The shocking things 286 days in space does to a human body: As rescued NASA astronauts stun the world with their frail and gaunt appearance, how their bodies have been ravaged by the void

After nine gruelling months in space, NASA’s stranded astronauts have finally returned to Earth.

However, experts warn that Butch Wilmore and Suni Williams’ unplanned stay on the International Space Station (ISS) could have serious health impacts.

Shocking before-and-after images show the terrifying damage that months spent in the harsh conditions in space will do to you.

From ‘chicken legs’ and ‘baby feet’ to an increased risk of deadly cancer, experts warn that the stranded astronauts could face years of health complications. 

As Williams, 59, and Wilmore, 62, emerged from their SpaceX Crew Dragon capsule yesterday, medical teams rushed to help them onto stretchers.

The astronauts will now undergo several days of intensive medical checks at NASA’s Johnson Space Center in Houston.

However, health experts have already noticed signs of physical decline in the stranded astronauts.

And even while they were on the ISS, experts expressed concern over the pair’s gaunt appearance and apparent weight loss.

After nine gruelling months in space, Suni Williams (pictured) and Butch Wilmore have finally returned to Earth. But shocking before-and-after images show the damage that their unintended stay in space has caused 

Even during their time in space, health experts raised concerns that Butch Wilmore (pictured) and Suni Williams were suffering from severe weight loss and muscle atrophy

During their nine months on the ISS, health experts raised concerns over Williams’ ‘gaunt’ appearance. A loss of appetite is common in space due to frequent nausea, sometimes leading to astronauts losing dangerous amounts of weight

The biggest impacts of time in space are caused by exposure to microgravity and intense radiation. Being away from Earth’s pull causes astronauts’ muscles to weaken, leaving them with walking issues upon return

Muscle and bone loss 

The biggest risks associated with an extended time in space come from the exposure to microgravity.

Away from the pull of Earth’s gravity, astronauts’ muscles begin to weaken through lack of work.

Over time this leads to muscle atrophy which leaves astronauts frail upon their return to Earth. 

To combat the effects of living in low gravity, astronauts exercise for at least two hours per day on the ISS. 

But this still isn’t enough to stop muscle and bone loss, doctors told the Daily Mail.

Astronauts who spend long periods of time in low gravity ‘lose musculature, they lose bone density,’ Dr Jaquish said.

‘The human body needs the Earth’s gravitational pull, and in an absence of that, a lot of things are not functioning correctly.’

Time spent in microgravity leads to a loss of muscle and bone mass which can be severe and long-lasting 

Research has shown that a 30 to 50-year-old astronaut who spends six months in space loses about half their strength. 

As seen during their dramatic landing yesterday evening, astronauts are typically unable to walk in the crushing weight of Earth’s gravity.

Despite following NASA’s rigorous exercise routine aboard the ISS, both Williams and Wilmore had to be helped out of the capsule and onto stretchers.  

Research has shown that the changes to bone density can be severe and long-lasting, leading to a greater risk of bone fractures or skeletal issues.

Dr Vinay Gupta, a pulmonologist and Air Force veteran said the astronauts could need up to six weeks of rehabilitation to regain their strength, which will include guided exercise and a nutritional plan. 

Weight loss

The impacts of microgravity are worsened by the fact that astronauts often struggle to maintain their weight in space.

Frequent nausea and a loss of smell and taste due to pressure in the sinuses means that astronauts lose their appetites.

Frequent nausea and a loss of smell and taste due to pressure in the sinuses means that astronauts lose their appetites

In November, doctors told DailyMail.com that Williams appeared ‘gaunt’ in a photo that was taken in September and said that she looked like she had lost weight. 

Later that month, an unnamed NASA source told the New York Post that the agency was scrambling to ‘stabilize the weight loss and hopefully reverse it.’

The unnamed employee who is ‘directly involved with the mission’ said that Williams has been ‘unable to keep up with the high-caloric diets that astronauts must consume’ while on the ISS. 

‘The pounds have melted off her and she’s now skin and bones. So it’s a priority to help her stabilize the weight loss and hopefully reverse it,’ the NASA source said.

Later that month, Williams hit back at the weight loss ‘rumours’ in a live video published by NASA, claiming that she had actually put on muscle. 

Fluid shift 

Additionally, since the body is 70 per cent water, this fluid tends to shift dramatically when in low gravity.

Just as if you were hanging upside down, NASA says that over 5.6 litres of liquid can migrate upwards through the body.

Suni Williams ‘gaunt’ appearance sparked concerns that she may be undergoing severe weight loss. However, Williams maintains that her changed appearance was due to fluid shifting into her face in microgravity 

Months spent in low gravity cause fluid shifts in the body which can cause health problems ranging from ‘chicken legs’ to vision loss 

In some cases, this leads to an issue which NASA calls ‘puffy face syndrome’, which causes severe swelling of the tissues in the head.

At the same time, fluid leaving the lower part of the body leads to what NASA calls ‘chicken legs’ and ‘baby feet’.

This is a condition in which the legs appear unusually small and weakened. 

While these cosmetic complications will likely clear up within about three days back in regular gravity, fluid shifting can also lead to serious health issues. 

The upward fluid shift their bodies experience on the ISS also increases astronauts’ risk of blood clots, specifically through the development of a condition known as Spaceflight Venous Thrombosis (SVT). 

Some astronauts who develop SVT have completely recovered after returning to Earth, but others need additional treatment, according to NASA.  

Vision loss and cognitive decline

Beyond looking unusual, this buildup of fluids in the head can also lead to serious medical complications.

As microgravity causes fluid to shift into the head, this not only causes a change in appearance but can also lead to vision loss in a condition called Spaceflight Associated Neuro-Ocular Syndrome (SANS)

As pressure builds up in the head it presses on the eyes and on the optical nerves causing something called Spaceflight Associated Neuro-Ocular Syndrome (SANS).

Over time, microgravity even causes changes in the shape of the eye including swelling of the optic nerve, flattening of the back of the eye, and the development of folds in the retina.

SANS causes blurry or fuzzy vision in about 70 per cent of all astronauts who go into space.

Astronauts’ eyes typically return to normal once they return to Earth, studies have shown, but NASA warns that some effects are permanent.

NASA also warns that the longer astronauts remain in space the greater the risk of vision damage, which will be concerning given Williams and Wilmore’s exceptionally long mission. 

Likewise, changing pressures in the brain, alongside the stress and lack of sleep, has been linked to cognitive decline in some astronauts.

Studies have shown that astronauts process some tasks significantly slower while in space than on Earth.

Research has also shown that astronauts have impaired working memory and attention, alongside altered risk-taking behaviour.

In addition to the physical issues, Williams and Wilmore are also at risk of cognitive decline. Studies have shown that astronauts display slower processing and weakened short-term memory while in space

However, there is currently no evidence that these changes persist once astronauts return to Earth.  

Radiation damage  

Williams and Wilmore will also have been exposed to extreme levels of space radiation during their extended ISS mission. 

In just one week on the ISS, astronauts are exposed to the equivalent of one year’s exposure on Earth. 

The type of radiation astronauts experience in space is also more dangerous than the common sources of radiation here on Earth.

Space radiation is made up of atoms which have had their electrons stripped away as they accelerated to nearly the speed of light.

Astronauts also have to contend with particles ejected from the sun during solar flares and galactic cosmic rays, high-energy protons and heavy ions from outside our solar system.

When these particles smash into astronauts’ bodies, they destroy the chains of DNA in our cells and trigger mutations which can develop into cancers.  

While in space astronauts face increased exposure to dangerous space radiation, this means that Butch Wilmore (pictured) now has a significantly greater risk of developing cancer 

This may increase their risk of developing cancer, central nervous system damage, bone loss and some cardiovascular diseases, according to NASA.

‘If I was their physician, I would think about a more proactive strategy for cancer screening,’ Dr Gupta said. 

‘We want to take a different approach here, given that they had such a unique exposure history,’ he said. 

Heart health 

It’s not just their muscles and bones taking a hit. Low gravity impacts their cardiovascular health too.

This is because blood and other bodily fluids shift upwards towards the head, which means the cardiovascular system doesn’t have to work as hard to maintain blood flow to the brain.

This can result in reduced blood volume and reduced function of the heart and blood vessels, according to NASA. 

Skin problems

Despite leaving Earth in good condition, NASA’s astronauts will now need months of health checks and rehabilitation to recover

Studies have shown that spending six months on the ISS wreaks havoc on the skin. 

One team of researchers found that astronauts’ epidermis gets thinner by nearly 20 per cent in space, perhaps due to low gravity, which may dysregulate the skin’s ability to grow and repair itself. 

Another study found that skin rashes are the most frequently reported clinical symptom during six-month ISS missions, occurring 25 per cent more frequently than they do for the general US population on Earth. 

These rashes may result from irritants or allergens found inside the space station, and the weakening effect that low gravity has on the immune system. Skin lesions also take longer to heal in space, according to NASA.

How do astronauts recover from their time in space? 

To help the astronauts overcome these long-term impacts, NASA has a specialised rehabilitation program for people returning from space.

Examinations begin as soon as they exit the capsule before they are flown to their crew quarters at NASA’s Johnson Space Center in Houston for several more days of routine health checks.

NASA astronauts who return from long ISS missions complete a 45-day rehabilitation program that requires them to exercise for two hours per day, seven days per week.

To maintain some of their strength, astronauts exercise for at least two hours per day on the ISS. Pictured: Sunita Williams uses the space station’s stationary bike during her 2012 mission

The program is tailored to the specific needs of each astronaut, according to NASA.

Phase one 

Phase one of a NASA astronaut’s post-mission rehabilitation plan focuses on regaining strength, flexibility and the ability to walk. 

This may include gait training exercises, range of motion exercises and obstacle training.

Gait training exercises are movements designed to improve strength, balance and coordination during walking. Examples include squats, straight leg raises, standing on one leg and seated marching. 

To improve their range of motion, the astronauts may perform ankle pumps, which involve sitting or lying down while flexing the feet. They may also do stretches to loosen the calves, quadriceps and hamstrings. 

Astronauts may have to navigate an obstacle course or step over and around objects to improve their coordination. 

Phase two 

Sunita Williams runs on the ISS treadmill during her 2012 mission 

After making some improvement during phase one the astronauts move on to phase two, which adds proprioceptive exercises and cardio reconditioning.

Proprioceptive exercises strengthen the body and improve the mind’s perception of its movement and position.

Examples include reverse lunges, banded toe taps and sumo squats with leg raises.

Some of these exercises are more complex. Astronauts may be asked to pick an object up off the floor while standing on one leg, which requires them to hinge at the waist and maintain their balance as they bend down. 

As for cardio training, the astronauts may use a treadmill, elliptical or stationary bike to get their endurance back to pre-flight status. 

Phase three 

Phase three, the longest phase, focuses on returning the astronaut to their optimal level of physical performance through functional development training. 

This training helps astronauts regain the skills and abilities they need in order to do their jobs and fully participate in their daily lives with ease and efficiency.

Sunita Williams and the rest of the ISS crew performed Olympic events on the space station last summer 

NASA astronaut Raja Chari performs strengthening exercises after returning from a 177-day-long ISS mission 

It may include more high-intensity exercises, such as jump squats and jump lunges, mountain climbers, planks and deadlifts. 

Most astronauts return to their re-mission fitness level after the 45 days, according to NASA. 

But it can take months or even years for some to recover, and research has shown that many astronauts never fully restore their bone density. 

Dr John Jaquish, a biomedical engineer, told the Daily Mail they could still recover their pre-flight bone density if they use osteogenic loading, but it won’t be easy. 

This involves exercises that strengthen bones by putting stress on them, such as squats, lunges or jumping.

But in order to stimulate bone growth, the astronauts’ bones will have to bear a load 4.2 times their body weight, Dr Jaquish said. 

For reference, ‘the world record squat is only four times body weight, so the minimum [weight] you need is more load than the world record holders,’ he said.