Deep space exploration requires a paradigm shift in astronaut medical support toward Earth-independent medical operations. Currently, astronauts rely on real-time communications with ground-based medical facilities. However, as the distance from Earth increases, communication delays and disruptions increase. Crews engaged in deep space exploration will need to autonomously detect, diagnose, treat, and prevent diseases. One potential solution is to enhance the knowledge, skills, and capabilities of crews participating in long-duration exploration missions with a digital clinical decision support system (CDSS).
The Exploration Medical Capability (ExMC) division of NASA’s Human Research Program is exploring the feasibility and value of expanded capabilities for the development and improvement of EIMO. The ExMC research team has developed a CDSS concept that would continuously collect medical data, through both passive and active monitoring, and provide recommendations in real time. This will improve patient outcomes and reduce the burden of health care.
The assistive technologies incorporated into the ExMC-developed CDSS system are designed to significantly enhance crew medical care capabilities. Private applications for this approach are currently being considered for commercial space programs, providing a relevant example of how ARC Space Biosciences’ research benefits the entire space sector.
Health in Space. NASA
During long-duration missions, NASA’s medical team focuses on optimizing astronauts’ physical and mental health and enhancing their performance to ensure mission success. These efforts also help NASA prepare for future human missions to the Moon, Mars, and beyond.
NASA maintains a team of doctors, psychologists, and other specialists on Earth who care for the health and well-being of astronauts before, during, and after each space mission. NASA assigns physicians with specialized training in space medicine, called flight surgeons, to each crew assigned to a mission. Flight surgeons oversee the medical care and training of crew members during mission preparation and monitor the crew’s health before, during, and after their flight to the space station.
The International Space Station is humanity’s home in space and a research station orbiting approximately 400 kilometers above Earth. NASA and its international partners have maintained a continuous human presence aboard the space station for over 24 years, conducting research that is impossible to achieve on Earth. People living and working aboard the microgravity laboratory also contribute to ongoing research, helping to address complex human health issues on Earth and prepare humanity for journeys further than ever before, including to the Moon and Mars.
NASA Expedition 69 astronaut Frank Rubio rests and talks with NASA ISS Program Manager Joel Montalbano (kneeling, left), NASA Flight Surgeon Josef Schmid (in red cap), and NASA Astronaut Office Chief Joe Acaba near the Soyuz MS-23 spacecraft after its landing with Roscosmos cosmonauts Sergey Prokopyev and Dmitry Petelin in a remote area near the city of Zhezkazgan, Kazakhstan, September 27, 2023. NASA/Bill Ingalls
A typical mission to the International Space Station lasts approximately six months, but this can vary depending on the schedule of visiting spacecraft, mission priorities, and other factors. NASA astronauts have also remained aboard the space station for longer periods. Such missions are known as long-duration missions, and previous missions have provided NASA with extensive data on long-duration spaceflight and its effects on the human body, which the agency applies to all human missions.
NASA’s Behavioral Health Team provides individualized psychological support services to crew members and their families during each mission. Ensuring astronauts’ success in extreme environments begins during the selection process, when candidates are assessed for qualities such as adaptability and resilience. Astronauts undergo extensive training that helps them use self-assessment tools and treatment methods to manage their behavioral health. NASA also conducts expedition skills training to prepare each astronaut for missions, developing important skills such as self-care and teamwork, communication, leadership, and follower skills.
To maintain motivation and morale aboard the space station, astronauts can send emails, call, and videoconference with their families and friends, receive aid packages aboard NASA cargo missions, and teleconference with a psychologist when needed.
In addition to technical training, astronauts undergo teamwork training. They learn how to effectively live in a group, as well as how to care for and support one another. Long-duration spaceflight, due to its remoteness and isolation, can make teamwork challenging. Astronauts must maintain situational awareness and execute the mission plan in a constantly changing environment. Therefore, effective communication is critical when working in a team onboard the station and with multiple support groups on Earth. Astronauts also need to be able to convey complex information to people with different professional backgrounds. Ultimately, astronauts are people living and working together onboard the station, and they must be able to perform complex technical work and resolve any interpersonal issues that may arise.
Doctors continuously monitor the astronauts’ health using sensors, tests, and sample collection to understand the long-term effects of spaceflight, helping maintain crew fitness for future missions to the Moon, Mars, and beyond, and advancing medical treatments on Earth. A key part of this work is physical exercise to prevent the loss of muscle and bone mass caused by spaceflight. During training and daily activities, astronauts periodically wear a Bio-Monitor vest and armband, equipped with sensors that track their heart, respiratory system, and other health conditions for up to 48 hours. The data can be monitored by doctors on Earth in real time or uploaded to Earth for later analysis.
For example, during Expedition 74, NASA Flight Engineer Chris Williams donned a wearable biomonitor early in the morning, beginning a two-day health monitoring session. He then exercised on an Advanced Resistance Device (ARED), which simulates free weights on Earth, and then ran on a COLBERT treadmill, which helped offset the effects of microgravity and allowed doctors to assess the health of his heart, lungs, muscles, and bones in zero gravity. The biomonitor, a biomedical device developed by the Canadian Space Agency, has been in use aboard the station since January 2019.
Williams later assisted NASA flight engineer Zena Cardman inside the Quest spacecraft’s airlock as she installed charged lithium-ion batteries into a pair of spacesuits.
All day Wednesday, station commander Mike Fincke spent servicing various training equipment and scientific instruments. First, he installed kinematics hardware on the ARED instrument, which monitors the muscle and bone loads experienced by the crew during space training. Researchers use the visual data to adjust training programs to maximize the crew’s fitness in microgravity. He then replaced a pair of hard drives and injected gas into the zero-evaporation experimental tank, which is being tested for its ability to store cryogenic liquids in spacecraft fuel tanks.
A reddish-yellow glow of the atmosphere bathes the Earth’s horizon, and the city lights of southwestern Europe and North Africa sparkle against the backdrop of the Atlantic Ocean and Mediterranean Sea separating the two continents. At the time this photograph was taken, the International Space Station was orbiting 262 miles above the Atlantic Ocean at approximately 7:47 p.m. local time. NASA
Flight engineer Kimiya Yui of JAXA (the Japan Aerospace Exploration Agency) began his shift in the Kibo laboratory module, checking for gas leaks inside the combustion research equipment. He then turned on a fluorescence microscope to observe changes in the formation of flat liquid crystal films in microgravity. The results of this study could contribute to the development of displays for touch panels and instrument panels, benefiting both ground and space equipment.
At the end of their shift, all four astronauts joined Roscosmos cosmonauts Sergei Kud-Sverchkov, Sergei Mikayev, and Oleg Platonov for emergency response exercises. The orbital seven practiced their responses to unlikely events, such as depressurization, a chemical leak, or a fire aboard the orbital station. The seven crew members used tablet computers and reviewed the procedures and communications protocols they will use in coordination with ground mission controllers.
A couple of days later, the Expedition 74 crew studied the effects of life in space on brain function and circulation to ensure crew health and the long-term success of the mission. As the week concluded, the International Space Station’s inhabitants also focused on spacewalk instruments and scientific equipment maintenance.
On Friday, NASA Flight Engineer Chris Williams began his shift by collecting blood and urine samples for analysis, then storing them in a freezer for scientific research. Williams then participated in two tests aimed at documenting potential changes in brain structure and function caused by spaceflight, as part of the long-term CIPHER study. The first test measured his spatial cognition, or ability to navigate in zero-gravity conditions, and the second recorded his reactions while practicing maneuvers with the Canadarm2 robotic arm during a computer simulation of a cargo spacecraft capture. Doctors will use the results to assess his cognitive abilities and develop tools to monitor and protect the brain in microgravity.
Station commander Mike Fincke of NASA and flight engineer Kimiya Yui of JAXA (the Japan Aerospace Exploration Agency) took turns studying blood flow from the brain to the heart to understand how efficiently the brain and heart function in space. Electrodes and sensors were attached to their necks, collarbones, and ribs to measure changes in blood flow and volume that could lead to space-related heart problems, such as thrombosis or arterial stiffness.
The Expedition 73 and 74 crews pose for a portrait the day before their return to Earth. NASA astronaut Johnny Kim and Roscosmos cosmonauts Sergey Ryzhikov and Alexey Zubritsky. Front row, left to right: NASA astronauts Chris Williams and Mike Fincke with Sergey Ryzhikov. Second row: Roscosmos cosmonaut Sergey Mikayev, NASA astronaut Zena Cardman, Roscosmos cosmonaut Sergey Kud-Sverchkov, and Johnny Kim. Second row: JAXA (Japan Aerospace Exploration Agency) astronaut Yui Kimiya and Roscosmos cosmonauts Oleg Platonov and Alexey Zubritsky. NASA
Roscosmos cosmonauts Sergei Kud-Sverchkov and Sergei Mikayev also studied vascular health using chest electrodes and blood pressure cuffs on the arms, wrists, and fingers as part of a human endothelial cell experiment conducted by the space agency. They studied how the inner lining of blood vessels ensures uninterrupted circulation, regulates blood pressure, and prevents blood clots in crew members. Doctors are monitoring how zero gravity and space radiation affect cosmonauts’ arteries, blood pressure, and hearts during spaceflight.
On Friday, NASA flight engineer Zena Cardman returned to the Quest airlock to prepare instruments for the spacewalk and, wearing virtual reality goggles, practiced operating the spacesuit’s emergency jetpack. This jetpack, officially called the Simplified Aid For EVA Rescue (SAFER), allows astronauts to safely return to the orbital station in the unlikely event of becoming detached from their tether.
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Roscosmos flight engineer Oleg Platonov completed the nighttime photography session, which automatically captured near-ultraviolet images of Earth landmarks while the crew slept. Platonov then replaced a vacuum pump and transferred fluids as part of routine maintenance on the orbital piping system. Finally, in his first time in space, he checked the video recording equipment and formatted the memory cards, concluding his work week aboard the orbital laboratory. The Expedition 74 crew will contact their families, share gifts and food, and celebrate Christmas and New Year in orbit.
Expedition 72 crew members explored ways to protect the immune and cardiovascular systems in microgravity and tested robotic docking procedures aboard the International Space Station.
Without Earth’s gravity, astronauts’ bodies begin to rapidly change, with numerous changes that medical teams study daily to maintain crew health during long-duration missions. As part of one experiment, the Immunity Assay, blood and saliva samples are collected from crew members for processing and storage in scientific freezers. The samples are then returned to Earth for analysis, which can identify space-induced cellular stress and tissue damage, potentially leading to the development of treatments for crews. JAXA (Japan Aerospace Exploration Agency) flight engineer Takuya Onishi contributed his samples to the study, which could help researchers prevent stress-related immune disorders in space and on Earth.
Station commander Alexey Ovchinin and flight engineer Ivan Vagner, both Roscosmos cosmonauts, continued their research in space biology, studying how blood flows from the brain to the extremities in microgravity. They took turns wearing sensors attached to their foreheads, fingers, and toes, which showed how the circulatory system adapts to spaceflight. The experienced cosmonauts are undergoing a week-long study, expanding the doctors’ extensive knowledge of space medicine, which they will use to protect crews embarking on long-distance missions.
Northrop Grumman’s Cygnus spacecraft is pictured moments after separating from the Canadarm2 robotic arm during the International Space Station’s flight over the South Pacific Ocean on January 31, 2020. NASA
Nutrition plays a vital role in maintaining astronaut health and optimal performance before, during, and after a mission. Food also plays a psychosocial role during an astronaut’s extended stay aboard the space station. Experts at NASA’s Space Food Systems Laboratory at the Johnson Space Center in Houston develop nutritious and appetizing meals. Crew members also have the opportunity to customize the menu with their favorite dishes and prepared foods to help them feel at home.
NASA nutritionists and scientists specializing in nutritional biochemistry determine the nutrients (vitamins, minerals, calories) astronauts need during their time in space. This team tracks each crew member’s diet using a special tablet app, which each astronaut completes daily. Data from the app is sent weekly to nutritionists for dietary monitoring. Analysis of astronauts’ blood and urine samples taken before, during, and after spaceflight is a crucial part of studying their bodies’ responses to the unique conditions of spaceflight. These samples provide valuable information about each astronaut’s adaptation to microgravity, radiation, and other factors that affect human physiology in space.
NASA astronaut and Expedition 71 flight engineer Tracy S. Dyson displays food bags from JAXA (the Japan Aerospace Exploration Agency) in the galley of the International Space Station’s Unity module. NASA
What happens if a medical emergency arises on the space station?
All astronauts undergo medical training and are in regular contact with a team of doctors who closely monitor their condition on Earth. NASA also maintains a well-equipped pharmacy and a range of medical equipment on board the space station to treat various illnesses and injuries. If a medical emergency requires a return to Earth, the crew will return aboard the spacecraft launched on board for emergency medical care on Earth.
Before each mission, astronauts undergo a series of medical tests to determine their pre-flight health status, using key parameters including aerobic fitness, agility, strength, and endurance. These pre-flight measurements and regular health monitoring onboard the space station help NASA Astronaut Strength and Conditioning Research (ASCR) specialists adjust and adapt the astronauts’ training programs to optimize their performance.
Recovery begins on the first day after returning to Earth with a medical examination and a gradual implementation of exercises that improve mobility, balance, flexibility, aerobic fitness, strength, endurance, and the body’s ability to sense position and movement. Returning astronauts undergo the same pre-flight tests to assess their health. These results are used to develop an individualized recovery program that allows for a safe and gradual return to their pre-flight physical performance. ASCRs develop an individualized rehabilitation plan based on the astronaut’s condition, test results, and health status. As crew members progress through the post-flight program, every aspect of their functional recovery is carefully monitored and addressed to ensure a smooth transition to everyday life and prepare them for future missions.
Post-flight rehabilitation is individualized for each astronaut. While most crew members achieve their pre-flight baseline fitness level within the first 45 days of returning to Earth, NASA often extends rehabilitation programs to suit the astronaut’s specific needs and recovery pace.
NASA astronaut and Expedition 72 flight engineer Nick Hague pedals the cycle ergometer with the Ceviation Isolation and Stabilization System (CEVIS) installed aboard the International Space Station’s Destiny laboratory module. The CEVIS provides aerobic and cardiovascular exercise in a reclined or standing position. NASA
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