Post Flight Reconditioning for US Astronauts Returning from the International Space Station

Prior to spaceflight, each astronaut undergoes medical requirement testing to establish a preflight baseline for physiologic functions. Astronauts returning from the International Space Station can experience deficits in all or some of the following areas: aerobic capacity, muscular strength, power, endurance, stamina, bone, balance, agility, coordination, orthostatic tolerances, proprioception, neurovestibular function and flexibility. These losses occur from living in microgravity and are consistent with deficits seen in terrestrial, de-conditioning individuals. Since 2001, the Astronaut Strength, Conditioning and Rehabilitation (ASCR) specialists have administered a reconditioning program, focusing on all deficits, which improves the physical condition of all returning astronauts. In most cases, astronauts have reached or surpassed their preflight physical condition. Purpose: This presentation will describe and explain the postflight reconditioning program for returning astronauts. Methods: The postflight reconditioning program is designed to stress the body systems that affect the following: aerobic capacity, muscular strength, power, endurance, stamina, bone, balance, agility, coordination, orthostatic tolerances, proprioception, neurovestibular function and flexibility. Postflight reconditioning begins on landing day, is scheduled for two hours per day, 7 days a week for 45 days and is tailored to the specific needs of the astronaut. Initially the program focuses on basic ambulation, cardiovascular endurance, strength, balance, flexibility and proprioception. The program advances through 45 days and specific attention is given to each astronaut s overall condition, testing results, medical status, and assigned duties after their mission. Conclusion: Astronauts will experience noticeable deficits in their physical condition after living in microgravity for an extended length of time. After completing postflight reconditioning, it is shown that astronauts have regained, and in most cases improved upon, their preflight baseline condition

Preflight and In-Flight Exercise Conditions for Astronauts on the International Space Station

The physiological demands of spaceflight require astronauts to have certain physical abilities. They must be able to perform routine and off-nominal physical work during flight and upon re-entry into a gravity environment to ensure mission success, such as an Extra Vehicular Activity (EVA) or emergency egress. To prepare the astronauts for their mission, a Wyle Astronaut Strength Conditioning and Rehabilitation specialist (ASCR) works individually with the astronauts to prescribe preflight strength and conditioning programs and in-flight exercise, utilizing Countermeasure Systems (CMS) exercise hardware. PURPOSE: To describe the preflight and in-flight exercise programs for ISS crewmembers. METHODS: Approximately 2 years before a scheduled launch, an ASCR is assigned to each astronaut and physical training (PT) is routinely scheduled. Preflight PT of astronauts consists of carrying out strength, aerobic and general conditioning, employing the principles of periodization. Exercise programs are prescribed to the astronauts to account for their individual fitness levels, planned mission-specific tasks, areas of concern, and travel schedules. Additionally, astronauts receive instruction on how to operate CMS exercise hardware and receive training for microgravity-specific conditions. For example, astronauts are scheduled training sessions for the International Space Station (ISS) treadmill (TVIS) and cycle ergometer (CEVIS), as well as the Advanced Resistive Exercise Device (ARED). In-flight programs are designed to maintain or even improve the astronauts pre-flight levels of fitness, bone health, muscle strength, power and aerobic capacity. In-flight countermeasure sessions are scheduled in 2.5 h blocks, six days a week, which includes 1.5 h for resistive training and 1 h for aerobic exercise. CONCLUSIONS: Crewmembers reported the need for more scheduled time for preflight training. During flight, crewmembers have indicated that the in-flight exercise is sufficient, but would like more reliable and capable hardware

Multiancestry association study identifies new asthma risk loci that colocalize with immune-cell enhancer marks.

We examined common variation in asthma risk by conducting a meta-analysis of worldwide asthma genome-wide association studies (23,948 asthma cases, 118,538 controls) of individuals from ethnically diverse populations. We identified five new asthma loci, found two new associations at two known asthma loci, established asthma associations at two loci previously implicated in the comorbidity of asthma plus hay fever, and confirmed nine known loci. Investigation of pleiotropy showed large overlaps in genetic variants with autoimmune and inflammatory diseases. The enrichment in enhancer marks at asthma risk loci, especially in immune cells, suggested a major role of these loci in the regulation of immunologically related mechanisms

Multiancestry association study identifies new asthma risk loci that colocalize with immune-cell enhancer marks

We examined common variation in asthma risk by conducting a meta-analysis of worldwide asthma genome-wide association studies (23,948 asthma cases, 118,538 controls) of individuals from ethnically diverse populations. We identified five new asthma loci, found two new associations at two known asthma loci, established asthma associations at two loci previously implicated in the comorbidity of asthma plus hay fever, and confirmed nine known loci. Investigation of pleiotropy showed large overlaps in genetic variants with autoimmune and inflammatory diseases. The enrichment in enhancer marks at asthma risk loci, especially in immune cells, suggested a major role of these loci in the regulation of immunologically related mechanisms

Management of coronary disease in patients with advanced kidney disease

BACKGROUND Clinical trials that have assessed the effect of revascularization in patients with stable coronary disease have routinely excluded those with advanced chronic kidney disease. METHODS We randomly assigned 777 patients with advanced kidney disease and moderate or severe ischemia on stress testing to be treated with an initial invasive strategy consisting of coronary angiography and revascularization (if appropriate) added to medical therapy or an initial conservative strategy consisting of medical therapy alone and angiography reserved for those in whom medical therapy had failed. The primary outcome was a composite of death or nonfatal myocardial infarction. A key secondary outcome was a composite of death, nonfatal myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. RESULTS At a median follow-up of 2.2 years, a primary outcome event had occurred in 123 patients in the invasive-strategy group and in 129 patients in the conservative-strategy group (estimated 3-year event rate, 36.4% vs. 36.7%; adjusted hazard ratio, 1.01; 95% confidence interval [CI], 0.79 to 1.29; P=0.95). Results for the key secondary outcome were similar (38.5% vs. 39.7%; hazard ratio, 1.01; 95% CI, 0.79 to 1.29). The invasive strategy was associated with a higher incidence of stroke than the conservative strategy (hazard ratio, 3.76; 95% CI, 1.52 to 9.32; P=0.004) and with a higher incidence of death or initiation of dialysis (hazard ratio, 1.48; 95% CI, 1.04 to 2.11; P=0.03). CONCLUSIONS Among patients with stable coronary disease, advanced chronic kidney disease, and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of death or nonfatal myocardial infarction

Health status after invasive or conservative care in coronary and advanced kidney disease

BACKGROUND In the ISCHEMIA-CKD trial, the primary analysis showed no significant difference in the risk of death or myocardial infarction with initial angiography and revascularization plus guideline-based medical therapy (invasive strategy) as compared with guideline-based medical therapy alone (conservative strategy) in participants with stable ischemic heart disease, moderate or severe ischemia, and advanced chronic kidney disease (an estimated glomerular filtration rate of <30 ml per minute per 1.73 m2 or receipt of dialysis). A secondary objective of the trial was to assess angina-related health status. METHODS We assessed health status with the Seattle Angina Questionnaire (SAQ) before randomization and at 1.5, 3, and 6 months and every 6 months thereafter. The primary outcome of this analysis was the SAQ Summary score (ranging from 0 to 100, with higher scores indicating less frequent angina and better function and quality of life). Mixed-effects cumulative probability models within a Bayesian framework were used to estimate the treatment effect with the invasive strategy. RESULTS Health status was assessed in 705 of 777 participants. Nearly half the participants (49%) had had no angina during the month before randomization. At 3 months, the estimated mean difference between the invasive-strategy group and the conservative-strategy group in the SAQ Summary score was 2.1 points (95% credible interval, 120.4 to 4.6), a result that favored the invasive strategy. The mean difference in score at 3 months was largest among participants with daily or weekly angina at baseline (10.1 points; 95% credible interval, 0.0 to 19.9), smaller among those with monthly angina at baseline (2.2 points; 95% credible interval, 122.0 to 6.2), and nearly absent among those without angina at baseline (0.6 points; 95% credible interval, 121.9 to 3.3). By 6 months, the between-group difference in the overall trial population was attenuated (0.5 points; 95% credible interval, 122.2 to 3.4). CONCLUSIONS Participants with stable ischemic heart disease, moderate or severe ischemia, and advanced chronic kidney disease did not have substantial or sustained benefits with regard to angina-related health status with an initially invasive strategy as compared with a conservative strategy

Health-status outcomes with invasive or conservative care in coronary disease

BACKGROUND In the ISCHEMIA trial, an invasive strategy with angiographic assessment and revascularization did not reduce clinical events among patients with stable ischemic heart disease and moderate or severe ischemia. A secondary objective of the trial was to assess angina-related health status among these patients. METHODS We assessed angina-related symptoms, function, and quality of life with the Seattle Angina Questionnaire (SAQ) at randomization, at months 1.5, 3, and 6, and every 6 months thereafter in participants who had been randomly assigned to an invasive treatment strategy (2295 participants) or a conservative strategy (2322). Mixed-effects cumulative probability models within a Bayesian framework were used to estimate differences between the treatment groups. The primary outcome of this health-status analysis was the SAQ summary score (scores range from 0 to 100, with higher scores indicating better health status). All analyses were performed in the overall population and according to baseline angina frequency. RESULTS At baseline, 35% of patients reported having no angina in the previous month. SAQ summary scores increased in both treatment groups, with increases at 3, 12, and 36 months that were 4.1 points (95% credible interval, 3.2 to 5.0), 4.2 points (95% credible interval, 3.3 to 5.1), and 2.9 points (95% credible interval, 2.2 to 3.7) higher with the invasive strategy than with the conservative strategy. Differences were larger among participants who had more frequent angina at baseline (8.5 vs. 0.1 points at 3 months and 5.3 vs. 1.2 points at 36 months among participants with daily or weekly angina as compared with no angina). CONCLUSIONS In the overall trial population with moderate or severe ischemia, which included 35% of participants without angina at baseline, patients randomly assigned to the invasive strategy had greater improvement in angina-related health status than those assigned to the conservative strategy. The modest mean differences favoring the invasive strategy in the overall group reflected minimal differences among asymptomatic patients and larger differences among patients who had had angina at baseline