High-intensity exercise does not protect against orthostatic intolerance following bedrest in 55- to 65-yr-old men and women.

Prolonged bedrest provokes orthostatic hypotension and intolerance of upright posture. Limited data are available on the cardiovascular responses of older adults to head-up tilt following bedrest, with no studies examining the potential benefits of exercise to mitigate intolerance in this age group. This randomized controlled trial of head-down bedrest (HDBR) in 55- to 65-yr-old men and women investigated if exercise could avert post-HDBR orthostatic intolerance. Twenty-two healthy older adults (11 female) underwent a strict 14-day HDBR and were assigned to either an exercise (EX) or control (CON) group. The exercise intervention included high-intensity, aerobic, and resistance exercises. Head-up tilt-testing to a maximum of 15 minutes was performed at baseline (Pre-Bedrest) and immediately after HDBR (R1), as well as 6 days (R6) and 4 weeks (R4wk) later. At Pre-Bedrest, three participants did not complete the full 15 minutes of tilt. At R1, 18 did not finish, with no difference in tilt end time between CON (422 ± 287 s) and EX (409 ± 346 s). No differences between CON and EX were observed at R6 or R4wk. At R1, just 1 participant self-terminated the test with symptoms, while 12 others reported symptoms only after physiological test termination criteria were reached. Finishers on R1 protected arterial pressure with higher total peripheral resistance relative to Pre-Bedrest. Cerebral blood velocity decreased linearly with reductions in arterial pressure, end-tidal CO2, and cardiac output. High-intensity interval exercise did not benefit post-HDBR orthostatic tolerance in older adults. Multiple factors were associated with the reduction in cerebral blood velocity leading to intolerance.

Dynamic Countermeasure Fabrics for Post-Spaceflight Orthostatic Intolerance.

INTRODUCTION: Aerospace orthostatic intolerance garments (OIG) have historically been pneumatic (e.g., NASA's antigravity suit), an approach that inhibits mobility and requires connection to an air supply. Elastic compression garments, an alternative technology, are difficult to don/doff and cannot be worn in a noncompressive state, resulting in discomfort and usability challenges. This research evaluates a novel technology-contractile shape memory alloy (SMA) knitted actuators-that can enable low-profile, dynamic compression for an aerospace OIG.METHODS: To characterize the functional capabilities of SMA knitted actuators, displacement control testing was conducted on 10 actuator samples with a range of geometric design parameters. Inactive (FI) and actuated forces (FA) were observed by repeatedly thermally cycling each sample at 0%, 15%, 30%, and 45% structural strain. Compression capabilities were approximated using medical compression hosiery standards and anthropometric data from a representative aerospace population (ANSUR 2012).RESULTS: Dynamic compression predictions reached 52 mmHg (single layer fabric) and 105 mmHg (double layer fabric) at the ankle. Low, inactive pressures (p < 20 mmHg) demonstrate that compression is controllable and can be dynamically increased upon actuation up to 33 mmHg in a single layer system and up to 67 mmHg in a double layer system.DISCUSSION: The results highlight the potential of SMA knitted actuators to enable low-profile, dynamic compression garments that can reach medically therapeutic pressures on an aerospace population to counteract OI symptoms. In addition to astronautic applications, this technology demonstrates widespread terrestrial medical and high-performance aircraft applicability.Granberry RM, Eschen KP, Ross AJ, Abel JM, Holschuh BT. Dynamic countermeasure fabrics for post-spaceflight orthostatic intolerance. Aerosp Med Hum Perform. 2020; 91(6):525-531.

Acute reduction in posterior cerebral blood flow following isometric handgrip exercise is augmented by lower body negative pressure.

The mechanism(s) for the increased occurrence of a grayout or blackout, syncope, immediately after heavy resistance exercise are unclear. It is well-known that orthostatic stress increases the occurrence of postexercise syncope. In addition, previous findings have suggested that hypo-perfusion, especially in the posterior cerebral circulation rather than anterior cerebral circulation, may be associated with the occurrence of syncope. Herein, we hypothesized that the postexercise decrease in posterior, but not anterior, cerebral blood flow (CBF) would be greater during orthostatic stress. Nine healthy subjects performed 3-min isometric handgrip (HG) at 30% maximum voluntary contraction without (CONTROL) and during lower body negative pressure (LBNP; -40 Torr) while vertebral artery (VA) blood flow, as an index of posterior CBF, and middle cerebral artery blood velocity (MCAv), as an index of anterior CBF, were measured. Immediately after HG (0 to 15 sec of recovery phase), mean arterial pressure decreased but there was no difference in this reduction between CONTROL and LBNP conditions (-15.4 ± 4.0% and -17.0 ± 6.2%, P = 0.42). Similarly, MCAv decreased following exercise and was unaffected by the application of LBNP (P = 0.22). In contrast, decreases in VA blood flow immediately following HG during LBNP were significantly greater compared to CONTROL condition (-24.2 ± 9.5% and -13.4 ± 6.6%, P = 0.005). These findings suggest that the decrease in posterior CBF immediately following exercise was augmented by LBNP, whereas anterior CBF appeared unaffected. Thus, the posterior cerebral circulation may be more sensitive to orthostatic stress during the postexercise period.

Improvement in low upright baroreflex sensitivity is associated with positive clinical effect of orthostatic training.

AIM: To assess the clinical efficacy of orthostatic training (OT) and its effect on the autonomic activity. METHODS: OT was performed in 38 patients (13 males, age 36.4 ± 15.2 years). Baroreflex sensitivity (BRS), heart rate variability, and quality of life (SF 36) were assessed before and after 6 months of OT. Patients with no recurrence of syncope and reduction of the presyncope number to one-third or less were classified as responders. RESULTS: Compliance to OT was low. Only 55% (38 from 69 patients) completed the training programme; 28 patients were responders (74%) and 10 patients were nonresponders. Before OT, BRS in upright position was lower in responders than in nonresponders (sitting: 8.05 ± 3.94 ms/mm Hg vs 12.51 ± 5.3 ms/mm Hg, P = 0.04, standing: 5.08 ± 2.34 ms/mm Hg vs 7.54 ± 2.16 ms/mm Hg, P = 0.02). After OT, BRS increased in responders (sitting: 8.05 ± 3.94 ms/mm Hg to 9.31 ± 4.49 ms/mm Hg, P = 0.05; standing: 5.08 ± 2.34 ms/mm Hg to 5.96 ± 2.38 ms/mm Hg, P = 0.03). No differences in supine BRS were observed. In responders, low frequency (LF) and high frequency (HF) power in sitting and standing positions significantly increased after OT (P < 0.05). In nonresponders, there was no significant rise in BRS, LF, and HF after OT. A significant increase in quality of life was noted in responders, but not in nonresponders. CONCLUSIONS: OT reduced symptoms in 74% patients who trained regularly. However, the compliance to training was low. Possible mechanism of OT is reconditioning effect on baroreceptor reactivity in upright position.

Morphing Compression Garments for Space Medicine and Extravehicular Activity Using Active Materials.

INTRODUCTION: Compression garments tend to be difficult to don/doff, due to their intentional function of squeezing the wearer. This is especially true for compression garments used for space medicine and for extravehicular activity (EVA). We present an innovative solution to this problem by integrating shape changing materials-NiTi shape memory alloy (SMA) coil actuators formed into modular, 3D-printed cartridges-into compression garments to produce garments capable of constricting on command. METHODS: A parameterized, 2-spring analytic counterpressure model based on 12 garment and material inputs was developed to inform garment design. A methodology was developed for producing novel SMA cartridge systems to enable active compression garment construction. Five active compression sleeve prototypes were manufactured and tested: each sleeve was placed on a rigid cylindrical object and counterpressure was measured as a function of spatial location and time before, during, and after the application of a step voltage input. RESULTS: Controllable active counterpressures were measured up to 34.3 kPa, exceeding the requirement for EVA life support (29.6 kPa). Prototypes which incorporated fabrics with linear properties closely matched analytic model predictions (4.1%/-10.5% error in passive/active pressure predictions); prototypes using nonlinear fabrics did not match model predictions (errors >100%). Pressure non-uniformities were observed due to friction and the rigid SMA cartridge structure. DISCUSSION: To our knowledge this is the first demonstration of controllable compression technology incorporating active materials, a novel contribution to the field of compression garment design. This technology could lead to easy-to-don compression garments with widespread space and terrestrial applications.

Breathing 100% oxygen during water immersion improves postimmersion cardiovascular responses to orthostatic stress.

Physiological compensation to postural stress is weakened after long-duration water immersion (WI), thus predisposing individuals to orthostatic intolerance. This study was conducted to compare hemodynamic responses to postural stress following exposure to WI alone (Air WI), hyperbaric oxygen alone in a hyperbaric chamber (O2 HC), and WI combined with hyperbaric oxygen (O2 WI), all at a depth of 1.35 ATA, and to determine whether hyperbaric oxygen is protective of orthostatic tolerance. Thirty-two healthy men underwent up to 15 min of 70° head-up tilt (HUT) testing before and after a single 6-h resting exposure to Air WI (N = 10), O2 HC (N = 12), or O2 WI (N = 10). Heart rate (HR), blood pressure (BP), cardiac output (Q), stroke volume (SV), forearm blood flow (FBF), and systemic and forearm vascular resistance (SVR and FVR) were measured. Although all subjects completed HUT before Air WI, three subjects reached presyncope after Air WI exposure at 10.4, 9.4, and 6.9 min. HUT time did not change after O2 WI or O2 HC exposures. Compared to preexposure responses, HR increased (+10 and +17%) and systolic BP (-13 and -8%), and SV (-16 and -23%) decreased during HUT after Air WI and O2 WI, respectively. In contrast, HR and SV did not change, and systolic (+5%) and diastolic BP (+10%) increased after O2 HC Q decreased (-13 and -7%) and SVR increased (+12 and +20%) after O2 WI and O2 HC, respectively, whereas SVR decreased (-9%) after Air WI Opposite patterns were evident following Air WI and O2 HC for FBF (-26 and +52%) and FVR (+28 and -30%). Therefore, breathing hyperbaric oxygen during WI may enhance post-WI cardiovascular compensatory responses to orthostatic stress.

Oral Midodrine Hydrochloride for Prevention of Orthostatic Hypotension during Early Mobilization after Hip Arthroplasty: A Randomized, Double-blind, Placebo-controlled Trial.

BACKGROUND: Early postoperative mobilization is essential for rapid recovery but may be impaired by orthostatic intolerance (OI) and orthostatic hypotension (OH), which are highly prevalent after major surgery. Pathogenic mechanisms include an insufficient postoperative vasopressor response. The oral α-1 agonist midodrine hydrochloride increases vascular resistance, and the authors hypothesized that midodrine would reduce the prevalence of OH during mobilization 6 h after total hip arthroplasty relative to placebo. METHODS: This double-blind, randomized trial allocated 120 patients 18 yr or older and scheduled for total hip arthroplasty under spinal anesthesia to either 5 mg midodrine hydrochloride or placebo orally 1 h before mobilization at 6 and 24 h postoperatively. The primary outcome was the prevalence of OH (decrease in systolic or diastolic arterial pressures of > 20 or 10 mmHg, respectively) during mobilization 6 h after surgery. Secondary outcomes were OI and hemodynamic responses to mobilization at 6 and 24 h. RESULTS: At 6 h, 14 (25%; 95% CI, 14 to 38%) versus 23 (39.7%; 95% CI, 27 to 53%) patients had OH in the midodrine and placebo group, respectively, relative risk 0.63 (0.36 to 1.10; P = 0.095), whereas OI was present in 15 (25.0%; 15 to 38%) versus 22 (37.3%; 25 to 51%) patients, relative risk 0.68 (0.39 to 1.18; P = 0.165). At 24 h, OI and OH prevalence did not differ between groups. CONCLUSIONS: Preemptive use of oral 5 mg midodrine did not significantly reduce the prevalence of OH during early postoperative mobilization compared with placebo. However, further studies on dose and timing are warranted since midodrine is effective in chronic OH conditions.

Effects of individualized centrifugation training on orthostatic tolerance in men and women.

AIMS: Exposure to artificial gravity (AG) at different G loads and durations on human centrifuges has been shown to improve orthostatic tolerance in men. However, the effects on women and of an individual-specific AG training protocol on tolerance are not known. METHODS: We examined the effects of 90 minutes of AG vs. 90 minutes of supine rest on the orthostatic tolerance limit (OTL), using head up tilt and lower body negative pressure until presyncope of 7 men and 5 women. Subjects were placed in the centrifuge nacelle while instrumented and after one-hour they underwent either: 1) AG exposure (90 minutes) in supine position [protocol 1, artificial gravity exposure], or 2) lay supine on the centrifuge for 90 minutes in supine position without AG exposure [protocol 2, control]. The AG training protocol was individualized, by first determining each subject's maximum tolerable G load, and then exposing them to 45 minutes of ramp training at sub-presyncopal levels. RESULTS: Both sexes had improved OTL (14 minutes vs 11 minutes, p < 0.0019) following AG exposure. When cardiovascular (CV) variables at presyncope in the control test were compared with the CV variables at the same tilt-test time (isotime) during post-centrifuge, higher blood pressure, stroke volume and cardiac output and similar heart rates and peripheral resistance were found post-centrifuge. CONCLUSIONS: These data suggest a better-maintained central circulating blood volume post-centrifugation across gender and provide an integrated insight into mechanisms of blood pressure regulation and the possible implementation of in-flight AG countermeasure profiles during spaceflights.

Perturbed and spontaneous regional cerebral blood flow responses to changes in blood pressure after high-level spinal cord injury: the effect of midodrine.

Individuals with spinal cord injury (SCI) above the T6 spinal segment suffer from orthostatic intolerance. How cerebral blood flow (CBF) responds to orthostatic challenges in SCI is poorly understood. Furthermore, it is unclear how interventions meant to improve orthostatic tolerance in SCI influence CBF. This study aimed to examine 1) the acute regional CBF responses to rapid changes in blood pressure (BP) during orthostatic stress in individuals with SCI and able-bodied (AB) individuals; and 2) the effect of midodrine (alpha1-agonist) on orthostatic tolerance and CBF regulation in SCI. Ten individuals with SCI >T6, and 10 age- and sex-matched AB controls had beat-by-beat BP and middle and posterior cerebral artery blood velocity (MCAv, PCAv, respectively) recorded during a progressive tilt-test to quantify the acute CBF response and orthostatic tolerance. Dynamic MCAv and PCAv to BP relationships were evaluated continuously in the time domain and frequency domain (via transfer function analysis). The SCI group was tested again after administration of 10 mg midodrine to elevate BP. Coherence (i.e., linearity) was elevated in SCI between BP-MCAv and BP-PCAv by 35% and 22%, respectively, compared with AB, whereas SCI BP-PCAv gain (i.e., magnitudinal relationship) was reduced 30% compared with AB (all P < 0.05). The acute (i.e., 0-30 s after tilt) MCAv and PCAv responses were similar between groups. In individuals with SCI, midodrine led to improved PCAv responses 30-60 s following tilt (10 ± 3% vs. 4 ± 2% decline; P < 0.05), and a 59% improvement in orthostatic tolerance (P < 0.01). The vertebrobasilar region may be particularly susceptible to hypoperfusion in SCI, leading to increased orthostatic intolerance.

Abdomen-high elastic gradient compression garments during post-spaceflight stand tests.

UNLABELLED: Space Shuttle astronauts wore an inflatable antigravity suit during reentry and landing, and astronauts and cosmonauts wear an elastic-compression garment (with lacing) during Soyuz re-entry and landings and in the first few days of recovery. However, neither garment is an ideal countermeasure to spaceflight-induced orthostatic intolerance. Our laboratory has been investigating an elastic graded compression garment (GCG) that applies graduated pressures from the feet to the abdomen for use following International Space Station missions and possibly during exploration missions. METHODS: Before and after Shuttle missions, 14 astronauts participated in a 3.5-min stand test. The stand test was conducted without garments preflight. On landing day, 7 astronauts wore the GCG while 7 astronauts did not (controls). Heart rate and blood pressure were measured in all astronauts during prone rest and standing. Stroke volume and cardiac output were measured only in GCG subjects. RESULTS: No astronauts in either group became presyncopal during the stand test preflight or postflight. The change in heart rate from prone to standing was lower in the GCG subjects on landing day than in the control subjects. Within the GCG subjects only, the increase in total peripheral resistance from prone to standing was higher after spaceflight. CONCLUSIONS: The GCG prevented tachycardia and increased total peripheral resistance with standing after spaceflight. The GCG shows promise as a countermeasure against post-spaceflight orthostatic intolerance, can be easily donned, and is relatively comfortable to wear, but has not been validated after long-duration spaceflight.

The effect of exercise training on left ventricular relaxation and diastolic suction at rest and during orthostatic stress after bed rest.

A marked reduction in upright stroke volume (SV) contributes substantially to orthostatic intolerance after exposure to spaceflight or bed rest. It is unclear whether slowed left ventricular (LV) relaxation and diastolic suction contribute to the reduction in SV or whether these changes are influenced by exercise training while in bed. Twenty-seven healthy adults completed 5 weeks of -6 deg head-down bed rest (HDBR). During HDBR, nine subjects were sedentary (NOEX), while 18 performed near-daily rowing ergometry (EX). Left ventricular mass, SV, LV end-diastolic volume (LVEDV), pulmonary capillary wedge pressure and Doppler ultrasound indices of LV function were collected pre- and post-HDBR during supine rest (twice) and during reduced LV loading (lower body negative pressure; LBNP) and increased LV loading (saline infusion). Post-HDBR, LV mass increased in the EX group, but decreased in the NOEX group. The reduction in SV and LVEDV during supine rest and LBNP were greater with NOEX in comparison to EX after HDBR. Peak early mitral annular velocity, isovolumic relaxation time, early propagation velocity, a non-invasive index of early diastolic filling and ventricular diastolic suction, and peak global longitudinal early strain rate were slowed during supine rest after HDBR with NOEX; however, these variables were either unaltered or the reduction was less prominent with EX. Doppler ultrasound measures of early diastolic filling, ventricular relaxation and diastolic suction were not significantly affected during LV unloading by LBNP after HDBR in either group. All Doppler indices were restored to pre-HDBR levels in both groups during saline infusion to normalize LV filling pressure after HDBR. It is concluded that Doppler indices of dynamic LV filling were reduced in both groups after HDBR; however, these effects were more pronounced in the NOEX group. Irrespective of group, post-HDBR Doppler parameters were restored when LV filling pressure was increased to pre-HDBR levels during saline infusion. Therefore, the reduction in upright SV after HDBR is more influenced by changes in LV loading conditions, namely left atrial pressure in the setting of LV remodelling, rather than ventricular relaxation and diastolic suction.

Update on the theory and management of orthostatic intolerance and related syndromes in adolescents and children.

Orthostasis means standing upright. One speaks of orthostatic intolerance (OI) when signs, such as hypotension, and symptoms, such as lightheadedness, occur when upright and are relieved by recumbence. The experience of transient mild OI is part of daily life. 'Initial orthostatic hypotension' on rapid standing is a normal form of OI. However, other people experience OI that seriously interferes with quality of life. These include episodic acute OI, in the form of postural vasovagal syncope, and chronic OI, in the form of postural tachycardia syndrome. Less common is neurogenic orthostatic hypotension, which is an aspect of autonomic failure. Normal orthostatic physiology and potential mechanisms for OI are discussed, including forms of sympathetic hypofunction, forms of sympathetic hyperfunction and OI that results from regional blood volume redistribution. General and specific treatment options are proposed.

A somatostatin analog improves tilt table tolerance by decreasing splanchnic vascular conductance.

Splanchnic hemodynamics and tilt table tolerance were assessed after an infusion of placebo or octreotide acetate, a somatostatin analog whose vascular effects are largely confined to the splanchnic circulation. We hypothesized that reductions in splanchnic blood flow (SpBF) and splanchnic vascular conductance (SpVC) would be related to improvements in tilt table tolerance. In randomized, double-blind, crossover trials, hemodynamic variables were collected in 14 women and 16 men during baseline, 70° head-up tilt (HUT), and recovery. A repeated-measures analysis of variance was used to compare changes from baseline with respect to sex and condition. HUT elicited an increase in heart rate and decreases in mean arterial pressure, cardiac index, stroke index, and systemic vascular conductance. Additionally, SpVC and non-SpVC were lower during HUT. Octreotide reduced SpBF and SpVC and increased systemic vascular conductance and non-SpVC. Changes in SpBF and SpVC between supine and HUT were smaller in women (P < 0.05). Tilt table tolerance was increased after administration of octreotide [median tilt time: 15.7 vs. 37.0 min (P < 0.05) and 21.8 vs. 45.0 min (P < 0.05) for women and men, respectively]. A significant relationship existed between change (Δ) in SpBF (placebo-octreotide) and Δtilt time in women (Δtilt time = 2.5-0.0083 ΔSpBF, P < 0.01), but not men (Δtilt time = 3.41-0.0008 ΔSpBF, P = 0.59). In conclusion, administration of octreotide acetate improved tilt table tolerance, which was associated with a decrease in SpVC. In women, but not men, the magnitude of reduction in SpBF was positively associated with improvements in tilt tolerance.

Effect of rowing ergometry and oral volume loading on cardiovascular structure and function during bed rest.

This study examined the effectiveness of a short-duration but high-intensity exercise countermeasure in combination with a novel oral volume load in preventing bed rest deconditioning and orthostatic intolerance. Bed rest reduces work capacity and orthostatic tolerance due in part to cardiac atrophy and decreased stroke volume. Twenty seven healthy subjects completed 5 wk of -6 degree head down bed rest. Eighteen were randomized to daily rowing ergometry and biweekly strength training while nine remained sedentary. Measurements included cardiac mass, invasive pressure-volume relations, maximal upright exercise capacity, and orthostatic tolerance. Before post-bed rest orthostatic tolerance and exercise testing, nine exercise subjects were given 2 days of fludrocortisone and increased salt. Sedentary bed rest led to cardiac atrophy (125 ± 23 vs. 115 ± 20 g; P < 0.001); however, exercise preserved cardiac mass (128 ± 38 vs. 137 ± 34 g; P = 0.002). Exercise training preserved left ventricular chamber compliance, whereas sedentary bed rest increased stiffness (180 ± 170%, P = 0.032). Orthostatic tolerance was preserved only when exercise was combined with volume loading (-10 ± 22%, P = 0.169) but not with exercise (-14 ± 43%, P = 0.047) or sedentary bed rest (-24 ± 26%, P = 0.035) alone. Rowing and supplemental strength training prevent cardiovascular deconditioning during prolonged bed rest. When combined with an oral volume load, orthostatic tolerance is also preserved. This combined countermeasure may be an ideal strategy for prolonged spaceflight, or patients with orthostatic intolerance.

Exercise plus volume loading prevents orthostatic intolerance but not reduction in cerebral blood flow velocity after bed rest.

This study tested the hypothesis that reduction in cerebral blood flow (CBF) during orthostatic stress after bed rest can be ameliorated with volume loading, exercise, or both. Transcranial Doppler was used to measure changes in CBF velocity during lower body negative pressure (LBNP) before and after an 18-day bed rest in 33 healthy subjects. Subjects were assigned into four groups with similar age and sex: 1) supine cycling during bed rest (Exercise group; n = 7), 2) volume loading with Dextran infusion after bed rest to restore reduced left ventricular filling pressure (Dextran group; n = 7), 3) exercise combined with volume loading to prevent orthostatic intolerance (Ex-Dex group; n = 7), and 4) a control group (n = 12). LBNP tolerance was measured using a cumulative stress index (CSI). After bed rest, CBF velocity was reduced at a lower level of LBNP in the Control group, and the magnitude of reduction was greater in the Ex-Dex group. However, reduction in orthostatic tolerance was prevented in the Ex-Dex group. Notably, volume loading alone prevented greater reductions in CBF velocity after bed rest, but CSI was reduced still by 25%. Finally, decreases in CBF velocity during LBNP were correlated with reduction in cardiac output under all conditions (r(2) = 0.86; P = < 0.001). Taken together, these findings demonstrate that volume loading alone can ameliorate reductions in CBF during LBNP. However, the lack of associations between changes in CBF velocity and orthostatic tolerance suggests that reductions in CBF during LBNP under steady-state conditions by itself are unlikely to be a primary factor leading to orthostatic intolerance.

Artificial gravity with ergometric exercise can prevent enhancement of popliteal vein compliance due to 4-day head-down bed rest.

Changes of venous compliance may contribute in part to postflight orthostatic intolerance. The purpose of the present study was to determine whether intermittent artificial gravity exposure with ergometric exercise could prevent venous compliance changes in the lower limbs due to simulated weightlessness. Twelve healthy male volunteers were exposed to simulated microgravity for 4 days of head-down bed rest (HDBR). Six subjects were randomly loaded 1.0-2.0 Gz intermittent artificial gravity (at foot level) with 40 W of ergometric workload every day (countermeasure group, CM). The six others served as the control (CON group). Venous compliance was estimated by measuring the corresponding change of cross-sectional area (CSA) of popliteal vein at each minute of various venous occlusion pressure stages. Basal CSA was significantly lower after bed rest in the control group, and preserved in the countermeasure group. The percent increase in the CSA of CON group was significantly greater almost at each minute of various venous cuff pressures after bed rest than before. Compliance of popliteal vein of CON group was significant greater when 40, 60 and 80 mmHg cuff pressure applied after bed rest than before of CON group. In conclusions, a 4-day simulated weightlessness leads to increase of popliteal venous compliance; centrifuge-induced artificial gravity with ergometric exercise can prevent enhancement of popliteal venous compliance due to 4-day head-down tilt bed rest, the effect of the countermeasure on compliance might involve changes in venous filling and changes in venous structure.

[Early post-operative mobilization and orthostatic intolerance]. / Tidlig postoperativ mobilisering og ortostatisk intolerans.

Early mobilization after surgery is crucial for an enhanced recovery and can reduce complications associated with immobility. Symptoms such as nausea, vomiting, blurred vision and dizziness are however known to impede early mobilization. Together these symptoms comprise orthostatic intolerance (OI), in which the ultimate manifestation is syncope. In reference to find preventive and relevant treatment for OI studies with a multimodal approach have shown promising results, though the pathophysiology behind OI is not fully understood.

[Space flight and modeling experiments: new approaches to evaluation and prophylaxis].

The article dwells on the general issues of orthostatic tolerance and new impedance methods of orthostatic test evaluation in spaceflight and simulated microgravity. The results imply that OT requires adequate body hydration and functioning of volume-regulating hormones. New pharmacological compensators of orthostatic intolerance were tested in modeling experiments. It was shown that desmopressin and water-salt supplements retain body liquid and electrolytes during bed rest and improve tolerance of the orthostatic test Therefore, simultaneous control of the hydration status and OT can be best provided through physiologically reasonable prescription of synthetic ADH analogs.

Metabolic consequences of garments worn to protect against post-spaceflight orthostatic intolerance.

INTRODUCTION: Astronauts have worn an inflatable antigravity suit (AGS) during Space Shuttle re-entry and landing to protect against hypotension and syncope, but ambulation with an inflated AGS requires significant effort and may prevent successful completion of an unaided emergency egress from the vehicle. NASA is considering the use of alternative garments to provide protection against post-spaceflight orthostatic intolerance. The purpose of this study was to compare the metabolic cost of walking in NASA's current AGS with that of walking in a commercially available elastic compression garment (thigh-high stockings), a candidate garment for use after exploration missions. METHODS: There were 10 volunteers (5 men, 5 women) who walked on a treadmill at 5.6 km x h(-1) for 5 min, a simulation of unaided egress previously used in our laboratory, in 3 different conditions presented in random order: wearing exercise clothes, wearing elastic compression garments, and wearing the AGS. Oxygen consumption (Vo2), carbon dioxide production (Vco2), and ventilation (V(E)) were compared using repeated-measures ANOVA and Tukey's Honestly Significant Difference test. RESULTS: Vo2 while wearing the AGS was 12% greater than when wearing the elastic compression garments and 15% greater than while wearing exercise clothes. There were no differences between the elastic compression garments and exercise clothes only conditions. Vco2 and VE also were greater while walking in the AGS than walking in the elastic compression garments or exercise clothes. CONCLUSIONS: Wearing elastic compression garments as a countermeasure to post-spaceflight orthostatic intolerance may not impair unaided egress from a space vehicle.