODS

Seven astronauts completed the Fine Motor Skills test battery 30-40 times before, during, and up to 30 days after standard duration International Space Station missions, while a matching set of seven ground-based control participants also completed the battery over a comparable period of time. Response time and accuracy were the primary outcome measures.

RESULTS

Relative to controls, astronauts experienced fine motor skill decrements at gravitational transitions (first week on orbit, and first month post landing). No decrements were found inflight after the first week of adaptation.

CONCLUSION

Gravitational transitions appear to negatively impact fine motor skills needed to operate small controls with accuracy, such as those on touchscreen interfaces. This raises concerns for future long-duration crewmembers who will land on a planetary surface and need to perform critical tasks accurately, such as configuring spacesuits, powering up a habitat, or teleoperating rovers.

APPLICATION

Results from this study highlight the need for confirmatory research, and the possible need for countermeasure development. The Fine Motor Skills test battery may have application outside of NASA as a fine motor skills diagnostic screening, rehabilitation, or readiness-to-perform tool.

Circuits and Biomarkers of the Central Nervous System Relating to Astronaut Performance: Summary Report for a NASA-Sponsored Technical Interchange Meeting

Biomarkers, ranging from molecules to behavior, can be used to identify thresholds beyond which performance of mission tasks may be compromised and could potentially trigger the activation of countermeasures. Identification of homologous brain regions and/or neural circuits related to operational performance may allow for translational studies between species. Three discussion groups were directed to use operationally relevant performance tasks as a driver when identifying biomarkers and brain regions or circuits for selected constructs. Here we summarize small-group discussions in tables of circuits and biomarkers categorized by (a) sensorimotor, (b) behavioral medicine and (c) integrated approaches (e.g., physiological responses). In total, hundreds of biomarkers have been identified and are summarized herein by the respective group leads. We hope the meeting proceedings become a rich resource for NASA's Human Research Program (HRP) and the community of researchers.

Sweat Production During Continuous and Interval Aerobic Exercise

INTRODUCTION:Aerobic exercise within the habitable volume of small spacecraft needed for space exploration beyond low Earth orbit is expected to challenge the capacity of environmental control systems. Moisture control is a primary concern. Crewmembers will contribute moisture to the cabin environment in the form of sweat while exercising. The effects of continuous aerobic exercise for improving and maintaining aerobic capacity is well characterized. Likewise, evidence suggests that high intensity interval exercise for shorter durations is also effective in building and maintaining aerobic capacity.METHODS: On separate days, measures of sweat and respiratory responses were made for continuous (30 min of steady state exercise at ∼75% of aerobic capacity) and two interval (4 × 4 min, 8 × 30 s) exercise protocols.RESULTS: We observed that the 4-min and 30-s interval protocols produce 16% and 66% less metabolic water loss vs. the continuous exercise protocol, respectively. These responses were highly correlated with the amount of work performed (R² = 0.81) and the amount of energy expenditure (R² = 0.83) during exercise.DISCUSSION: These results suggest that interval exercise may be a useful alternative to continuous aerobic exercise when metabolic water production is an environmental concern. The results may inform the choices of aerobic exercise countermeasure protocols for use in deep space exploration.Ryder JW, Crowell JB, Song HJ, Ewert M. Sweat production during continuous and interval aerobic exercise. Aerosp Med Hum Perform. 2023; 94(8):623-628.

Paving the way to better understand the effects of prolonged spaceflight on operational performance and its neural bases

Space exploration objectives will soon move from low Earth orbit to distant destinations like Moon and Mars. The present work provides an up-to-date roadmap that identifies critical research gaps related to human behavior and performance in altered gravity and space. The roadmap summarizes (1) key neurobehavioral challenges associated with spaceflight, (2) the need to consider sex as a biological variable, (3) the use of integrative omics technologies to elucidate mechanisms underlying changes in the brain and behavior, and (4) the importance of understanding the neural representation of gravity throughout the brain and its multisensory processing. We then highlight the need for a variety of target-specific countermeasures, and a personalized administration schedule as two critical strategies for mitigating potentially adverse effects of spaceflight on the central nervous system and performance. We conclude with a summary of key priorities for the roadmaps of current and future space programs and stress the importance of new collaborative strategies across agencies and researchers for fostering an integrative cross- and transdisciplinary approach from cells, molecules to neural circuits and cognitive performance. Finally, we highlight that space research in neurocognitive science goes beyond monitoring and mitigating risks in astronauts but could also have significant benefits for the population on Earth.

Daily Artificial Gravity Partially Mitigates Vestibular Processing Changes Associated with Head-down Tilt Bedrest

Microgravity alters vestibular signaling and reduces body loading, driving sensory reweighting and adaptation. The unloading effects can be modelled using head down tilt bedrest (HDT). Artificial gravity (AG) has been hypothesized to serve as an integrated countermeasure for the physiological declines associated with HDT and spaceflight. Here, we examined the efficacy of 30 minutes of daily AG to counteract brain and behavior changes that arise from 60 days of HDT. One group of participants received 30 minutes of AG daily (AG; n = 16) while in HDT, and another group served as controls, spending 60 days in HDT bedrest with no AG (CTRL; n = 8). We examined how HDT and AG affect vestibular processing by collecting fMRI scans from participants as they received vestibular stimulation. We collected these data prior to, during (2x), and post HDT. We assessed brain activation initially in 10 regions of interest (ROIs) and then conducted an exploratory whole brain analysis. The AG group showed no changes in brain activation during vestibular stimulation in a cerebellar ROI, whereas the CTRL group showed decreased cerebellar activation specific to the HDT phase. Additionally, those that received AG and showed little pre- to post-bed rest changes in left OP2 activation during HDT had better post-HDT balance performance. Exploratory whole brain analyses identified increased pre- to during-HDT activation in the CTRL group in the right precentral gyrus and the right inferior frontal gyrus specific to HDT, where the AG group maintained pre-HDT activation levels. Together, these results indicate that AG could mitigate brain activation changes in vestibular processing in a manner that is associated with better balance performance after HDT.

Daily artificial gravity is associated with greater neural efficiency during sensorimotor adaptation

Altered vestibular signaling and body unloading in microgravity results in sensory reweighting and adaptation. Microgravity effects are well-replicated in head-down tilt bed rest (HDBR). Artificial gravity (AG) is a potential countermeasure to mitigate the effects of microgravity on human physiology and performance. We examined the effectiveness of daily AG for mitigating brain and/or behavioral changes in 60 days of HDBR. One group received AG for 30 minutes daily (AG; n = 16) and a control group spent the same time in HDBR but received no AG (CTRL; n = 8). All participants performed a sensorimotor adaptation task five times during fMRI scanning: twice prior to HDBR, twice during HDBR, and once following HDBR. The AG group showed similar behavioral adaptation effects compared with the CTRLs. We identified decreased brain activation in the AG group from pre to late HDBR in the cerebellum for the task baseline portion and in the thalamus, calcarine, cuneus, premotor cortices, and superior frontal gyrus in the AG group during the early adaptation phase. The two groups also exhibited differential brain-behavior correlations. Together, these results suggest that AG may result in a reduced recruitment of brain activity for basic motor processes and sensorimotor adaptation. These effects may stem from the somatosensory and vestibular stimulation that occur with AG.

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.

Time perception in astronauts on board the International Space Station

We perceive the environment through an elaborate mental representation based on a constant integration of sensory inputs, knowledge, and expectations. Previous studies of astronauts on board the International Space Station have shown that the mental representation of space, such as the perception of object size, distance, and depth, is altered in orbit. Because the mental representations of space and time have some overlap in neural networks, we hypothesized that perception of time would also be affected by spaceflight. Ten astronauts were tested before, during, and after a 6-8-month spaceflight. Temporal tasks included judging when one minute had passed and how long it had been since the start of the workday, lunch, docking of a vehicle, and a spacewalk. Compared to pre-flight estimates, there is a relative overestimation for the 1-min interval during the flight and a relative underestimation of intervals of hours in duration. However, the astronauts quite accurately estimated the number of days since vehicle dockings and spacewalks. Prolonged isolation in confined areas, stress related to workload, and high-performance expectations are potential factors contributing to altered time perception of daily events. However, reduced vestibular stimulations and slower motions in weightlessness, as well as constant references to their timeline and work schedule could also account for the change in the estimation of time by the astronauts in space.

Human Health during Space Travel: State-of-the-Art Review

The field of human space travel is in the midst of a dramatic revolution. Upcoming missions are looking to push the boundaries of space travel, with plans to travel for longer distances and durations than ever before. Both the National Aeronautics and Space Administration (NASA) and several commercial space companies (e.g., Blue Origin, SpaceX, Virgin Galactic) have already started the process of preparing for long-distance, long-duration space exploration and currently plan to explore inner solar planets (e.g., Mars) by the 2030s. With the emergence of space tourism, space travel has materialized as a potential new, exciting frontier of business, hospitality, medicine, and technology in the coming years. However, current evidence regarding human health in space is very limited, particularly pertaining to short-term and long-term space travel. This review synthesizes developments across the continuum of space health including prior studies and unpublished data from NASA related to each individual organ system, and medical screening prior to space travel. We categorized the extraterrestrial environment into exogenous (e.g., space radiation and microgravity) and endogenous processes (e.g., alteration of humans' natural circadian rhythm and mental health due to confinement, isolation, immobilization, and lack of social interaction) and their various effects on human health. The aim of this review is to explore the potential health challenges associated with space travel and how they may be overcome in order to enable new paradigms for space health, as well as the use of emerging Artificial Intelligence based (AI) technology to propel future space health research.

Are head-down tilt bedrest studies capturing the true nature of spaceflight-induced cognitive changes? A review

Although a number of studies have examined cognitive functions in space, the reasons behind the observed changes described by space research and anecdotal reports have not yet been elucidated. A potential source of cognitive changes is the cephalad fluid shift in the body caused by the lack of hydrostatic pressure under microgravity. These alterations can be modeled under terrestrial conditions using ground-based studies, such as head-down tilt bedrest (HDBR). In this review, we compare the results of the space and HDBR cognitive research. Results for baseline and in-flight/in-HDBR comparisons, and for baseline and post-flight/post-HDBR comparisons are detailed regarding sensorimotor skills, time estimation, attention, psychomotor speed, memory, executive functions, reasoning, mathematical processing, and cognitive processing of emotional stimuli. Beyond behavioral performance, results regarding brain electrical activity during simulated and real microgravity environments are also discussed. Finally, we highlight the research gaps and suggest future directions.

Contributions of physical inactivity and sedentary behavior to metabolic and endocrine diseases

Physical inactivity is the fourth leading global cause of death and is a major contributor to metabolic and endocrine diseases. In this review we provide a current update of the past 5 years in the field as it pertains to the most prevalent and deadly chronic diseases. Despite the prevalence of physical inactivity in modern society, it remains largely overlooked relative to other comparable risk factors such as obesity, and our molecular understanding of how physical inactivity impacts metabolism is still partially unknown. Therefore, we discuss current clinical inactivity models along with their most recent findings regarding health outcomes along with any discrepancies that are present in the field. Lastly, we discuss future directions and the need for translatable animal models of physical inactivity to discover novel molecular targets for the prevention of chronic disease.

To infinity and beyond: Strategies for fabricating medicines in outer space

Recent advancements in next generation spacecrafts have reignited public excitement over life beyond Earth. However, to safeguard the health and safety of humans in the hostile environment of space, innovation in pharmaceutical manufacturing and drug delivery deserves urgent attention. In this review/commentary, the current state of medicines provision in space is explored, accompanied by a forward look on the future of pharmaceutical manufacturing in outer space. The hazards associated with spaceflight, and their corresponding medical problems, are first briefly discussed. Subsequently, the infeasibility of present-day medicines provision systems for supporting deep space exploration is examined. The existing knowledge gaps on the altered clinical effects of medicines in space are evaluated, and suggestions are provided on how clinical trials in space might be conducted. An envisioned model of on-site production and delivery of medicines in space is proposed, referencing emerging technologies (e.g. Chemputing, synthetic biology, and 3D printing) being developed on Earth that may be adapted for extra-terrestrial use. This review concludes with a critical analysis on the regulatory considerations necessary to facilitate the adoption of these technologies and proposes a framework by which these may be enforced. In doing so, this commentary aims to instigate discussions on the pharmaceutical needs of deep space exploration, and strategies on how these may be met.

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Space is a hostile environment that threatens human health and drug stability.

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Data on the behaviour of medicines in space is critical but lacking.

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Novel drug manufacturing and delivery strategies are needed to safeguard crewmembers’ safety.

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Chemputing, synthetic biology, and 3D printing are examples of such emerging technologies.

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A regulatory framework for space medicines must be implemented to assure quality.

Mission-critical tasks for assessing risks from vestibular and sensorimotor adaptation during space exploration

To properly assess the risk induced by vestibular and sensorimotor adaptation during exploration missions, we examined how long-duration stays on the International Space Station affect functional performance after gravity transitions. Mission-critical tasks that challenge the balance and the locomotion control systems were assessed: i.e., sit-to-stand, recovery-from-fall, tandem-walk, and walk-and-turn. We assessed 19 astronauts, including 7 first-time flyers and 12 experienced flyers, before their flight, a few hours after landing, and then 1 day and 6-11 days later. Results show that adaptation to long-term weightlessness causes deficits in functional performance immediately after landing that can last for up to 1 week. No differences were observed between first-time and experienced astronaut groups. These data suggest that additional sensorimotor-based countermeasures may be necessary to maintain functional performance at preflight levels when landing on planetary surfaces after a long period in weightlessness.

Physiological Alterations in Relation to Space Flight: The Role of Nutrition

Astronauts exhibit several pathophysiological changes due to a variety of stressors related to the space environment, including microgravity, space radiation, isolation, and confinement. Space motion sickness, bone and muscle mass loss, cardiovascular deconditioning and neuro-ocular syndrome are some of the spaceflight-induced effects on human health. Optimal nutrition is of the utmost importance, and-in combination with other measures, such as physical activity and pharmacological treatment-has a key role in mitigating many of the above conditions, including bone and muscle mass loss. Since the beginning of human space exploration, space food has not fully covered astronauts' needs. They often suffer from menu fatigue and present unintentional weight loss, which leads to further alterations. The purpose of this review was to explore the role of nutrition in relation to the pathophysiological effects of spaceflight on the human body.

Tandem Walk in Simulated Martian Gravity and Visual Environment

Astronauts returning from long-duration spaceflights experience visual-vestibular conflicts that causes motion sickness, perceptions that the environment is moving when it is not, and problems with walking and other functional tasks. To evaluate whether astronauts will have similar decrements after they land on Mars following exposure to weightlessness, participants were held by a device that offloads their weight, first entirely (0 G), and then partially (0.38 G) or not at all (1 G). Tandem (heel-to-toe) walk on a medium-density foam surface was used to assess the subject’s walking performance. Two visual conditions in virtual reality were investigated: normal vision and a visual-vestibular conflict generated by disorienting optokinetic stimulation (DOS). Tandem walking performance with DOS was better in 0.38 G compared to 1 G. Tandem walking performance in DOS in 1 G was not significantly different from tandem walking performance after spaceflight or bed rest. The increased tandem walking performance in 0.38 G compared to 1 G was presumably due to an increased cone of stability, allowing a larger amplitude of body sway without resulting in a fall. Tandem walking on a compliant foam surface with a visual-vestibular conflict is a potential analog for simulating postflight dynamic balance deficits in astronauts.

Multiple field tests on landing day: Early mobility may improve postural recovery following spaceflight

Adaptation to microgravity causes astronauts to experience sensorimotor disturbances during return to Earth leading to functional difficulties. Recently, the Field Test (FT) study involving an incrementally demanding sensorimotor functional test battery has allowed for an unprecedented view into early decrements and recovery from multiple tests conducted on the landing day following 6-months International Space Station missions. Although the protocol was challenging and temporarily increased motion sickness symptoms, there were anecdotal reports that performing these tasks within the first few hours of landing accelerated their recovery. Therefore, results from computerized dynamic posturography (CDP) following return to Houston were used to compare recovery between crewmembers that participated in FT (n = 18) with those that did not (controls, n = 11). While there were significant decrements in postural performance for both groups, some FT participants tended to perform closer to their preflight baseline in the most challenging condition of the CDP sensitive to vestibular function—eyes closed, unstable support and head movements. However, the distribution of difference scores appeared bimodal with other FT participants in the lower range of performance. We attribute these observations to the manner in which the field tests were implemented—some benefitted by encouraging early movement to drive adaptation when performed in a constrained incremental fashion; however, movements above aversive thresholds may have impaired adaptation in others. Challenging the sensorimotor system with increasingly provocative movements performed as close to landing as possible, as long as within individual thresholds, could be a useful intervention to accelerate astronaut’s sensorimotor readaptation that deserves further study.

Integrated Application of Low-Intensity Pulsed Ultrasound in Diagnosis and Treatment of Atrophied Skeletal Muscle Induced in Tail-Suspended Rats

Long-term exposure to microgravity leads to muscle atrophy, which is primarily characterized by a loss of muscle mass and strength and reduces one′s functional capability. A weightlessness-induced muscle atrophy model was established using the tail suspension test to evaluate the intervention or therapeutic effect of low-intensity pulsed ultrasound (LIPUS) on muscle atrophy. The rats were divided into five groups at random: the model group (B), the normal control group (NC), the sham-ultrasound control group (SUC), the LIPUS of 50 mW/cm2 radiation group (50 UR), and the LIPUS of 150 mW/cm2 radiation group (150 UR). Body weight, gastrocnemius weight, muscle force, and B-ultrasound images were used to evaluate muscle atrophy status. Results showed that the body weight, gastrocnemius weight, and image entropy of the tail suspension group were significantly lower than those of the control group (p < 0.01), confirming the presence of muscle atrophy. Although the results show that the muscle force and two weights of the rats stimulated by LIPUS are still much smaller than those of the NC group, they are significantly different from those of the pure tail suspension B group (p < 0.01). On day 14, the gastrocnemius forces of the rats exposed to 50 mW/cm2 and 150 mW/cm2 LIPUS were 150% and 165% of those in the B group. The gastrocnemius weights were both 135% of those in the B group. This suggests that ultrasound can, to a certain extent, prevent muscular atrophy.

Express: Cognition in Zero Gravity: Effects of Non-Terrestrial Gravity on Human Behaviour

As humanity prepares for deep space exploration, understanding the impact of spaceflight on bodily physiology is critical. While the effects of non-terrestrial gravity on the body are well established, little is known about its impact on human behaviour and cognition. Astronauts often describe dramatic alterations in sensorimotor functioning, including orientation, postural control and balance. Changes in cognitive functioning as well as in socio-affective processing have also been observed. Here we have reviewed the key literature and explored the impact of non-terrestrial gravity across three key functional domains: sensorimotor, cognition, and socio-affective processing. We have proposed a neuroanatomical model to account for the effects of non-terrestrial gravity in these domains. Understanding the impact of non-terrestrial gravity on human behaviour has never been more timely and it will help mitigate against risks in both commercial and non-commercial spaceflight.

Introducing the Concept of Exercise Holidays for Human Spaceflight - What Can We Learn From the Recovery of Bed Rest Passive Control Groups

In an attempt to counteract microgravity-induced deconditioning during spaceflight, exercise has been performed in various forms on the International Space Station (ISS). Despite significant consumption of time and resources by daily exercise, including around one third of astronauts’ energy expenditure, deconditioning—to variable extents—are observed. However, in future Artemis/Lunar Gateway missions, greater constraints will mean that the current high volume and diversity of ISS in-flight exercise will be impractical. Thus, investigating both more effective and efficient multi-systems countermeasure approaches taking into account the novel mission profiles and the associated health and safety risks will be required, while also reducing resource requirements. One potential approach is to reduce mission exercise volume by the introduction of exercise-free periods, or “exercise holidays”. Thus, we hypothesise that by evaluating the ‘recovery’ of the no-intervention control group of head-down-tilt bed rest (HDTBR) campaigns of differing durations, we may be able to define the relationship between unloading duration and the dynamics of functional recovery—of interest to future spaceflight operations within and beyond Low Earth Orbit (LEO)—including preliminary evaluation of the concept of exercise holidays. Hence, the aim of this literature study is to collect and investigate the post-HDTBR recovery dynamics of current operationally relevant anthropometric outcomes and physiological systems (skeletal, muscular, and cardiovascular) of the passive control groups of HDTBR campaigns, mimicking a period of ‘exercise holidays’, thereby providing a preliminary evaluation of the concept of ‘exercise holidays’ for spaceflight, within and beyond LEO. The main findings were that, although a high degree of paucity and inconsistency of reported recovery data is present within the 18 included studies, data suggests that recovery of current operationally relevant outcomes following HDTBR without exercise—and even without targeted rehabilitation during the recovery period—could be timely and does not lead to persistent decrements differing from those experienced following spaceflight. Thus, evaluation of potential exercise holidays concepts within future HDTBR campaigns is warranted, filling current knowledge gaps prior to its potential implementation in human spaceflight exploration missions.

Effects of 15-Days −6° Head-Down Bed Rest on the Attention Bias of Threatening Stimulus

Previous researchers have found that head-down bed rest (HDBR) will affect the emotional state of individuals, and negative emotions such as anxiety are closely related to attention bias. The present study adopted the dot-probe task to evaluate the effects of 15-days of −6° HDBR on the attention bias of threatening stimulus in 17 young men, which was completed before (Pre-HDBR), during (HDBR-1, HDBR-8, HDBR-15), after (Post-HDBR) the bed rest. In addition, self-report inventories (State Anxiety Inventory, SAI; Positive Affect and Negative Affect Scale, PANAS) were conducted to record emotional changes. The results showed that the participants’ negative affect scores on HDBR-8 were significantly lower than the HDBR-1 in PANAS while there was no significant difference on positive affect scores and anxiety scores in SAI. And the results showed that at the Pre-HDBR, HDBT-1, HDBR-15, Post-HDBR, the response speed to threatening stimulus was faster than neutral stimulus, but no statistical significance. However, reaction time of threatening stimulus is significantly longer than neutral stimulus in the HDBR-8, indicating that HDBR may have an effect on the participants’ attention bias, and this effect is manifested as attention avoidance.

Cortical thickness of primary motor and vestibular brain regions predicts recovery from fall and balance directly after spaceflight

Motor adaptations to the microgravity environment during spaceflight allow astronauts to perform adequately in this unique environment. Upon return to Earth, this adaptation is no longer appropriate and can be disruptive for mission critical tasks. Here, we measured if metrics derived from MRI scans collected from astronauts can predict motor performance post-flight. Structural and diffusion MRI scans from 14 astronauts collected before launch, and motor measures (balance performance, speed of recovery from fall, and tandem walk step accuracy) collected pre-flight and post-flight were analyzed. Regional measures of gray matter volume (motor cortex, paracentral lobule, cerebellum), myelin density (motor cortex, paracentral lobule, corticospinal tract), and white matter microstructure (corticospinal tract) were derived as a-priori predictors. Additional whole-brain analyses of cortical thickness, cerebellar gray matter, and cortical myelin were also tested for associations with post-flight and pre-to-post-flight motor performance. The pre-selected regional measures were not significantly associated with motor behavior. However, whole-brain analyses showed that paracentral and precentral gyri thickness significantly predicted recovery from fall post-spaceflight. Thickness of vestibular and sensorimotor regions, including the posterior insula and the superior temporal gyrus, predicted balance performance post-flight and pre-to-post-flight decrements. Greater cortical thickness pre-flight predicted better performance post-flight. Regional thickness of somatosensory, motor, and vestibular brain regions has some predictive value for post-flight motor performance in astronauts, which may be used for the identification of training and countermeasure strategies targeted for maintaining operational task performance.

The Effects of 30 Minutes of Artificial Gravity on Cognitive and Sensorimotor Performance in a Spaceflight Analog Environment

The altered vestibular signaling and somatosensory unloading of microgravity result in sensory reweighting and adaptation to conflicting sensory inputs. Aftereffects of these adaptive changes are evident postflight as impairments in behaviors such as balance and gait. Microgravity also induces fluid shifts toward the head and an upward shift of the brain within the skull; these changes are well-replicated in strict head-down tilt bed rest (HDBR), a spaceflight analog environment. Artificial gravity (AG) is a potential countermeasure to mitigate these effects of microgravity. A previous study demonstrated that intermittent (six, 5-mins bouts per day) daily AG sessions were more efficacious at counteracting orthostatic intolerance in a 5 day HDBR study than continuous daily AG. Here we examined whether intermittent daily AG was also more effective than continuous dosing for mitigating brain and behavioral changes in response to 60 days of HDBR. Participants (n = 24) were split evenly between three groups. The first received 30 mins of continuous AG daily (cAG). The second received 30 mins of intermittent AG daily (6 bouts of 5 mins; iAG). The third received no AG (Ctrl). We collected a broad range of sensorimotor, cognitive, and brain structural and functional assessments before, during, and after the 60 days of HDBR. We observed no significant differences between the three groups in terms of HDBR-associated changes in cognition, balance, and functional mobility. Interestingly, the intermittent AG group reported less severe motion sickness symptoms than the continuous group during centrifugation; iAG motion sickness levels were not elevated above those of controls who did not undergo AG. They also had a shorter duration of post-AG illusory motion than cAG. Moreover, the two AG groups performed the paced auditory serial addition test weekly while undergoing AG; their performance was more accurate than that of controls, who performed the test while in HDBR. Although AG did not counteract HDBR-induced gait and balance declines, iAG did not cause motion sickness and was associated with better self-motion perception during AG ramp-down. Additionally, both AG groups had superior cognitive performance while undergoing AG relative to controls; this may reflect attention or motivation differences between the groups.

Limb position sense and sensorimotor performance under conditions of weightlessness

This is a review of the current state of knowledge of the effects of weightlessness on human proprioception. Two aspects have been highlighted: the sense of limb position and performance in sensorimotor tasks. For the sense of position, an important consideration is that there probably exists more than one sense: one measured in a blindfolded, two-limb position matching task, the other, by pointing to the perceived position of a hidden limb. There is evidence that these two senses are supported by distinct central projection pathways. When assessing the effects of weightlessness this must be considered. Whether there is a role for vestibular influences on position sense during changes in gravitational forces is an issue for future experiments. A consideration that has proved helpful for the study of sensorimotor tasks under conditions of weightlessness is to examine the performance of subjects who have lost their proprioceptive senses, either congenitally, or later in life, as a result of disease. In weightlessness, normal subjects appear to have particular difficulties with feedback-controlled tasks. A major factor is the influence of vision on performance. In addition, the stress of working in a weightless environment leads to additional cognitive load, making the execution of even simple everyday tasks difficult.

Contributions of Body-Orientation to Mental Ball Dropping Task During Out-of-Body Experiences

Out-of-body experiences (OBEs) provide fascinating insights into our understanding of bodily self-consciousness and the workings of the brain. Studies that examined individuals with brain lesions reported that OBEs are generally characterized by participants experiencing themselves outside their physical body (i.e., disembodied feeling) (Blanke and Arzy, 2005). Based on such a characterization, it has been shown that it is possible to create virtual OBEs in immersive virtual environments (Ehrsson, 2007; Ionta et al., 2011b; Bourdin et al., 2017). However, the extent to which body-orientation influences virtual OBEs is not well-understood. Thus, in the present study, 30 participants (within group design) experienced a full-body ownership illusion (synchronous visuo-tactile stimulation only) induced with a gender-matched full-body virtual avatar seen from the first-person perspective (1PP). At the beginning of the experiment, participants performed a mental ball dropping (MBD) task, seen from the location of their virtual avatar, to provide a baseline measurement. After this, a full-body ownership illusion (embodiment phase) was induced in all participants. This was followed by the virtual OBE illusion phase of the experiment (disembodiment phase) in which the first-person viewpoint was switched to a third-person perspective (3PP), and participants' disembodied viewpoint was gradually raised to 14 m above the virtual avatar, from which altitude they repeated the MBD task. During the experiment, this procedure was conducted twice, and the participants were allocated first to the supine or the standing body position at random. Results of the MBD task showed that the participants experienced increased MBD durations during the supine condition compared to the standing condition. Furthermore, although the findings from the subjective reports confirmed the previous findings of virtual OBEs, no significant difference between the two postures was found for body ownership. Taken together, the findings of the current study make further contributions to our understanding of both the vestibular system and time perception during OBEs.

Mental imagery of object motion in weightlessness

Mental imagery represents a potential countermeasure for sensorimotor and cognitive dysfunctions due to spaceflight. It might help train people to deal with conditions unique to spaceflight. Thus, dynamic interactions with the inertial motion of weightless objects are only experienced in weightlessness but can be simulated on Earth using mental imagery. Such training might overcome the problem of calibrating fine-grained hand forces and estimating the spatiotemporal parameters of the resulting object motion. Here, a group of astronauts grasped an imaginary ball, threw it against the ceiling or the front wall, and caught it after the bounce, during pre-flight, in-flight, and post-flight experiments. They varied the throwing speed across trials and imagined that the ball moved under Earth's gravity or weightlessness. We found that the astronauts were able to reproduce qualitative differences between inertial and gravitational motion already on ground, and further adapted their behavior during spaceflight. Thus, they adjusted the throwing speed and the catching time, equivalent to the duration of virtual ball motion, as a function of the imaginary 0 g condition versus the imaginary 1 g condition. Arm kinematics of the frontal throws further revealed a differential processing of imagined gravity level in terms of the spatial features of the arm and virtual ball trajectories. We suggest that protocols of this kind may facilitate sensorimotor adaptation and help tuning vestibular plasticity in-flight, since mental imagery of gravitational motion is known to engage the vestibular cortex.

The Effects of Long Duration Spaceflight on Sensorimotor Control and Cognition

Astronauts returning from spaceflight typically show transient declines in mobility and balance. Other sensorimotor behaviors and cognitive function have not been investigated as much. Here, we tested whether spaceflight affects performance on various sensorimotor and cognitive tasks during and after missions to the International Space Station (ISS). We obtained mobility (Functional Mobility Test), balance (Sensory Organization Test-5), bimanual coordination (bimanual Purdue Pegboard), cognitive-motor dual-tasking and various other cognitive measures (Digit Symbol Substitution Test, Cube Rotation, Card Rotation, Rod and Frame Test) before, during and after 15 astronauts completed 6 month missions aboard the ISS. We used linear mixed effect models to analyze performance changes due to entering the microgravity environment, behavioral adaptations aboard the ISS and subsequent recovery from microgravity. We observed declines in mobility and balance from pre- to post-flight, suggesting disruption and/or down weighting of vestibular inputs; these behaviors recovered to baseline levels within 30 days post-flight. We also identified bimanual coordination declines from pre- to post-flight and recovery to baseline levels within 30 days post-flight. There were no changes in dual-task performance during or following spaceflight. Cube rotation response time significantly improved from pre- to post-flight, suggestive of practice effects. There was also a trend for better in-flight cube rotation performance on the ISS when crewmembers had their feet in foot loops on the “floor” throughout the task. This suggests that tactile inputs to the foot sole aided orientation. Overall, these results suggest that sensory reweighting due to the microgravity environment of spaceflight affected sensorimotor performance, while cognitive performance was maintained. A shift from exocentric (gravity) spatial references on Earth toward an egocentric spatial reference may also occur aboard the ISS. Upon return to Earth, microgravity adaptions become maladaptive for certain postural tasks, resulting in transient sensorimotor performance declines that recover within 30 days.

Neuro-consequences of the spaceflight environment

As human space exploration advances to establish a permanent presence beyond the Low Earth Orbit (LEO) with NASA's Artemis mission, researchers are striving to understand and address the health challenges of living and working in the spaceflight environment. Exposure to ionizing radiation, microgravity, isolation and other spaceflight hazards pose significant risks to astronauts. Determining neurobiological and neurobehavioral responses, understanding physiological responses under Central Nervous System (CNS) control, and identifying putative mechanisms to inform countermeasure development are critically important to ensuring brain and behavioral health of crew on long duration missions. Here we provide a detailed and comprehensive review of the effects of spaceflight and of ground-based spaceflight analogs, including simulated weightlessness, social isolation, and ionizing radiation on humans and animals. Further, we discuss dietary and non-dietary countermeasures including artificial gravity and antioxidants, among others. Significant future work is needed to ensure that neural, sensorimotor, cognitive and other physiological functions are maintained during extended deep space missions to avoid potentially catastrophic health and safety outcomes.

Molecular and Metabolic Mechanism of Low-Intensity Pulsed Ultrasound Improving Muscle Atrophy in Hindlimb Unloading Rats

Low-intensity pulsed ultrasound (LIPUS) has been proved to promote the proliferation of myoblast C2C12. However, whether LIPUS can effectively prevent muscle atrophy has not been clarified, and if so, what is the possible mechanism. The aim of this study is to evaluate the effects of LIPUS on muscle atrophy in hindlimb unloading rats, and explore the mechanisms. The rats were randomly divided into four groups: normal control group (NC), hindlimb unloading group (UL), hindlimb unloading plus 30 mW/cm² LIPUS irradiation group (UL + 30 mW/cm²), hindlimb unloading plus 80 mW/cm² LIPUS irradiation group (UL + 80 mW/cm²). The tails of rats in hindlimb unloading group were suspended for 28 days. The rats in the LIPUS treated group were simultaneously irradiated with LIPUS on gastrocnemius muscle in both lower legs at the sound intensity of 30 mW/cm² or 80 mW/cm² for 20 min/d for 28 days. C2C12 cells were exposed to LIPUS at 30 or 80 mW/cm² for 5 days. The results showed that LIPUS significantly promoted the proliferation and differentiation of myoblast C2C12, and prevented the decrease of cross-sectional area of muscle fiber and gastrocnemius mass in hindlimb unloading rats. LIPUS also significantly down regulated the expression of MSTN and its receptors ActRIIB, and up-regulated the expression of Akt and mTOR in gastrocnemius muscle of hindlimb unloading rats. In addition, three metabolic pathways (phenylalanine, tyrosine and tryptophan biosynthesis; alanine, aspartate and glutamate metabolism; glycine, serine and threonine metabolism) were selected as important metabolic pathways for hindlimb unloading effect. However, LIPUS promoted the stability of alanine, aspartate and glutamate metabolism pathway. These results suggest that the key mechanism of LIPUS in preventing muscle atrophy induced by hindlimb unloading may be related to promoting protein synthesis through MSTN/Akt/mTOR signaling pathway and stabilizing alanine, aspartate and glutamate metabolism.

COMPASS: Computations for Orientation and Motion Perception in Altered Sensorimotor States

Reliable perception of self-motion and orientation requires the central nervous system (CNS) to adapt to changing environments, stimuli, and sensory organ function. The proposed computations required of neural systems for this adaptation process remain conceptual, limiting our understanding and ability to quantitatively predict adaptation and mitigate any resulting impairment prior to completing adaptation. Here, we have implemented a computational model of the internal calculations involved in the orientation perception system’s adaptation to changes in the magnitude of gravity. In summary, we propose that the CNS considers parallel, alternative hypotheses of the parameter of interest (in this case, the CNS’s internal estimate of the magnitude of gravity) and uses the associated sensory conflict signals (i.e., difference between sensory measurements and the expectation of them) to sequentially update the posterior probability of each hypothesis using Bayes rule. Over time, an updated central estimate of the internal magnitude of gravity emerges from the posterior probability distribution, which is then used to process sensory information and produce perceptions of self-motion and orientation. We have implemented these hypotheses in a computational model and performed various simulations to demonstrate quantitative model predictions of adaptation of the orientation perception system to changes in the magnitude of gravity, similar to those experienced by astronauts during space exploration missions. These model predictions serve as quantitative hypotheses to inspire future experimental assessments.

HDAC6 Negatively Regulates miR-155-5p Expression to Elicit Proliferation by Targeting RHEB in Microvascular Endothelial Cells under Mechanical Unloading

Mechanical unloading contributes to significant cardiovascular deconditioning. Endothelial dysfunction in the sites of microcirculation may be one of the causes of the cardiovascular degeneration induced by unloading, but the detailed mechanism is still unclear. Here, we first demonstrated that mechanical unloading inhibited brain microvascular endothelial cell proliferation and downregulated histone deacetylase 6 (HDAC6) expression. Furthermore, HDAC6 promoted microvascular endothelial cell proliferation and attenuated the inhibition of proliferation caused by clinorotation unloading. To comprehensively identify microRNAs (miRNAs) that are regulated by HDAC6, we analyzed differential miRNA expression in microvascular endothelial cells after transfection with HDAC6 siRNA and selected miR-155-5p, which was the miRNA with the most significantly increased expression. The ectopic expression of miR-155-5p inhibited microvascular endothelial cell proliferation and directly downregulated Ras homolog enriched in brain (RHEB) expression. Moreover, RHEB expression was downregulated under mechanical unloading and was essential for the miR-155-5p-mediated promotion of microvascular endothelial cell proliferation. Taken together, these results are the first to elucidate the role of HDAC6 in unloading-induced cell growth inhibition through the miR-155-5p/RHEB axis, suggesting that the HDAC6/miR-155-5p/RHEB pathway is a specific target for the preventative treatment of cardiovascular deconditioning.

Ophthalmic changes in a spaceflight analog are associated with brain functional reorganization

Following long-duration spaceflight, some astronauts exhibit ophthalmic structural changes referred to as Spaceflight Associated Neuro-ocular Syndrome (SANS). Optic disc edema is a common sign of SANS. The origin and effects of SANS are not understood as signs of SANS have not manifested in previous spaceflight analog studies. In the current spaceflight analog study, 11 subjects underwent 30 days of strict head down-tilt bed rest in elevated ambient carbon dioxide (HDBR+CO2 ). Using functional magnetic resonance imaging (fMRI), we acquired resting-state fMRI data at 6 time points: before (2), during (2), and after (2) the HDBR+CO2 intervention. Five participants developed optic disc edema during the intervention (SANS subgroup) and 6 did not (NoSANS group). This occurrence allowed us to explore whether development of signs of SANS during the spaceflight analog impacted resting-state functional connectivity during HDBR+CO2 . In light of previous work identifying genetic and biochemical predictors of SANS, we further assessed whether the SANS and NoSANS subgroups exhibited differential patterns of resting-state functional connectivity prior to the HDBR+CO2 intervention. We found that the SANS and NoSANS subgroups exhibited distinct patterns of resting-state functional connectivity changes during HDBR+CO2 within visual and vestibular-related brain networks. The SANS and NoSANS subgroups also exhibited different resting-state functional connectivity prior to HDBR+CO2 within a visual cortical network and within a large-scale network of brain areas involved in multisensory integration. We further present associations between functional connectivity within the identified networks and previously identified genetic and biochemical predictors of SANS. Subgroup differences in resting-state functional connectivity changes may reflect differential patterns of visual and vestibular reweighting as optic disc edema develops during the spaceflight analog. This finding suggests that SANS impacts not only neuro-ocular structures, but also functional brain organization. Future prospective investigations incorporating sensory assessments are required to determine the functional significance of the observed connectivity differences.

Brain and Behavioral Evidence for Reweighting of Vestibular Inputs with Long-Duration Spaceflight

Microgravity alters vestibular signaling. In-flight adaptation to altered vestibular afferents is reflected in post-spaceflight aftereffects, evidenced by declines in vestibularly mediated behaviors (e.g., walking/standing balance), until readaptation to Earth's 1G environment occurs. Here we examine how spaceflight affects neural processing of applied vestibular stimulation. We used fMRI to measure brain activity in response to vestibular stimulation in 15 astronauts pre- and post-spaceflight. We also measured vestibularly-mediated behaviors, including balance, mobility, and rod-and-frame test performance. Data were collected twice preflight and four times postflight. As expected, vestibular stimulation at the preflight sessions elicited activation of the parietal opercular area ("vestibular cortex") and deactivation of somatosensory and visual cortices. Pre- to postflight, we found widespread reductions in this somatosensory and visual cortical deactivation, supporting sensory compensation and reweighting with spaceflight. These pre- to postflight changes in brain activity correlated with changes in eyes closed standing balance, and greater pre- to postflight reductions in deactivation of the visual cortices associated with less postflight balance decline. The observed brain changes recovered to baseline values by 3 months postflight. Together, these findings provide evidence for sensory reweighting and adaptive cortical neuroplasticity with spaceflight. These results have implications for better understanding compensation and adaptation to vestibular functional disruption.

Visuomotor Adaptation Brain Changes During a Spaceflight Analog With Elevated Carbon Dioxide (CO2): A Pilot Study

Astronauts on board the International Space Station (ISS) must adapt to several environmental challenges including microgravity, elevated carbon dioxide (CO₂), and isolation while performing highly controlled movements with complex equipment. Head down tilt bed rest (HDBR) is an analog used to study spaceflight factors including body unloading and headward fluid shifts. We recently reported how HDBR with elevated CO₂ (HDBR+CO₂) affects visuomotor adaptation. Here we expand upon this work and examine the effects of HDBR+CO₂ on brain activity during visuomotor adaptation. Eleven participants (34 ± 8 years) completed six functional MRI (fMRI) sessions pre-, during, and post-HDBR+CO₂. During fMRI, participants completed a visuomotor adaptation task, divided into baseline, early, late and de-adaptation. Additionally, we compare brain activity between this NASA campaign (30-day HDBR+CO₂) and a different campaign with a separate set of participants (60-day HDBR with normal atmospheric CO₂ levels, n = 8; 34.25 ± 7.9 years) to characterize the specific effects of CO₂. Participants were included by convenience. During early adaptation across the HDBR+CO₂ intervention, participants showed decreasing activation in temporal and subcortical brain regions, followed by post- HDBR+CO₂ recovery. During late adaptation, participants showed increasing activation in the right fusiform gyrus and right caudate nucleus during HDBR+CO₂; this activation normalized to baseline levels after bed rest. There were no correlations between brain changes and adaptation performance changes from pre- to post HDBR+CO₂. Also, there were no statistically significant differences between the HDBR+CO₂ group and the HDBR controls, suggesting that changes in brain activity were due primarily to bed rest rather than elevated CO₂. Five HDBR+CO₂ participants presented with optic disc edema, a sign of Spaceflight Associated Neuro-ocular Syndrome (SANS). An exploratory analysis of HDBR+CO₂ participants with and without signs of SANS revealed no group differences in brain activity during any phase of the adaptation task. Overall, these findings have implications for spaceflight missions and training, as ISS missions require individuals to adapt to altered sensory inputs over long periods in space. Further, this is the first study to verify the HDBR and elevated CO₂ effects on the neural correlates of visuomotor adaptation.

Developing Proprioceptive Countermeasures to Mitigate Postural and Locomotor Control Deficits After Long-Duration Spaceflight

Astronauts experience post-flight disturbances in postural and locomotor control due to sensorimotor adaptations during spaceflight. These alterations may have adverse consequences if a rapid egress is required after landing. Although current exercise protocols can effectively mitigate cardiovascular and muscular deconditioning, the benefits to post-flight sensorimotor dysfunction are limited. Furthermore, some exercise capabilities like treadmill running are currently not feasible on exploration spaceflight vehicles. Thus, new in-flight operational countermeasures are needed to mitigate postural and locomotor control deficits after exploration missions. Data from spaceflight and from analog studies collectively suggest that body unloading decreases the utilization of proprioceptive input, and this adaptation strongly contributes to balance dysfunction after spaceflight. For example, on return to Earth, an astronaut's vestibular input may be compromised by adaptation to microgravity, but their proprioceptive input is compromised by body unloading. Since proprioceptive and tactile input are important for maintaining postural control, keeping these systems tuned to respond to upright balance challenges during flight may improve functional task performance after flight through dynamic reweighting of sensory input. Novel approaches are needed to compensate for the challenges of balance training in microgravity and must be tested in a body unloading environment such as head down bed rest. Here, we review insights from the literature and provide observations from our laboratory that could inform the development of an in-flight proprioceptive countermeasure.

The role of nutrition in space exploration: Implications for sensorimotor, cognition, behavior and the cerebral changes due to the exposure to radiation, altered gravity, and isolation/confinement hazards of spaceflight

Multi-year crewed space exploration missions are now on the horizon; therefore, it is important that we understand and mitigate the physiological effects of spaceflight. The spaceflight hazards-radiation, isolation, confinement, and altered gravity-have the potential to contribute to neuroinflammation and produce long-term cognitive and behavioral effects-while the fifth hazard, distance from earth, limits capabilities to mitigate these risks. Accumulated evidence suggests that nutrition has an important role in optimizing cognition and reducing the risk of neurodegenerative diseases caused by neuroinflammation. Here we review the nutritional perspective of how these spaceflight hazards affect the astronaut's brain, behavior, performance, and sensorimotor function. We also assess potential nutrient/nutritional countermeasures that could prevent or mitigate spaceflight risks and ensure that crewmembers remain healthy and perform well during their missions. Just as history has taught us the importance of nutrition in terrestrial exploration, we must understand the role of nutrition in the development and mitigation of spaceflight risks before humans can successfully explore beyond low-Earth orbit.

Influence of vestibular signals on bodily self-consciousness: Different sensory weighting strategies based on visual dependency

Previous studies showed that the vestibular system is crucial for multisensory integration, however, its contribution to bodily self-consciousness more specifically on full-body illusions is not well understood. Thus, the current study examined the role of visuo-vestibular conflict on a full-body illusion (FBI) experiment that was induced during a supine body position. In a mixed design experiment, 56 participants underwent through a full-body illusion protocol. During the experiment, half of the participants received synchronous visuo-tactile stimulation, and the other half received asynchronous visuo-tactile stimulation, while their physical body was lying in a supine position, but the virtual body was standing. Additionally, the contribution of individual sensory weighting strategies was investigated via the Rod and Frame task (RFT), which was applied both before (pre-FBI standing and pre-FBI supine) and after the full-body illusion (post-FBI supine) protocol. Subjective reports of the participants confirmed previous findings suggesting that there was a significant increase in ownership over a virtual body during synchronous visuo-tactile stimulation. Additionally, further categorization of participants based on their visual dependency (by RFT) showed that those participants who rely more on visual information (visual field dependents) perceived the full-body illusion more strongly than non-visual field dependents during the synchronous visuo-tactile stimulation condition. Further analysis provided not only a quantitative demonstration of full-body illusion but also revealed changes in perceived self-orientation based on their field dependency. Altogether, findings of the current study make further contributions to our understanding of the vestibular system and brought new insight for individual sensory weighting strategies during a full-body illusion.

Nonuniform loss of muscle strength and atrophy during bed rest: a systematic review

Muscle atrophy and decline in muscle strength appear very rapidly with prolonged disuse or mechanical unloading after acute hospitalization or experimental bed rest. The current study analyzed data from short-, medium-, and long-term bed rest (5-120 days) in a pooled sample of 318 healthy adults and modeled the mathematical relationship between muscle strength decline and atrophy. The results show a logarithmic disuse-induced loss of strength and muscle atrophy of the weight-bearing knee extensor muscles. The greatest rate of muscle strength decline and atrophy occurred in the earliest stages of bed rest, plateauing later, and likely contributed to the rapid neuromuscular loss of function in the early period. In addition, during the first 2 wk of bed rest, muscle strength decline is much faster than muscle atrophy: on day 5, the ratio of muscle atrophy to strength decline as a function of bed rest duration is 4.2, falls to 2.4 on day 14, and stabilizes to a value of 1.9 after ∼35 days of bed rest. Positive regression revealed that ∼79% of the muscle strength loss may be explained by muscle atrophy, while the remaining is most likely due to alterations in single fiber mechanical properties, excitation-contraction coupling, fiber architecture, tendon stiffness, muscle denervation, neuromuscular junction damage, and supraspinal changes. Future studies should focus on neural factors as well as muscular factors independent of atrophy (single fiber excitability and mechanical properties, architectural factors) and on the role of extracellular matrix changes. Bed rest results in nonuniform loss of isometric muscle strength and atrophy over time, where the magnitude of change was greater for muscle strength than for atrophy. Future research should focus on the loss of muscle function and the underlying mechanisms, which will aid in the development of countermeasures to mitigate or prevent the decline in neuromuscular efficiency.NEW & NOTEWORTHY Our study contributes to the characterization of muscle loss and weakness processes reflected by a logarithmic decline in muscle strength induced by chronic bed rest. Acute short-term hospitalization (≤5 days) associated with periods of disuse/immobilization/prolonged time in the supine position in the hospital bed is sufficient to significantly decrease muscle mass and size and induce functional changes related to weakness in maximal muscle strength. By bringing together integrated evaluation of muscle structure and function, this work identifies that 79% of the loss in muscle strength can be explained by muscle atrophy, leaving 21% of the functional loss unexplained. The outcomes of this study should be considered in the development of daily countermeasures for preserving neuromuscular integrity as well as preconditioning interventions to be implemented before clinical bed rest or chronic gravitational unloading (e.g., spaceflights).