How to Stay Healthy at 17,500 mph: A Space Doctor's Insight

An Interview With Frank Rubio, MD

Interviewer: Melissa Walton-Shirley, MD; Interviewee: Frank Rubio, MD


May 17, 2023

This transcript has been edited for clarity.

Houston: Station, this is Houston. Are you ready for the event?

Frank Rubio, MD: Houston, this is station. We are ready for the event.

Melissa Walton-Shirley, MD: Hi. I'm Melissa Walton-Shirley with Medscape, and I'm so excited you're joining us today for our interview with Dr Frank Rubio. We linked directly for video with Dr Rubio through the International Space Station, Houston, and New York. Then you're going to hear my voice; I'm on audio only because it's a landline link that I had to access through our community church.

I hope you'll enjoy this interview. It was a great, uplifting look at everyday life at the International Space Station.

This is Dr Melissa Walton-Shirley with Medscape, and I'm excited to speak with Dr Frank Rubio, astronaut and physician who's coming to us live from the International Space Station. Welcome, Frank, and thank you for your time.

Rubio: Well, thank you so much. It's an honor to spend some time with you guys. I've used Medscape for years, so it's great to finally meet you.

Walton-Shirley: Thank you. During your now over 200 days in space, has your background as a board-certified family physician and flight surgeon proven useful for your work on the space station?

Rubio: Well, you know having a physician on board always brings some peace of mind. We do have a full medical suite up here and can treat up to Advanced Cardiac Life Support (ACLS) protocol. But fortunately, I haven't really had to use many of my medical skills. All of my crewmates are incredibly healthy. We all tend to stay in pretty good shape. You're always ready for the worst but hope to never have to use even the least of our skills up here.

Staying Physically and Mentally Healthy

Walton-Shirley: Could you describe some general measures to ensure both good physical and mental health for astronauts in space? For example, what is your daily fitness routine, Frank?

Rubio: Some of the processes that we see in space tend to mimic medical processes that we see in humans as we get older, but they tend to happen a lot quicker here in space, the major ones being bone loss and muscle density loss. So we do tend to spend quite a bit of time doing resistance training, weightlifting essentially. But you can't lift weights in space, so we use two large pistons to create resistance.

Astronaut Doug Wheelock demonstrates a squat on the International Space Station.

Every day we do about 2 hours of fitness routine — about an hour of resistance training, lots of lower body [work], because those femurs that produce the vast majority of our blood tend to suffer the most loss, our hips and femurs. We do a lot of lower-body exercises: squats, deadlifts, and things like that. And then we spend about 45 minutes on either the treadmill or a stationary bike and get our cardiovascular workout. Every day seems like a lot, but because you're not walking around and you're not bearing your weight, your body tends to recover much quicker, so you're able to work out on a much more consistent basis up here.

Walton-Shirley: Are you able to communicate with your family on a daily basis? Is there also video and audio capability to help you feel as if you're closer to home?

Rubio: The team does a great job of supporting us on that. Every week, we have an allotted time to spend with our family, and we call those family conferences. And we just recently started using a video conferencing capability, and that's proven to be a great boost for our mental health. We stay much more connected. There's something about seeing your loved ones on screen vs just hearing them on the phone. And we can use that almost on a daily basis.

We do stay pretty busy up here. Our workday tends to be about 12 hours, but that includes some meal time and that workout time that we talked about. But still, most of us try to block out 10-20 minutes to stay in touch with our loved ones almost daily. That really does help with our time up here. But we also have a family up here in space. We call them our space family — that's our crewmates. They've become some of my best friends. Fortunately, some of them were already among my best friends. It makes it really easy to get along and just have a great time together up here.

Walton-Shirley: Fantastic. Some of our readers wanted to know what type of blood tests are performed regularly on astronauts at the space station.

Rubio: Well, quite a bit. We are trying to establish a baseline for the physiologic effects that space has on humans. Unfortunately, there haven't been many astronauts, as you know, for any study to have power. We need more and more subjects.

Because of that, almost all of us get the full gamut of blood tests while we're up here. The tests get drawn up here, but they don't necessarily get run up here. We tend to send most of our samples back, either frozen or ambient. Then the labs down at NASA will store some of the samples for a long-term study and also study them as we go. So really, almost any test that you can think of, we tend to get up here.

Walton-Shirley: As you know, the Artemis Project will eventually take humans to Mars. What do you foresee as the greatest danger to human health during extended and deeper space travel?

Rubio: As always, unfortunately, you know, once we leave the protector field, the protective electromagnetic field that the Earth provides, that exposes us to a tremendous amount of radiation. And the further we get away from Earth, the more that has an effect on us. That's probably the number one overall risk factor that we face.

Microgravity in and of itself obviously provides risk, like we talked about, to our bone health and our muscle density health. Isolation, as you alluded to, tends to be a factor for our mental health. And for our loved ones dealing with the risks that we expose ourselves to. I think most of us see this job as tremendous fun and a great opportunity. But the reality is that despite all the amazing work that the ground teams do, we still face tremendous risks. I think it's important for our families and loved ones to learn how to cope with those risks and also for us to help them deal with those risks as we travel deeper into space.

NASA does an amazing job of breaking down any risk, whether it's an engineering risk or a medical risk. We break it down into the smallest blocks possible and mitigate everywhere that we can. So despite the tremendously dangerous environment that we operate in — the rockets that we work in and the places that we go — the reality is that it's an incredibly safe job because we have incredible support from the ground teams and the engineering teams that are part of the NASA family.

Potential Benefits for Medicine

Walton-Shirley: Frank, could you take one specific future medical benefit that may affect us terrestrials that you might obtain from your work through the International Space Station or even from Artemis? What specific one are you most excited about?

Rubio: We're looking at some really cool things recently. There are two that I've been most excited about. We recently had a biofabrication machine up here; essentially, we're 3D-printing human tissues. We're starting with some very basic tissues, like meniscus. But eventually the goal would be to use that type of technology to possibly print human organs. The fact that we can do that in microgravity and remove the sedimentary effects, the convective effects that the environment down on Earth has on those processes, we could possibly produce much higher-quality organs. Now, there's still a lot of challenges as far as transportation, both up and down from space, But we're starting to slowly make progress toward that real possibility.

The other thing that we look at is crystal growth. Again because we are able to remove some of those forces that we experience on Earth, we can manufacture much higher-quality crystals up here in space. I think that will have an effect on the medicines that we can create — much more stable medicines that maybe are more resistant to heat and will see less degradation over time. And I think that will make much higher-quality medicines available to a greater portion of the population down on earth. Those type of things are pretty promising for what benefits space can provide for people back on Earth.

Walton-Shirley: Well, Frank, hopefully you'll be home soon and reunited with your family, friends, and your earthbound colleagues. I want to thank you for your service to our country and, more accurately, for your service to humanity. This is Dr Melissa Walton-Shirley, signing off for Medscape.

Rubio: Dr Walton-Shirley, it was an honor. Thank you so much for your time. Take care.

Houston: Station, this is Houston. That concludes the Medscape Cardiology portion of the event.

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