Cardiovascular deconditioning during weightlessness simulation and the use of lower body negative pressure as a countermeasure to orthostatic intolerance

The cardiovascular function is one of the main disturbed by weightlessness: it is particularly affected by the astronaut's return to Earth, where symptoms linked to the cardiovascular deconditioning syndrom appear in the following forms: (1) orthostatic intolerance with its risk of syncope: (2) higher submaximal oxygen consumption for an equivalent work load. Lower Body Negative Pressure (LBNP) is intended to stimulate the venous system of the lower limbs; however, the specific effects of periodical LBNP sessions on the orthostatic intolerance have never been studied. With this objective in mind, 5 volunteers took part in two recent antiorthostatic bedrest experiments for 30 days. In the first experiment 3 subjects were submitted to several sessions of LBNP experiment per day and 2 others were controls; in the second experiment the LBNP group of the 1st one became controls and vice-versa. Two orthostatic investigations were performed: (1) 5 days before the bedrest; (2) at the end of the 30 day bedrest period. The results showed: (1) when the subjects were control, a high orthostatic intolerance post bedrest with 3 syncopes and one presyncopal state during the first minutes of the tilt test; (2) when the subjects were submitted to LBNP sessions, no orthostatic intolerance.     

Social support and depressed mood in isolated and confined environments

The influence of isolation and confinement on social support and depressed mood was examined in a study of 235 men and women who spent a year at McMurdo Station in Antarctica, and a study of 77 men and women who spent a year at the Amundson-Scott South Pole Station. Although availability of support remained unchanged, there was a significant decrease in reported satisfaction with support obtained, as well as a significant increase in depressed mood. Satisfaction with support was inversely associated with depressed mood at the beginning and end of isolation and confinement. At the end of winter, this association varied by source of support. High levels of tension-anxiety, depression and anger preceded an increase in advice seeking, but high levels of advice seeking also preceded an increase in tension-anxiety and depression. Results suggest a significant erosion of social support under conditions of prolonged isolation and confinement, leading to an increase in depressed mood.     

Biofeedback monitoring-devices for astronauts in space environment

After a reconsideration of the state-of-the-art in biofeedback research the implementation of biofeedback systems is envisioned as a countermeasure of stress for the psychoprophylaxis of the astronaut. A one-session experiment performed on two groups of subjects to assess the interference from EMG-feedback on the performance in a simultaneous psychomotor trial with a view to expanding biofeedback application is described. The results show that the experimental group performed in the same way as the control without feedback, but with less CNS activation. Some general conclusions are drawn from the advances in technology.     

Hydroelectrolytic and hormonal modifications related to prolonged bedrest in antiorthostatic position

The effects of prolonged bedrest in antiorthostatic position (-4 degrees head down) on electrolyte balance were studied in 4 young volunteers. An increase was noted in sodium excretion during the first 4 days. Plasma renin activity and plasma aldosterone varied in parallel manner during the same period. Potassium balance and creatinine clearance were not significantly modified. In light of these data we feel that prolonged bedrest in antiorthostatic position constitutes an effective way to simulate on earth metabolic and hormonal modifications occurring in man under weightlessness conditions.     

Transcultural group performance in extreme environment: Issues, concepts and emerging theory

A simulation for flight of international crew on space station took place in Moscow from July 1999 to April 2000 (SFINCS) at the State Biomedical Institute of Russia (IBMP) isolation chambers. Objectives of this study were to identify concepts of psychosocial adaptation and of social interactions to develop an explanation of the transcultural group performance. Method: constructivist epistemology with grounded theory research and fourth generation evaluation were used. Data on processes and interactions were gathered during 110 days of confinement as a subject and extended to 240 days as an outside scientist. Results indicate that coping is influenced by usual coping strategies and coping behaviors inside. Several stresses and human factor issues were identified altering well being and performance inside the chambers. Enabling and limiting forces are discussed. A theory on transcultural group performance is proposed. Issues are raised that appear critical to selection, training and group performance.     

Adaptational changes in the neural control of cardiorespiratory function in a confined environment: the CNEC#3 experiment

The goal of the study was to characterize the changes in neurovegetative control of the circulation, attending the presumed physiological and psychological stress originated by the isolation and confinement typical of the living condition of space stations, as simulated in a ground based unit, using time and frequency domain analysis. As a secondary goal we sought to verify the implementation of real time data acquisition, for off line spectral analisys of R-R interval, systolic arterial pressure (by Finapres) and respiration (by PVF2 piezoelectric sensors).

We addressed the cardiorespiratory and neurovegetative responses to standardized, simple Stressors (active standing, dynamic and static handgrip) on the EXEMSI 92 crew, before, during and after the isolation period.

On average the appropriate excitatory responses (to stand, dynamic and static handgrip) were elicited also in isolation and confinement.

Active standing and small masses muscular exercises are easy to be performed in a confined and isolated environment and provide a valuable tool for investigating the adaptational changes in neural control mechanisms.

The possibility there exists of using this time and frequency domain approach to monitor the level of performance and well being of the space crew in (quasi) real time.     

Space analogue studies in Antarctica

Medical research has been carried out on the Australian National Antarctic Research Expeditions (ANARE) for 50 years. As an extension of this program collaborative Australian/United States research on immunology, microbiology, psychology and remote medicine has produced important data and insight on how humans adapt to the stress of extreme isolation, confinement and the harsh environment of Antarctica. An outstanding analogue for the isolation and confinement of space missions (especially planetary outposts), ANARE has been used as an international research platform by Australia and the United States since 1993. Collaborative research has demonstrated a lowered responsiveness of the immune system under the isolation and confinement of Antarctic winter-over; a reduction of almost 50% in T cell proliferation to mltogen phytohaemogglutinin, as well as changes in latent herpesvirus states and the expansion of the polyclonal latent Epstein-Barr virus infected B cell populations. Although no clinically significant disease has been found to result from these immune changes, research is currently assessing the effects of psychological factors on the immune system. This and associated research performed to date and its relevance to both organisations is discussed, and comment made on possible extensions to the program in both medical and other fields.     

Pre-adaptation to shiftwork in space

Astronauts are often required to work in shift schedules. To test pre-mission adaptation strategies and effects on the circadian system, a study was performed using microgravity simulation by head-down bedrest. Eight male subjects were studied over 4 control days, and 7 days each for pre-mission adaptation, bedrest, and readjustment. The circadian system was assessed by monitoring ECG and temperature, and by collecting urine for determination of hormones and electrolytes. Rhythms did not achieve complete adjustment within the adaptation period when the sleep-wake cycle was shortened by 1 h/day, but resynchronization continued during bedrest. After the bedrest period when the time shift was reversed by a 7-h delay within 2 days, resynchronization was achieved satisfactorily only within 7 days. From the results it is concluded that a sleep-wake cycle advance as used in this study is insufficient to keep the circadian system in pace. Under operational conditions the circadian system of astronauts may become longer and more destabilized than under controlled laboratory conditions.     

Status of vestibular function after prolonged bedrest.

6 young, healthy, male volunteers were submitted to one week of head down (-4 degrees) bedrest. This position simulates the cerebral hemodynamic conditions in weightlessness. Measurements of vestibular equilibrium and of oculomotor system function were made before and after the prolonged bedrest. Analysis of the results indicates that vestibular responses, as measured by the maximal speed of the slow phase of the provoked nystagmus (caloric and sinusoidal rotatory stimulations), are decreased after prolonged bedrest. This statistically significant diminution requires confirmation with a greater number of cases. The reflex conflicting or interacting with the cervico-ocular and optokinetic reflexes on the one hand and the foveal vision on the other, is one of several possible explanations for the observed changes.     

Fluid volumes changes induced by spaceflight

The blood volume (BV), plasma volume (PV), and extracellular fluid volume changes produced in crewmembers during spaceflights of 11-84 days were compared to changes after 14 or 28 days of bedrest. Spaceflight and bedrest produce approximately equal BV changes but the recorded PV change after spaceflight was less. However, the diurnal change in PV may explain the smaller decreases recorded after spaceflight. The cardiovascular deconditioning caused by spaceflight and bedrest was compared using the mean heart rate response to lower body negative pressure (LBNP) testing at -50 mmHg pressure. These tests show approximately equal LBNP produced heart rate changes after bedrest and spaceflight. A countermeasure which includes 4 hr of LBNP treatment at -30 mmHg and the ingestion of one l. of saline was studied and found capable of returning the heart rate response and the PV of bedrested subjects to control (prebedrest) levels suggesting that it would be useful to the crewmembers after a spaceflight.     

Cognitive performance aboard the life and microgravity spacelab

The impact of microgravity and other stressors on cognitive performance need to be quantified before long duration space flights are planned or attempted since countermeasures may be required. Four astronauts completed 38 sessions of a 20-minute battery of six cognitive performance tests on a laptop computer. Twenty-four sessions were preflight, 9 sessions were in-orbit, and 5 sessions were postflight. Mathematical models of learning were fit to each subject's preflight data for each of 14 dependent variables. Assuming continued improvement, expected values were generated from the models for in-orbit comparison. Using single subject designs, two subjects showed statistically significant in-orbit effects. One subject was degraded in two tests, the other was degraded in one test and exceeded performance expectations in another. Other subjects showed no statistically significant effects on the tests. The factors causing the deterioration in the two subjects can not be determined without appropriate ground-based control groups.     

Human thermohomeostasis onboard "Mir" and in simulated microgravity studies.

Significant changes of thermogomeostatic parameters was obtained by thermotopometric method using the techniques simulate of microgravity effects: bed rest, pressurized isolation, suit immersion (SI). However, each of ground models made rectal temperature (T) trend downward. The autothermometric study (24 and 12 sessions, 2-13th and 6-174th flight days) was carried out onboard "Mir" by two flight engineers who had preliminary tested at SI (1-2 days). Studies of German investigators onboard "Mir" confirmed: rectal T must be higher in space flight as compared to the normal environment (n=4). Comparative studies suggest that microgravity is a key factor for the human body surface T raise and abolishment of the external/internal T-gradient. T-homeostasis was not really changing during missions and could be regarded as acute effect of microgravity. After delineation of changes in body surface T--by Carnot's thermodynamic law--rectal T raise should have been anticipated. Facts pointing to the excess entropy of human body must not be passed over.     

Cardiovascular effects of simulated zero-gravity in humans

Head-down and head-up [correction of heat-up] tilted bedrest (5 degrees) and head out water immersion (HOWI) for 6 hr were compared. Parameters: Cardiac output (rebreathing method), blood pressure (arm cuff), forearm blood flow (venous occlusion plethysmography), total peripheral (TPR), and forearm vascular (FVR) resistances, Hct, Hb, relative plasma volume (PV) changes, and plasma catecholamines (single-isotope assay). During HOWI there was as expected a decrement in TPR, FVR, Mean arterial pressure (MAP, from 100 to 80 mmHg), Hct, and PV, and--as a new finding--catecholamines, which were 30-50% lower compared with both +5 and -5 degrees bedrest. During head down tilt, MAP was elevated (to 100-110 mmHg) and catecholamines did not fall, while TPR and EVR slowly decreased over 6 hr. HOWI is a stronger stimulus than -5 degrees bedrest, probably because HOWI elevates central venous pressure more markedly emptying the peripheral veins, while bedrest permits a distension of veins, which induces an increase in sympathetic nervous activity.     

Evaluation of spontaneous baroreflex response after 28 days head down tilt bedrest

The spontaneous baroreflex response was evaluated during supine rest and head up tilt (60 degrees) before and immediately after a 28 day 6 degrees HDT bedrest in 6 healthy adult men (age 30-42 years). Sequences of 3 or more beats where RR-interval and systolic blood pressure changed in the same direction were used to evaluate baroreflex response slope (BRS). Prior to bedrest, the mean BRS and RR-interval were 18.0 +/- 3.9 ms/mm Hg and 926 +/- 61 ms at rest and 10.5 +/- 2.5 ms/mm Hg and 772 +/- 63 ms during the first 10 min of 60 degrees tilt. Following bedrest, these values changed to 15.6 +/- 2.7 ms/mm Hg and 780 +/- 53 ms at rest, and to 6.5 +/- 1.2 ms/mm Hg and 636 +/- 44 ms during tilt. Thus, (1) the spontaneous baroreflex can be evaluated in human subjects during experiments of orthostatic stress; (2) the baroreflex slope was reduced on going from supine to the head up tilt position; and (3) 28 days of bedrest reduced the spontaneous baroreflex slope.     

Bright light as a chronobiological countermeasure for shiftwork in space

Work-rest schedules during long duration space missions involve several factors which could disrupt sleep and circadian temporal organisation: (1) displacement of sleep due to two-shift operations; (2) planned or unplanned schedule changes due to operational requirements; (3) social and light Zeitgebers different from those on earth; (4) changes in the gravitational exposure. Timed bright light treatment has the potential to accelerating adaptation to schedule changes. Four male subjects were exposed to two sessions of 11 d of simulated microgravity (6 ° head down tilt bedrest) with 6-h extensions of the wake period on 2 days (12-h phase delay). In a blind crossover design, subjects were exposed to bright light (> 3500 lux) for 5 h on each of the 2 shift days and the following day, at times either expected to accelerate the adjustment to the phase delay (experimental condition) or to have no phase shifting effect (control condition). Sleep was recorded polygraphically, the circadian system was monitored by recordings of heart rate and body temperature, and by collection of urine (electrolyte and hormone excretion). Only the rhythms of 6-hydroxymelatoninsulphate and potassium excretions showed significantly enhanced adjustment under the experimental condition. Different rhythms Actapted to the 12-h delay at different rates, comparable to those observed after time zone shifts. Sleep was shorter in simulated weightlessness than in normal ambulatory age-matched subjects, consistent with the shorter sleep durations characteristic of space flight. These results confirm the disruptive effects of wake-rest schedule shifts on sleep and circadian rhythms. Contrary to our initial hypothesis, 5-h exposures to bright light finishing at the time of the circadian temperature minimum were not more effective at accelerating adjustment to a 12-h schedule delay than exposures coinciding with the temperature maximum. We conclude that, while bright light may accelerate adjustment to work-rest schedule delays, any such effect seems to be largely independent from the timing of the light exposure.     

The NASA Performance Assessment Workstation: cognitive performance during head-down bed rest

The NASA Performance Assessment Workstation was used to assess cognitive performance changes in eight males subjected to seventeen days of 6 degrees head-down bed rest. PAWS uses six performance tasks to assess directed and divided attention, spatial, mathematical, and memory skills, and tracking ability. Subjective scales assess overall fatigue and mood state. Subjects completed training trials, practice trials, bed rest trials, and recovery trials. The last eight practice trials and all bed rest trials were performed with subjects lying face-down on a gurney. In general, there was no apparent cumulative effect of bed rest. Following a short period of performance stabilization, a slight but steady trend of performance improvement was observed across all trials. For most tasks, this trend of performance improvement was enhanced during recovery. No statistically significant differences in performance were observed when comparing bed rest with the control period. Additionally, fatigue scores showed little change across all periods.     

Changes in mood status and neurotic levels during a 20-day bed rest

This study evaluated changes of mood status and depressive and neurotic levels in nine young male subjects during a 20-day 6 degrees head-down tilting bed rest and examined whether exercise training modified these changes. Participants were asked to complete psychometrical inventories on before, during, and after the bed rest experiment. Depressive and neurotic levels were enhanced during bed rest period according to the Japanese version of Zung's Self-rating Depression Scale and the Japanese version of the General Health Questionnaire. Mood state "vigor" was impaired and "confusion" was increased during bed rest and recumbent control periods compared to pre-bed rest and ambulatory control periods according to the Japanese version of Profiles of Mood State, whereas the mood "tension-anxiety", "depression-dejection", "anger-hostility" and "fatigue" were relatively stable during experiment. Isometric exercise training did not modify these results. Microgravity, along with confinement to bed and isolation from familiar environments, induced impairment of mental status.     

The implementation of game in a 20-day head-down tilting bed rest experiment upon mood status and neurotic levels of rest subjects

This study evaluated the effect of the implementation of game on mental health among participants in a bedrest (BR) experiment. Subjects were 12 healthy males aged 20-26, who participated in a 20-day 6-degrees head-down tilting BR experiment. The participants were asked to complete psychometrical questionnaires before, during, and after the experiment. We entrusted the participants to manage their leisure time and they intended a game in which all of them could take part over the experiment period. The general conversation and light-hearted mood among the subjects continued during the experimental period. Longitudinal data analysis showed that levels of neurosis and mood status did not deteriorate during the experiment, while our previous experiments, which were performed under the same protocol as this study except for the implementation of the game showed a distinct deterioration in psychosocial status. We consider that the implementation of game autonomously contributes to the positive effects on the mental health among the participants.     

U.S. manned space flight: the first twenty years, a biomedical status report.

In the last 20 years, the biomedical problems facing man in space have been brought into sharper focus. Space motion sickness is presently our most serious problem. Its etiology remains obscure, but the "sensory conflict" theory appears most plausible. No valid predictive tests of susceptibility exist and presently we must rely on medication for prevention or mitigation of symptoms. Adaptation/biofeedback techniques may prove useful. Cardiovascular "deconditioning" may be effectively attenuated by use of anti-g suits or plasma expanding techniques. Recent bedrest simulation studies would seem to indicate that concerns about chronically elevated central venous pressure during space flight are unfounded. The loss of red cell mass in space flight appears to be self-limited, independent of mission duration, and not of clinical concern, based on recent Soviet experiences. And finally, clodronate, a new diphosphonate effective in preventing hypercalciuria and negative calcium balance in normal human bedrested subjects, may prove effective in preventing or lessening skeletal mineral loss in space.     

Isolation,confinement, and sensory deprivation

Long-duration space flight involves sensory monotony, isolation, and confinement. Obviously, data from other such environments are relevant to our concerns; and the application of the concept of arousal both to interpersonal relations and to task performance in space can point to appropriate selection, training, and spacecraft design features. In the context of space flight, all of these leads remain conjectural--simulation as well as laboratory research and initiation of long-duration flights will be the crucial test of the hypotheses.