Astronauts do not experience dizziness or fainting during routine activity after landing

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Nearly 50 years after man’s first steps on the moon, researchers have discovered a way that may help astronauts spending prolonged time in space come back to Earth on more stable footing, according to new research in the American Heart Association’s journal Circulation.

“One of the biggest problems since the inception of the manned space program has been that astronauts have fainted when they came down to Earth.

The longer the time in a gravity-free environment space, the greater the risk appeared,” said Benjamin Levine, M.D., the study’s senior author who is a professor of Exercise Sciences at UT Southwestern Medical Center and director of the Institute for Exercise and Environmental Medicine at Texas Health Presbyterian Hospital in Dallas.

“This problem has bedeviled the space program for a long time, but this condition is something ordinary people often experience as well.”

Orthostatic hypotension is the technical term for a temporary drop in blood pressure when a person stands up after sitting or lying down because blood rushes to the feet, away from the brain.

Dizziness or fainting due to changes in blood flow can occur after lengthy bed rest, among people with certain health disorders or, in the case of astronauts, being in a low-gravity environment.

The study included 12 astronauts (eight men and four women age 43-56) who spent about six months in space.

All performed individualized endurance and resistance exercise training for up to two hours daily during space flight to prevent cardiovascular, bone and muscle deconditioning.

They also received a saline infusion upon landing.

The astronauts’ blood pressure was recorded with every heartbeat over each 24-hour period before, during and after their time in space.

The researchers found that there was minimal impact on their blood pressure during all phases of measurement and none of the astronauts in the study experienced dizziness or fainting during routine activities 24 hours after landing.

This is the first study to demonstrate that astronauts do not experience dizziness or fainting during routine activity after landing, as long as they participate in certain types of exercise training while in flight and receive IV fluids when they return to earth, said Levine

“What surprised me the most was how well the astronauts did after spending six months in space. I thought there would be frequent episodes of fainting when they returned to Earth, but they didn’t have any. It’s compelling evidence of the effectiveness of the countermeasures–the exercise regimen and fluid replenishment,” he said.

This shows a space suit

Next, the researchers would like to study larger numbers of astronauts and those who spend longer than six months in space. The image is in the public domain.

The researchers note that the sample size was small.

Also, they could not clearly distinguish whether specific in-flight blood pressure readings occurred while the astronauts were awake or asleep, so the data were combined and examined over 24-hour periods.

Since all the astronauts participated in the exercise regimen and received a saline fluid infusion upon landing, researchers do not know the blood pressure stabilization would have occurred without those measures.

Next, the researchers would like to study larger numbers of astronauts and those who spend longer than six months in space.

“Understanding the physiology of space flight can be helpful for understanding many conditions experienced by non-astronauts.

For example, the exercise program our lab developed for the space program is already helping people with a fainting condition known as postural orthostatic tachycardia syndrome (POTS),” Levine said. “

As we prepare to celebrate the 50th anniversary of the Apollo 11 moon landing, it’s exciting to think of how our exploration in and of space can lead to important medical advances here on Earth.”

Co-authors are Qi Fu, M.D., Ph.D.; Shigeki Shibata, M.D. Ph.D.; Jeffrey L. Hastings, M.D.; Steven H. Platts, Ph.D.; Douglas M. Hamilton, M.D.; Michael W. Bungo, Ph.D.; Michael B. Stenger, Ph.D.; Christine Ribeiro, J.D., M.S., and Beverly Adams-Huet, M.S.


Astronauts returning to Earth sometimes feel light-headed.

It’s been a problem since the earliest days of human space exploration, but now doctors may have a solution.

Researchers have learned that the sensation is caused, in part, by orthostatic hypotension — “in other words, a temporary drop in blood pressure,” explains NASA Chief Medical Officer Rich Williams.

On Earth you can feel it by standing or sitting up too fast.

Gravity has much the same effect on astronauts returning from a long spell in space: Blood rushes down and the space travelers become, literally, lightheaded.

Susceptibility is highly individual. Some astronauts are hardly affected while others feel very dizzy: About 20% of short-duration and 83% of long-duration space travelers experience the symptoms during re-entry or after they land. [source]

“Cosmonauts who spent a long time onboard Mir commonly had to be carried away in stretchers when they came home,” recalls Williams. Fortunately, their Soyuz return capsules did not require a pilot to land, so it didn’t matter much. Shuttle pilots, on the other hand, must perform complex re-entry procedures. To them it matters a great deal.

Orthostatic hypotension can strike Earth-dwellers for many reasons: Weak hearts might not pump enough blood, for example. Certain medications or even a hot shower can dilate blood vessels and cause blood pressure to drop. Women — especially pregnant women — are more likely to suffer from it than men. “Some patients with this condition are afraid to leave home or even get out of bed,” writes neurologist Phillip Low of the Mayo Clinic.

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Astronauts experience orthostatic hypotension because of the way human bodies respond to gravity, explains Richard Cohen of the Harvard-MIT Division of Health Sciences and Technology. (Cohen leads the Cardiovascular Alterations Team at the National Space Biomedical Research Institute, or “NSBRI.”) On Earth gravity pulls blood toward the lower body. But in space — either in free-fall or far from a source of gravity — blood that normally pools in the legs collects in the upper body instead. That’s why astronauts have puffy-looking faces and spindly “chicken legs.”

Above: Fluid shifts caused by space flight. From “The Bone”(Vol. 11 No.2 1997.6) Medical View Co., Ltd. [more]

Astronauts don’t feel orthostatic hypotension while they’re traveling through space, but they do begin to feel it during re-entry (when g-forces mimic gravity) and after landing. Blood returns to the lower body and blood pressure to the head is suddenly reduced. Hence the dizziness. (The sensation can continue for a while after landing, too.)

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It’s a classic case of “use it or lose it.” Veins in human legs contain tiny muscles that contract when the veins fill with blood. Their function is to send blood uphill toward the heart and so maintain blood pressure. But in space there is no “uphill,” so those tiny muscles in the veins are less-used — a normal adaptation to weightlessness.

During re-entry those muscles are needed again, but they have temporarily “forgotten” how to contract. They fail to push blood back toward the heart and brain. “This effect is more severe after prolonged space flights,” notes Cohen.

Right: Muscles in the veins of the legs help force back uphill toward the heart. From Grey’s Anatomy.

For many years astronauts have tried to counteract orthostatic hypotension by drinking lots of salt water, which increases the volume of bodily fluids.(There is a general loss of body fluids during space missions.) Astronauts also wear “G-suits” — rubberized full-body suits that can be inflated with air. This action squeezes the extremities and raises blood pressure.

Such countermeasures are only partially effective. “Almost all returning astronauts experience changes in gait and balance,” continues Williams. Nevertheless, “most are able to walk around just fine. A small number experience orthostatic changes that render them quite dizzy.”

An anti-dizzy pill would be helpful, but until recently there was no such thing.

Enter Midodrine: Midodrine is the first drug approved by the United States Food and Drug Administration to treat orthostatic hypotension. It constricts blood vessels and so increases blood pressure. “By increasing blood pressure when patients need it, Midodrine can help people lead a more normal life,” writes Low.

Cohen thinks it might help astronauts, too.

Below: ISS crewmembers will soon participate in tests of Midodrine. Pictured here is the crew of the ISS Expedition Four.

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Cohen works with Janice Meck, head of the Cardiovascular Lab at NASA’s Johnson Space Center, and Gordon Williams, a doctor at the Brigham and Womans’ hospital in Boston, to study adverse effects of space flight on the human cardiovascular system. Following animal studies and computer simulations (performed by members of the NSBRI Cardiovascular Alterations Team), they conducted bed-rest testing of real humans — a situation that simulates the effect of space travel on the cardiovascular system. Astronauts, they concluded, would likely benefit from the drug.

An important advantage to Midodrine, says Cohen, is that it can be administered just before re-entry or even after landing. The benefits are immediate. Astronauts wouldn’t have to take it throughout their mission when it might interfere with their body’s own (and welcome) adaptations to zero-g.

“A flight study protocol has recently been approved to test the drug’s effects on space shuttle astronauts and ISS crewmembers,” says Cohen.

Perhaps soon astronauts returning home from space will feel lightheaded — but only due to elation. Orthostatic hypotension will have nothing to do with it.


Source:
American Heart Association
Media Contacts: 
Karen Astle – American Heart Association
Image Source:
The image is in the public domain.

Original Research: Closed access
“Impact of Prolonged Spaceflight on Orthostatic Tolerance During Ambulation, and Blood Pressure Profiles in Astronauts”. Qi Fu, Shigeki Shibata, Jeffrey L. Hastings, Steven H. Platts, Douglas M. Hamilton, Michael W. Bungo, Michael B. Stenger, Christine Ribeiro, Beverley Adams-Huet and Benjamin D. Levine.
Circulation. doi:10.1161/CIRCULATIONAHA.119.041050

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