Space exploration and lifestyle medicine: A narrative review of its implications for astronaut health and remote Earth-based environments

Raphaëlle Giguère^1,2Alexandre Marois^2,3Daniel Fortin-Guichard⁴Jonathan Charest^3,5Julie Rocheleau⁶Keith Thompson⁷Michael Stolberg⁸Philippe St-Martin^10,11,9Audrey Bergouignan^11,12Victor Niaussat¹³Jean-Sébastien Paquette^14,15,2Marie-Pierre Gagnon^16,17,2Maxime Sasseville^17,18,2Caroline Rheaume^19,2,20*

• ¹Department of Medicine, Faculty of Medicine, Universite Laval, Québec City, Canada
• ²VITAM – Research Center on Sustainable Health, Quebec, Canada
• ³École de psychologie, Faculté des sciences sociales, Université Laval, Quebec, Canada
• ⁴Sylvan Adams Sports Science Institute, Department of Kinesiology and Physical Education, McGill University, Montreal, Canada
• ⁵Idorsia Pharmaceuticals Canada, Montréal, Canada
• ⁶Department of Psychology, Universite du Quebec a Montreal, Montreal, Canada
• ⁷Western Space Institute, Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada
• ⁸Département des sciences de l’activité physique, Universite du Quebec a Montreal, Montreal, Canada
• ⁹Faculty of Physical Activity Sciences, Universite de Sherbrooke, Sherbrooke, Canada
• ¹⁰Research Centre on Aging, Université de Sherbrooke, Québec, Canada
• ¹¹Pluridisciplinary Hubert Curien Institute (IPHC UMR 7178), French National Center for Scientific Research (CNRS), Universite de Strasbourg, Strasbourg, France
• ¹²ivision of Endocrinology, Metabolism and Diabetes, Anschutz Health & Wellness Center, University of Colorado, Anschutz Medical Campus, Aurora, University of Colorado Denver, Denver, United States
• ¹³Thales AVS France, Bordeaux, France
• ¹⁴Family Medicine and Emergency Medicine Department, Faculty of Medicine, Universite Laval, Québec City, Canada
• ¹⁵Primary Care Research and Innovation Laboratory (Laboratoire ARIMED), Groupe de Médecine de Famille Universitaire du Nord de Lanaudière, Quebec, Canada
• ¹⁶Faculty of nursing, Universite Laval, Québec City, Canada
• ¹⁷Universite de Sherbrooke Faculte des Sciences de l'Activite Physique, Sherbrooke, Canada
• ¹⁸Faculty of nursing, Université Laval, Québec, Canada
• ¹⁹Family Medicine and Emergency Medicine Department, Faculty of Medicine, Laval University, Quebec, Canada
• ²⁰Institut Universitaire de Cardiologie et de Pneumologie de Quebec - Universite Laval, Québec City, Canada

Background: Space exploration, especially long-duration missions such as those to Mars, presents unique and significant challenges to astronaut health. Space medicine, which focuses on maintaining health in extreme environments without access to definitive medical care, emphasizes preventive measures. Lifestyle medicine (LM), grounded in six pillars such as healthy nutrition, regular physical activity, restorative sleep, stress management, positive social connections, and avoidance of risky substances, has proven effective for disease prevention on Earth. However, its application to spaceflight and remote Earth environments remains underexplored. This raises the question of how LM framework can sustain astronaut health and inform preventive and primary care strategies for Earth populations. Objective: This narrative review examines how LM can support astronaut health during long-duration missions and draws parallels with healthcare needs in Earth populations. It establishes principles for integrating lifestyle and space medicine and provides recommendations for their application in both contexts. Results: Each LM pillar is uniquely challenged in space. Nutritional constraints arise from limited food variety and storage capacity; microgravity and workload restrictions limit physical activity; circadian disruption and environmental noise affect sleep; isolation, confinement, and mission stress compromise stress regulation and social connections; restricted crew size and communication delays limit social connection; and strict medication policies highlight the dual role of substance use as both risks and necessity. While individual countermeasures have been tested in space, no integrated framework addressing all pillars simultaneously has yet been implemented. Technological innovations, such as wearable devices for continuous monitoring, telehealth modules for remote support, and virtual reality platforms for mental health and social engagement, appear as promising enablers of such an integrated approach for both astronauts and populations in medically underserved areas on Earth. Conclusion: LM provides a preventive framework that complements traditional countermeasure may enhance resilience and autonomy during space missions. Future research should prioritize integrated, longitudinal studies in analog environments to quantify the synergistic effects of integrated LM interventions versus single pillar countermeasures. Its translation to remote and underserved populations on Earth could help reduce healthcare disparities and support scalable, autonomy-centered models of care, underscoring the bidirectional value of combining lifestyle and space medicine.