Category Archives: High Altitude Training & Fitness

What are the challenges and benefits of recreation and training in a high altitude environment? How does it affect your body’s physiology? What are the inherent risks?

Acclimation, Child Growth & Development, Health, High Altitude, High Altitude Training & Fitness, Mountaineering

Can I take my child up a 14er?

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There are over fifty 14ers in Colorado. A 14er is a mountain with an elevation of at least 14,000 feet. If summited, these majestic peaks afford their climbers spectacular views of the surrounding landscape. Being that many people within Colorado – and those who come to visit – are active, a question often voiced by parents is: “Can my child hike up a 14er with me?” Unfortunately, there is no straightforward answer to this question and the simplest response is: it depends.

According to recent research, it appears that children are largely similar to adults when it comes to adapting to higher elevations. Research examined children’s short-term cardiorespiratory adaptation, incidence of acute mountain sickness, hypoxic ventilatory response, and maximal exercise capacity and found little variance between adults and children (Garlick, O’Connor, & Shubkin, 2017).

When CAN you take your child up a 14er? There are a multitude of factors that affect when and if a child can climb a 14er. For example, children develop and mature at different rates. This might affect whether your 11-year-old is able to climb a 14er, compared to someone else’s 11-year-old. Additionally, some children grow up being exposed to technical hikes and climbs, while others are not. This affects ability level and is certainly something to keep in mind (Provance, n.d.). Another factor to keep in mind is whether you’re child has an underlying condition. For example, conditions such as congenital heart disease, asthma, sickle cell anemia, an upper respiratory infection, or an ear infection can significantly increase the risk for high altitude illnesses (Garlick, O’Connor, & Shubkin, 2017, p. 6). Yet another factor is whether you live at altitude or are visiting from a lower elevation. There is a strong recommendation for those individuals traveling from a lower altitude to take some time to acclimate. Spending a night or two at an intermediate altitude is recommended. Additionally, be mindful not to overdo it when you do ascend to a higher elevation: stay hydrated and don’t overexert yourself. If you decide to climb a 14er, it is imperative that you give your body at least a few days to acclimate to the altitude (“How can I optimize my health at high altitude?”, 2016).

So, what’s the bottom line? Since it isn’t possible to place a concrete age on when it’s okay for your child to climb a 14er, it is ultimately up to you to know you’re child’s limits and to decide if such a challenging hike is right for you and them. The most important thing is to make sure that everyone remains safe.

If you do decide to set out on the challenge of hiking up a 14er, there are some things to remember in order to keep yourself and your child as safe as possible and ensure that the hike is an enjoyable experience for all (Kirkland, 2015):

  • Set out early: Summiting the peak by noon is recommended in order to avoid afternoon weather, thunderstorms, and potential lightning strikes.
  • Start slow and easy: It’s important for you to determine whether or not you’re child will be able to summit a 14er. Start with easy hikes and build up over time so that you have a good understanding of your child’s abilities.
  • Know the weather forecast: Check the weather before you set out to prevent getting stuck in a storm.
  • Clothing: Wear appropriate clothing. It is important to layer since it can be colder on top of the mountain. Additionally, it is important to wear clothing that protects you from the elements (including the sun!).
  • Protect yourself from the sun: The sun can be very strong when one is high up. It is very important to ensure that your child is adequately protected from the sun: sunscreen, clothing, etc.
  • Food and Fluids: Bring adequate nutrition and hydration.
  • Be prepared to turn around ahead of time: There are many things that could cause you to turn around. It’s very important to accept ahead of time that you might not manage to summit the peak and to accept that’s okay.
  • High altitude illness: It is incredibly important for you to know the symptoms of high altitude illness and be prepared to turn around should your child exhibit any of them. Symptoms of high altitude illness include: fussiness or irritability, refusal to eat, lack of energy, nausea and/or vomiting, dizziness, and light headedness (Provance, n.d.).

References:

Garlick, V., O’Connor, A., & Shubkin, C. D. (2017). High-altitude illness in the pediatric population: A review of the literature on prevention and treatment. Current Opinion in Pediatrics, doi:10.1097/MOP.0000000000000519

How can I optimize my health at high altitude? (2016). Retrieved from http://www.altitudemedicine.org/optimizing-health-at-altitude/

Kirkland, E. (2015, May). Taking kids to new heights: Hiking Colorado’s “14er” mountains. Retrieved from http://www.outdoorfamiliesonline.com/hiking-colorados-14er-mountains/

Provance, A.J. (n.d.). What age can my child start hiking fourteeners? Retrieved from https://www.childrenscolorado.org/conditions-and-advice/new-and-featured-articles/sports-safety/when-can-kids-start-hiking-fourteeners/

Rianne Smeele, BSN, RN, Regis University FNP Student

Acclimation, Child Growth & Development, Health, High Altitude, High Altitude Training & Fitness, Medicine, Mountaineering

Slumber Up: Sleeping at High Altitude

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Does high altitude affect sleep quality? The answer is that for some, it does. If you’ve ever quickly arrived to the mountains on a ski or summer getaway, you may have experienced fitful and non-restful sleep. Individual responses to high altitude may vary, however there is an understood physiological basis for sleep disruption at altitude.

 

A phenomenon known as “periodic breathing of altitude” is commonly experienced above 2500 m of elevation (about 8200 ft) in those not previously acclimatized [2]. This is a common sleep elevation in Colorado mountain towns such as Frisco, Colorado (proud home to this blog!). Periodic breathing of altitude may be more likely to occur as sleeping altitude increases. Here’s the science behind it:

 

The decreased atmospheric pressure at altitude results in less oxygen driven into the lungs and through to the bloodstream. The body attempts to compensate by increasing the rate of breathing (tachypnea), which also causes more carbon dioxide to be exhaled. Chemoreceptors sense the decrease in carbon dioxide and signal the body to stop breathing temporarily (apnea) to correct the imbalance. Alternating cycles of tachypnea and apnea continue to occur during sleep. The result is decreased REM sleep, which is a critical restful and rejuvenating phase [2].

 

Worried about your next sleepless night on a mountain trip? Fortunately, there’s acetazolamide (Diamox). It is a carbonic anhydrase inhibitor that works by eliminating bicarbonate in the urine, which is a base. The body subsequently becomes more acidic, and that acid in the bloodstream is readily converted to carbon dioxide. The body is “tricked” into thinking that there is plenty of carbon dioxide present in the bloodstream, and periods of apnea during sleep may be reduced or eliminated [3].

 

To help prevent periodic breathing of altitude, adults can take acetazolamide preferably starting on the day before ascent or on the first day at altitude. Adults typically take 125 mg twice a day until either 3 days at altitude has been reached or descent back down has occurred [1]. Ask your healthcare provider about what’s right for you. Consider acetazolamide next time you’re sleeping up high, and get that refreshing sleep that allows you to better enjoy the things you love at altitude!

 

-Justin Murphy, PA-S

Red Rocks Community College Physician Assistant Program

Clinical Rotation- May 2017

 

References

1) Athena Health (2017). Acetazolamide generic. Epocrates Online. Retrieved from: https://online.epocrates.com/drugs/12701/acetazolamide/Adult-Dosing

2) Gallagher, S. A., Hackett, P., & Rosen, J. M. (2017). High altitude illness: Physiology, risk factors and general prevention. Up To Date, Topic 181,  Version 20.0.  Retrieved from: https://www.uptodate.com/contents/high-altitude-illness-physiology-risk-factors-and-general-prevention?source=search_result&search=high%20altitude%20sleep&selectedTitle=2~150

3) Winter, C. (2016). Sleeping around: How to sleep at high altitude. Huffington Post. Retrieved from: http://www.huffingtonpost.com/entry/sleeping-around-how-to-sleep-at-high-altitude_us_5806da29e4b08ddf9ece1228?ncid=engmodushpmg00000006

Acclimation, Health, High Altitude, High Altitude Training & Fitness, Medicine, Mountaineering

Live High Train Low- What’s an athlete to do?

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I just came across this study in the literature from a couple years ago

Optimizing Altitude for Live High-Train

Low (LHTL) Training

Chapman et al (2013) hypothesized that athletes living at

higher altitudes would experience greater improvements in sea

level performance, secondary to greater hematological acclimatization,

compared to athletes living at lower altitudes. After

4 weeks of group sea level training and testing, 48 collegiate

distance runners (32 men, 16 women) were randomly assigned

to one of four living altitudes (1780m, 2085m, 2454m, or

2800 m). All athletes trained together daily at a common altitude

from 1250m to 3000m following a modified LHTL

model. Subjects completed hematological, metabolic and

performance measures at sea level before and after altitude

training. Upon return from altitude, 3000m time-trial performance

was only significantly improved in groups living at the

middle two altitudes. EPO remained elevated after 72 h except

in the 1780m group. Erythrocyte volume was significantly

higher in all groups but not different between groups. These

data suggest that a 4 week LHTL altitude camp at 2000m to

2500m is optimal for sea level performance.

 

HIGH ALTITUDE MEDICINE & BIOLOGY

Volume 15, Number 1, 2014

ª Mary Ann Liebert, Inc.

DOI: 10.1089/ham.2014.1513

4

 

Acclimation, Health, High Altitude, High Altitude Training & Fitness, Medicine, Mountaineering

How Long With Low Oxygen?

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We frequently measure oxygen levels on people of all ages here in our mountain clinics. We order nighttime oximetry and sleep studies and analyze hundreds of data points reflecting heart rate and oxygen levels over time. When we see someone with a low oxygen in clinic, there may be no way of knowing if they have been hypoxic for hours, days, weeks unless they have an illness with an abrupt onset, like influenza or pneumonia or they just returned from sea level. Babies during the first weeks may have low oxygen with no symptoms, since they are accustomed to this in the womb where oxygen saturations run 40-60 %.

A recent article in the Journal of the American Medical Association studied extremely premature babies at 18 months for adverse outcomes including vision, hearing, cognition, motor, and language. They correlated the degree of disability with the length of time the child was hypoxic during the first few months. One minute of hypoxia seemed to be the cut-off. Now this doesn’t tell us how low or how many but it may be a helpful guide when watching someone’s oxygen or analyzing a sleep study. Shorter episodes may be insignificant long term.

This is a complex article and the children with the poorer outcomes had more episodes of hypoxia at older ages- 9-10 weeks after birth. This could mean that the insult to the brain was contributing to the hypoxic episodes as well as the deficits.

 

Acclimation, Health, High Altitude, High Altitude Training & Fitness, Medicine, Mountaineering, Technology

Does sleeping on oxygen at high altitude improve athletic performance?

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I have read many scientific studies on athletic performance at altitude. Active high altitude residents are always looking for ways to improve. As we age we experience a loss of speed and endurance, even with regular training. Some of this is inevitable, but how can we know if there is something else affecting our fitness?

I started sleeping on oxygen 9 months ago because of high blood pressure, which was instantly cured. Now I find that my strength and endurance have improved during the last few months. For example, I was rowing 13400 meters per hour with several brief pauses last fall, and now I am at an all-time high of 14100 m per hour with one pause. My running feels better, I’m back up to 6 miles from 4.

There are other factors that could influence this. In 2012-2013 I was on 17 pills including prednisone and had four surgeries for tongue cancer and myasthenia gravis. I was able to continue working out daily although part of that was less intense, such as yoga. I also had rotator cuff surgery. So my current fitness improvement could just be a rebound from overcoming those health conditions.

The only way to know for sure is to do a randomized controlled double blind study of athletes performance on and off nightly oxygen, or study the same athlete with and without oxygen. This is not an immediate effect, so months or years of observation and measurements would be needed.

In the meantime, if you live above 2500 meters/9000 feet and are losing stamina or strength consider having a night time pulse oximetry test to check for hypoxia during sleep.

Acclimation, Health, High Altitude, High Altitude Training & Fitness, Mountaineering

Kilimanjaro

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Overflow crowd tonight at St. John’s church where Katherine Jeter shared her story of climbing Mt Kilimanjaro with others from the county, celebrating her 75th birthday that year. I am so inspired by the people older than I am who are challenging themselves like this. This peak is a mile higher than our 14er’s! The average age in this group was 65. Using acetazolamide/Diamox helped many of the climbers.