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atients on earth with illness can be described as peo- ple who live in a normal earth environment but who have abnormal physiology. In contrast, astronauts are people with normal physiology who live in an abnormal environment. It is this abnormal environment in space that, for the most part, causes unique alterations in astronauts' physiology that require the attention of clinicians and scien- tists. In this review, we build on the first article 1 in this series and provide an overview of the many complex physiologic changes that take place in short- and long-duration space flight, most often in response to microgravity. The goal of sending people farther into space and extending the duration of missions from months to years will challenge the current capabilities of space medicine. The knowledge and experience in bioastronautics, associated with almost 50 years of human space flight, will be critical in developing counter- measures and clinical interventions to enable people to partici- pate in these missions and return safely to earth. Evidence To complement our first-hand experiences from space (col- lectively over 2000 hours), we reviewed technical and special publications from the National Aeronautics and Space Ad- ministration (NASA) and peer-reviewed medical literature. Most of the literature in this field is made up of case series and descriptive studies. In this article, unreferenced state- ments reflect our opinions as physician-astronauts who have observed first-hand the physiologic acclimation to micrograv- ity. Our clinical experiences as crew medical officers have also been incorporated where applicable. Acclimation

Acclimation during space flight: effects on human physiology