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Project Title:  An Integrated Musculoskeletal Countermeasure Battery for Long-Duration Lunar Missions Reduce
Fiscal Year: FY 2012 
Division: Human Research 
Research Discipline/Element:
HRP HHC:Human Health Countermeasures
Start Date: 09/01/2007  
End Date: 09/30/2012  
Task Last Updated: 01/08/2013 
Download report in PDF pdf
Principal Investigator/Affiliation:   Lang, Thomas F. Ph.D. / University of California, San Francisco 
Address:  Department of Radiology and Biomedical Imaging 
185 Berry Street 
San Francisco , CA 94143-0649 
Email: Thomas.Lang@ucsf.edu 
Phone: 415-353-4552  
Congressional District:
Web:  
Organization Type: UNIVERSITY 
Organization Name: University of California, San Francisco 
Joint Agency:  
Comments:  
Co-Investigator(s)
Affiliation: 
Bloomberg, Jacob  NASA Johnson Space Center 
Mulavara, Ajitkumar  USRA 
Cavanagh, Peter  University of Washington 
Grodsinsky, Carlos  ZIN Technologies, Inc. 
Sibonga, Jean  USRA 
Lee, Stuart  Wyle Integrated Sciences and Engineering Group 
Spiering, Barry  California State University, Fullerton 
Project Information: Grant/Contract No. NCC 9-58-BL01301 
Responsible Center: NSBRI 
Grant Monitor:  
Center Contact:   
Solicitation / Funding Source: 2007 NSBRI-RFA-07-01 Human Health in Space 
Grant/Contract No.: NCC 9-58-BL01301 
Project Type: GROUND 
Flight Program:  
TechPort: Yes 
No. of Post Docs:
No. of PhD Candidates:
No. of Master's Candidates:
No. of Bachelor's Candidates:
No. of PhD Degrees:
No. of Master's Degrees:
No. of Bachelor's Degrees:
Human Research Program Elements: (1) HHC:Human Health Countermeasures
Human Research Program Risks: (1) Osteo:Risk Of Early Onset Osteoporosis Due To Spaceflight (No longer used, July 2020)
Human Research Program Gaps: (1) Osteo04:We do not know the contribution of each risk factor on bone loss and recovery of bone strength, and which factors are the best targets for countermeasure application (IRP Rev E)
Task Description: The degree to which the musculoskeletal system will maintain its integrity during prolonged sojourns in the reduced gravity of the lunar surface is presently unknown. It is, however, likely that without countermeasures there will be adaptive changes in muscle strength, bone mineral density, bone geometry, and sensorimotor status. When the combined effects of these changes are considered in the context of the construction and exploration tasks that will be performed at the lunar base or at other lunar sites, the risk of injury secondary to a fall is likely to be elevated. To address this problem, we constructed a compact platform that integrates a time efficient integrated battery of countermeasures that can be conducted in the confines of the lunar habitat to minimize the risk of musculoskeletal injury. Ultimately, we expect that this battery of countermeasures will be validated using a 10 head-up bedrest simulation of a lunar mission, although it could also be tested in the standard 6 degree head down simulation.

The specific objectives of the countermeasure battery are: to preserve muscle strength and cardiovascular fitness; to minimize decrements in postural stability, dynamic balance, and the ability to make corrective actions prior to a fall; to preserve functional performance on mission relevant tasks; and to minimize bone loss in the proximal femur. To accomplish these objectives, we have constructed a unique multi-functional countermeasure device which integrates cardiovascular, balance control, and resistance training functions. The stepper system provides cardiovascular exercise. When the stepper is locked down, the device may be utilized for lower body strengthening exercises such as squats, leg extensions, and abductor/adductor exercises. For balance training, the stepper/resistive system is mounted on a Stuart Platform allowing 3D translations with a range of +/- 10 cm and pitch/yaw/roll of +/- 10 degrees.

In the second and third years of the study, based on a request from the Human Research Program, we rescoped the project to carry out a training study in which we have evaluated the ability of combined countermeasure device (CCD) exercise to generate improvements in cardiovascular function and lower body resistive strength. 15 subjects underwent a 12 week training study which involved three weekly one hour sessions of cardiovascular and lower body resistive training. The cardiovascular training initially involved stepper exercise (5 subjects, 5% mean 12 week improvement in VO2max, non-significant change), but based on poor results we changed the aerobic protocol to bike exercise (10 subjects, 27% mean 12 week improvement in VO2max, p=0.004), following a design simulation illustrating that a compact exercise bike could be folded into the footprint of the CCD. The 10 subjects exercised on the bike showed improvements ranging from 17%-38%. Leg press strength increased in all 15 subjects over 12 weeks (mean change 68%, range 47-85%, p=0.0001). Isokinetic strength measures showed variable response, with hip abduction, adduction, and ankle plantarflexion strength increasing by 22%, 31%, and 13%, respectively (all p<0.05), but leg extension, leg flexion, and hip flexion strength showed non-significant increases. Weight lifted by all subjects in each exercise increased significantly (all exercises p=0.0001). Thus, we were able to conclude that CCD exercise was well tolerated, and could produce significant improvements in physical fitness, thus achieving the goal of the training study.

Because a project goal is to develop an exercise protocol in which squatting and hip ab/adduction exercise protect against hip bone loss, Dr. Cavanagh's group adapted the Lifemodeler computational tool to simulate the effect of the muscle contractions produced by CCD squatting and ab/adduction exercise. LifeModeler incorporates contractions of 47 muscles in the leg, and fully models all of the CCD exercise. To validate, Drs. Cavanagh and Hanson used the Orthoload Database, which contains results from studies of volunteers who received hip prostheses instrumented with strain sensors, allowing for calculation of hip loading forces associated with different exercises, including abduction and squatting. Simulating the exercise protocols used in the Orthoload Study, the Lifemodeler calculations produced hip loads that were in quantitative agreement with the measured Orthoload results. These calculations showed that 1g CCD abduction exercise produced peak forces of 4 body weights on the hip, compared to 2.5 body weights for squatting. On June 4, we presented our training study and Lifemodeler work to the Human Health Countermeasures (HHC) Control Board. Based on the heavy load on the Bedrest Facility, the CCD was not placed into the bedrest study, but followup on our ab/adduction results were considered highly exciting. Based on this, we carried out a study to evaluate the effects of ab/adduction exercise on hip bone strength and density measured by quantitative computed tomography and finite element modeling. We compared standard Advanced Resistive Exercise Device (aRED) lower body exercise, combined aRED, and ab/adduction and ab/adduction only, maintaining the same number of repetitions per group, in a 16 week study, with three exercise sessions per week. Eight subjects were assigned to each group. aRED exercise resulted in increased spine and femoral neck bone density, as well as increased hip strength by FEM in the stance loading condition. Ab/Add exercise showed increased cortical bone volume at the trochanter and a borderline insignificant increase of hip strength by FEM in the fall loading condition. The combined group showed no changes. Thus, while AbAdd exercise appears to have a modest osteogenic effect, any application of this approach for prevention of hip bone loss would require additional exercise. Given the modest osteogenic effect we observed, the value of Ab/Adductor exercise may rest more in preservation of functional mobility and fall protection rather than bone loss prevention.

Research Impact/Earth Benefits: Outside of the space medicine community, there is a growing appreciation of the importance of an integrated musculoskeletal approach towards prevention of age-related skeletal fractures. Hip fractures, which represent the most serious manifestation of osteoporosis, rarely occur without falls, and the exercise strategies developed here could potentially be adapted to an older demographic, with the same compact exercise and balance countermeasures geared towards reduction of falls and bone loss in the growing population of elderly. We believe that the compact characteristics of the combined countermeasure device (CCD), which are optimal for the spaceflight environment, will also fulfill the needs for an in-house exercise device or for a nursing home. It is well known that impaired balance is associated with aging and with an increased risk of falling. Balance training exercise in the elderly has been shown to reduce risk of falls. In particular, resistive exercise has been shown to increase muscle strength in the elderly, and increases in muscle strength and balance are associated with improvements in performance and mobility, which are important determinants of quality of life in the elderly. Finally, by focusing on resistive exercise in the abductor and adductor muscle groups, this device is expected both to improve lateral balance and reduce the rate of age-related bone loss by stressing those muscle groups that attach at the hip and thus provide significant mechanical loads on the proximal femur.

Task Progress & Bibliography Information FY2012 
Task Progress: In the past year, we carried out a study to evaluate the effects of ab/adduction exercise on spine bone density and hip bone strength and density measured by quantitative computed tomography and finite element modeling. In 24 healthy subjects, we compared standard aRED lower body exercise, combined aRED, and ab/adduction and ab/adduction only, maintaining the same number of repetitions per group, in a 16 week study, with three exercise sessions per week. Eight subjects were assigned to each group. At the end of the study, two subjects had dropped out, leaving us with 8 subjects in the Ab/Add group, and 7 subjects each in the aRED and combined groups. The three groups showed differential responses of spine and hip bone density and hip bone strength to 16 weeks of training. The group of subjects doing aRED-like exercise consisting of squats and deadlifts showed robust increases in vertebral trabecular bone density (9% p<0.05), as well as smaller but statistically significant increases in femoral neck integral bone density, femoral neck cortical bone density, and femoral neck cortical volume. No changes were observed in the trochanteric region of the hip. No changes were observed in trabecular bone at any subregion of the hip. Using non-linear finite element modeling based on the quantitative computed tomography (QCT) images, we estimated changes of hip whole bone strength under simulated conditions of single-legged stance and a posterolateral fall. We observed that in the aRED-like group, there was a 9% increase in stance strength (p<0.05) but not in fall strength. The group of subjects carrying out abduction and adduction exercise showed no changes in any of the vertebral bone parameters. Abduction and adduction exercise resulted in changes in cortical bone parameters at the trochanter, with a 4.4% increase (p<0.01) in cortical bone volume, and a marginally insignificant 2.1% increase in the trochanteric compressive strength index, which integrates bone density and size to provide a measure of the resistance of the trochanter to compressive loading forces. Finite element computed strength in simulated fall loading resulted in a borderline insignificant trend (p=0.15) towards an increase (5.5%). The group doing combined exercise (half aRED-like and half abduction and adduction) showed no changes in any of the bone parameters. Thus, our study showed that standard aRED exercises consisting of squats, deadlifts, and heel raises have an osteogenic effect on the spine and to a lesser extent on the hip, focused on the femoral neck. While abductor and adductor exercise appears to have a modest osteogenic effect (cortical bone formation) on the trochanter of the hip, the failure of the combined group to show any changes indicates that any adbuctor/adductor exercise needs to be carried out in addition to the standard exercise protocol. The modest effects hint that the proper focus of the exercise could be functional mobility and strength rather than bone protection.

Bibliography Type: Description: (Last Updated: 03/20/2017)  Show Cumulative Bibliography Listing
 
Abstracts for Journals and Proceedings Hanson AM, Lang TF, Cavanagh PR. "Enhancing Efficacy of Exercise in Reduced Gravity Environments through Computer Simulation." 57th Annual Meeting of the Orthopaedic Research Society, Long Beach, CA, January 13-16, 2011.

57th Annual Meeting of the Orthopaedic Research Society, Long Beach, CA, January 13-16, 2011. 2011 Abstract Book, January 2011. , Jan-2011

Abstracts for Journals and Proceedings Hanson AM, Reed EW, Cavanagh PR. "Optimizing Muscle Parameters in Musculoskeletal Modeling using Monte Carlo Simulation." 27th Annual Meeting of the American Society for Gravitational and Space Biology, San Jose, CA, November 3-6, 2011.

Program and abstracts. 27th Annual Meeting of the American Society for Gravitational and Space Biology, San Jose, CA, November 3-6, 2011. , Nov-2011

Abstracts for Journals and Proceedings Streeper T, Cavanagh PR, Hanson AM, Carpenter RD, Saeed I, Kornak J, Frassetto L, Grodsinsky C, Funk J, Lee SM, Spiering BA, Bloomberg J, Mulavara AP, Sibonga J, Lang T. "Development of an integrated countermeasure device for use in long-duration space flight." American College of Sports Medicine 58th Annual Meeting, Denver, CO, May 31-June 4, 2011.

Medicine & Science in Sports & Exercise. 2011 May;43 Supp 1(5):820-1. http://dx.doi.org/10.1249/01.MSS.0000402286.94289.35 , May-2011

Articles in Peer-reviewed Journals Lang TF, Saeed IH, Streeper T, Carballido-Gamio J, Harnish RJ, Frassetto LA, Lee SM, Sibonga JD, Keyak JH, Spiering BA, Grodsinsky CM, Bloomberg JJ, Cavanagh PR. "Spatial heterogeneity in the response of the proximal femur to two lower-body resistance exercise regimens." J Bone Miner Res. 2014 Jun;29(6):1337-45. http://dx.doi.org/10.1002/jbmr.2155 ; PubMed PMID: 24293094; PubMed Central PMCID: PMC4029859 , Jun-2014
Articles in Peer-reviewed Journals Harnish R, Streeper T, Saeed I, Schreck C, Dannoon S, Slater J, Blecha J, VanBrocklin H, Hernandez-Pampaloni M, Hawkins R, Seo Y, Sayre G, Lang T. "Quantification of changes in skeletal muscle amino acid kinetics in adult humans in response to exercise via positron-emission tomography with L-[methyl-11C] methionine." Journal of Molecular Imaging & Dynamics. 2012;2:1. http://dx.doi.org/10.4172/2155-9937.1000103 , Jan-2012
Articles in Peer-reviewed Journals Streeper T, Cavanagh PR, Hanson AM, Carpenter RD, Saeed I, Kornak J, Frassetto L, Grodsinsky C, Funk J, Lee SM, Spiering BA, Bloomberg J, Mulavara A, Sibonga J, Lang T. "Development of an integrated countermeasure device for use in long-duration spaceflight." Acta Astronautica. 2011 Jun-Jul;68(11-12):2029-37. http://dx.doi.org/10.1016/j.actaastro.2010.11.002 , Jul-2011
Project Title:  An Integrated Musculoskeletal Countermeasure Battery for Long-Duration Lunar Missions Reduce
Fiscal Year: FY 2010 
Division: Human Research 
Research Discipline/Element:
HRP HHC:Human Health Countermeasures
Start Date: 09/01/2007  
End Date: 04/30/2012  
Task Last Updated: 09/14/2010 
Download report in PDF pdf
Principal Investigator/Affiliation:   Lang, Thomas F. Ph.D. / University of California, San Francisco 
Address:  Department of Radiology and Biomedical Imaging 
185 Berry Street 
San Francisco , CA 94143-0649 
Email: Thomas.Lang@ucsf.edu 
Phone: 415-353-4552  
Congressional District:
Web:  
Organization Type: UNIVERSITY 
Organization Name: University of California, San Francisco 
Joint Agency:  
Comments:  
Co-Investigator(s)
Affiliation: 
Bloomberg, Jacob  NASA Johnson Space Center 
Mulavara, Ajitkumar  USRA 
Cavanagh, Peter  University of Washington 
Grodsinsky, Carlos  ZIN Technologies, Inc. 
Sibonga, Jean  USRA 
Lee, Stuart  Wyle Integrated Sciences and Engineering Group 
Spiering, Barry  California State University, Fullerton 
Project Information: Grant/Contract No. NCC 9-58-BL01301 
Responsible Center: NSBRI 
Grant Monitor:  
Center Contact:   
Solicitation / Funding Source: 2007 NSBRI-RFA-07-01 Human Health in Space 
Grant/Contract No.: NCC 9-58-BL01301 
Project Type: GROUND 
Flight Program:  
TechPort: Yes 
No. of Post Docs:
No. of PhD Candidates:
No. of Master's Candidates:
No. of Bachelor's Candidates:
No. of PhD Degrees:
No. of Master's Degrees:
No. of Bachelor's Degrees:
Human Research Program Elements: (1) HHC:Human Health Countermeasures
Human Research Program Risks: (1) Osteo:Risk Of Early Onset Osteoporosis Due To Spaceflight (No longer used, July 2020)
Human Research Program Gaps: (1) Osteo04:We do not know the contribution of each risk factor on bone loss and recovery of bone strength, and which factors are the best targets for countermeasure application (IRP Rev E)
Flight Assignment/Project Notes: NOTE: Change in end date to 04/30/2012 (from 8/31/2011) per N. Gibbins/NSBRI (Ed., 9/19/2011)

Task Description: The degree to which the musculoskeletal system will maintain its integrity during prolonged sojourns in the reduced gravity of the lunar surface is presently unknown. It is, however, likely that without countermeasures there will be adaptive changes in muscle strength, bone mineral density, bone geometry, and sensorimotor status. When the combined effects of these changes are considered in the context of the construction and exploration tasks that will be performed at the lunar base or at other lunar sites, the risk of injury secondary to a fall is likely to be elevated. To address this fundamental problem, we have constructed a compact platform that integrates a time efficient integrated battery of countermeasures that can be conducted in the confines of the lunar habitat to minimize the risk of musculoskeletal injury. Ultimately, we expect that this battery of countermeasures will be validated using a 10° head-up bedrest simulation of a lunar mission, although it could also be tested in the standard 6 degree head down simulation.

The specific objectives of the countermeasure battery are: to preserve muscle strength and cardiovascular fitness; to minimize decrements in postural stability, dynamic balance, and the ability to make corrective actions prior to a fall; to preserve functional performance on mission relevant tasks; and to minimize bone loss in the proximal femur. To accomplish these objectives, we have constructed a unique multi-functional countermeasure device which integrates cardiovascular, balance control, and resistance training functions. The stepper system provides cardiovascular exercise. When the stepper is locked down, the device may be utilized for lower body strengthening exercises such as squats, leg extensions and abductor/adductor exercises. To facilitate balance training, the stepper/resistive system is mounted on a Stuart Platform allowing 3D translations with a range of +- 10 cm and pitch/yaw/roll of +-10 degrees. In the second and third years of the study, based on a request from the Human Research Program, we have rescoped the project to carry out a training study in which we have evaluated the ability of CCD exercise to generate improvements in cardiovascular function and lower body resistive strength. 15 subjects underwent a 12 week training study which involved three weekly one hour sessions of cardiovascular and lower body resistive training. The cardiovascular training initially involved stepper exercise (5 subjects, 5% mean 12 week improvement in VO2max, non-significant change), but based on poor results we changed the aerobic protocol to bike exercise (10 subjects, 27% mean 12 week improvement in VO2max, p0.004), following a design simulation illustrating that a compact exercise bike could be folded into the footprint of the CCD. The 10 subjects exercised on the bike showed improvements ranging from 17%-38%. Leg press strength increased in all 15 subjects over 12 weeks (mean change 68%, range 47-85%, p=0.0001). Isokinetic strength measures showed variable response, with hip abduction, adduction and ankle plantarflexion strength increasing by 22%, 31% and 13% respectively (all p<0.05), but leg extension, leg flexion and hip flexion strength showed non-significant increases. Weight lifted by all subjects in each exercise increased significantly (all exercises p=0.0001) over the course of the study. Thus, from our training study data, we were able to conclude that CCD exercise was well tolerated, and could produce significant improvements in physical fitness, thus achieving the goal of the training study. Because one of the key goals of the project is to develop a novel exercise protocol in which squatting and hip ab/adduction exercise are employed to protect against hip bone loss, Dr. Cavanagh's group has adapted the Lifemodeler computational tool to simulate the effect of the muscle contractions produced by CCD squatting and ab/adduction exercise on the hip. This calculation incorporates the contractions of 47 muscles in the leg, and fully models all of the CCD exercise. To validate this model, Drs. Cavanagh and Hanson utilized the Orthoload Database, which contains results from studies of volunteers who received hip prostheses instrumented with strain sensors, allowing for calculation of hip loading forces associated with different exercises, including abduction and squatting. Simulating the exercise protocols used in the Orthoload Study, the Lifemodeler calculations produced hip loads that were in quantitative agreement with the measured Orthoload results, validating the use of Lifemodeler to estimate load forces on the hip associated with CCD exercises. These calculations showed that in 1g, CCD abduction exercise produced peak forces of four body weights on the hip, compared to 2.5 body weights for squatting exercise. On June 4, we presented the results of our training study and Lifemodeler work to the HHC Control Board. Based on the heavy load on the Bedrest Facility placed by the ongoing aRED studies, it was decided not to place the CCD into the bedrest study, but followup on our ab/adduction results were considered highly exciting and worthy of pursuit. Based on this evaluation, we plan for the final year of our grant, a detailed evaluation of the effects of ab/adduction exercise on hip bone strength and density as measured by quantitative computed tomography and finite element modeling. This study will compare standard aRED lower body exercise, combined aRED and ab/adduction and ab/adduction only, maintaining the same number of repetitions per group.

Research Impact/Earth Benefits: Outside of the space medicine community, there is a growing appreciation of the importance of an integrated musculoskeletal approach towards prevention of age-related skeletal fractures. Hip fractures, which represent the most serious manifestation of osteoporosis, rarely occur without falls, and the exercise strategies developed here could potentially be adapted to an older demographic, with the same compact exercise and balance countermeasures geared towards reduction of falls and bone loss in the growing population of elderly.

We believe that the compact characteristics of the CCD which are optimal for the spaceflight environment will also fulfill the needs for an in-house exercise device or for a nursing home. It is well known that impaired balance is associated with aging and with an increased risk of falling. Balance training exercise in the elderly has been shown to reduce risk of falls. In particular, resistive exercise has been shown to increase muscle strength in the elderly, and increases in muscle strength and balance are associated with improvements in performance and mobility, which are important determinants of quality of life in the elderly. Finally, by focusing on resistive exercise in the abductor and adductor muscle groups, this device is expected both to improve lateral balance and reduce the rate of age-related bone loss by stressing those muscle groups that attach at the hip and thus provide significant mechanical loads on the proximal femur.

Task Progress & Bibliography Information FY2010 
Task Progress: In the past year, we demonstrated the efficacy of CCD exercise for improvement of muscle strength and aerobic fitness, and implemented and validated a computer simulation to estimate the loads on the hip exerted by lower body muscles during CCD exercise.

15 subjects completed our 12 week training study, which involved pre- and post training evaluation of VO2max, leg press strength, and isokinetic measures of knee extension and flexion strength, hip ab/adduction strength, hip flexion strength and ankle plantarflexion strength. 5 subjects underwent a 12 week training study which involved three weekly one hour sessions of cardiovascular and lower body resistive training. The cardiovascular training initially involved stepper exercise (5 subjects, 5% mean 12 week improvement in VO2max, non-significant change), but based on poor results we changed the aerobic protocol to bike exercise (10 subjects, 26% mean 12 week improvement in VO2max, p<0.05), following a 3D design simulation illustrating that a compact exercise bike could be folded into the footprint of the CCD. The 910 subjects exercised on the bike showed improvements ranging from 17%-38% (95 CI). Leg press strength increased in all 15 subjects over 12 weeks (mean change 68%, range 47-85% 95CI, p=0.0001). Isokinetic strength measures showed variable response, with hip abduction, adduction and ankle plantarflexion strength increasing by 22%, 31% and 13% respectively (all p<0.05), but leg extension, leg flexion and hip flexion strength showing non-significant increases. Weight lifted by all subjects in each exercise increased significantly over the course of the study. Thus, from our training study data, we were able to conclude that CCD exercise was well tolerated, and could produce dramatic improvements in physical fitness, thus achieving the goal of the training study.

LifeModeler Calculations: Dr. Cavanagh's group has adapted the Lifemodeler computational tool to estimate the peak hip loads exerted by the muscle contractions produced by CCD squatting and ab/adduction exercise. This calculation incorporates the contractions of 47 muscles in the leg, and fully models all of the CCD exercises. To validate this model, Drs. Cavanagh and Hanson utilized the Orthoload Database, which contains results from studies of volunteers who received hip prostheses instrumented with strain sensors, allowing for calculation of hip loading forces associated with different exercises, including abduction and squatting. Simulating the exercise protocols used in the Orthoload Study, the Lifemodeler calculations produced hip loads that were in quantitative agreement with the measured Orthoload results, validating the use of Lifemodeler to estimate load forces on the hip associated with CCD exercises. These calculations showed that in 1g, CCD abduction exercise produced forces of four body weights on the hip, compared to 2.5 body weights for squatting exercise.

Bibliography Type: Description: (Last Updated: 03/20/2017)  Show Cumulative Bibliography Listing
 
Articles in Peer-reviewed Journals Streeper T, Cavanagh PR, Hanson AM, Carpenter D, Saeed I, Kornak J, Frassetto L, Grodsinsky C, Funk J, Lee SM, Spiering BA, Bloomberg J, Mulavara AP, Sibonga J, Lang T. "Development of an integrated countermeasure device for use in long-duration space flight." Acta Astronautica. Submitted, 2010. , Jul-2010
Project Title:  An Integrated Musculoskeletal Countermeasure Battery for Long-Duration Lunar Missions Reduce
Fiscal Year: FY 2009 
Division: Human Research 
Research Discipline/Element:
HRP HHC:Human Health Countermeasures
Start Date: 09/01/2007  
End Date: 08/31/2011  
Task Last Updated: 09/15/2009 
Download report in PDF pdf
Principal Investigator/Affiliation:   Lang, Thomas F. Ph.D. / University of California, San Francisco 
Address:  Department of Radiology and Biomedical Imaging 
185 Berry Street 
San Francisco , CA 94143-0649 
Email: Thomas.Lang@ucsf.edu 
Phone: 415-353-4552  
Congressional District:
Web:  
Organization Type: UNIVERSITY 
Organization Name: University of California, San Francisco 
Joint Agency:  
Comments:  
Co-Investigator(s)
Affiliation: 
Bloomberg, Jacob  NASA JSC 
Grodsinsky, Carlos  ZIN Technologies, Inc. 
Sibonga, Jean  USRA 
Mulavara, Ajitkumar  USRA 
Lee, Stuart  Wyle Integrated Sciences and Engineering Group 
Cavanagh, Peter  University of Washington 
Project Information: Grant/Contract No. NCC 9-58-BL01301 
Responsible Center: NSBRI 
Grant Monitor:  
Center Contact:   
Solicitation / Funding Source: 2007 NSBRI-RFA-07-01 Human Health in Space 
Grant/Contract No.: NCC 9-58-BL01301 
Project Type: GROUND 
Flight Program:  
TechPort: Yes 
No. of Post Docs:
No. of PhD Candidates:
No. of Master's Candidates:
No. of Bachelor's Candidates:
No. of PhD Degrees:
No. of Master's Degrees:
No. of Bachelor's Degrees:
Human Research Program Elements: (1) HHC:Human Health Countermeasures
Human Research Program Risks: (1) Osteo:Risk Of Early Onset Osteoporosis Due To Spaceflight (No longer used, July 2020)
Human Research Program Gaps: (1) Osteo04:We do not know the contribution of each risk factor on bone loss and recovery of bone strength, and which factors are the best targets for countermeasure application (IRP Rev E)
Task Description: The degree to which the musculoskeletal system will maintain its integrity during prolonged sojourns in the reduced gravity of the lunar surface is presently unknown. It is, however, likely that without countermeasures there will be adaptive changes in muscle strength, bone mineral density, bone geometry, and sensorimotor status. When the combined effects of these changes are considered in the context of the construction and exploration tasks that will be performed at the lunar base or at other lunar sites, the risk of injury secondary to a fall is likely to be elevated. To address this fundamental problem, we have constructed a compact platform that integrates a time efficient integrated battery of countermeasures that can be conducted in the confines of the lunar habitat to minimize the risk of musculoskeletal injury. Ultimately, we expect that this battery of countermeasures will be validated using a 10° head-up bedrest simulation of a lunar mission, although it could also be tested in the standard 6 degree head down simulation. The specific objectives of the countermeasure battery are: to preserve muscle strength and cardiovascular fitness; to minimize decrements in postural stability, dynamic balance, and the ability to make corrective actions prior to a fall; to preserve functional performance on mission relevant tasks; and to minimize bone loss in the proximal femur. To accomplish these objectives, we have constructed a unique multi-functional countermeasure device which integrates cardiovascular, balance control, and resistance training functions. The stepper system provides cardiovascular exercise. When the stepper is locked down, the device may be utilized for lower body strengthening exercises such as squats, leg extensions and abductor/adductor exercises. To facilitate balance training, the stepper/resistive system is mounted on a Stuart Platform allowing 3D translations with a range of +/- 10 cm and pitch/yaw/roll of +/-10 degrees. As a next step, we are carrying out a training study to quantify, in the 1-g setting, increases in cardiovascular function (VO2 max) and lower body strength in volunteers characteristic of the population of the Flight Analog Project Bedrest study. Also, in the coming year, we plan to carry out a substudy testing the balance training function of our device in subjects with sensorimotor deficits. We believe that this study will establish that the gains is muscle strength and VO2max, when the device is used with an exercise prescription simulating its function in bedrest and spaceflight, will be comparable to historical studies in which resistive and cardiovascular exercises have been performed in parallel. We hypothesize that the combined effect of this multifaceted intervention will be to significantly reduce the risk of a work-related falls and subsequent injury. Ultimately, we expect to test our hypothesis in a bedrest study by randomizing half of our subjects to a group which will undergo the integrated countermeasure and the other half to a control group. Pre- and post-bedrest, we will compare indices of balance, muscle strength, and skeletal density and function using a combination of functional and strength tests, serum and urine bone markers and CT and DXA imaging of the hip, spine and tibia.

Research Impact/Earth Benefits: Outside of the space medicine community, there is a growing appreciation of the importance of an integrated musculoskeletal approach towards prevention of age-related skeletal fractures. Hip fractures, which represent the most serious manifestation of osteoporosis, rarely occur without falls, and the exercise strategies developed here could potentially be adapted to an older demographic, with the same compact exercise and balance countermeasures geared towards reduction of falls and bone loss in the growing population of elderly.

We believe that the compact characteristics of the CCD which are optimal for the spaceflight environment will also fulfill the needs for an in-house exercise device or for a nursing home. It is well known that impaired balance is associated with aging and with an increased risk of falling. Balance training exercise in the elderly has been shown to reduce risk of falls. In particular, resistive exercise has been shown to increase muscle strength in the elderly, and increases in muscle strength and balance are associated with improvements in performance and mobility, which are important determinants of quality of life in the elderly. Finally, by focusing on resistive exercise in the abductor and adductor muscle groups, this device is expected both to improve lateral balance and reduce the rate of age-related bone loss by stressing those muscle groups that attach at the hip and thus provide significant mechanical loads on the proximal femur.

Task Progress & Bibliography Information FY2009 
Task Progress: In November 2008, the Combined Countermeasure Device (CCD) was installed at the PI’s laboratory at UC San Francisco. The CCD combines cardiovascular exercise, neurovestibular stimulation, and lower body strength exercise into a single compact design of 32" diameter. Resistive exercise employs cables attached to Subject Loading Devices to provide resistance for squats, leg extensions and flexions, hip adduction and abduction and ankle plantar flexion. Cardiovascular stimulus is obtained by stepping exercise. The platform used for the resistive and stepping exercise is integrated onto a Stewart platform offering ten degrees of pitch, roll and yaw and translation in three dimensions. The balance exercise is designed to be carried in combination with visual stimulation provided by changing scenes projected onto a stationary screen.

The current year of the study, ending 8/31/09, was devoted to starting a training study to demonstrate that cardiovascular and resistive exercise could improve measures of muscle strength and endurance. The study components included training on the CCD at our facility and pre- intermediate and post training testing at the Exercise Laboratory at the Clinical Research Center (CRC) of the UCSF Clinical and Translational Science Institute. We have made considerable progress:

1) The CCD was installed in 12/2008. We also brought new personnel onto the project so that the training study could be carried out at UCSF. Mr. Tim Streeper, an Exercise Physiologist, was brought in to lead the training study. Dr. Lynda Frassetto, Medical Director of the CRC, joined as our Study Physician. Dr. Kathleen Mulligan, director of the CRC Exercise Lab, became a co-investigator. Drs. Frassetto and Mulligan have been instrumental in use of the CRC for the pre and post training strength and VO2max testing.

2) We carried out pilot studies to reveal issues with the study logistics and operation of the CCD. These pilot studies revealed multiple technical issues with the operation of the device in strength training and stepping mode. These problems were identified and fixed in the first part of 2009, which delayed the projected start of the training study from March to May 2009.

3) We started the training study in May 2009. As of time of this report, three subjects have finished the full twelve week study, with four more subjects in initial and intermediate phases of the study. By the end of the project period, four subjects will have completed training.

4) Initial results are positive. On average, with three subjects complete, VO2max increases by an average of 7%, and leg press strength by 60%. Hip abductor and adductor strength increase by 20 and 68% respectively. Given that the technical problems associated with the early part of the study have been addressed, we expect to make considerable progress towards completing the study in the coming year.

Bibliography Type: Description: (Last Updated: 03/20/2017)  Show Cumulative Bibliography Listing
 
 None in FY 2009
Project Title:  An Integrated Musculoskeletal Countermeasure Battery for Long-Duration Lunar Missions Reduce
Fiscal Year: FY 2008 
Division: Human Research 
Research Discipline/Element:
HRP HHC:Human Health Countermeasures
Start Date: 09/01/2007  
End Date: 08/31/2011  
Task Last Updated: 10/08/2008 
Download report in PDF pdf
Principal Investigator/Affiliation:   Lang, Thomas F. Ph.D. / University of California, San Francisco 
Address:  Department of Radiology and Biomedical Imaging 
185 Berry Street 
San Francisco , CA 94143-0649 
Email: Thomas.Lang@ucsf.edu 
Phone: 415-353-4552  
Congressional District:
Web:  
Organization Type: UNIVERSITY 
Organization Name: University of California, San Francisco 
Joint Agency:  
Comments:  
Co-Investigator(s)
Affiliation: 
Bloomberg, Jacob  NASA JSC 
Grodsinsky, Carlos  ZIN Technologies, Inc. 
Sibonga, Jean  USRA 
Mulavara, Ajitkumar  USRA 
Lee, Stuart  Wyle Integrated Sciences and Engineering Group 
Cavanagh, Peter  University of Washington 
Project Information: Grant/Contract No. NCC 9-58-BL01301 
Responsible Center: NSBRI 
Grant Monitor:  
Center Contact:   
Solicitation / Funding Source: 2007 NSBRI-RFA-07-01 Human Health in Space 
Grant/Contract No.: NCC 9-58-BL01301 
Project Type: GROUND 
Flight Program:  
TechPort: Yes 
No. of Post Docs:
No. of PhD Candidates:
No. of Master's Candidates:
No. of Bachelor's Candidates:
No. of PhD Degrees:
No. of Master's Degrees:
No. of Bachelor's Degrees:
Human Research Program Elements: (1) HHC:Human Health Countermeasures
Human Research Program Risks: (1) Osteo:Risk Of Early Onset Osteoporosis Due To Spaceflight (No longer used, July 2020)
Human Research Program Gaps: (1) Osteo04:We do not know the contribution of each risk factor on bone loss and recovery of bone strength, and which factors are the best targets for countermeasure application (IRP Rev E)
Task Description: The degree to which the musculoskeletal system will maintain its integrity during prolonged sojourns in the reduced gravity of the lunar surface is presently unknown. It is, however, likely that without countermeasures there will be adaptive changes in muscle strength, bone mineral density, bone geometry, and sensorimotor status. When the combined effects of these changes are considered in the context of the construction and exploration tasks that will be performed at the lunar base or at other lunar sites, the risk of injury secondary to a fall is likely to be elevated. To address this fundamental problem, we have constructed a compact platform that integrates a time efficient integrated battery of countermeasures that can be conducted in the confines of the lunar habitat to minimize the risk of musculoskeletal injury. Ultimately, we expect that this battery of countermeasures will be validated using a 10° head-up bedrest simulation of a lunar mission, although it could also be tested in the standard 6 degree head down simulation. The specific objectives of the countermeasure battery are: to preserve muscle strength and cardiovascular fitness; to minimize decrements in postural stability, dynamic balance, and the ability to make corrective actions prior to a fall; to preserve functional performance on mission relevant tasks; and to minimize bone loss in the proximal femur. To accomplish these objectives, we have constructed a unique multi-functional countermeasure device which integrates cardiovascular, balance control, and resistance training functions. The stepper system provides cardiovascular exercise. When the stepper is locked down, the device may be utilized for lower body strengthening exercises such as squats, leg extensions and abductor/adductor exercises. To facilitate balance training, the stepper/resistive system is mounted on a Stuart Platform allowing 3D translations with a range of +- 10 cm and pitch/yaw/roll of +-10 degrees. As a next step, during the coming two project years, we will carry out a training study to quantify, in the 1-g setting, increases in cardiovascular function (VO2 max) and lower body strength in 30 volunteers characteristic of the population of the Flight Analog Project Bedrest study. We believe that this study will establish that the gains is muscle strength and VO2max, when the device is used with an exercise prescription simulating its function in bedrest and spaceflight, will be comparable to historical studies in which resistive and cardiovascular exercises have been performed in parallel. We hypothesize that the combined effect of this multifaceted intervention will be to significantly reduce the risk of a work-related falls and subsequent injury. Ultimately, we expect to test our hypothesis in a bedrest study by randomizing half of our subjects to a group which will undergo the integrated countermeasure and the other half to a control group. Pre- and post-bedrest, we will compare indices of balance, muscle strength, and skeletal density and function using a combination of functional and strength tests, serum and urine bone markers and CT and DXA imaging of the hip, spine and tibia.

Research Impact/Earth Benefits: Outside of the space medicine community, there is a growing appreciation of the importance of an integrated musculoskeletal approach towards prevention of age-related skeletal fractures. Hip fractures, which represent the most serious manifestation of osteoporosis, rarely occur without falls, and the exercise strategies developed here could potentially be adapted to an older demographic, with the same compact exercise and balance countermeasures geared towards reduction of falls and bone loss in the growing population of elderly.

We believe that the compact characteristics of the CCD which are optimal for the spaceflight environment will also fulfill the needs for an in-house exercise device or for a nursing home. It is well known that impaired balance is associated with aging and with an increased risk of falling. Balance training exercise in the elderly has been shown to reduce risk of falls. In particular, resistive exercise has been shown to increase muscle strength in the elderly, and increases in muscle strength and balance are associated with improvements in performance and mobility, which are important determinants of quality of life in the elderly. Finally, by focusing on resistive exercise in the abductor and adductor muscle groups, this device is expected both to improve lateral balance and reduce the rate of age-related bone loss by stressing those muscle groups that attach at the hip and thus provide significant mechanical loads on the proximal femur.

Task Progress & Bibliography Information FY2008 
Task Progress: We have completed the first Specific Aim of our NSBRI project, which was to develop a combined countermeasure device (CCD). The CCD combines cardiovascular exercise, neurovestibular stimulation, and lower body strength exercise into a single compact station design of 32" diameter. This design is based on a compact stepper and subject load device (SLD) pneumatic technology. The novel integration of balance and visual cues have been introduced through a Stewart Platform that provides 6 degree of freedom compliance, with a 10 cm range of motion in three axes and ten degree range of rotations in pitch, yaw and roll. The integration of platform, stepper and SLD allows the subject to perform exercise that requires balance motor functions while the platform moves with the exercise motions of the subject. A visual cue will be provided by a stationary LCD display which will be integrated to the platform when bedrest study commences. The use of stepper and SLD pneumatics and provides an integrated platform that is compact and power efficient.

For cardiovascular exercise, the stepper is bolted to the platform. The stepper allows for 8" maximum displacement between petals at high stepping rates. Balance training is carried out during the stepping motion, as the subject moves the passive Stewart platform in concert with the displayed visual cues.

For resistive lower body exercise, the subject is loaded onto the platform with four pneumatic subject load devices attached to the subject through a shoulder harness.

Together, the SLDs provide a maximum resistive load up to 435 lbs in 5 lb increments. The device is designed to support the following resistive exercises:

• Squats: 20" maximum vertical displacement with a maximum load up to 435 lbs. This exercise is carried out on an empty platform with the stepper removed.

• Abductor/Adductor exercises: the stepper is removed and replaced with a horizontal rail system allowing 15" horizontal leg motion in each direction against a maximum load up to 435 lbs.

• Heel raises are performed with the device configured for squats, against a maximum load of 435 lbs.

• Leg extensions are carried out with the device configured for squats. A bungee configuration is employed to produce high levels of resistance.

The device in its current form will be transferred to UCSF where it will be employed in a training study with the goal of qualifying the CCD for eventual inclusion in the Flight Analog Project bedrest study. For eventual flight status, the device will be redesigned to obviate the need to replace the stepper and horizontal rail adjustment in transition between exercise modalities.

Bibliography Type: Description: (Last Updated: 03/20/2017)  Show Cumulative Bibliography Listing
 
 None in FY 2008
Project Title:  An Integrated Musculoskeletal Countermeasure Battery for Long-Duration Lunar Missions Reduce
Fiscal Year: FY 2007 
Division: Human Research 
Research Discipline/Element:
HRP HHC:Human Health Countermeasures
Start Date: 09/01/2007  
End Date: 08/31/2011  
Task Last Updated: 11/29/2007 
Download report in PDF pdf
Principal Investigator/Affiliation:   Lang, Thomas F. Ph.D. / University of California, San Francisco 
Address:  Department of Radiology and Biomedical Imaging 
185 Berry Street 
San Francisco , CA 94143-0649 
Email: Thomas.Lang@ucsf.edu 
Phone: 415-353-4552  
Congressional District:
Web:  
Organization Type: UNIVERSITY 
Organization Name: University of California, San Francisco 
Joint Agency:  
Comments:  
Co-Investigator(s)
Affiliation: 
Bloomberg, Jacob  NASA JSC 
Cavanagh, Peter  The Cleveland Clinic Foundation 
Grodsinsky, Carlos  NASA GRC 
Lee, Stuart  Wyle Laboratories 
Mulavara, Ajitkumar P.  USRA  
Sibonga, Jean  USRA 
Project Information: Grant/Contract No. NCC 9-58-BL01301 
Responsible Center: NSBRI 
Grant Monitor:  
Center Contact:   
Solicitation / Funding Source: 2007 NSBRI-RFA-07-01 Human Health in Space 
Grant/Contract No.: NCC 9-58-BL01301 
Project Type: GROUND 
Flight Program:  
TechPort: Yes 
No. of Post Docs:  
No. of PhD Candidates:  
No. of Master's Candidates:  
No. of Bachelor's Candidates:  
No. of PhD Degrees:  
No. of Master's Degrees:  
No. of Bachelor's Degrees:  
Human Research Program Elements: (1) HHC:Human Health Countermeasures
Human Research Program Risks: (1) Osteo:Risk Of Early Onset Osteoporosis Due To Spaceflight (No longer used, July 2020)
Human Research Program Gaps: (1) Osteo04:We do not know the contribution of each risk factor on bone loss and recovery of bone strength, and which factors are the best targets for countermeasure application (IRP Rev E)
Task Description: The degree to which the musculoskeletal system will maintain its integrity during prolonged sojourns in the reduced gravity of the lunar surface is presently unknown. It is, however, likely that without countermeasures there will be adaptive changes in muscle strength, bone mineral density, bone geometry and sensorimotor status. When the combined effects of these changes are considered in the context of the construction and exploration tasks that will be performed at the lunar base or at other lunar sites, the risk of injury secondary to a fall is likely to be elevated.

We aim to devise a time-efficient integrated battery of countermeasures that can be conducted in the confines of the lunar habitat to minimize the risk of musculoskeletal injury. These countermeasures will be validated using a 10-degree head-up bed-rest simulation of a lunar mission. The specific objectives of the countermeasure battery will be to preserve muscle strength and cardiovascular fitness; to minimize decrements in postural stability, dynamic balance and the ability to make corrective actions prior to a fall; to preserve functional performance on mission-relevant tasks; and to minimize bone loss in the proximal femur.

This will be accomplished through a combination of novel resistance exercises on a device designed by our commercial partner that will load specific muscle groups at the hip and in the lower extremity. It will also allow balance and coordination training. We hypothesize that the combined effect of this multifaceted intervention will be to significantly reduce the risk of a work-related falls and subsequent injuries. We will test our hypothesis by randomizing half of our subjects to a group which will undergo the integrated countermeasure and the other half to a control group. Pre- and post-bed rest, we will compare indices of balance, muscle strength, and skeletal density and function using a combination of functional and strength tests, serum and urine bone markers, and CT and DXA imaging of the hip, spine and tibia.

Research Impact/Earth Benefits: 0

Task Progress & Bibliography Information FY2007 
Task Progress: New project for FY2007.

Bibliography Type: Description: (Last Updated: 03/20/2017)  Show Cumulative Bibliography Listing
 
 None in FY 2007