Ever considered being an Astronaut

Physiotherapist?

Do you want to be an Astronaut Physiotherapist?

Maybe this isn’t a question you hear very often? However,

astronauts encounter a range of medical challenges associated with
entering periods of reduced gravity. These include muscle
weakening, cardiovascular deconditioning and
neuromusculoskeletal activation pattern changes. They require in-
flight preventative measures, post flight rehabilitation to minimise
symptomatic episodes and long term monitoring to check they are in
good health. With the three core physiotherapy disciplines being
musculoskeletal, neurology and cardiovascular respiratory
rehabilitation there is large potential for physiotherapists to draw
on the full range of their training to help combat the medical
problems of human spaceflight.
To find out more about this fascinating medical specialty, you are
invited to attend the first UK Space Environments Conference
hosted by the UK Space Biomedical Agency at the Satrosphere
Centre in Aberdeen on June 16th and 17th 2012.

The program includes key note lectures from NASA head of human
space flight, Dr Jeff Davis and ESA British astronaut Tim Peake
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Consumer News
Anti-Gravity Treadmills Offer Effective Physical Therapy: NASA
Inspiration Also New Training Tool For Pro-Athletes
Oct 15, 2013 03:14 PM By Susan Scutti

Anti-gravity treadmills are the latest tool in

physical therapy and have been found effective in rehabilitating patients post-surgery. AlterG, screen
capture

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The goal of rehabilitation therapy, according to the NYU Langone Medical Center, is to restore
function of the involved joint or muscle so that patients can perform functional activities in
accordance with their individual goals. New research in the field of rehabilitation has recently
begun to explore the anti-gravity treadmill as a new tool for achieving positive patient outcomes.
So far, all signs point forward.

What Is An Anti-Gravity Treadmill?

AlterG bills itself as “the next stride in physical therapy and athletic training,” yet the anti-
gravity treadmill is not a new idea by any means. Originally conceived over 20 years ago, Dr.
Robert Whalen and Dr. Alan Hargens developed the idea while designing an effective exercise
program for use on the space station by NASA’s astronauts. NASA had found by studying
astronauts returning from space that bone loss and muscle deterioration were a consequence of
lack of gravity. To mimic the feeling of gravity, Whalen and Hargens used Differential Air
Pressure (DAP) technology to create a machine that sucked air out of a chamber in which the
runner exercises.

The AlterG treadmill essentially does the reverse and pumps air into a chamber to counteract
gravity. In this way, DAP technology “unweights” a user and so reduces the impact of walking
or running on both muscles and joints. In practical terms, while on the AlterG, a patient weighs
less so that stress and impact are significantly reduced during exercise. In turn, this experience of
carrying less load enables patients to maintain their natural gait while rehabilitating and may
even speed the process of therapy.

In Guidelines for Using the AlterG: Patients with Orthopedic Problems, the chief medical officer
and clinical specialist of AlterG, Inc. explain how “unweighting an individual to the appropriate
loads” may:

 decrease pain and minimize swelling in the early stages of recovery

 increase hip, knee, and ankle mobility by encouraging assistive range of motion
 progressively load the lower extremities to assist with strength, endurance, and neuromuscular
re-education
 increase cardiovascular and muscular endurance in the later recovery stages of recovery
 initiate weightbearing activities earlier

Using AlterG, a physical therapist sets the parameters for "unweighting," treadmill speed,
treadmill incline, and duration/frequency of treatment, based on the patient’s ability to bear
weight. Progressively, these parameters are adjusted so that a patient gradually improves over
time.

Does It Work?
In one study published earlier this year, researchers examined anti-gravity or “lower body
positive pressure” (LBPP) treadmills to understand if they have the potential to enhance
recovery following lower limb surgery. Through an extensive experiment that involved
implanting custom electronic tibial prostheses to measure forces in the knee in subjects, the
researchers monitored tibiofemoral forces while subjects exercised on a treadmill at certain
speeds, inclines, and pressure settings (that reduced body weight up to 25 percent).

What did the team decide? After making a series of adjustments in speed, incline, and pressure
setting for each of the subjects, the researchers determined that the anti-gravity treadmill “allows
for more precisely achieving the target knee forces desired during early rehabilitation.” The anti-
gravity treadmill, then, “might be an effective tool in the rehabilitation of patients following
lower-extremity surgery,” the authors wrote in their study.
Sports therapists as well as sports trainers have already incorporated anti-gravity into their
sessions. There’s an Instagram photo of Kobe Bryant running on an AlterG and tweets of Eddy
Lacy (Green Bay Packers) and Barrett Jones (St. Louis Rams) following suit. Since American
professional athletes probably have the most expensive, if not the best, sports programs in the
world, you can bet that anti-gravity treadmills must be living up to their claims of offering
'remarkable' recovery times.

Reason alone suggests the anti-gravity treadmill, with its ability to progressively re-introduce
weight as an injured patient exercises, is an excellent tool for rehabilitation. Although very few
studies have been conducted so far, only positive comments have been made and meanwhile
therapists and researchers continue to study the impact on real patients. If nothing else, anti-
gravity treadmills sound like the next wave in gym exercising.

Running with a lot less impact on my knees? Sign me up!

Source: Patil S, Steklov N, Bugbee WD, et al. Anti-gravity treadmills are effective in reducing
knee forces. Journal of Orthopedic Research. 2013.

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Importance of Physiotherapy in Space
April 29, 2016

To stay healthy in space, astronauts are scheduled to exercise for

two and a half hours per day for six days per week. Most,
however, exercise seven days per week. They perform both
cardio and resistance exercises to keep their muscles and bones
strong.
“The theory was that a more stringent regimen of resistance
training and interval aerobic exercise would help the astronauts
stay fit while on the space station
Exercise is the number one health priority in space and it is so
important for astronauts to exercise while they’re in space. Bone
and muscle will decrease in size and strength, and can reduce an
astronaut’s ability to do work because it makes them weak, and
the weakened muscles and bones would make walking difficult.
Exercises on Space Station 2002. Credit: NASA

Bone plays an important role as a structure that supports the

body and stores calcium. It retains fracture resistance by
remodeling through a balance of bone resorption and formation.
In a microgravity environment, because of reduced loading
stimuli, there is increased bone resorption and no change in or
possibly decreased bone formation, leading to bone mass loss at
a rate of about ten times that of osteoporosis. The calcium
balance (the difference between intake and excretion), which is
about zero on Earth, decreases to about -250 mg/day during
flight, a value that increases the risk of kidney stones.
Bisphosphonate is a therapeutic agent that has been used to treat
osteoporosis patients for more than a decade, with a proven
efficacy to increase bone mass and decrease the occurrence of
bone fracture. Meals should be nutritionally balanced with
calcium-rich foods (milk, small fish, etc.) and vitamin D (fish,
mushrooms, etc.). Limited sunbathing is also important for
activation of vitamin D. Physical exercise to increase bone load
and muscle training should also be integrated into each person’s
daily life.

Astronaut works out on the ergometer on the Space Shuttle

Atlantis in 2001.
Credit: NASA

In microgravity, body fluids are moved around. Fluids such as

plasma are lost throughout the body. Plasma is where red blood
cells live. Less plasma means there is less blood to carry oxygen
to the rest of the body. Exercise, however, has been shown to
increase the amount of plasma in the body. Astronauts who
exercise make more red blood cells.
Microgravity also brings about another change in something
called “orthostatic intolerance. It does so by increasing its heart
rate and blood pressure to keep more blood returning to your
heart. If you can’t do that, you’ll pass out. With no gravity and
less blood volume, astronauts are more prone to fainting. Again,
exercise can help increase blood volume and circulation. That
helps prevent fainting.

Main Exercises in Space:

In space, astronauts use some of these exercise equipment. Each

piece does something different. The exercise equipment is put
on raised platforms to reduce the noise the machines make.
1. Cycle Ergometer: This is like a bicycle, and the main activity is
pedaling. It is used to measure fitness in space because it’s easy to
check heart rate and how much work is being done.

2. Treadmill: Walking or jogging on the treadmill is like walking on

Earth. Walking is the single most important way to keep bones
and muscles healthy. Because the lack of gravity tends to make
people float, harnesses are attached to the astronauts to hold
them to the walking surface.

3. Resistance Exercise Device (RED): The RED looks like weight-

lifting machines you may see on television. To use it, astronauts
 pull and twist stretchy rubber-band-like cords attached to pulleys.
The RED can be used for a total body workout. From squats and
bending exercises for the legs, to arm exercises and heel raises,
astronauts can do them all on the RED.

An Astronaut uses the RED equipment on the Space

Station in 2003.
Credit: NASA

4. ARED (Advanced Resistive Exercise Device): was

designed for weightlifting in a weightless
environment; it consists of two evacuated, pistol-driven canisters
with a flywheel mechanism. Astronauts can configure
the machine to perform exercises like dead lifts, squats,
biceps curls, and calf raises.
Anti-gravity Treadmill:

Sunitha Williams Performing in an Anti gravity Treadmill

Whalen designed a treadmill that would let astronauts run in a

more natural way. The design,patented in 1992, encloses a
treadmill and the astronaut’s lower body in an airtight chamber.
Lowering the air pressure inside the chamber pushes the
astronaut down, simulating gravity. Whereas the ISS’s old
treadmill allowed Williams to run on about 60 percent of her
Earth weight, Whalen’s treadmill would have allowed her to
exercise at her normal Earth weight. That’s important for
keeping the muscles and bones healthy for when astronauts get
home.

Instead of adding weight to astronauts in space, they used the

technology to take the weight off of rehab patients recovering
from leg and foot injuries.
The machine uses “unweighting technology” to make you feel
up to 80 percent lighter—so if you weigh 100 pounds, you could
feel as light as 20 pounds on the treadmill.
CEVIS (Cycle Ergometer with Vibration Isolations and
Stabilization System) is the closest thing you’ll get to a
stationary bike in space. CEVIS doesn’t have a seat because
astronauts can’t sit in zero gravity. (The bike in the image below
has a seat for training on Earth.) Instead, astronauts snap their
shoes to the pedals and tether themselves to the bike with a
seatbelt in order to cycle upright and obtain the aerobic and
cardiovascular benefits. They can adjust the workload and
change speeds to hit their target heart rates.
CEVIS

The role of physiotherapy in the European Space

Agency strategy for preparation and
reconditioning of astronauts
Posted on February 15, 2017 by Scott Buxton

Spaceflight and exposure to microgravity have wide-ranging

effects on many systems of the human body. At the European
Space Agency (ESA), a physiotherapist plays a key role in the
multidisciplinary ESA team responsible for astronaut health,
with a focus on the neuro-musculoskeletal system. In
conjunction with a sports scientist, the physiotherapist prepares
the astronaut for spaceflight, monitors their exercise
performance whilst on the International Space Station (ISS), and
reconditions the astronaut when they return to Earth. This
clinical commentary outlines the physiotherapy programme,
which was developed over nine long-duration missions.
Principles of physiotherapy assessment, clinical reasoning,
treatment programme design (tailored to the individual) and
progression of the programme are outlined. Implications for
rehabilitation of terrestrial populations are discussed. Evaluation
of the reconditioning programme has begun and challenges
anticipated after longer missions, e.g. to Mars, are considered.
Lambrecht G, Petersen N, Weerts G, Pruett C, Evetts S, Stokes M, Hides
J. Musculoskelet Sci Pract. 2017 Jan;27 Suppl 1:S15-S22.

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