PURPOSE: This study aimed to comprehensively evaluate the physiological challenges posed by microgravity on the neuromuscular and cardiovascular systems of astronauts and to assess exercise-based countermeasures designed to mitigate these effects during longduration spaceflight.METHODS: We conducted a structured review of over 70 peer-reviewed studies on spaceflight missions, ground-based analogs, and exercise intervention trials. Findings related to musculoskeletal atrophy, cardiovascular deconditioning, and neurovestibular adaptations were analyzed, with special emphasis on the efficacy of resistance, aerobic, and sensorimotor training regimens, as well as wearable technologies and physiological monitoring strategies used on the International Space Station.RESULTS: Microgravity induced significant muscle atrophy, bone mineral loss, cardiovascular fluid shift, autonomic dysregulation, and sensorimotor deficits. Resistance training using devices such as ARED has been shown to attenuate muscle and bone loss, whereas aerobic training with equipment such as CEVIS helped preserve VO2peak. Sensorimotor exercises improved postflight postural stability. Wearable monitoring systems facilitated real-time health data tracking, allowing personalized adjustments to exercise protocols.CONCLUSIONS: Exercise is the most effective and multifaceted countermeasure against microgravity-induced deconditioning. Future countermeasure strategies should integrate individualized exercise regimens with real-time physiological monitoring, artificial intelligence-supported prediction, and adaptive systems to optimize astronaut health during prolonged missions, particularly beyond the low Earth orbit.
Kim et al. (Thu,) studied this question.