PRESERVE THE MUSCLE

Z. Ceyhan, R. Feiner, L. Fellner, Z. Islam, M. Juen, H. Pirhan-Özer, P. Wegscheider, D. Zimmermann

BACKGROUND
In the next 10 to 15 years a group of astronauts will be sent to the surface of mars. The mission is about 450 days long. During such a long
period of time in space, the astronauts must contend with one major problem and that is muscle atrophy. Muscle atrophy is the
pathological loss of muscle mass and the associated loss of muscle size [1]. Due to the lack of gravity in space, especially the leg
muscles are less stressed, because they do not have to counteract against the Earth's gravitational pull, and thus they are more strongly
and more quickly degraded [2]. Another reason that is important in this context is that, due to the reduced load, protein synthesis, which
is responsible for cell growth, decreases [3]. A possible third reason, which is often discussed, is the reduced level of growth hormones
and the increase of glucocorticoids [4]. To enable longer space missions, Preserve the Muscle presents several approaches to counteract
the loss of muscle mass.

MEASUREMENT TRAINING
• Precise measurements of atrophy progression • Astronauts need keep their functional fitness
• Payload restrictions limit available devices high during missions [9]
• For establishing a reliable baseline on Earth: • Current training devices:
◦ Dual energy x-ray absorptiometry (DEXA) [5] ◦ CEVIS (Cycle ergometer) [9]
◦ Computed tomography (CT) [5] ◦ ARED (Resisted lifting exercises) [9]
◦ Magnetic resonance imaging (MRI) [5] ◦ T2 (Treadmill) [9]
[6] • Features are comparable to conventional models
• During the mission: on ground [9]
◦ Bioimpedance analysis (BIA): fast, widespread yet fairly • Proven partially effective in countering atrophy
inaccurate [5] [10]
◦ Ultrasonography: already available on ISS, precise
measurements of thickness and volume of muscles [6, 7, 8] • NASA's Sprint study tested efficacy of high-
• Suggestion: Frequent use of BIA with regular ultrasonography intensity/low-volume training (HIT) [11] [9]
checks • Able to reduce training time for same effect [11]

STIMULATION STEROIDS
• Functional and neuromuscular electrical • Anabolic androgenic steroids (AAS) are a synthetic version of
stimulation (FES, NMES) testosterone
• Type II fibers more prone to atrophy [12, 13] • Build large amounts of muscle in minimal time [15]
• Inverse recruitment ➔ Type II fibers stimulated • NASA found positive outcome after 70-day bedrest study [16]
first [12, 13]
• But potential for several complications:
• Proven to combat atrophy after surgery or ◦ Cardiovascular complications [15]
neurological disease [12] ◦ Infertility [15]
• Ideally combined with functional training [12] ◦ Cognitive and behavioral changes (especially aggression)
• MYOSTIM study showed a reduction of atrophy [17, 18]
with the use of electrode trousers [14]
• AAS effective against atrophy but side effects need to be
• Suggestion: Develop the concept and minimized
investigate combination with HIT [14]

CONCLUSION
It is paramount to any long-term space mission to preserve enough muscle and functional fitness to fulfill the mission parameters. We rest
our proposed solution on four pillars: Precise measurements of muscle function and strength pre-, peri- and postflight enable us to
personalize our approach to the individual astronaut. Training devices like the ARED or CEVIS allow astronauts to do compensatory
workouts, which can be refined using state of the art training regimes like HIT. The effect of these workouts can be maximized by
additionally targeting known, atrophy-prone muscle groups with FES or NMES. Finally, we want to utilize the positive, growth-stimulating
effects of AAS to counteract atrophy at a cellular level. Due to the potential of negative physiological and behavioral side-effects the doses
must be kept at a minimum and tests about the individual astronaut’s tolerance should be performed preflight.

In conclusion, Preserve the Muscle is truly an interdisciplinary challenge and scientists across all relevant fields need to work in unison to
accomplish our vision of safe extended space exploration.

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