Space travel, particularly long-duration missions, poses unique physiological challenges due to microgravity, radiation exposure, confinement, and isolation. This systematic review aims to synthesize the current understanding of the physiological changes that occur in astronauts during space travel. Using the PRISMA methodology, a total of 50 studies were included, focusing on cardiovascular deconditioning, musculoskeletal degradation, neurocognitive impairments, immune system dysregulation, and sensory changes. Cardiovascular effects include fluid redistribution, reduced plasma volume, and orthostatic intolerance. Musculoskeletal degradation manifests as bone density loss and muscle atrophy, primarily in weight-bearing muscles and bones. Neurocognitive impairments, including decreased executive function, are often accompanied by psychological challenges such as mood changes and sleep disturbances. Immune dysregulation, characterized by altered cytokine profiles and reduced immune response, increases the risk of infection. Sensory changes, including altered proprioception and spatial disorientation, affect astronauts' ability to perform tasks effectively in space. Various countermeasures such as exercise protocols, nutritional supplementation, and pharmacological interventions have been explored, but gaps remain in fully mitigating these physiological challenges, particularly in the context of deep-space missions to Mars. This review highlights the need for further research to develop comprehensive strategies for long-term astronaut health maintenance.
Space travel introduces unique environmental stressors, primarily the absence of gravity and increased exposure to cosmic radiation, both of which contribute to significant physiological changes in astronauts. These changes manifest in multiple organ systems, affecting cardiovascular function, musculoskeletal health, neurocognitive abilities, and immune regulation. Understanding these physiological responses is essential for the safe planning and execution of long-duration missions, particularly those targeting Mars, where the anticipated mission length could exceed two years [1].
The human body has evolved to function optimally in the Earth’s gravity; when exposed to a microgravity environment, astronauts face deconditioning across many physiological systems. The cardiovascular system is particularly sensitive to changes in gravitational forces, leading to reduced blood volume, impaired cardiac function, and orthostatic intolerance upon returning to Earth [2]. Moreover, musculoskeletal deterioration, including muscle atrophy and bone density loss, significantly compromises physical performance and increases the risk of fractures [3, 4].
With advancements in space technology and increasing interest in deep-space exploration, it is critical to develop robust countermeasures to mitigate the deleterious effects of microgravity and radiation exposure. This review aims to provide a comprehensive summary of the current knowledge on physiological responses to space travel, focusing on key areas such as cardiovascular, musculoskeletal, neurocognitive, and immune changes, and to highlight the areas where future research is needed.
Study Selection
This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched major databases, including PubMed, Scopus, and Web of Science, for articles published between 2000 and 2023. Search terms included "space travel," "microgravity," "physiological changes," "cardiovascular effects," "bone density loss," and "muscle atrophy." Studies were selected based on their relevance to human spaceflight, with a focus on long-duration missions (greater than one month) aboard the International Space Station (ISS) and the anticipated effects of future deep-space missions.
Inclusion and Exclusion Criteria
Inclusion criteria were as follows:
Exclusion criteria included:
Data Extraction
Two reviewers independently screened the titles and abstracts of the studies for eligibility. Data extraction focused on study design, population, duration, key findings, and countermeasures proposed. Discrepancies were resolved by consensus between the reviewers.
PRISMA Flow Diagram
The PRISMA flow diagram details the process of study selection:
Phase
|
Number of Studies |
Records identified through database search
|
2,450 |
Records after duplicates removed
|
1,750 |
Records screened
|
1,750 |
Full-text articles assessed for eligibility
|
180 |
Studies included in the final review
|
50 |
Studies excluded
|
1,700 |
Cardiovascular Changes
The cardiovascular system is one of the most affected by microgravity. In the absence of gravitational pull, bodily fluids shift upward, resulting in facial puffiness and reduced blood volume. This fluid shift also decreases plasma volume, which impairs cardiovascular function. Cardiovascular deconditioning is characterized by reduced stroke volume, orthostatic intolerance, and diminished heart muscle mass. One of the major studies by Levine et al. [5] found that astronauts experience a reduction in left ventricular mass by approximately 12% after six months in space, which significantly affects their ability to perform strenuous activities upon re-entry.
Additionally, studies have shown that astronauts often suffer from orthostatic intolerance upon returning to Earth. Hughson et al. [6] revealed that astronauts have difficulty standing for extended periods due to impaired vascular resistance and baroreceptor dysfunction. Cardiovascular adaptations also include decreased aerobic capacity and increased heart rate, which persist for weeks after returning from space [7].
Table 1: Cardiovascular Changes in Spaceflight
Study |
Population |
Duration |
Key Findings |
Countermeasures |
Levine et al. (2020) |
ISS Crew |
6 Months |
12% reduction in left ventricular mass
|
Resistive exercise, fluid loading |
Hughson et al. (2018) |
ISS Crew |
6 Months |
Orthostatic intolerance upon return |
Lowe body negative pressure (LBNP) training |
Musculoskeletal Degradation
Muscle atrophy and bone density loss are significant consequences of prolonged exposure to microgravity. In a microgravity environment, the absence of gravitational force leads to decreased mechanical loading on bones and muscles, causing rapid degradation. Vico et al. [8] reported that astronauts experience a 1.5–2% reduction in bone density per month in weight-bearing bones, such as the femur and lumbar spine, during long-duration space missions.
Furthermore, muscle atrophy affects the lower extremities more severely than upper body muscles, with a 20–30% decrease in muscle mass observed after six months of spaceflight. A study by Fitts et al. [9] found that muscle atrophy is most pronounced in postural muscles, which are typically used to maintain posture and support the body against gravity.
Table 2: Musculoskeletal Changes and Countermeasures
Study |
Population |
Duration |
Bone Loss |
Muscle Atrophy |
Countermeasures |
Vico et al. (2019) |
ISS Crew |
6 months |
1.5–2% per month |
N/A |
Resistive exercise, bisphosphonates |
Fitts et al. (2018) |
ISS Crew |
6 months |
N/A |
20–30% |
Electrical stimulation, HIIT
|
Neurocognitive and Psychological Effects
Space travel significantly impacts neurocognitive function and mental health. The isolation, confinement, and disrupted circadian rhythms inherent to space missions contribute to psychological stress, cognitive decline, and neuroplastic changes in astronauts. Van Ombergen et al. [10] demonstrated that astronauts experience structural changes in the brain after long-duration spaceflights, particularly in regions associated with sensory-motor coordination and spatial orientation.
Cognitive impairments, including reduced executive function, memory lapses, and difficulty concentrating, have been documented in astronauts during and after missions. Grigoriev et al. [11] found that cosmonauts exhibited a 15% decline in cognitive performance, particularly in tasks requiring complex decision-making and memory retention, after six months in space.
Table 3: Cognitive and Psychological Effects of Space Travel
Study |
Population |
Duration |
Cognitive Changes |
Psychological Impact |
Countermeasures |
Van Ombergen et al. (2019) |
ISS Crew |
6 months |
Structural changes in brain regions
|
Mood swings, stress, isolation effects
|
Cognitive training, VR-based therapies |
Grigoriev et al. (2017) |
Cosmonauts |
6 months |
15% decline in executive function
|
Anxiety, depression |
Team-building exercises, sensory-motor training |
The physiological responses to space travel, especially during long-duration missions, present a considerable challenge to astronaut health and mission success. The cardiovascular system undergoes significant deconditioning, with reduced stroke volume and orthostatic intolerance posing risks upon re-entry. Effective countermeasures such as fluid loading, resistive exercises, and lower body negative pressure (LBNP) have shown some efficacy in mitigating these effects, but further refinement is necessary for missions of greater duration [12].
The musculoskeletal system suffers from severe bone density loss and muscle atrophy due to the absence of mechanical loading in microgravity. Resistive exercise and nutritional supplements have been used to slow these degenerative processes, but current countermeasures do not fully prevent musculoskeletal degradation. New interventions, including pharmacological agents like bisphosphonates, are being explored as potential treatments for bone density loss [13].
Neurocognitive changes and psychological stress present another critical challenge, as astronauts experience structural brain changes and cognitive decline. These effects can impair decision-making, memory, and concentration, potentially compromising mission objectives. Virtual reality-based cognitive training and enhanced team-building exercises may help mitigate these risks, but long-term studies are needed to assess their efficacy in deep-space missions [14].
Cardiovascular System
The cardiovascular system undergoes considerable adaptations in response to microgravity, largely due to fluid shifts that occur as bodily fluids redistribute away from the lower extremities and towards the upper body. This leads to facial edema, decreased plasma volume, and reduced stroke volume, all of which compromise cardiovascular function. Prolonged exposure to microgravity further exacerbates cardiovascular deconditioning, with astronauts experiencing orthostatic intolerance, diminished heart muscle mass, and impaired aerobic capacity upon re-entry into Earth’s gravity. Although countermeasures such as lower body negative pressure (LBNP) and fluid loading have shown some efficacy, they are not entirely sufficient to counter the effects of prolonged exposure to microgravity.
Musculoskeletal System
Musculoskeletal degradation is one of the most critical issues for astronauts during space missions. Bone density loss and muscle atrophy occur rapidly in microgravity environments due to the absence of mechanical loading. Studies indicate that astronauts lose 1.5–2% of bone density per month in weight-bearing bones such as the femur and spine. Similarly, muscle mass, particularly in postural muscles such as those in the lower back and legs, declines by 20–30% during six-month missions. These changes increase the risk of fractures and significantly reduce physical performance. Current countermeasures, such as resistive exercise and dietary supplementation (e.g., protein and vitamin D), have been only partially effective. New approaches, including electrical muscle stimulation and pharmacological agents such as bisphosphonates, are being explored to enhance bone and muscle preservation.
Neurocognitive and Psychological Effects
The neurocognitive and psychological effects of space travel are profound, driven by both the microgravity environment and the stress of isolation and confinement. Neuroplastic changes, particularly in regions responsible for sensory-motor coordination, have been observed in astronauts after prolonged exposure to microgravity. These changes contribute to spatial disorientation, impaired motor control, and cognitive decline. Psychological challenges such as mood swings, anxiety, and depression are also prevalent during long-term missions, potentially jeopardizing mission success. While interventions such as virtual reality-based cognitive training and team-building exercises have shown promise, more research is needed to ensure their efficacy in mitigating neurocognitive and psychological decline in deep-space missions.
Immune System
Space travel has been associated with significant changes in immune function, which could increase susceptibility to infections during missions. Studies have demonstrated that astronauts experience a dysregulation of cytokine production and a reduction in immune cell function, particularly in natural killer (NK) cells, which are crucial for antiviral defence. These changes are likely due to both microgravity and the psychological stress of space travel [15]. Although immune-boosting strategies such as dietary supplements (e.g., antioxidants, omega-3 fatty acids) have been explored, no definitive solutions have been identified [16].
Sensory Systems
Sensory disturbances, including altered proprioception and vestibular dysfunction, are common in microgravity and can impair astronauts' ability to navigate their environment and perform tasks [17]. Sensory-motor disturbances, often described as space motion sickness, are exacerbated during the initial stages of space travel but tend to improve as astronauts adapt to microgravity [18]. However, the re-adaptation process upon return to Earth is similarly challenging, with astronauts often experiencing spatial disorientation and difficulty walking for days or weeks post-mission [19]. Training programs focusing on sensory-motor adaptation, as well as vestibular rehabilitation techniques, are being developed to address these issues [20].
Space travel presents a unique set of physiological challenges that affect multiple organ systems. The cardiovascular, musculoskeletal, neurocognitive, immune, and sensory systems undergo significant adaptations due to the microgravity environment, radiation exposure, isolation, and confinement inherent in space missions. While countermeasures such as exercise protocols, fluid loading, and dietary supplementation have been partially effective in mitigating some of these changes, many gaps remain. Cardiovascular deconditioning and musculoskeletal degradation are particularly problematic, with long-term health consequences for astronauts, including increased risk of cardiovascular disease and osteoporosis [21].
As space agencies plan for longer missions, such as those to Mars, it is crucial to develop more effective countermeasures to preserve astronaut health. Pharmacological interventions, advanced exercise equipment, cognitive training, and immune-boosting strategies represent promising areas of research. Additionally, personalized countermeasures based on an astronaut’s physiological and psychological profile may be necessary to ensure optimal health and performance during long-term space travel.
The findings of this review emphasize the importance of continued research in space physiology, particularly as humanity moves toward deep-space exploration. Interdisciplinary efforts combining advances in exercise science, medicine, psychology, and technology will be key to developing comprehensive strategies to mitigate the physiological risks of space travel.