P atients on earth with illness can be described as people who live in a normal earth environment but who have abnormal physiology. In contrast, astronauts are people with normal physiology who live in an abnormal environment. It is this abnormal environment in space that, for the most part, causes unique alterations in astronauts' physiology that require the attention of clinicians and scientists. In this review, we build on the first article 1 in this series and provide an overview of the many complex physiologic changes that take place in short-and long-duration space flight, most often in response to microgravity.The goal of sending people farther into space and extending the duration of missions from months to years will challenge the current capabilities of space medicine. The knowledge and experience in bioastronautics, associated with almost 50 years of human space flight, will be critical in developing countermeasures and clinical interventions to enable people to participate in these missions and return safely to earth.
EvidenceTo complement our first-hand experiences from space (collectively over 2000 hours), we reviewed technical and special publications from the National Aeronautics and Space Administration (NASA) and peer-reviewed medical literature. Most of the literature in this field is made up of case series and descriptive studies. In this article, unreferenced statements reflect our opinions as physician-astronauts who have observed first-hand the physiologic acclimation to microgravity. Our clinical experiences as crew medical officers have also been incorporated where applicable.
AcclimationAcute changes in normal physiology in response to abnormal environments are labelled acclimation for short-term exposure (hours to days) or acclimatization for longer-term exposure (days to months). In this review, we use the term acclimation to describe the physiologic and psychological responses to the space-flight environment. Table 1 provides a timeline of these responses from launch to the period after landing.Microgravity has the largest effect of the space-flight environment on human physiology; all organ systems are affected to some degree. Isolation and confinement can also have important effects on the psychological well-being of astronauts. Table 2 outlines the key effects of the space-flight environment on humans and the countermeasures that are taken to address them.
Shift in body fluidsAcclimation of the cardiovascular system to weightlessness is complex and not completely understood. Control mechanisms involving the autonomic nervous system, cardiac functions and peripheral vasculature all play a role. 20,21 However, the primary cause of these acclimations can be attributed to a redistribution of body fluids toward the head. 22 The supine prelaunch position with the lower limbs raised above the thoracoabdominal coronal plane initiates a fluid shift, which continues during orbit, with blood and other fluids moving from the lower limbs to the torso and head. During space flight, the volume i...