ROLE OF BLOOD FLOW RESTRICTED EXERCISE REGIMEN

AND ADVANCED RESISTIVE EXERCISE DEVICE (A.R.E.D.) IN

PREPARATION AND RECONDITIONING OF ASTRONAUTS IN
SPACE

Submitted by
Mr .M . EASHWAR PRASAD
Regd.no.15044005
(2015-2019)

Guided by
DR.G.VIJAYA JYOTHI,
MPT (NEUROLOGY),M.I.A.P

MODERN INSTITUTE OF PHYSICAL MEDICINE &

REHABILITATION
HYDERABAD-500 012
1
 (AFFILIATED TO DR. NTRUHS VIJAYAWADA)

CERTIFICATE

This is to certify that “ROLE OF BLOOD FLOW RESTRICTED

EXERCISE REGIMEN AND ADVANCED RESISTIVE
EXERCISE DEVICE (A.R.E.D.) IN PREPARATION AND
RECONDITIONING OF ASTRONAUTS IN SPACE” is a bonafide
work by Mr. M. EASHWAR PRASAD final year Student of Modern
Institute of Physical Medicine and Rehabilitation (2015-2019) batch,
towards the partial fulfilment of the Bachelor of Physiotherapy B.P.T,
degree course under Dr.N.T.R University of health sciences,
Vijayawada.

Project guide: Principal:

DR.G.VIJAYA JYOTHI DR. G. ARUN BABU
MPT (NEUROLOGY) MPT (Neuro)
2
MIMPR, HYDERABAD. MIMPR, HYDERABAD.

CERTIFICATE

This is to certify that “ROLE OF BLOOD FLOW RESTRICTED

EXERCISE REGIMEN AND ADVANCED RESISTIVE
EXERCISE DEVICE (A.R.E.D.) IN PREPARATION AND
RECONDITIONING OF ASTRONAUTS IN SPACE” is a bonafide
work by Mr. M. EASHWAR PRASAD final year Student of Modern
Institute of Physical Medicine and Rehabilitation (2015-2019) batch,
towards the partial fulfilment of the Bachelor of Physiotherapy B.P.T,
degree course under Dr.N.T.R University of health sciences,
Vijayawada.

INTERNAL EXAMINER EXTERNAL EXAMINER

Date: Place:
3
 ACKNOWLEDGEMENT
It is my esteemed pleasure to present this project work on the topic
“ROLE OF BLOOD FLOW RESTRICTED EXERCISE REGIMEN
AND ADVANCED RESISTIVE EXERCISE DEVICE (A.R.E.D.) IN
PREPARATION AND RECONDITIONING OF ASTRONAUTS IN
SPACE” and take opportunity to thank everyone who helped me in this
task

First I would like to thank God and my parents who have the greatest
contribution in all my achievements.

My special thanks to respected Principal Dr. G. ARUN BABU, MPT

(NEUROLOGY) for having faith in me and allowing me to do this
project.

I deeply indebted and thankful to my project guide Dr.G.VIJAYA

JYOTHI,MPT(NEUROLOGY),M.I.A.P for her unflagging energy and

4
dedication. She has tried in every conceivable way to get me to complete
this project.

I also thank the staff member of my college for the guidance and
encouragement.

CONTENTS
 1.INTRODUCTION
 SPACE
 SPACEFLIGHT
 2.BIOPHYSICS
 GRAVITY
 MICROGRAVITY
 3.SPACE ORGANISATIONS
 MISSIONS &ACHIEVEMENTS
 4.ASTRONAUT/COSMONAUT
 DEFINITION
 ROLE &RESPONSIBILITIES
 SELECTION CRITERIA
 QUALIFICATION
 ASTRONAUT TRAINING SESSION
 5 ,HEALTH IMPLICATIONS OF ASTRONAUT
IN SPACE (MICROGRAVITY)
 6.PATHOPHYSIOLOGICAL CHANGES IN
SPACE (MICROGRAVITY)
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 7 .INVESTIGATIONS-SCREENINGS
 8 .MANAGEMENT
 DIETARY SUPPLEMENT
 MEDICAL MANAGEMENT
 EXERCISE THERAPY
 9.EXERCISE INTERVENTIONS
&MANAGEMENT
 PRE FLIGHT
 INFLIGHT
 POST FLIGHT
 10.RATIONALE BLOOD FLOW RESTRICTED
EXERCISE AND ADVANCED RESISTIVE EXERCISE
DEVICE
 11.ORTHOTICS /PROSTHETICS /ROBOTICS
 12.ERGONOMICS IN SPACE
 13.CURRENT RESEARCHES
 14.CONCLUSION
 15.BIBILIOGRAPHY

6
INTRODUCTION

7
 INTRODUCTION
Space exploration is the ongoing discovery and exploration of celestial
structures in outer space by means of continuously evolving and growing
space technology.
While the study of space is carried out mainly by astronomers with
telescopes, the physical exploration of space is conducted both by
unmanned robotic probes and human spaceflight.
Astronauts are the unique population of physically and mentally
fit individuals who have to travel from gravity to microgravity and back
to the gravity.
Microgravity is an environment in which body experiences less or no
gravitational force. The physiologic functions of the human body are
suited to the gravitational force on earth.
Gravity is defined as force of attraction between all the masses of the
universe. Humans, being terrestrial animals, are subjected to constant
force of gravity right from their birth. In accordance with Newton’s first
law of motion, our body constantly works to maintain an upright posture
against this invisible force of attraction towards the earth (9.8m/s2). This
force of gravity has major influence on musculoskeletal, neuro-
vestibular, cardiovascular and pulmonary systems. Effects of space travel
on the human body like space sickness, disorientation, migration of
organic fluids to the upper body, bone deterioration, muscular atrophy,
lengthening of the spine, backaches, gait disturbances motor
performance degradation, electrical activity disturbances neuro reflexes
Re adjustment, motion sickness, fluid loss, electrolyte changes etc.
Astronauts experience microgravity during their space flight wherein
they undergo similar physiological adaptations as seen in senile bed
ridden patient or those seen with detraining in athletes. These
8
effects of microgravity adversely affect astronaut’s fitness & interfere
with space mission activities. A well planned exercise training program
is essential to prevent these adverse effects while in space & to regain
fitness post flight.
.
Exercise role is to make sure the astronaut readapts to gravity conditions
on Earth as soon as possible.
The astronaut who is assigned for a mission in the preflight period to
make them ‘fit for space’ and to train all exercises he/she has to do while
on the ISS.
During the in-flight period we control the exercises via video, sometimes
in real time, to make sure that the performance is perfect and the effect
optimal.
To restore the normal physiological function of the body by more
physical activity is necessary to rebuild the muscle strength, bone health
and cardiovascular activity.
To improve cardio vascular function by ergonomics and aerobics
exercises. To maintain balance and co-ordination by adaptability
training, Swiss ball exercises. Whilst in space, physiological changes to
the human body can go unnoticed in an astronaut’s day-to-day
performance.
Development of countermeasures designed to try and simulate Earth-like
movements and stresses or reloading of gravity has, consequently,
become essential to protect the health of astronauts.
Many countermeasures have been designed over the decades of space
flight to help mitigate the microgravity effects on different body systems,
although none, either on their own or in combination, has proven to be
100% effective.

9
For this we are training each system with specific techniques to
rearranging body functions normal.
The aim of this project is to present the role of BLOOD FLOW
RESTRICTED EXERCISE AND ADVANCED RESISTIVE
EXERCISE DEVICE interventions and its benefits to improve the health
status of astronauts.

SPACE
 Space is everything in the universe that exists beyond the top of
Earths atmosphere about 100kms (60miles)and between celestial
objects where there is no appreciable air to breath or to scatter light.
 Space is not completely empty it is a hard vaccum meaning that
sound cannot carry because molecules are not close enough to
transmit sound between them.
 Space contains a low density of particles predominantly a plasma of
hydrogen and helium as well as electromagnetic radiation,
magnetic fields and cosmic rays.
SPACE FLIGHT
 Spaceflight is ballistic flight into or through outer space and is used
in space exploration, and also in commercial activities like space
tourism and satellite telecommunications.

10
 Additional non-commercial uses of spaceflight include space
observatories, reconnaissance satellites and other Earth observation
satellites.
 Examples of human spaceflight include the U.S. Apollo Moon
landing and Space Shuttle programs and the Russian Soyuz
program, as well as the ongoing International Space Station.
 Examples of unmanned spaceflight include space probes that leave
Earth orbit, as well as satellites in orbit around Earth, such as
communications satellites.
 A spaceflight typically begins with a rocket launch, which provides
the initial thrust to overcome the force of gravity and propels the
spacecraft from the surface of the Earth.

BIOPHYSICS
ACCELERATION IN ONE DIRECTION SHIFTS
BLOOD VOLUME IN OPPOSITE DIRECTION
 Newton’s 1st Law of Motion – Inertia
“A body remains at rest, and a body in motion remains in motion,
at the same velocity, unless acted upon by an external force”
 Newton’s 2nd Law of Motion – Momentum
 Momentum = Mass X Velocity
“When an external force acts on a body, the change in body’s
momentum is in the direction of the force”
 Newton’s 3rd Law of Motion
‘For every action, there is an equal but opposite reaction.”

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GRAVITATIONAL FORCE
 Gravity provides an invisible attraction that makes any mass exert
downward force or have weight. The universality of gravitational
law discovered in 1687 by Sir Isaac Newton (1642-1727)
States that “every particle in matter in the universe attracts every
other particle with a force directly proportional to the product of
masses of the particles and inversely proportional to the squar of
distance between them’’
 Dimensionless number that describes the magnitude of acceleration
force (a) experienced by an astronaut, relative to the force the
astronaut experiences due to the earth’s gravity at sea level.
 G forces propel the body’s tissues in the direction opposite the
direction of acceleration.
 G forces tend to shift the blood volume away from the directionof
acceleration, adding to the other component forces that determine
blood pressure.

MICROGRAVITY /WEIGHTLESSNESS
 The force of gravity never truly reaches an absolute value of zero,
because a gravitational force still exists (000.01G).consequently,
the term microgravity ,not weightlessness ,correctly describes what
astronauts feel during space flight in earth’s orbit when the altitude
of the rocket exceeds approximately 160km (100mi) at a velocity of
approximately 17,500mph.
 A microgravity environment is one in which the apparent weight of
a system is small compared to its actual weight due to gravity In
practice, the microgravity environments used by scientific
researchers range from about one percent of Earth’s gravitational
acceleration (aboard aircraft in parabolic flight) to better than one
part in a million (for example, on board Earth orbiting research
12
 satellites). Quantitative systems of measurement, such as the metric
system, commonly use micro- to mean one part in a million.
 Using that definition, the acceleration experienced by an object in a
microgravity environment would be one-millionth (10-6) of that
experienced at Earth’s surface Researchers can create microgravity
conditions in two ways. Because gravitational pull diminishes with
distance, one way to create a microgravity environment (following
the quantitative definition) is to travel away from Earth.
 To reach a point where Earth’s gravitational pull is reduced to
onemillionth cf that at the surface, you would have to travel into
space a distance of 6.37 million kilometers from Earth (almost 17
times farther away than the Moon, 1400 times the highway distance
between New York City and Los Angeles, or about 70 million
football fields).
 This approach is impractical, except for automated spacecraft,
because humans have yet to travel farther away from Earth than the
distance to the Moon. However, freefall can be used to create a
microgravity environment consistent with our primary definition of

13
microgravity

14
 SPACE ORGANISATIONS
 There are numerous space organisations working on our planet to
explore and find out the mysterious matters present in our space.
 Each organisation has certain rules and policies regarding their
capacity to develop and money spend per year on each space
research project.
 Some of notable organisations are as follows
NASA:

NASA stands for National Aeronautics Space Agency.

 The National Aeronautics and Space Administration (NASA ) is an
independent agency of the United States Federal Government
responsible for the civilian space program, as well as aeronautics
and aerospace research.
 NASA was established in 1958, succeeding the National Advisory
Committee for Aeronautics (NACA).
 The new agency was to have a distinctly civilian orientation,
encouraging peaceful applications in space science.

15
 Since its establishment, most US space exploration efforts have
been led by NASA, including the Apollo Moon landing missions,
the Skylab space station, and later the Space Shuttle.
 NASA is supporting the International Space Station and is
overseeing the development of the Orion Multi-Purpose Crew
Vehicle, the Space Launch System and Commercial Crew vehicles.
 The agency is also responsible for the Launch Services Program
which provides oversight of launch operations and countdown
management for unmanned NASA launches.
I.S.R.O

 ISRO (for short) is the Indian government space agency, stands for
the Indian Space Research Organisation.
 It was established in 1969 and their motto is “space technology in
the service of human kind.”

16
 o
 The agency has conducted various major operations on national as
well as international level.

Major Accomplishments of ISRO

 Chandrayaan-1: First mission to moon
 Mangalyaan: Mars Orbiter Mission
 Recently, they launched PSLV-C36 which deposited a record 104
satellites into space.
 On February 15, 2017, ISRO launched 104 satellites in a single
rocked named PSLV-C37 and made a world record. Of these 104
satellites, one is 714 kilogram main satellite for earth observation
and 103 smaller “nano satellites” which weigh 664 kilogram
combined.
17
 The government is pleased with ISRO’s progress and announced
23% raise in its annual budget.
 On 5th June, they launched 640 ton GSLV Mk III rocket, carrying
GSAT-19 communication satellite.
 The 141 foot rocket is allegedly as heavy as 200 full-grown Asian
elephants.
 This mission takes India closer to the next generation launch
vehicle and satellite capabilitity.

18
19
 GAGANYAN -VYOMANAUTS
 ISRO to send first Indian into Space by 2022 as announced by PM,
says Dr Jitendra Singh, Rs. 10,000 crore mission will be a turning
point in India’s space journey; most engineering components are
ready: ISRO Chairman Chandrayaan-2 scheduled to be launched in
January, 2019
I.S.S.I. :
 The International Space Science Institute (ISSI) is a nonprofit
space organisation established in 1995.
 It’s an advanced studies institute that primarily focused on
planetary science, cosmology, solar system, earth science,
astrophysics and Astrobiology.
 Visit to space, research and scientific activities allows them to
develop advanced technologies too.
 The whole institute is under a foundation of Swiss law and
supported by European Space Agency (ESA).
 J.E.S.A :
 Japan Aerospace Exploration Agency is Japan’s national aerospace
working agency which was established in 2003 and headquartered
in Chofu (Tokyo).
 It is responsible for technology development, research works,
launch of a satellite into the orbit, asteroid data, moon exploration
and many other advanced missions.
 Agency’s main motto is one i.e. Reaching for the skies, exploring
space.
 The overall yearly budget for experimental work is $2.6 billion.
20
E.S.A :

o
 European Space Agency (ESA) established in 1975, is an
intergovernmental organisation under 20 European states.
 It has more than 2k employees and an annual budget of $5 Billion.
 Agency’s program includes exploration to another planet, moon,
human spaceflight through international space station, science,
earth observation, telecommunication, spaceport etc.
 The Ariane 5 operated thought Arianespace with ESA sharing the
cost and further development.

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ASTRONAUT /COSMONAUT
 The term "astronaut" derives from the Greek words meaning "space
sailor," and refers to all who have been launched as crew members
aboard spacecraft bound for orbit and beyond.
ROLES AND RESPONSIBILITIES OF ASTRONAUTS IN
SPACE (MICROGRAVITY)
 Observing and photographing natural and manmade changes on
Earth over time as well as short timescale events like storms so we
can better understand our planet
 Studying how humans behave in isolation and confinement
 Leaving potential future spacecraft equipment outside to see how
well it withstands being in space to improve materials used to build
spacecraft
 Studying magnetorheological fluids using the glovebox to
hopefully lead to the construction of better brake systems, seat
suspensions, and airplane landing gear here on Earth
GENERAL CONSIDERATIONS –INCLUSIVE CRITERIA OF
AN ASTRONAUT
 Distant and near VISUAL ACUITY must be correctable to 20/20
for each eye. The use of glasses is acceptable
 BLOOD PRESSURE: 140/90 measured in a sitting position.
 HEIGHT in between 62 and75inches.
 WEIGHT in between 70-72 kgs in the early stages of space flight
and in between 50-95 kgs has been taken as today’s astronaut
selection criteria.

22
 o ++++==

 NONMEDICAL CRITERIA -QUALIFICATION

 Astronaut requirements have changed with SPACE
ORGANISATION s goals and missions.
 Today, to be considered for an astronaut position, citizens must
meet the following qualifications:
 A bachelor's degree in engineering, biological science, physical
science, computer science or mathematics.
 At least three years of related professional experience obtained
after degree completion OR at least 1,000 hours pilot-in-command
time on jet aircraft.
 The ability to pass the NASA long-duration astronaut physical test.

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EVALUATION FOR SELECTION OF AN ASTRONAUT BY
NATIONAL AERONAUTICS SPACE AGENCY (N.A.S.A)
NASA devised first medical evaluation in 1959.
Candidates for astronauts currently undergo extensive medical and
psychological evaluation .
The evaluation criteria for mercury astronaut selection include
1. Younger than age 40 years,
2. Less than 71 inches tall (no weight requirement )
3. Excellent physical condition,
4. Minimum of 1500 hours flying time,
5. Graduation from test pilot school
6. Qualified test pilot.

The qualified astronauts should achieve the following goals:

 Survive :demonstrate ability to fly in space and return safely.
 Perform :demonstrate ability to perform effectively under
conditions of space flight.
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  Serve as a backup for automatic controls and instrumentation.
 Serve as a scientific engineer ,observer and true test pilot.
PHYSIOLOGIC TESTS :
 Harvard step test :subject steps up 20 inches to platform and down
once every 2s for 5 min to measure physical fitness.
 Treadmill maximum workload :subject walks at constant rate on
moving platform elevated 1 degree each minute ;test continues until
heart rate reaches 180 beats /minute ;test of physical fitness.
 Cold pressor :subject plunges feet into tub of ice water ;pulses and
blood pressure measured before and during test.
 Complex behaviour simulator :a panel with 12 signals, each
requiring a different response ,measures ability to react reliably in
confusing situations.
 Tilt table :subject lies on steeply inclined table for 25 minutes to
measure heart’s ability to compensate for unusual body position for
extended duration.
 Partial pressure suit :subject is taken to simulated altitude of
65,000 ft. for 1 hour in MC-1 partial pressure suit; measure of
cardiovascular efficiency and breathing at low ambient pressures.
 Isolation:subject enters a dark ,soundproof room for 3 hours to
assess adaptation to unusual circumstances and coping without
external stimuli.
 Acceleration: subject placed in centrifuge with seat inclined at
various angles ;assesses near-multiple gravity forces.
 Heat :subject spends 2 hours in chamber at 130degree F; measures
reactions of heat and body functions to this stress.

25
 Equilibrium and vibration :subject seated on chair that rotates
simultaneously on two axes ;subject required to maintain chair on
even keel using control stick with and without vibration ;subject
tested with and without blindfold.
 Noise :subject exposed to different sound frequencies to determine
susceptibility to high frequency tones.
PSYCHOLOGIC TESTS :
 Extensive interviews(psychiatrist)
 Rorschach (ink blot test)
 Thermal ice appreciation
 Drawing a person
 Sentence completion
 Determination of authoritarian attitudes
 Peer ratings
 Interpretation of the question “ who am I ?”
 Wechsler adult scale
 Miller analogies test
 Raven progressive matrices
 Dopplet mathematical reasoning scale
 Engineering analogies
 Spatial orientation
 Mechanical comprehension
 Air force officer qualification test
 Aviation qualification tests(USN)space memory
 Gottschaldt hidden figures
 Guilford-zimmerman spatial visualisation
Beginning in 1977,NASA adopted medical evaluation criteria for
astronauts selection ,relying on some test procedures gleaned
26
 from exercise physiology research experiments that assessed
maximal physiological responses during treadmill and cycle
ergometer tests .
ASTRONAUT SELECTION CRITERIA BY EUROPEAN SPACE
AGENCY (E.S.A)
The steps in the selection process
1. Initial selection according to basic criteria
2. Psychological tests for selected candidates
3. Second round of psychological tests and interviews
4. Medical tests
5. Job interview
The final list of applicants is submitted to the Director General of the
European Space Agency ( E.S.A )for recruitment.

Medical examinations:
In general, the examinations are designed from established standards in
the following medical systems:
1. General Medicine
2. Ears, Nose, Throat
3. Ophthalmology
4. Pulmonology
5. Cardiovascular
6. Hematology
7. Abdomen and Digestive System
8. Endocrine and Metabolic
9. Genitourinary
10. Musculoskeletal and Orthopedics
11. Dermatology
12. Neurology
13. Psychiatry and Human Behavior
14. Obstetrics and Gynecology
27
15. Dental
16. Infectious Diseases
17. Anthropometry
18. Radiation Exposure
19. Nutrition
20. Physical Fitness
21. Special Tests as Indicated by ESA Astronaut Applicant Medical
Examination List
examinations.
A selection of some of the tools astronauts use during EVAs
 PGT (Pistol Grip Tool)
Basically, a fancy cordless drill, used for extraction and installation of
bolts, and also used to torque bolts
 EMU Wrist Mirror
Extravehicular mobility unit wrist mirror, used to let the astronaut see
things on their suit below their chest, since they can’t bend their head
forward and look.
 RET (Retractable Equipment Tether)
One on PGT, one on bag. Whenever small items are to be transferred
between crewman and crewman, or between crewman and bag, or
between crewman and a structure, one of these tethers must be used to
ensure the item doesn’t float away.
 Mini-Workstation Swing-Arm
Swings to stow itself up against the astronaut’s side and provides
additional bayonet receivers and clips for tools.
 Six-foot Waist Tether
Used to anchor the astronaut at various sites on the structure, just to hold
position. This is called local tethering, as opposed to more permanent
attachment with the much larger 85-foot safety tether.
 Bayonet Receivers

28
Fittings for attaching tools to the mini-workstation. Tools and
equipment, like the EVA trash bag, have bayonet fittings that are mated
to these receivers.
 85-foot Safety Tether
When an astronaut egresses the airlock, this safety tether is immediately
hooked to a designated position just outside the airlock. That way, the
astronaut is always connected to the station no matter what.
 End Effector — AKA “Grabber Daddy”
Another tethering device, used to grab onto a structure quickly and
temporarily anchor an astronaut there. Not used as much as the waist
tether or the BRT.
 EVA Trash Bag
Small pouch with a double-flap opening. Gives the astronaut a place to
stow bolts or other miscellaneous small items during the EVA so they
don’t float away.
 D-Rings with D-Ring Extensions
The D-rings are used as attachment points for various things with clips,
but the astronaut can’t see them so they have extenders – the tethers
coming down from them – which the astronaut can flip up and see.
 BRT (Body Restraint Tether) clip
Secondary attachment point for the body restraint tether (BRT).
 BRT (Body Restraint Tether) — stowed position
Flexible tool used to fix and hold an astronaut in position relative to a
structure when he or she is going to perform a task. The BRT consists of
an interlocking stack of spheres and can be rigidized to lock the astronaut
into a position and/or orientation.
It is also used to carry cargo such as tool bags, crew lock bags, or bigger
bags that are clamped in the jaws and dragged behind the astronaut. The
two brass-colored cylindrical knobs are used to adjust the BRT’s joints
once it is rigidized. The vertical knob rotates the elbow, and the
horizontal knob rotates the wrist

29
TRAINING SESSIONS
 Designing a training program to prepare astronauts for the
uniqueness of working in microgravity presents its own
set of challenges.
 Trainers must not only familiarize astronauts with
complex and highly specialized flight vehicles, equipment
and suits, but must do it in a way that simulates a
microgravity working environment.
Simulators
 Highly realistic mock ups, housed in both the Jake Garn
Training Facility and the Space Vehicle Mockup Facility,
are used to train astronauts in vehicle operations.
 Astronauts prepare for launch, landing, payload and
International Space Station operations and rendezvous
activities in the Garn Facility.
 A motion based trainer simulates the vibrations, noise and
views the astronauts experience during shuttle launch and
landing.
 A fixed base simulator is used for rendezvous and payload
operations training, and a functional space station
simulator is used to train astronauts in the use of the on
orbit laboratory’s systems.
 The Space Vehicle Mock up Facility is home to full sized
mock ups of the shuttle’s flight deck and middeck and one
full sized shuttle mock up.
 Station mock ups of the complex’s different habitable
elements help familiarize astronauts with the station’s
layout.
 Before their first mission, astronauts typically train for a
combined total of 300 hours in these simulators.

30
 Astronauts preparing for spacewalks or robotic arm
operations test their skills in the Virtual Reality
Laboratory, which immerses them in a computer
generated microgravity environment.
Sonny Carter Training Facility
 The world’s largest indoor pool, the Neutral Buoyancy
Laboratory – housed within the Sonny Carter Training
Facility – holds 6.2 million gallons of water and is more
than 200 feet long and 40 feet deep.
 Deep within the pool, which simulates the weightless
environment of space, astronauts train for spacewalks on
full sized replicas of space station modules. They spend
approximately 10 hours under water for every hour they
spend walking in space.
 Aircraft training
 Pilot astronauts train in a Gulfstream jet aircraft that has
been specially modified to mimic the approach and landing
of the space shuttle.
 This jet provides a unique training experience that helps
prepare astronauts for the spacecraft’s runway approach,
which is nearly seven times steeper than that of a
commercial airliner.
 Pilots will fly more than 1,000 approaches in this aircraft
before ever landing the shuttle.
 All astronauts train in T38 jets learning flight techniques
and cockpit management.

31
HEALTH IMPLICATIONS IN SPACE
(MICROGRAVITY)
NON EMERGENCY MEDICAL CONDITIONS :
 Most of the medical conditions that happen in space are
not medical emergencies and can be treated on board.
 About 75% of all astronauts have taken medication during
shuttle missions for conditions such as motion sickness
,headache, sleeplessness, and back pain.
 Other common conditions include
minor trauma, burns, dermatological and musculoskeletal
injuries, respiratory illnesses and genitourinary problems.
 The human immune system is a complicated network of
different cell types (granulocytes, lymphocytes,
monocytes, etc.), that reside in various tissues throughout
the body.

32


33
 EMERGENCY MEDICAL CONDITIONS:
 Research on the medical emergencies that may occur in
space include fatal and nonfatal arrhythmia, heart
attacks, cardiac arrests, embolisms
,massive hemorrhages renal stone formations, fatal and
non-fatal infections, and thrombotic complications.

Of these conditions, only arrhythmia, renal colics, and
infections have occurred in the history of spaceflight.

The arrhythmia cases included occasional premature atrial
contractions (PACs) and premature ventricular
contractions (PVCs), which happened to 30% of astronauts
at some point during periods of intense physical activity.

Potentially serious arrhythmia cases (superventricular
tachycardia) have also been reported.

For example, during the Apollo 15 flight, one crew
member experienced ventricular bigeminy; ventricular
ectopy was reported on Skylab; and on Mir, a crew
member experienced a 14-beat run of ventricular
tachycardia.
 In a few cases, astronauts were brought back to Earth due
to episodes of renal colic and arrhythmia, shortening their
stays in space and possibly ending their missions.
 People who are exposed to harsh environments have
suffered medical conditions that could be considered
as analogs of the space environment.

 The rate of these conditions is relatively low (10-50 cases

per 100,000 people per day) and most were non-emergency

34
 (trauma, infection, psychiatric disorders), but they required
an evacuation that would be impossible to provide in
space.
 Crews living and working in harsh environments
(Antarctic expeditions, submarines, and undersea habitats)
had medical emergencies such as intracerebral
hemorrhage, stroke, myocardial infarction, appendicitis,
and bone fractures as well as cases
of cancer and psychiatric illness.
 However, the overall rate of serious medical or surgical
emergencies was low.

35
 Some Major Human Physiological Changes Resulting from
Extended Travel in Earth Orbit
 MUSCULOSKELETAL SYSTEM
 Loss of bone mineral density
 Loss of skeletal muscle
 CARDIOVASCULAR SYSTEM
 Orthostatic hypotension
 Loss of hydrostatic pressure
 PULMONARY SYSTEM
 Changes in pulmonary circulation and gas
exchange
 ALIMENTARY SYSTEM
 Decrease in absorption or malabsorption
 NERVOUS SYSTEM
 Ataxia
 Motion sickness
 Disturbed fine motor and gross motor functions
 Altered sleep-circadian rhythm and sleep
deprivation
 REPRODUCTIVE SYSTEM
 Effects of radiation on gametes
 URINARY SYSTEM
 Renal calculi
 HEMATOLOGICAL AND IMMUNOLOGICAL SYSTEMS
 Anemia Potential immunologic depression.

36
MEDICAL CONDITIONS DUE TO LONG TERM
RADIATION :
 Radiation exposure could also cause medical problems due
to the technical problems involved in the shielding of space
craft, especially given the length of missions to Mars.
 Given that these missions could last several years at the
level of technology available in 2014, age-related medical
conditions would be likely to occur at the same rate as the
general population.
 These probabilities have been assessed in astronaut pre-
and post-flight health databases.
 Another problem related to long-term missions has been
the design of medical care systems within space craft due
to the limited amount of available space.
 Medical care systems for spaceships must include the
technology necessary to heal exposure to toxic chemicals
and gases, and chemical and electrical burns.

37

Astronauts may also suffer from trauma aboard and
during extra-vehicular activities outside space craft.
 Several consistent medical problems have been
encountered by astronauts during space flights.
 These include vestibular dysfunction, weight loss, increase
in height, upward fluid shift, anemia, cardiovascular
deconditioning, muscle atrophy, and bone loss.
 Almost all of these alterations can be attributed to the
absence of gravitational force.
 Most are adaptive in nature and therefore reversible, but
re adaptation after returning to earth may cause further
problems (e.g., in the case of vestibular dysfunction).

38
 The most recalcitrant and disturbing of all these problems
is the relentless bone loss associated with negative calcium
balance.
 This problem appears to be irreversible, and critical
demineralization can occur after two years in a weightless
state.
 Unless its mechanism is elucidated and preventive
measures are taken, the bone loss may prove to be the
medically limiting factor for the duration of space flight.
 PSYHOLOGICAL FACTORS:
 Alzheimer's disease (AD), also known as Alzheimer
disease, or just Alzheimer's, accounts for 60% to 70% of
cases of dementia.
 It is a chronic neurodegenerative disease that usually starts
slowly and gets worse over time.
 The most common early symptom is difficulty in
remembering recent events (short-term memory loss)


39

 OTHER PHYSIOLOGICAL CHANGES:
o Expose to high energy cosmic waves radiation
increases risk of neurodegenerative disease31.
o Eye abnormalities may arises due to UV exposure
increases the intra cranial pressure.
o Due to microgravity, distributions of fluid to upper
body result in "puffy face" appearance.
o Nasal congestion due to fluid distribution causes
anosmia (loss of smell) and diminished taste.
o Heart stroke volume decreases as cardiovascular
system adapts to microgravity. RBC count also
 decreases.
o Musculoskeletal adaptation to microgravity leads to
loss of muscle mass and bone density.

40
 o Blood plasma volume is reduced by increased kidney
output , elevated calcium secretions results
 in increased risk of kidney stones17.
o Stresses of spaceflight, including ionizing radiation,
results in compromised immune system
 function.
o Fluids redistribution from leg to upper body results in
10-30% decreased leg circulations.
o Sleep disorder.

41
PATHOPHYSIOLOGICAL CHANGES IN SPACE
.

42
MUSCULOSKELETAL - LOSS OF MUSCLE MASS
 In space, the musculoskeletal system muscles, which are
underused, become flabby and lose tone and mass.
 The astronauts are then subject to muscular atrophy. The
bones, too, become weaker because ofa loss of minerals
(calcium, potassium and sodium).
 This bone degradation7 can reduce bone in the lower limbs
by up to 10%.
 In space, muscles in the legs, back,
o Spine ,and heart weaken and get atrophied because
they are no longer needed to overcome gravity, just as
people lose muscle when they age due to reduced
physical activity
 Astronauts rely on research in the following areas to build
muscle and maintain body
 Exercise may build muscle if at least two hours a day is
spent doing resistance trainingroutines.
 Hormone supplements (hGH) may be a way to tap into the
body’s natural growth signals.
 Medication may trigger the body into producing muscle
growth

43
LOSS OF BONE DENSITY:
 Shifting from an environment with gravity to a
microgravity8 environment causes changes in an
astronaut’s body.
 One area of concern for the astronauts’ health is the loss of
bone density7. On Earth, a person’s bone density peaks
around the age of 30. After the age of 35, the bone density
decreases on average by < 1% each year.
 Space travellers aren't the only ones who worry about
bone loss.
 New techniques are being developed to help astronauts
recover faster. Research in the following areas holds the
potential to aid the process of growing new bone
 Diet and Exercise changes may reduce osteoporosis.
 Vibration Therapy may stimulate bone growth.
 Medication could trigger the body to produce more of the
protein responsible for bone growth and formation.

44


 CIRCULATORY SYSTEM:
45
 CIRCULATORY SYSTEM:

 In spaceflight, shortly after reaching orbit, astronauts

experience much lower gravity than on Earth. This is
known as microgravity.Therefore, the average physical
exertion of astronauts on board the space shuttle and the
International Space Station (ISS) is reduced compared to

46
 pre-flight, with the exception of challenging extravehicular
activities such as a space walk.
 An astronaut’s circulatory system, 34which is accustomed
to working against gravity, receives a different set of
signals and stimuli in microgravity and adapts to the new
environment.
 The heart does not need to work as hard to send blood to
the upper body as it does when itworking against gravity.
This causes blood volume to increase in the upper body .
 During systole, ventricles contract to pump a volume of
blood through the body which increases the volume of
blood in the arteries and therefore also increases the
pressure in the arteries.
 During diastole, the heart relaxes and fills with blood;
therefore, the volume of blood and the pressure in the
arteries decreases.
 A microgravity environment leads to changes in fluid
distribution, muscle loading, and altered signaling
pathways.
 Some basic changes include alterations in blood pressure
and the quantity of blood that is pumped by the heart with
each beat.
 The human heart is designed to force blood to the body,
and the most difficult organ to perfuse is the brain since it
is above the heart.
 In space your heart does not have to work against gravity
to pump blood to your brain andblood accumulates in the
upper body because gravity is not there to pull it toward
your feet.
 Your body takes advantage of this lack of work and begins
to be less efficient as
47
 o demonstrated by the lower stroke volume.
 The heart generates slightly higher systolic and diastolic
pressures because large muscle groups (like the legs) are
inactive and do not demand blood, resulting in
vasoconstriction.
 Also, since the heart is less efficient some blood remains in
the heart after each contraction which slightly increases the
pressure during the relaxation phase known as diastole.
 Taken together, the amount of blood that is being pumped
out of the heart (stroke volume) will change.
 As the flight duration increases, these changes become
slightly more dramatic, and may affect an astronaut’s other
physiological functions.
 There could even be permanent changes in the way organs
and blood vessels behave.
 Resistance training (weight lifting) and cardiovascular
(aerobic) exercise to minimize muscle atrophy and
cardiovascular de-conditioning are very important
countermeasures
 Lack of activity and a sedentary lifestyle may lead to the
same problems that astronauts face in microgravity.
 As the heart 12becomes less efficient, other physiological
functions of the body are affected.
 Long term sedentary lifestyle may lead to permanent
changes that may increase risks of certain cardiac diseases.

 INFLUENCE ON BLOOD CIRCULATION:

48

 One of the most visible effects of a space mission is no
doubt the “puffy-face”, “bird-leg” look that astronauts get.
 On Earth, the heart is programmed to distribute blood
evenly throughout the body.
 The heart must do more work to supply the upper body,
because blood is naturally drawn downward by the force of
gravity.
 The lower limbs do not have this problem, as the blood
coming to them is gravity assisted.
 In space, bodily fluids no longer flow back down naturally
by gravity.
 The heart is still programmed the way it was on Earth.
So,veins and arteries, the blood rushes to the person’s torso
and head, and they then experience“puffy face syndrome.”

49
 The veins of the neck and face stand out more than usual;
the eyes become red and swollen.
 This effect is often accompanied by nasal congestion and
sometimes even headaches. Astronaut’s legs also grow
thinner, because instead of dropping effortlessly down to
the lower limbs, the blood has to be pumped there by the
heart.
 Particularly because of physiological
 sickness or space adaptation syndrome (the space
version of what we call motion sickness on Earth).
 About 40% of those who have gone into space have had
dizziness or nausea.
 Both generally wear off after 2 or 3 days, as soon as the
astronaut’s body has had time to adapt.
 CARDIAC RHYTHMS:
 Heart rhythm disturbances have been seen among
astronauts blood coming to them is gravity of microgravity
and body changes
 under the pressure of the heart and the
 ffect physiological changes such as these, astronauts suffer
from space
 Most of these have been related to cardiovascular disease,
but it is not clear whether this was due to pre-existing
conditions or effects of space flight.
 It is hoped that advanced screening for coronary disease
has greatly mitigated this risk. Other heart rhythm
problems, such as atrial fibrillation, can develop over time,
necessitating periodic screening of crewmembers’ heart
rhythms.
 Beyond these terrestrial heart risks, some concern exists
that prolonged exposure
50
 to microgravity may lead to heart rhythm disturbances.
 Although this has not been observed to date, further
surveillance is warranted.

o
 ORTHOSTATIC INTOLARENCE:
 In space, astronauts lose fluid volume—including up to
22% of their blood volume.
 Because it has less blood to pump, the heart will atrophy.
A weakened heart results in low blood
 pressure and can produce a problem with “orthostatic
tolerance,” or the body’s ability to send enough oxygen to
the brain without fainting or becoming dizzy.
 "Under the effects of the earth's gravity, blood and other
body fluids are pulled towards the lower body.
 When gravity is taken away or reduced during space
exploration, the blood tends to collect in the upper body
instead, resulting in facial edema and other unwelcome
side effects.
 Upon return to earth, the blood begins to pool in the lower
extremities again, resulting in orthostatic hypotension."
 LOSS OF BALANCE:
51
 Leaving and returning to Earth’s gravity causes “space
sickness,” dizziness, and loss of balance in astronauts.
 By studying how changes can affect balance in the human
body—involving the
o senses, the brain, the inner ear, and blood pressure—
NASA hopes to develop treatments that can
 be used on Earth and in space to correct balance disorders.
 Until then, NASA’s astronauts must rely on a medication
called Midodrine (an “anti-dizzy” pill that temporarily
increases blood pressure) to help carry out the tasks they
need to do to return home safely.
 DECREASED IMMUNE SYSTEM FUNCTIONING:
 Astronauts in space have weakened immune systems,
which means that in addition to increased vulnerability to
new exposures, viruses already present in the body—which
would normally be suppressed—become active.
 In space, T-cells (a part of white blood cells) do not
reproduce properly.
 T-cells that do exist are less able to fight off infection.
NASA research is measuring the change in the immune
systems of its astronauts as well as performing experiments
with T-cells in space.

52
 MEDICAL SCREENING
Medical Examination Requirements (MER) for
Astronauts
ESA Medical Examinations and Parameters:
1. Interview/Questionnaire evaluation of family history,
personal history and medical history.

2. General physical examination, including

 a. all major organ systems, including skin
 b. mobility of extremities, joints and spine
 c. routine ears-nose-throat examination
 d. applicant must be able to understand correctly ordinary
conversational speech at a
 distance of 2 meters from and with his back turned towards
the examiner
 e. basic neurology assessment
 f. genito-urinary evaluation
 g. for females: gynecologic evaluation
 h. resting heart rate and blood-pressure
 i. Hearing Analysis

 3. Standard 12-lead Resting ECG

 4. Blood analysis for Hemoglobin (Hb), Lipids and
Cholesterol
 5. Urine stick analysis, including Glucose, Leucocytes,
Erythrocytes, Protein
 6. Ophthalmologic Analysis (can also be performed by
ophthalmologist or vision care
 specialist, e.g. optometrist)
53
 a. vision in both eyes
 b. distant visual acuity with or without correction of 0.5
(6/12) or better in each eye
 separately and with both eyes 1.0 (6/6) or better
 i. Refractive error shall not exceed +5 to -8 diopters
 ii. Astigmatism shall not exceed 3 diopters
 c. normal color perception (Ishihara or Nagel’s
anomaloscope)

 Examination:
 PRE FLIGHT:-
 Physical examinations include-
 Abdominal Organs and Gastrointestinal System
 Blood and Blood Forming Tissue Diseases
 Body Build
 Dental
 Ears and Hearing
 Endocrine and Metabolic Disorders
 Upper Extremities
 Lower Extremities
 Miscellaneous Conditions of the Extremities
 Mental Health
 Eyes and vision
 General and Miscellaneous Conditions and Defects
 Genitalia and Reproductive Organs
 Head
 Heart and Vascular System
 Height and Weight
 Lungs, Chest Wall, Pleura, and Mediastinum
 Mouth
 Neck
54
  Neurological Disorders
 Nose, Sinuses, and Larynx
 Skin and Cellular Tissues
 Spine and Sacroiliac Joints
 Systemic Diseases
 Tumors and Malignant Diseases
 Urinary System

 POST FLIGHT:-
 Blood tests
 Brain CT –to detect any bleeding ,tumour,anurysums.
 Electrocardiogram (ECG)- to know the heart functioning.
 Magnetic resonance imaging(MRI)- to know any
changes occer in brain.
 Muscle biopsy-to assess for muscle atrophy.
 Electromyography(EMG)-to analyzed to detect medical
abnormalities and biomechanics of human.
 Bone scan- To know density of bone .
1.Laboratory Testing

55
 Immune Blood Sample Draw


 MER1. Hematology (annually)
 Tests: Complete Blood Count – hemoglobin, hematocrit,
red blood cell count, red blood cell indices, white blood
cell count, differential count, platelet count.
 Rationale: The results of this test are used to diagnose
conditions and diseases such as anemia, infection, and
thrombocytopenia.
 There currently is no occupational surveillance activity,
associated with an exposure-identified occupational health
risk, that requires the information from this test.
 This screening is a standard of care and is included in the
annual Lifetime Surveillance of Astronaut Health (LSAH)
examination.

56
 These data are also needed to support Epidemiology's
astronaut surveillance activities for detection of unknown
adverse health conditions that may be related to
occupational exposures.
o MER 2. Biochemistry (annually)

Tests:
 Liver function – AST, ALT, GGT, bilirubin, ALP, LDH
 Renal function – urea, creatinine, electrolytes (Na, K, Cl),
uric acid
 Endocrine – TSH, free T4
 Fasting blood glucose and hemoglobin A1c
 Cardiovascular profile –
 fasting total cholesterol,
 HDL,
 LDL,
 non-HDLcholesterol,
 triglycerides,
 Calcium,
57
 magnesium,
 inorganic phosphate
 Prostate-specific antigen (males) beginning at age 50
 Iron,
 total iron-binding capacity,
 percentage saturation of transferrin, ferritin
 Rationale: A chemistry panel determines an astronaut’s
general health status, elucidating the body's electrolyte
balance, arbohydrate, lipid status, and status of several
major body organs, such as the kidney, liver, and thyroid
gland.
 The long-term effects of radiation and microgravity
exposure are poorly understood.
 Although the short-term health effects of radiation
exposure seem benign in low Earth orbit, the long-term
effects of exposure to relatively low doses of radiation on
various organ systems are unknown and need to be
monitored.
 The United States Preventative Services Task Force
(USPSTF) Guideline: The USPSTF strongly recommends
screening men aged 35 and older for lipid disorders.
 The USPSTF strongly recommends screening women aged
45 and older for lipid disorders if they are at increased risk
for coronary heart disease.
 UCD - Male Bellows Catheter.
 MER 3. Urinalysis (annually)

58

 Test: Standard urinalysis test strip.
 Rationale:
 There currently is no occupational health risk surveillance
activity associated with an identified occupational
exposure, that requires the information from this test.
 This screening is a standard of care and is included in the
annual LSAH examination.
 These data are also needed to support Epidemiology's
astronaut surveillance activities for detection of unknown
adverse health conditions that may be related to
occupational exposures.

 MUSCULOSKELETAL
 MER 1 .Bone Health (Every 3 years)
 Test: Dual-energy X-ray absorptiometry (DXA) and bone
health serologic markers.
 Rationale: CHS manages an astronaut-specific bone health
program through the JSC clinic.
59
 This aspect of long-term astronaut monitoring is unique to
NASA and the astronaut corps.
 Concerns exist that exposure to the space flight
environment (microgravity, space radiation, and elevated
CO2 levels) may cause a decrease in bone strength and,
thus, an increase in the risk of non-traumatic fractures for
astronauts relative to healthy non-astronauts.
 A major risk to crew health is the change in bone ultimate
strength with respect to mechanical loads; it is possible that
a fracture may occur from activities that would be unlikely
to induce fracture before space flight.
 From an occupational health perspective, occupational
surveillance needs to be conducted throughout the lifetime
of astronauts to detect health issues and develop mitigation
strategies to reduce the risk.

 DERMATOLOGY
 MER Clinical Evaluation (Annually)
 Test: Visual exam of the skin with photo documentation of
any abnormalities.
 Rationale: Although the difference is not statistically
significant, the rate of melanoma skin cancers are 59%
higher in astronauts than in a control group.
 The incidence rate of diagnosed non-melanoma skin
cancers appears to be increased post-flight.
60
 The incidence of non-melanomas skin cancers is not
reported to cancer registries; therefore, the literature
regarding its incidence in the general population is limited.
 Because of the limited documentation, this exam is needed
to gather data to better understand the incidence rate in the
astronaut population.
 Participants are referred to a dermatologist when results of
the exam indicate the presence of potential skin cancer.
 Ophthalmology/Optometry
 MER4 Assessment of Visual Function

 NASA astronaut Karen Nyberg conducts an ocular health

exam on herself.
 NASA astronaut Karen Nyberg, Expedition 36 flight
engineer, conducts an ocular health exam on herself in the
Destiny laboratory of the Earth-orbiting International
Space Station. (NASA)
 Test: Visual acuity, color vision, and extraocular muscles.
 Rationale: An ophthalmologic examination measures the
astronaut’s ocular health and visual status, in order to
61
 detect abnormalities in the components of the visual
system and to determine how well the person can see.
 It may also reveal the presence of hypertension, increased
intracranial pressure, or diabetes.
 The lens of the eye is recognized as one of the most
radiosensitive tissues in the human body, and it is known
that cataracts can be induced by acute doses of less than 2
Gy of lowLET ionizing radiation and less than 5 Gy of
protracted radiation.
 Although much work has been carried out in this area, the
exact mechanisms of radiation cataractogenesis are still not
fully understood.
 In particular, the question of the threshold dose for
cataract development is not resolved.
 Cataracts have been classified as a deterministic effect of
radiation exposure with a threshold of approximately 2 Gy.
 Studies indicate the threshold for cataract development is
less than was previously estimated, on the order of 0.5 Gy,
and that radiation cataractogenesis may, in fact, be more
accurately described by a linear, no-threshold model.
 There appears to be no relationship between radiation
exposure and the progression rate of an aggregate area of
posterior subcapsular cataract or nuclear cataract.
 However, longer follow-up is needed to further understand
any impact of space radiation on progression rates for these
types of cataracts and to characterize changes in visual
acuity.
62
 Cataract formation rates are being characterized by the
Epidemiology group.
 MER Refraction Manifest/Cycloplegic (Annually)


 Test: Manifest/Cycloplegic refraction test.
 Rationale: Refraction tests are used to measure refractive
errors (myopia–nearsightedness, hyperopia –
farsightedness, and astigmatism), and determine a person’s
prescription for eyeglasses or contact lenses.
 As reported in the postflight exam vision questionnaire, 50
percent of astronauts living on the International Space
Station have reported vision changes related to flight.
 However, long-term effects of vision changes secondary
to microgravity are not well understood.
 From an occupational health perspective, occupational
surveillance needs to be conducted throughout the lifetime

63
 of astronauts to detect ocular health issues and develop
mitigation strategies to reduce the risk.
 NASA astronaut Barry Wilmore conducts a Tonometry
exam on NASA astronaut Terry Virts.
 Tonometry measures the intra-ocular pressure of the
subject.
 MER Intraocular Pressure (IOP) (Annually)
 Test: Tonometry test
 Rationale: Elevated IOP has been observed during
parabolic flight and during microgravity exposure.
 The clinical significance of this rise in IOP in
microgravity is unknown. However, it is theorized that a
prolonged increase in IOP during space flight could put
astronauts at risk for optic nerve damage.
 Those at risk for glaucomatous optic nerve damage would
most likely be those who were exposed to microgravity for
months to years.
 From an occupational health perspective, occupational
surveillance needs to be conducted throughout the lifetime
of astronauts to detect ocular health issues and develop
mitigation strategies to reduce the risk
 MER Ocular Health Assessment – Imaging (Annually)
 Test: Dilated fundus exam, retinal photographs, and optical
coherence tomography (OCT)
 Rationale: There are many concerns related to the ocular
system, cephalad fluid shift during microgravity exposure

64
 and potential increased intracranial pressure being chief
among these concerns.
 Permanent hyperopic shifts have been documented after
long-duration flights.
 Additionally, optic disc edema, globe flattening, and
choroidal folds have been documented in these astronauts.
 Some individuals experienced transient changes post flight
while others have reported persistent changes with varying
degrees of severity.
 The exact cause(s) and long-term effects of these
phenomena are not known at this time.
 From an occupational health perspective, occupational
surveillance needs to be conducted throughout the lifetime
of astronauts to detect health issues and develop mitigation
strategies to reduce the risk.
 AUDIOLOGY

65
 MER Clinical Evaluation/Audiometry l

 Test: Hearing questionnaire and pure-tone audiometry test.

 Rationale: NASA is concerned about strategies to assess
and reduce acute, chronic, and delayed effects of hearing
loss due to terrestrial (ground-based) and space flight noise
exposures experienced by astronauts.
 There is a significant concern about synergistic interactions
between noise, vibration, workload, and comorbidity
factors of radiation, toxicology, and microgravity on
auditory status.
 The long-term effects of these occupational exposures are
unknown. A hearing questionnaire and pure-tone
audiometry test can also help identify the site of lesion of a
hearing loss.
 NASA is currently examining its extensive astronaut
audiometric database, including results of mission-related

66
 tests and those from long-term follow-up physical exams,
to differentiate between normal changes in hearing due to
aging and changes unique to the physical environment of
space flight.
 As a result, annual audiometric tests will continue to be
included as part of the annual exams.
 CARDIOPULMONARY
 MER Hypertension Screening (annually and as clinically
indicated)
 Test: Hypertension screening using a sphygmomanometer.
 Rationale: This screening is based on the United States
Preventative Services Task Force (USPSTF) guidelines.
 There currently is no occupational health risk associated
with hypertension. This screening is a standard of care and
is included in the annual Lifetime Surveillance of
Astronaut Health examination.
 These data are also needed to support Epidemiology's
astronaut surveillance activities for detection of unknown
adverse health conditions that may be related to
occupational exposures.
 USPSTF Guideline: The USPSTF recommends screening
for high blood pressure in adults aged 18 and older.
 MER Resting 12-lead ECG (Annually)
 Test: Resting 12-lead electrocardiogram.
 Rationale: There are concerns that astronauts may have
subclinical cardiac abnormalities that could be exacerbated

67
 by the adaptive responses of the cardiovascular system to
microgravity.
 Currently, the long-term effect of these adaptive responses
is not known.
 This test is required to obtain the data needed to determine
whether exacerbation of subclinical cardiac abnormalities
is a valid long-term impact of occupational exposure to
space flight. Knowing this may have implications for long-
duration space missions in the future.
 MER Cardiovascular Health Screening (Annually)
 Test: Cardiovascular health screening.
 Rationale: The cardiovascular health screening documents
cardiovascular risk factors (blood pressure, age, gender,
cholesterol, smoking status) and includes CIMT
calculation.
 These risk factors are used to calculate a Framingham Risk
Score.
 The Framingham Risk Score is a gender-specific algorithm
used to estimate the 10-year cardiovascular risk of an
individual.
 Astronauts may have subclinical cardiac abnormalities that
could be exacerbated by the adaptive responses of the
cardiovascular system to microgravity and exposure to
space radiation.
 We do not currently know the long-term effect of these
adaptive responses. This test is required to obtain the data
needed to determine whether exacerbation of subclinical
68
 cardiac abnormalities is a valid long-term impact of
occupational exposure to space flight.
 Knowing this may have implications for long-duration
space missions in the future.
 Gastroenterology
 This medical exam is done as clinically indicated.
 Reproductive Health
 This medical exam is done as clinically indicated.

69
MANAGEMENT
 DIETARY
SUPPLEMENTS
&NUTRITION IN SPACE
 MEDICAL
MANAGEMENT
 EXERCISE PROTOCOL

70
DIETARY SUPPLMENTS
The International Space Station (ISS) will become operational
on a full-time basis with a crew of three. Later, the crew size
will grow to a maximum of seven people.

International Space Station food tray (frozen food

The crew will reside in the Habitation Module (HAB). Food and
other supplies will be re -supplied every 90 days by the Multi-
Purpose Logistics Module (MPLM). The MPLM is a
pressurized module carried in the Space Shuttle payload bay that
is used to transport materials and supplies. The food system
described here is for the completed ISS and will be
considerably different from the Space Shuttle food system .But
until 2004 when the HAB module is launched, ISS residents will
utilize a joint U.S.-Russian food (Shuttle-Mir) system. The fuel
cells, which provide electrical power for theSpace Shuttle,
produce water as a byproduct, which isthen used for food
preparation and drinking. However, onthe ISS, the electrical
power will be produced by solararrays. This power system does
71
not produce water. Waterwill be recycled from a variety of
sources, but that willnot be enough for use in the food system.
Therefore, mostof the food planned for the ISS will be frozen,
refrigerat-ed, or thermostabilized (heat processed, canned,
andstored at room temperature) and will not require the addi-
tion of water before consumption. Although many of
thebeverages will be in the dehydrated form, concentratedfruit
juices will be added to the beverages offered andwill be stored
in the onboard refrigerator. Similar to the Space Shuttle, the ISS
beverage package ismade from a foil and plastic laminate to
provide for alonger product shelf life. An adapter located on the
pack-age will connect with the galley, or kitchen area, so
thatwater may be dispensed into the package. This water willmix
with the drink powder already in the package. Theadapter used
to add water also holds the drinking strawfor the astronauts. The
food package is made from amicrowaveable material. The top of
the package is cut offwith a pair of scissors, and the contents are
eaten with afork or spoon.

72
International Space Station frozen food storage:Food will be
stowed in pullout drawers, which allowcomplete viewing of
drawer contents. Lipped edgeson the food package interface
with the storage con-tainer, oven, and serving tray.
Types
of Space Food
There are eight categories of space food:
Rehydratable Food:The water is removed fromrehydratable
foods to make them easier to store. Thisprocess of dehydration
(also known as freeze drying) isdescribed in the earlier Gemini
section. Water is replacedin the foods before they are eaten.
Rehydratable itemsinclude beverages as well as food items. Hot
cereal suchas oatmeal is a rehydratable food.
Thermostabilized Food:Thermostabilized foods areheat
processed so they can be stored at room temperature.Most of the
fruits and fish (tuna fish) are thermostabilizedin cans. The cans
open with easy-open pull tabs similar tofruit cups that can be
purchased in the local grocery store.Puddings are packaged in
plastic cups.
Intermediate Moisture Food:Intermediate moisturefoods are
preserved by taking some water out of the prod-uct while
leaving enough in to maintain the soft texture.This way, it can
be eaten without any preparation. Thesefoods include dried
peaches, pears, apricots, and beefjerky.
Natural Form Food:These foods are ready to eat andare
packaged in flexible pouches. Examples include nuts,granola
bars, and cookies.
Irradiated Food:Beef steak and smoked turkey are theonly
irradiated products being used at this time. Theseproducts are
cooked and packaged in flexible foil pouch-es and sterilized by

73
ionizing radiation so they can be keptat room temperature. Other
irradiated products are beingdeveloped for the ISS.
Frozen Food:These foods are quick frozen to preventa buildup
of large ice crystals. This maintains the originaltexture of the
food and helps it taste fresh. Examplesinclude quiches,
casseroles, and chicken pot pie
.Fresh Food:These foods are neither processed nor arti-ficially
preserved. Examples include apples and bananas.
Refrigerated Food:These foods require cold or
cooltemperatures to prevent spoilage. Examples includecream
cheese and sour cream.

Food on the Space Shuttle comes in several cate-gories.

Represented here are: thermostabilized,intermediate
moisture, rehydratable, natural form,and beverage.

74
MEDICAL INTERVENTIONS :.
 FOR IMPROVING THE BONE HEALTH:
 Bone and calcium metabolism have been a concern for
space travelers, literally since before human space flight
was a reality.
 Vitamin D is a concern for space travelers, in part because
their dietary sources of vitamin D are insufficient, and in
part because they lack ultraviolet light exposure.
 Vitamin D stores decline during flight if supplemental
intake of this vitamin is inadequate.
 Recent studies have documented that supplementation
with 800 IU vitamin D/day will maintain vitamin D stores
in astronauts on 6-month space missions.
 Although vitamin D is likely not a countermeasure for
space flight-induced bone loss, vitamin D deficiency will
surely exacerbate the problem.
 FOR IMPROVING THE MUSCLE HEALTH:
 Treatment will depend on the diagnosis and the severity of
your muscle loss. Any underlying medical conditions must
be addressed.
 Common treatments for muscle atrophy include:
 In severe cases of muscular atrophy, the use of an anabolic
steroid such as methandrostenolone is administered to
patients as a potential cure.
 Novel classes of drugs, called SARM (selective androgen
receptor modulators) are being investigated with promising
results.
 They would have fewer side-effects, while still promoting
muscle and bone tissue growth and regeneration.

75
 SURGERY may be necessary if your tendons, ligaments,
skin, or muscles are too tight and prevent you from
moving.
 Surgery may be able to correct it if your muscle atrophy is
due to malnutrition.

 TO IMPROVE CADIOVASCULAR SYSTEM:

 Medication:
 Over-the-counter and prescription medications37 are
readily available, such as
o Dramamine (dimenhydrinate),
o Stugeron (cinnarizine), and
o Bonine/Antivert (meclizine).
o Scopolamine is effective and is sometimes used in the
form of transdermal patches (1.5 mg) or as a newer
tablet form (0.4 mg).
 The selection of a transdermal patch or scopolamine tablet
is determined by a doctor after consideration of the
patient's age, weight, and length of treatment time required.
 TO IMPROVE VESTIBULAR SYSTEM:
 Many pharmacological treatments which are effective for
nausea and vomiting in some medical conditions may not
be effective for motion sickness. 47
 For example,
 metoclopramide and
 prochlorperazine,
 Although widely used for nausea, are ineffective for
motion-sickness prevention and treatment.
 This is due to the physiology of the CNS vomiting centre
and its inputs from the chemoreceptor trigger zone versus
the inner ear.
76
  Sedating anti-histamine medications such as promethazine
work quite well for motion sickness, although they can
cause significant drowsiness.
 As astronauts frequently have motion sickness, NASA has
done extensive research on the causes and treatments for
motion sickness.
 One very promising looking treatment is for the person
suffering from motion sickness to wear LCD shutter
glasses that create a stroboscopic vision of 4Hz with a
dwell of 10 milliseconds.53

EXERCISE
INTERVENTIONS
&MANAGEMENT

77
 MANAGEMENT
 AIMS:
 TO IMPROVE MUSCLE STRENGTH
 TO IMPROVE ENDURENCE
 TO IMPROVE BALANCE AND CO-ORDINATION
 PHYSICAL ACTIVITY IMPORTANCE:
 _ Physical activity is an overarching concept which is
expressed in many forms, for example;
 play, physical education, daily activities including walking,
going up and down stairs, cycling
 to work, movement activities, exercise, and sports.28
 _ Physical activity can be defined as "all physical motion
produced by skeletal muscles
 resulting in a substantial increase of energy consumption
beyond the normal level" .
 _ Moderate physical activity is defined as an activity that
requires three to six times as much
 energy as the energy used at rest.
 _ Exercise is physical activity that is planned, structured
and repeated, aiming to improve or
 maintain physical fitness

78

.
 EXERCISE OVERCOMES
 “DECONDITIONING” OF MUSCLES DURING
 SPACE FLIGHT
 Intermittent loading of muscles, bone and
 cardiovascular system prevents
 deconditioning effects of spaceflight on
 muscle mass and performance.
 Most effective exercise – treadmill with
lower
 body encased in a negative-pressure
 chamber.
 RETURN TO EARTH REQUIRES SPECIAL
MEASURES TO ENSURE MAINTENANCE OF
ARTERIAL BLOOD PRESSURE
 Most dramatic effects are decrease in blood
79
 volume and decrease in tone of leg vessels
 decrease cardiac preload, orthostatic
 In recent years, astronauts have employed
 various strategies just before re-entry to
 counter the adaptations to microgravity.
 The countermeasure to orthostatic
 intolerance is restoration of blood volume
 before re-entry. One means of attenuating
 the reduction of blood volume in space flight
 is an exercise program.
 Even a brief period (e.g., 30minutes) of
intense exercise expands plasma albumin
content and increases plasma oncotic
 pressure and plasma volume by10% within 24 hours
 A second way of minimizing the decreased
 blood volume is to increase salt and fluid
 intake. However, this practice has proven
 difficult to implement because of the
 consequent increase in urine flow.
 Currently, astronauts are educated about the
 effects of prolonged space flight and are
 then maintained under continuous scrutiny
 after re-entry until they have regained a
 normal orthostatic response

 PRE-FLIGHT PHASE
 MOTOR FITNESS:
 Motor fitness training develops the endurance, strength,
power, balance, agility and flexibility to climb efficiently
on steep and challenging terrain.

80
 STRENGTH AND POWER TRAINING:
 In addition to leg strength, mountaineering requires a
strong core (back and stomach) as heavy pack weights add
a new dimension to climbing. Strength training principles
are essentially thesame for upper and lower bodies.
Strength training can involve body weight exercises as
well as routines using traditional weights.
 CORE STRENTHENING EXERCICES:
 Core strength exercises strengthen your core muscles,
including your abdominal muscles, back muscles and the
muscles around the pelvis. Strong core muscles make it
easier to do many physical activities.
 Core exercises build abs and other core muscles.
 DEEP (FULL) SQUATS:-
 Full squats push the knee joint past 90 degrees.
 Whether they are done with or without weights (abarbell or
a weight held across the shoulders or in the hands) this can
strain the ligaments, cartilage and muscle of the knee joint
and lower back, and create problems with the tracking
(movement) of the kneecap. Suggestions include:
 Perform half-squats instead (45-degree bend of the knee).
 Use a mirror to check when your knee joint is at 90
degrees. You could also ask someone else to watch you or
seek instruction from a qualified fitness professional.

81


 DOUBLE LEG RISES:-

 Avoid double leg raises. This exercise involves lying on
your back and raising both legs at the sametime.
 This places enormous stress on the lower back.
 Another potentially harmful variation is to lie on your
stomach and lift both legs at the same time.
 An alternative is to perform the exercise one leg at a time,
making sure your hips remain stable throughout the

82
 movement. Keep the other leg bent, with your foot on the
ground.


 BEHIND THE NECK PRESS:-
 The ‘behind the neck presses or ‘latpulldown behind the
neck’ should be avoided, especially if youhave been told
you have instability in the front of your shoulder.

83

 Fig no-14 neck press strengthening of back muscles
 Push-ups:-
 Push-ups can range in difficulty from very easy to so
difficult that few people can do them.
 Adjusting the difficulty level is simply a matter of
changing hand placement and body level to alter leverage
and load.

84
 Fig no-15 picture showing the which muscles are
strengthen by push ups
 Keeping the body upright and the hands in line with the
shoulders scales the pushup for people who are just
beginning their fitness journey.
 Placing the feet high and moving the hands lower, toward
thehips, increases the loads dramatically and can challenge
world-class athletes.
 Decline push-up:-
 To do push-ups with little or no resistance, start in a
standing position, arms-length from a wall.
 Extend the arms in front of you at shoulder height to place
your hands on the wall slightly wider than shoulder-width.
These push-ups (or, more literally, push-outs) are

85
 appropriate for beginners and those who are rehabilitating
injuries.
 With the body almost completely vertical, these can be
used to restore and build mobility in the arms and
shoulders, to teach the plank body position, and to work
o toward a horizontal push-up on the floor.

 Fig no-16 pushups with no resistance

 Even with this simple movement it is important to keep a
rigid body and full range of motion(ROM).
 Each rep should bring the chest and face as close as
possible to the wall and finish with the arms completely
straight and the shoulders fully extended.
 The degree of difficulty can be additionally fine tuned by
adjusting the distance of the feet from the wall
 Obviously, the farther out they are - and the more acute the
angle of the body - the more difficult they will be.
 L-sit/V-sit:-

86
 L-sits can be performed on the ground, with legs extended
straight in front of you and hands flat on the floor on either
side of the legs.
 This requires a conscious effort to push the shoulders
down to liftthe body high enough to perform the L on flat
ground. ( Fig;17)You can also do a straddle L, with
o hands on the ground between your legs.

 Fig no- 17, L- sit/v sit for the triceps and abs
 STANDING AND TOE TOUCH:-
 Avoid standing toe-touches altogether. Bending down to
touch the toes, with straight legs, can overstretch the lower

87
 back muscles and hamstrings, and stress the vertebrae,
discs and muscles of the lower Back and hamstrings.
 Adding a twisting movement to the toe-touch can cause
damage to the joints.
 Alternative stretches for the abdominal muscles or the
lower back muscles and hamstrings include:
 Stretch the hamstrings and lower back muscles by placing
one foot on a low bench or chair, with both legs slightly
bent so as not to stress the knee joints and, keeping your
back straight, gently reach forward with your arms.
 An alternative hamstring stretch involves lying on your
back with both knees bent. Straighten one leg by lifting it
towards the ceiling, keeping the knee slightly bent. Support
this leg by clasping both hands behind the knee.
 Hold. Repeat for the other leg. You should feel the stretch
on the back thigh of the straight leg.
 For an alternative lower-back stretch, sit cross-legged on
the floor then slowly lean forward, keeping your back
straight while reaching your arms out to the floor. Hold.


 Fig no- 18 toe touching

88
 SIT –UPS:-
 Two common but potentially harmful variations of the sit-
up include anchoring the feet (where your training partner
holds your feet) or keeping the legs straight along the floor.
 The hands are held behind the head or neck, and the upper
body lifted. These types of sit-ups strain the lower back
and tend to target the muscles of the hips and thighs rather
than the abdomen
 Fig.19 sit ups.
 Suggestions include
 Avoid this style of sit-up altogether.
 Perform abdominal curls instead. Lie on your back with
your knees bent, feet flat on the floor and arms folded
across your chest or alongside your body. Breathe out and
curl your ribcage towards your pelvis.
 Hollow rock:-
 The starting position is lying on the back in a hollow. A
hollow position for this purpose is one in which the pelvis
is turned under (i.e., tail tucked), legs are lifted slightly off
the floor, lower back is touching the ground, head and
shoulders are lifted slightly off the floor, and arms are held
by the ears, off the ground.
 From this position, rock smoothly back and forth, keeping
the body tight, the hip angle constant (no pinking of the
hip), and the lower back rounded.
 Any thumping in the motion shows that the hollow
position has been compromised, which indicates that the
trainees abs are not strong enough to keep the pelvis turned
under in this position. Continued training will alleviate this
deficiency.
 Fig no-20 hallo rock moves
89
 BURPEE:-
 To do a burpee in its most basic form, start from standing,
squat with your hands on the floor, and jump your feet
back to put you in a prone position with straight arms (as at
the top of a push-up).
 Then bring your legs forward into a squat again and return
to standing. This basic version is also sometimes called a
squat thrust.


 Fig no-21 procedure to perform the burpe
 Several modifications can be made to the burpee to
increase its demands: add a push-up in the prone position,
add a jump at the end as you return to standing, perform
the burpee under a bar and jump up to do a pull-up in each
rep, etc. Be creative with burpees and see what variations
you can come up with.
 JUMPING JACK:-
 Most people have done jumping jacks in a PE class at
some point. They are an excellent way to warm up, and
they can be included in a conditioning set either as a
station where fatigued muscles are allowed to recover

90
 while metabolic demands are kept high, or as a significant
component of a metabolic conditioning circuit. Jumping
jacks should be practiced both with arms and legs in
concert (legs straddling while arms are swung upward) and
in opposition (legs straddling while arms are

broughtdown).

 Fig no - 22 showing the changing leg by sequence

 HANDSTAND AND PRESS HANDSTAND:-
 Handstand pushup benefits are many. Some might even
call it one of the greatest exercises ever invented.fig 23
 Strengthens the triceps, shoulders and chest
 Strengthens many stabilizer muscles
 Requires coordination and balance
 Can be an effective muscle builder
91
 Provides the benefits of inversion
 It’s an impressive skill few people can do
 Can be handled very progressively
 Handstand and press handstands are excellent exercises for
developing strength

 Fig no
 ANTI- GRAVITY TREADMILL TRAINING
 In weightlessness at anti gravity
 Then a normal thread mill which can
 Activates proprioceptors.
 Fig no
 35
 no-23 hand stand and press
 TRAINING:-
 treadmill, it makes running on treadmill more effective
 be adapted to the zero gravity. 28
 no-24 Anti gravity thread mill
 effective.
 36
 UNDER WATER STENGTH TRAINING:

92

 HydroWorx’s patented underwater treadmill is
revolutionizing physical therapy, sports medicine and
conditioning.
 This proprietary feature comes standard in all of our
therapy pools.
 The powered underwater treadmills are integrated into the
pool floor and feature a polished stainless steel frame that
is professionally welded for durability and safety.
 Our endless rubberized treadmill belts offer excellent
traction and may be utilized with bare feet or shoes.50
 Fig no-25.1 under water thread mill
 When a person runs on an underwater treadmill, his or her
body undergoes greater exertion due to the viscosity of the
water.

93
 This leads to greater hip, leg and foot strength, as well as
improvements in core muscle groups throughout the body.
 Fig no-25.2 An underwater treadmill also provides
resistance for range of motion exercises and for stretching
and therapeutic exercises.
 CARDIOVASCULAR FITNESS:-
 Cardiovascular training uses both aerobic exercises 12 and
interval training and functions as the foundation for your
ability to climb for long periods of time.
 A variety of aerobic exercises work well for training,
including climbing and descending hills, stairs or stadium
bleachers, skiing, running and cycling.
 Build your aerobic training over time, beginning with
shorter sessions and increasing to longer workouts.
 By the time your climb approaches you should feel
comfortable with an aerobic exertion that is similar to any
day of your anticipated climb.33

 Fig no:-26 aerobics exercises
 38

94
 ENDURANCE TRAINING:-

 Endurance is a motor skill like strength and balance and

can be developed with training.
 In short, endurance training is a focus on continually
increasing the intensity of your training and not becoming
complacent in your routine or your level of fitness20.
 This will build a more durable body
o and allow you to climb strongly for an extended
period of time as well as adapt to the unanticipated
physical challenges of the climb.
 Fig no-27 training under parabolic flight.

 HYPOXIC MANAGEMENT
 IHT or Intermittent Hypoxic Training involves short
intervals of breathing (4-6 minutes) of hypoxic20 air
interspersed with intervals (4-6 minutes) inhaling ambient
air.

95
 Improve breathing economy and the ability.
 Fig no-28 under clinical test
 INTERMITTENT HYPOXIC TRAINING
 Intermittent Hypoxic Training system (IHT) enables
athletes, injured athletes, and sedentary individuals to
enhance performance, increase fitness while injured, and
pre-acclimatize to high altitudes.
 IHT involves short intermittent inhalations (3-5 minutes)
of hypoxic air (10% O2, 20,000ft/6000m) interspersed
with inhalations of ambient air (2-5 minutes).
 IN-FLIGHT PHASE
 when they are in space station ,all astronauts are required
to exercise 2-5 hours per day six days a week in orde to
prevent muscle atrophy14 and bone mineral density and
cardio vascular losses.
 In weightlessness at zero gravity it moves running ona
treadmil more effective
 The treadmil features a rotating belt with or without
resistance44
 Fig no- 29, T2 treadmill (Normal thread mill without
whistles or fancy bells)
 Like treadmil the stationary bike appears to be a no- trils
version of one that might befound in a recreation gym,
the only component it lacks and hardles a seat the later of
which isn't needed in space as long as the individual
feet's anchored to the bike53. To keep them in place,they
were cycling shoes that clips to the bike pedals.[fig no-
30]
 Fig no - 30 cycle Ergo meter
 Blood Flow Restriction

96
 Blood flow restriction (BFR) is a novel exercise modality
that is becoming increasinglymore popular. BFR uses
exercise cuffs or bands to restrict venous blood flow during
exercise .
 The restriction of venous blood flow limits stroke volume
and compensatory increases in heart rate during exercise.
 Recent studies have shown that BFR exercisetraining can
result in significant and rapid increases in muscle
hypertrophy and aerobic capacity.
 While the exact reason for these rapid results is still
unknown, the results produced are similar to the results
gained through highintensity resistance training programs.
This unique characteristic of BFR training allows
substantial muscle hypertrophy to occur even when
training at exercise intensities as low as 20% of 1 RM (Abe
et al., 2006; Abe at el., 2010). Therefore, low-intensity
exercise (i.e. walking) with BFR may provide a more
favorable alternative to high-intensity exercise to increase
muscle size, strength and functional capacity
 Much of the research done using BFR has been acute
training studies lasting up to 6 weeks as the long-term
effects of BFR combined with exercise are still not
established. However, BFR research has been done in a
variety of populations, including: the elderly, elite-athlete,
and clinical recovery patients
 Two primary exercise modalities used in combination with
BFR are resistance exercise and aerobic exercise.
97
 Safety Concerns Using BFR
 Safety concerns using BFR have arisen due to the cuff
inflation and restriction of venousblood flow during
exercise. Numerous reviews have shown that BFR exercise
has possible side effects but does not increase risk for
cardiovascular disease. A nationwide review of safety of
BFR practitioners reported possible side effects and
prevalence during BFR exercise:
 bruising (mostly in arms) – 13.1%,
 temporary numbness – 1%,
 thrombosis – 0.055%, and
 pulmonary embolism – 0.008%
 Another review reported:
 thrombosis - < 0.06%,
 rhabdomyolysis - < 0.01%, and pulmonary embolism - <
0.01%
 Despite low reported rates of thrombosis and pulmonary
embolism, the
 development of blood clots during BFR continues to be a
concern. Recent studies looking into blood markers post-
BFR exercise has shown no increase in clot formation
markers
 Additionally, increased cardiovascular responses seen
during lowintensity
 BFR exercise are lower than those seen during traditional
high-intensity exercise.

98
 Therefore, low-intensity BFR exercise poses no greater
threat to participant safety than traditional high-intensity
exercise
 BFR Combined with Aerobic and Resistance Exercise
Training
 Findings demonstrate that BFR when used in combination
with resistance exercise can lead to increased muscle
cross-sectional area and muscle strength
 Additionally, during a 2-week walk training study with
BFR, maximal oxygen utilization (VO2max) increased by
11.6% in college male athletes
 Studies have shown that the decrease in venous blood
return during BFR training causes a
 resulting decrease in heart SV) and a compensatory
increase in heart rate (HR)
 This decrease in SV is likely caused by the restricted
venous return of blood due to the
 inflated cuff.

 BFR exercise is also a potential countermeasure for OI.

Cuffs worn on the upper thighs during space flight have
been shown to help maintain central and peripheral
hemodynamics and mitigate the flow of bodily fluids
headwards .
 Blood flow restriction offers great potential to counter the
negative physiological effectsof microgravity.

99
 With the potential to prevent muscle loss, and minimize OI
upon reentry to earth’s gravity, BFR is an ideal
intervention to counter two of the most common side-
effectsexperienced by astronauts .

 Equipment needed to complete BFR exercise are also very

minimal when compared to previous methods (COLBERT,
ARED), making it an ideal exercise protocol during long
during space flight missions where future mission craft
space will be minimal.
 Blood flow restriction (BFR) is a novel exercise
intervention that involves the application of inflated
tourniquet cuffs that restrict venous blood flow during
exercise. Despite being a novel form of exercise
intervention, BFR has been shown to elicit rapid and
progressive gains in muscular strength, endurance and
aerobic capacity
 . Two widely used forms of BFR are the Kaatsu and Delfi
training cuffs. The former has been widely used in Japan
and the ladder is showing increasing use in clinical
populations.
 BFR allows participants to train at lower-submaximal
(30% of one repetition maximum (1RM)) intensities yet
receive the benefits as if they had trained at higher-
submaximal (70% 1RM) intensities.

100

 ADVANCED RESISTIVE EXCERCISE DEVICE
(ARED):-
 Advanced resistive exercise device which resembles the
proto type of a bow flex or a
 similarly at home gym with a bench weight resistance
levels provided by two vacuum
 cylinder.
 The high load is needed because we have to compensate
for no body weight in zero gravity.
 Although daily strength training is non-negotiate in
space, astronauts are able to choose their
 cardiac workout.53
 Fig no- 31weights lifting with resistence
 Fig no-32 Advance resistive exercise device with
combination ofwholebody vibration
 specially designed for astronauts in space.

101
 ELECTRICAL STIMULATION TO MUSCLES:-

 Electrical muscle stimulation37 at zero gravity to prevent

the muscle atrophy and
o Demineralization of bone.

102
 Fig no-33 electrical stimulation for the quadriceps and
Doris flexors.
 POST-FLIGHT PHASE
 Astronauts returning from challenging long-duration
missions face one more challenge when they get back to
Earth - standing up and walking.
 Upon returning to normal gravity, astronauts often suffer
from balance problems that lead to dizziness and difficulty
standing, walking and turning corners.
 Tilt Table:-
 Astronauts after the space travel , they may get dizzy when
they stand up 39(orthostatic hypotension—see Dizziness or
Light-Headedness When Standing Up).
 A tilt table may be used to help astronauts. This procedure
may retrain blood vessels to narrow (constrict) and widen
(dilate)
 appropriately in response to changes in posture43. People
lie face up on a padded table with a footboard and are held
in place with a safety belt.
 The table is tilted very slowly, determined by how well
people tolerate it, until they are nearly upright. The slow
change in posture enables the blood vessels to regain the
ability to constrict.
 How long the upright position is maintained depends on
how well people tolerate it, but it should not exceed 45
minutes.
 The tilt-table procedure is done once or
 twice a day. Its effectiveness varies depending on the type
and degree of disability.13

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 Fig no-34 tilt table

 Adaptability Training System:-

 National Space Biomedical Research Institute (NSBRI)
scientists51 in a project to develop techniques to help
astronauts adapt quickly to a new gravity environment and
to overcome balance disturbances.
 This concept will also have benefits for non-astronaut
populations such as the elderly or people with balance
disorders.
 They use a system that consists of a treadmill mounted on
a base that can be actively moved in different directions to
simulate balance disturbances called an Adaptability
Training System.
 The treadmill has a projection screen in front of it that
shows an image of a room or hallway that moves as the
user walks. Disturbances are simulated by tilting the
treadmill in one direction as the image is tilted in another.

 Fig no-35 treadmill with front facing projection screen.

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 "At first, people find it difficult to walk on the treadmill
since its movement and images are out of sync.
 But over time, they learn to walk on it efficiently. We call
this concept 'learning to learn,'"
 In order to perform everyday activities, the brain interprets
information provided by the body's sensory systems: the
eyes, the inner ear balance organs, the skin and muscle
movement receptors.
 The problems for astronauts occur during the transition
period in which the brain is trying to adapt to a new gravity
environment - either returning to Earth or in the future
adjusting to lunar or Martian gravity.

 "In space, information from the sensory systems is

different, particularly when you take away gravity.
 The brain reinterprets that information, makes adjustments
and allows you to do the activities you need to do in
space,"
 The down side to that is when you return to Earth, the
sensory systems are not used to a normal gravity
environment."
 An astronaut has been in space on a typical two-week
shuttle mission, it may take several days to recover.
 For six-month stays aboard the ISS, it could take at least
several weeks to return to normal.
 Adaptability Training System that induces balance
disturbances through support surface movement
 and changes in visual information. The system consists of
a treadmill mounted on a base that can be
 actively moved in different directions paired with a virtual
scene projected in front of the subject
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 providing a variety of balance challenges as the user walks.
 To Build Up Atrophied Muscles-
 _ Progressive exercise program.
 Step 1
 Begin with isometric exercises to improve circulation and
increase strength in the atrophied muscle.
 Isometric exercises involve simply contracting the muscle
for a few seconds at a time. For example,
 contracting your quadriceps with your leg straight would
begin to improve quad strength just as
 contracting your biceps while your arm remains in a
relaxed, bent position would begin to rebuild
 atrophied arm muscle. Gradually increase the contraction
time and repetitions as your strength
 improves.
 Fig no-36 isometric exercise for quadriceps
 46
 Step 2
 Progress to range of motion exercises that involve joint
movement but do not use outside resistance.
 For atrophied quadriceps muscles, for example, sit in a
chair and simply straighten your leg to
 engage the atrophied muscles. These types of exercises can
be performed several times throughout
 the day to keep your blood flowing and muscles limber.

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
 Fig no-37 range of motion exercise for quadriceps
 Step 3
 Use light resistance such as small hand weights or
resistance tubing to begin rebuilding your lost
 muscle mass. Resistance needs to be added gradually,
adding too much too quickly can result in
 injury. A leg extension with a resistance band is an
example exercise for atrophied quadriceps
 muscles.

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
 Fig no-38 light resistence exercises through theraband
 47
 Step 4
 Add more resistance, moderately, in the form of heavier
free weights or weight machines. Include
 more functional movements into your exercise program.
Squats and step-ups will help to continue to
 build up atrophied quadriceps muscles while overhead
presses will strengthen atrophied muscles in
 the upper body.
s
 Fig no-39 weight training
 48

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 Exercise as a countermeasure
 As part of the daily activities on the ISS, astronauts are
required to exercise for up to two hours a day, including
running on treadmills, pedalling on cycle ergometers or
performing resistance exercise (good substitutes for weight
based exercise).
 Effective exercise protocols to maintain astronaut health
could ultimately also benefit people on Earth.
 A lot of research has been conducted by space agencies to
ascertain the best way of providing efficient protection
against microgravity; most will be based on the adaptation
of equipment and evolution of exercise protocols.
 A current NASA study called Sprint will evaluate the
effectiveness of interval training, alternating between
periods of high intensity exercise with short periods of low
intensity effort.
 A more individualized approach is also being considered
with the development of specific exercise training
regimens for each astronaut.
 What is undoubtedly true is the effect that these
programmes have on the re-adaptation process.
 There is an overall positive effect for astronauts on re-
entry to Earth’s gravity.
 Microgravity exercise regimes could help prevent or treat
terrestrial conditions

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 An interesting comparison can, in fact, be made between
the effects of prolonged exposure to microgravity on the
human body and the aging process.
 The absence of gravity on an astronaut’s body can leave
them with less bone mass, atrophied muscles and feeling
weaker.

 This is a scenario not dissimilar to symptoms experienced

by the elderly or people leading an overly very sedentary
lifestyle.
 Countermeasures used in space to avoid or minimize the
deleterious effects of microgravity could also help prevent
or treat terrestrial conditions.

 The Advanced Resistive Exercise Device (ARED)

functions to maintain crew health in space. Crew members
exercise daily on ARED to maintain their preflight muscle
and bone strength and endurance. EVA, IVA, re-entry, and
emergency egress activities necessitate the crew members'
continued strength and endurance. The current resistive
exercise device is the Advanced Resistive Exercise Device,
or ARED. It was taken to the International Space Station
on space shuttle mission STS-126 in November 2008 and
put into service January 2009.

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 The ARED has the capability to exercise all major muscle
groups while focusing on the primary resistive exercise:
squats, dead lifts, and heel raises.
 The ARED accommodates all crew members, from the 5th
percentile Japanese female to the 95th percentile American
male.
 The ARED provides a load of up to 600 pounds for bar and
250 pounds for cable exercise and connects to a Space
Station Computer (SSC) that makes it easier for crew
members to follow a personalized exercise plan. Resistive
exercise is a countermeasure, which prevents the major
muscle groups from weakening and lessens bone loss.
Resistive exercise helps astronauts maintain strength and
endurance.

 RATIONALE

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 Prolonged exposure to microgravity leads to a progressive
loss in muscular strength, endurance, and aerobic capacity.
 This microgravity-induced deconditioning is detrimental to
the health and performance of crewmembers, as well as
overallmission success.
 Countermeasures are in place on board the International
Space Station (ISS) to combat in-flight deconditioning;
however, these current methods do not mitigate
deconditioning entirely.
 As much as a fifth of muscle mass is lost during the first
four months in space; additionally, peak oxygen
consumption (VO2peak) and left ventricular mass decrease
early in flight by ~17% and ~ 12% respectively.
 Emergency mission egress tasks may require normal
ambulatory participants to work at intensities at 85% of
maximum heart rate. Even a relatively small decrease in
VO2peak (e.g., 10%) can greatly impact an astronaut’s
ability to meet these high-energy demands
 The National Aeronautics and Space Administration
(NASA) created the Human Research Program (HRP) to
investigate and mitigate high risk outcomes that impede
crewmember health and performance.
 Two major risks identified by the HRP include the risk of
reduced physical performance capabilities due to reduced
aerobic capacity and the risk of impaired performance due
to reduced muscle mass, strength, and endurance. Gaps of
knowledge within these risks include the development of
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 effective exercise programs for the maintenance of muscle
function and VO2 standards, and the development of pre-
flight, in-flight, and post-flight evaluations to determine if
muscle function and VO2 standards are being met during
missions.
 Prior research and study acknowledges that VO2peak and
muscle function decline during
 spaceflight, but can be mitigated with in-flight exercise
However, performance decrements are still observed
despite current countermeasures, and research into
advanced in-flight exercise protocols is necessary to
identify activity thresholds and exercise prescriptions for
crewmembers.
 The current exercise countermeasures on board the ISS
must be completed on separate devices, increasing the time
required to meet exercise prescriptions


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
 Two notable pieces of equipment are the Advanced
Resistance Exercise Device (ARED) and the Combined
Operational Load Bearing External Resistance Treadmill
(COLBERT). The former allows for up to 600 lbs. of
eccentric-concentric resistance strength training, while the
latter provides astronauts with aerobic training by
reachingup to 12 mph.

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
Physiological Responses to Rowing
 The seated position and involvement of more muscles
during rowing exercise facilitates
 venous return and is accompanied by a higher VO2
response when compared to running at the same relative
intensity. Enhanced venous return elevates central blood
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 volume and lowers HR response due to increases in stroke
volume by the Frank-Starling mechanism
 Interestingly, when compared to cycle ergometers, at the
same metabolic rates
 there were no significant differences in Q when using the
cycle and rowing ergometers. Additionally, Horn, Ostadal
has shown that when compared to cycling, rowing exercise
lead to a more extensive stimulation of cardiac contractility
and/or decreased peripheral vascular resistance.


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CONCLUSION
 Space science is a specialized field, astronauts need a
special preparation to overcome the varied
 changes in the gravitational pull at various levels of ascent
and duration of the stay in specified
 situations in the space stations.
 Bone demineralization
 Muscle atrophy
 Circulatory problems
 Respiratory complications
 A specialized physiotherapy rehabilitation team needed to
train certain conditions like strength
 training, muscle, balance, coordination and cardio
respiratory conditions etc.
 The whole topic deals with the physiotherapeutic measures
to shorten the microgravity effects on
 astronauts. Physiotherapy helps to improve the muscle
strength, endurance, co-ordination and
 balance. To shorten the complications of micro gravity on
astronaut through the physiotherapy
 intervention. Physical Therapy focuses on to restore
overall function to get them moving faster and
 feeling better. Physiotherapist will provide you with a
customized recovery program that will restore
 you to your maximal potential, and get you moving faster.
The ultimate goal is to enable our patients to manage their
own physical well-being independently
 ISRO to send first Indian into Space by 2022 as
announced by PM, says Dr Jitendra Singh,
Rs. 10,000 crore mission will be a turning point in

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
 8India’s space journey; most engineering components
are ready: ISRO Chairman Chandrayaan-2 scheduled
to be launched in January, 2019


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