NOTE: End date changed to 06/30/2024 per S. Mack/JSC (Ed., 7/11/23)

NOTE: End date changed to 06/30/2023 per NSSC information (Ed., 3/3/23)

NOTE: End date changed to 01/31/2023 per NSSC information (Ed., 3/10/21)

SA1. Determine the effects of an in-flight validated exercise regimen (‘SPRINT’) on behavioral health, fatigue, cognitive, sensorimotor, and immune system function in an ICC spaceflight analog;

SA2. Determine the impact of guided imagery on exercise adherence and positive affective responses to exercise in the ICC spaceflight analog. We will also explore the effects of adding guided imagery to the exercise regimen on behavioral health, fatigue, cognitive, sensorimotor, and immune system function;

SA3. Determine if exercise training, with or without guided imagery, has a positive impact on biomarkers of stress and central nervous system function in the ICC spaceflight analog and can increase resilience during an acute stress model of sleep deprivation relative to the control group.

We will use the Human Exploration Research Analog (HERA) and recruit crewmembers over 12 separate 45-day HERA missions. We anticipate enrolling participants from 3 campaigns (4 crewmembers per mission) over a 3-year period (n= 48). Four HERA missions (n=16) will receive the in-flight validated Integrated Aerobic and Resistance Exercise Training Prescription (‘SPRINT’) protocol only; Four HERA missions (n=16) will receive the same training regimen but with GI to augment the exercise response; And four HERA missions (n=16) will serve as the control group, receiving access to the exercise equipment but no GI or ‘SPRINT’ protocol. Measures of behavioral health, cognitive, sensorimotor, and immune (NK-cell cytotoxicity) function will be measured before, during, and after the mission, and the mediating/correlating effects of stress and central nervous system function will be determined by measuring biomarkers (cortisol, dehydroepiandrosterone (DHEA), Macrophage Inflammatory Protein (MIP), brain-derived neurotrophic factor (BDNF)) longitudinally in saliva. On completion of this project we expect to: (1) determine if the ‘SPRINT’ protocol is sufficient to maintain behavioral health of individuals during a spaceflight stress analog; and (2) ascertain whether or not the addition of a GI can augment the exercise training effects on ameliorating stress (including acute stress derived from sleep deprivation) and central nervous system dysfunction to maintain behavioral health, cognitive, sensorimotor, and immune system function in a high fidelity, isolated, confined, and controlled spaceflight simulation analog.

The "Promoting Health Through Exercise and Imagery" (PHETI) study was initiated in 2019 but experienced significant delays due to the COVID-19 pandemic.

Whilst waiting on the NASA Human Exploration Research Analog (HERA) Campaign 6 to begin, the study team focused on identifying psychological 'targets' that could be manipulated through guided imagery to improve exercise adherence. This involved an extensive review of the literature which resulted in a completed MS thesis by student Jamie Lee-Elliot (advisors: Judith Gordon and Richard Simpson). This thesis is currently being re-formatted for publication in a scientific journal. A poster presentation was delivered at the NASA Human Research Program Investigators' Workshop (IWS) in Galveston, TX in February 2023 and in February 2024.

HERA Campaign 6 Mission 1 began October 1, 2021. As of April 12, 2024, we have received full sample details from 16 participants across the 4 missions in Campaign 6. Mission 1 of Campaign 7 has been completed and we are awaiting sample delivery from NASA Johnson Space Center (NASA-JSC). The following analytical procedures have been completed for all 16 participants of Campaign 6:

1. Complete blood counts and immunophenotyping 2. NK-cell cytotoxicity assays in vitro 3. Aerobic fitness and isometric strength testing pre and post mission 4. Exercise adherence and exercise volume analysis during the mission 5. Serum biomarkers for stress and cognitive function, including cortisol, epinephrine, norepinephrine, DHEA-s and BDNF.

Below is an abstract summary of our findings and conclusions to date. This will form the basis of an MS thesis defense for Ms. Elizabeth Beattie (scheduled for May 3, 2024).

Abstract of Interim Campaign 6 data

NASA considers spaceflight as an isolated, confined, and extreme environment (ICE), which consequently embodies multiple hazards that may impair both the physical and psychological well-being of the astronauts, implying that robust countermeasures to minimize health risks to the crew are vital. Immunity may be dysregulated due to various ICE factors, particularly chronic stress. This is a critical concern as it amplifies health risks, such as viral reactivation and impaired anti-tumor immune surveillance, especially in combination with other ICE aspects. An abundance of literature has shown that exercise has a mitigating effect on chronic stress and can also preserve and improve the normal functioning of the immune system, but it is not known if exercise performed in an ICE analog can impact potential changes in biomarkers of stress and immune function. The aim of this study was to determine the effects of a 45-day terrestrial Human Exploration Research Analog (HERA) mission on immune cell phenotypes and function (NK-cell cytotoxicity), and blood biomarkers of stress (cortisol, epinephrine, norepinephrine, DHEA-S) and cognitive function (BDNF). We also sought to determine voluntary exercise patterns among the crew and their associations with stress and immune biomarkers. Surprisingly, we found that biomarkers of stress and cognitive function did not change significantly in response to the HERA mission. There was, however, a decrease in NK-cell cytotoxicity during the late stage of the mission, which has also been documented previously in astronauts aboard the International Space Station. The crew were found to perform aerobic exercise at a consistent volume (intensity x duration) throughout the mission, which resulted in discernible improvements in cardiorespiratory fitness (VO2max) and isometric strength of the thigh muscles. No correlations were found between the change in aerobic fitness or the cumulative exercise volume and the observed decline in NK-cell cytotoxicity. We conclude that a 45-day HERA mission may not accurately capture the stressful environment experienced by astronauts during spaceflight but can cause transient immune dysregulation. Additional data acquired over future HERA missions are required to fully understand the impact that prescribed exercise training may have on immune function during ICE.

Development of the Guided Imagery Component

An Institutional Review Board (IRB) amendment was submitted and approved to incorporate the Guided Imagery (GI) component of the study. Our study team will interview Campaign 6 crewmembers in order to develop the GI scripts that will be used in Campaign 8. The goal of the GI intervention is to increase exercise adherence and enjoyment. Direct comparisons will be made between Campaign 8 crewmembers and Campaign 7 crewmembers, who will receive the same exercise prescriptions without GI. Dr. Judith Gordon is currently scheduling interviews with the C6 crewmembers and expects to complete all interviews by the end of summer 2024.

NOTE: End date changed to 01/31/2023 per NSSC information (Ed., 3/10/21)

SA1. Determine the effects of an in-flight validated exercise regimen (‘SPRINT’) on behavioral health, fatigue, cognitive, sensorimotor, and immune system function in an ICC spaceflight analog;

SA2. Determine the impact of guided imagery on exercise adherence and positive affective responses to exercise in the ICC spaceflight analog. We will also explore the effects of adding guided imagery to the exercise regimen on behavioral health, fatigue, cognitive, sensorimotor, and immune system function;

SA3. Determine if exercise training, with or without guided imagery, has a positive impact on biomarkers of stress and central nervous system function in the ICC spaceflight analog and can increase resilience during an acute stress model of sleep deprivation relative to the control group.

We will use the Human Exploration Research Analog (HERA) and recruit crewmembers over 12 separate 45-day HERA missions. We anticipate enrolling participants from 3 campaigns (4 crewmembers per mission) over a 3-year period (n= 48). Four HERA missions (n=16) will receive the in-flight validated Integrated Aerobic and Resistance Exercise Training Prescription (‘SPRINT’) protocol only; Four HERA missions (n=16) will receive the same training regimen but with GI to augment the exercise response; And four HERA missions (n=16) will serve as the control group, receiving access to the exercise equipment but no GI or ‘SPRINT’ protocol. Measures of behavioral health, cognitive, sensorimotor, and immune (NK-cell cytotoxicity) function will be measured before, during, and after the mission, and the mediating/correlating effects of stress and central nervous system function will be determined by measuring biomarkers (cortisol, dehydroepiandrosterone (DHEA), Macrophage Inflammatory Protein (MIP), brain-derived neurotrophic factor (BDNF)) longitudinally in saliva. On completion of this project we expect to: (1) determine if the ‘SPRINT’ protocol is sufficient to maintain behavioral health of individuals during a spaceflight stress analog; and (2) ascertain whether or not the addition of a GI can augment the exercise training effects on ameliorating stress (including acute stress derived from sleep deprivation) and central nervous system dysfunction to maintain behavioral health, cognitive, sensorimotor, and immune system function in a high fidelity, isolated, confined, and controlled spaceflight simulation analog.

Whilst waiting on the NASA Human Exploration Research Analog (HERA) Campaign 6 to begin, the study team focused on identifying psychological 'targets' that could manipulated through guided imagery to improve exercise adherence. This involved an extensive review of the literature which resulted in a completed MS thesis by student Jamie Lee-Elliot (advisors: Judith Gordon and Richard Simpson). This thesis is currently being re-formatted for publication in a scientific journal.

HERA Campaign 6 Mission 1 began in October 1st 2021. We successfully performed data collection on all participants (n=4) as outlined in our study protocol. Similarly, Mission 2 was completed in March 2022 and data collection was successfully performed on all participants (n=4). Bio specimens collected from the crew have been transferred to the University of Arizona for analysis, which is currently ongoing. Mission 3 of Campaign 6 is ongoing at the time of submitting this task book report. The study will be complete when data has been collected and analyzed from all HERA crewmembers participating in Campaign 6, 7, and 8.

SA1. Determine the effects of an in-flight validated exercise regimen (‘SPRINT’) on behavioral health, fatigue, cognitive, sensorimotor, and immune system function in an ICC spaceflight analog;

SA2. Determine the impact of guided imagery on exercise adherence and positive affective responses to exercise in the ICC spaceflight analog. We will also explore the effects of adding guided imagery to the exercise regimen on behavioral health, fatigue, cognitive, sensorimotor, and immune system function;

SA3. Determine if exercise training, with or without guided imagery, has a positive impact on biomarkers of stress and central nervous system function in the ICC spaceflight analog and can increase resilience during an acute stress model of sleep deprivation relative to the control group.

We will use the Human Exploration Research Analog (HERA) and recruit crewmembers over 12 separate 45-day HERA missions. We anticipate enrolling participants from 3 campaigns (4 crewmembers per mission) over a 3-year period (n= 48). Four HERA missions (n=16) will receive the in-flight validated Integrated Aerobic and Resistance Exercise Training Prescription (‘SPRINT’) protocol only; Four HERA missions (n=16) will receive the same training regimen but with GI to augment the exercise response; And four HERA missions (n=16) will serve as the control group, receiving access to the exercise equipment but no GI or ‘SPRINT’ protocol. Measures of behavioral health, cognitive, sensorimotor, and immune (NK-cell cytotoxicity) function will be measured before, during, and after the mission, and the mediating/correlating effects of stress and central nervous system function will be determined by measuring biomarkers (cortisol, dehydroepiandrosterone (DHEA), Macrophage Inflammatory Protein (MIP), brain-derived neurotrophic factor (BDNF)) longitudinally in saliva. On completion of this project we expect to: (1) determine if the ‘SPRINT’ protocol is sufficient to maintain behavioral health of individuals during a spaceflight stress analog; and (2) ascertain whether or not the addition of a GI can augment the exercise training effects on ameliorating stress (including acute stress derived from sleep deprivation) and central nervous system dysfunction to maintain behavioral health, cognitive, sensorimotor, and immune system function in a high fidelity, isolated, confined, and controlled spaceflight simulation analog.