Risk of Impaired Performance Due to Reduced Muscle Mass, Strength &, Endurance (Short Title: Muscle) and Risk of Reduced Physical Performance Capabilities Due to Reduced Aerobic Capacity (Short Title: Aerobic)

This report reviews the scientific literature regarding the human system risks to the microgravity environment of space flight in relation to human performance. The primary human performance-related risks involve deconditioning of the cardiovascular and skeletal muscles systems due to prolonged exposure to the reduced gravitational input. The chronological history of U.S. space flight is reviewed as a starting point to inform and understand the gaps in the knowledge to these risks.

Maintenance of physical performance capabilities involves understanding the health of many organ systems (peripheral [vascular, heart, blood volume, skeletal muscle] and central [brain]) that ultimately contribute to the submaximal and maximal capacity of the aerobic (VO2peak), skeletal muscle (strength and endurance) systems. Maintaining astronaut VO2peak, muscle mass, strength, and endurance before, during, and after space flight is a significant priority to NASA for the current International Space Station (ISS) era, as well as for future exploration missions. A growing research database from both space flight and ground-based analog studies finds that the cardiorespiratory system is compromised and skeletal muscles (predominantly postural muscles of the lower limbs) undergo atrophy. These structural and metabolic responses to living in microgravity conditions contribute to physiological deconditioning during space flight that potentially increase the risks to astronauts returning to surface operations (i.e., Moon, Mars, or Earth). The time course changes from short to long-duration space flight and the relationships between in-flight performance deconditioning levels are not well characterized. Moreover, there are large interindividual variabilities that may be dependent on genetics, age, sex, preflight fitness levels, and individual exercise prescriptions that need further careful evaluations. Efforts should be made to understand the current status of preflight, in-flight, and postflight exercise performance capability and to define the operational goals and target areas for protection with the in-flight exercise program.

There is a bi-directional relationship between exercise prescription and hardware countermeasures that need further understanding in-flight. For example, hardware with limited capabilities/modalities may be counterbalanced by changes in exercise prescription (i.e., frequency, time, intensity, volume) for providing effective responses to maintain fitness. Importantly, the minimal requirements for exercise prescription on ISS hardware may not translate to lower capability hardware on exploration missions. Due to limited volume on exploration vehicles, future Artemis missions to the Lunar surface will not have similar exercise hardware capabilities as ISS. This may alter the effectiveness of hardware to provide adequate physiological stress on bodily systems allowing for adaptations to maintain aerobic capacity, strength, and bone density. Thus, it will be important to understand the exercise responses of current ISS countermeasures to develop individualized exercise prescriptions that minimize aerobic and muscular risks, accounting for the large variability of responses among crewmembers. Newer exploration exercise hardware is currently being evaluated that is more compact (i.e., E4D and Orion Flywheel) and will require careful evaluation of the hardware on the stressor (i.e., metabolic rate, oxygen uptake, and heart rate work relationships, and force plate load profiles) needed the human body to protect and maintain crew health and performance. Moreover, exercise responses on the hardware need careful evaluation on the chronic adaptations. Lastly, in-flight evaluation of hardware exercise response may differ in 0-g or partial-g compared to 1-g. Therefore, it cannot be assumed that the stress on the body will be the same in each environment. Understanding this has a direct impact on exercise prescriptions.

This document provides an overview of key scientific investigations that have been conducted before, during, and after human space flight missions, as well as from human ground-based analog studies that contribute to the evidence base on changes in aerobic capacity and muscle mass, strength, and endurance. Additional data from rodent and nonhuman primate experiments of skeletal muscle unloading completed during space flight or ground-based flight-simulations provide supportive information about this risk topic. Most importantly, a recent, large dataset from long-duration ISS crew has been added to give improved insight into the variability of exercise response of crew, demonstrating that a large portion of the crew population return to Earth with greater than 10-20% loss of aerobic capacity and muscle strength and endurance. Data from human space flight and ground-based studies are narrowing in on the required exercise paradigms but thus far still provide an incomplete answer to an effective approach for maintaining skeletal muscle function and aerobic fitness of all human space travelers. Finally, the relationship of this risk topic to various space flight operational scenarios is examined and discussed.