High Altitude Training

Question:

My client is training to climb Mt Everest - can I get some information on this type of sports specific training?

Answer:

High altitude mountain climbing is a very challenging sport, involving high demand on all the body’s energy systems, though almost certainly the main issues will be dealing with the weather and altitude. The ACSM identifies these two factors as being of the greatest concern to people preparing for an event of this nature.

There is a wide range of effects on the body when ascending to altitude, though these will vary greatly between individuals. They include increased pulmonary ventilation, hypoxic ventilatory response at rest and during exercise, increases in heart rate and, very importantly, a linear decrease in maximal oxygen uptake at a ratio of 10 percent per 1000m altitude when above 1500m sea level. This means that there is higher relative exercise intensity for any given workload, and this is going to significantly affect performance.

The main risk to health is developing a form of Acute Mountain Sickness (AMS), which although usually benign and self-limiting in nature, can progress to more serious conditions such as High Altitude Pulmonary Edema (HAPE) or High Altitude Cerebral Edema (HACE). Counseling on recognizing the signs and symptoms of these conditions is invaluable in recognition and treatment as they are potentially fatal (see McArdle et al for more information).

It is difficult to know how badly your client will be affected by this. Studies have not been able to reliably predict the effects of altitude on individuals based on sea-level performance, though it is clear all people going to altitude will benefit from conditioning training, if only to help preserve functional capacity under hypoxic conditions. Alternatives for this include the use of a prophylactic drug such as acetazolamide, though prescription of this is beyond the scope of this article and us as trainers. However, some research has indicated good results with gingko biloba or antioxidants to help reduce the effect of free radical damage that may be implicated in AMS, though results are mixed and by no means conclusive.

The rule of specificity tells us that training for a mountain ascent must involve climbing other mountains beforehand, though there will be plenty you can do in the gym with your client that can potentially help them. Poor conditioning increases the risk of AMS/HAPE and HACE, and the use of aerobically demanding circuits and interval training can increase cardiac output, maximal oxygen uptake and capillarisation, improve ventilation efficiency, improve oxygen extraction and slow the onset of blood lactate accumulation.

Strength training can be adopted using a periodized format. I would recommend developing a strong overall base of strength and stability before moving into an approach that facilitates training of all the energy systems, incorporating demanding exercises (like weighted chin-ups, for example) into a circuit that develops the ability to perform strength-based movements under aerobic stress.

Hope this helps!

References:

1. Baechle & Earle (2000) Essentials of Strength Training and Conditioning, Champaign IL, Human Kinetics
2. Basnyat B, Murdoch D R (2003) High Altitude Illness. Lancet Medical Journal 361 (9373) 1967-74
3. Bartsch et al (2004) Acute Mountain Sickness: Controversies and Advances. Journal of High Altitude Medical Biology 5(2)110-24
4. Biedelman et al (2004) Intermittent Altitude Exposure reduces AMS at 4300m. Journal of Clinical Science 106(3) 321-8
5. Dehnert et al (2003) Acute mountain sickness and HAPE: How to protect the mountain climber from the effects of the altitude haze. MMW Fortscher Med 145(8) 33-5
6. Gallagher (2004) High Altitude Illness. Journal of Emergency Medical Clinics 22(2) 329-55
7. Gertsch et al (2004) Randomized double blind, placebo controlled comparison of gingko biloba and acetazolamide for prevention of AMS among Himalayan trekkers. British Medical Journal 328(7443) 797
8. Grant et al (2002) Sea Level and acute responses to hypoxia: do they predict physiological responses and AMS at altitude. British Journal of Sports Medicine 36: 141-146
9. Havenith & Holewijn (2001) Exercise and the Environment: Altitude and Air Pollution – in ACSM Resource Manual - Guidelines for Exercise Testing and Prescription. Baltimore MA Lippincott Williams and Wilkins
10. Johnson E P (2000) Editor ACSM Guidelines for Exercise Testing and Prescription (6th Edition) Baltimore MA Lippincott Williams and Wilkins
11. McArdle et al (2001) Exercise Physiology, Baltimore MA Lippincott Williams and Wilkins
12. Porcelli (1995) A trek to the top – a review of mountain sickness. Journal of the American Osteopathic Association