Trekking with non-cardiovascular preexisting health conditions at altitude
DOI:
https://doi.org/10.55225/hppa.607Keywords:
trekking, prevention, diseases, Nepal, altitude, pre-existing diseases, travel medicineAbstract
Aim: An epidemiological assessment of the preexisting health conditions of trekkers in the Solu-Khumbu region / Mount Everest (Nepal) to inform preventative and future pre-travel advice.
Material and methods: Adult volunteers (n = 350, 122 female, mean age 42.7 y (SD = 13.5), 35% aged 50 y+) completed a comprehensive health survey followed by a basic medical examination while trekking at 2800–5160 m. Cardiological problems were excluded.
Results: Only 51% sought some kind of medical pre-travel advice, and 150 reported one or more preexisting health conditions (predominately orthopaedic and trauma surgery n = 91). Many did not receive some, or all, of the recommended vaccinations. AMS symptoms were reported by 213, 59/350 took acetazolamide, and 53 didn’t factor in any acclimatisation days. None of the volunteers undertook specific muscular training before their trek (i.e. hiking with a rucksack the same weight as on trek), though 257/350 participated in some sport regularly back home. In those experiencing “a current pain” (n = 135), 64 had cephalgia, 28 had knee pain, 13 had shoulder pain, and more. Alcohol abuse or dependence was probable in 30/84 assessed; and 26/350 were occasional or regular users of recreational drugs. Existing or past nicotine abuse was reported by 104/350 with an average consumption of 14.8 cigarettes a day, and 25 continued to smoke during the trek with an average SpO₂ value of 90.9% (SD 3.8) vs. 90.5% (SD 4.4) in non-smokers. In 308 who provided their height and weight, 219 had a normal BMI, and 76 had pre-adiposity.
Conclusion: The preexisting health conditions of trekkers included a broad spectrum of diagnoses and fitness. Exacerbations of some of these conditions can be consequential when compounded by remote locations, AMS and limited or no access to comprehensive health care. Most would have benefited from comprehensive pre-travel medical advice.
Downloads
References
Government of Nepal. Nepal tourism statistics 2012. Kathmandu: Ministry of Culture, Tourism & Civil Aviation, Planning & Evaluation Division Statistical Section; 2013. Google Scholar
Luitel HM, ed. Nepal tourism statistics 2021. Kathmandu: Ministry of Culture, Tourism & Civil Aviation; 2022. Google Scholar
Basnyat B. Acute mountain sickness in local pilgrims to a high altitude lake (4154 m) in Nepal. J Wild Med. 1993;4(3):286-292. doi: 10.1580/0953-9859-4.3.286. Google Scholar
Basnyat B, Subedi D, Sleggs J, et al. Disoriented and ataxic pilgrims: An epidemiological study of acute mountain sickness and high-altitude cerebral edema at a sacred lake at 4300 m in the Nepal Himalayas. Wilderness Environ Med. 2000;11(2):89-93. doi: 10.1580/1080-6032(2000)011. Google Scholar
MacInnis MJ, Carter EA, Freeman MG, et al. A prospective epidemiological study of acute mountain sickness in Nepalese pilgrims ascending to high altitude (4380 m). PLoS One. 2013;8(10):e75644. doi: 10.1371/journal.pone.0075644. Google Scholar
Zafren K, Pun M, Regmi N, et al. High altitude illness in pilgrims after rapid ascent to 4380 m. Travel Med Infect Dis. 2017;16:31-34. doi: 10.1016/j.tmaid.2017.03.002. Google Scholar
Küpper T, Hemmerling AV, Caesar M. Risikomanagement beim organisierten Trekking. In: Waanders R, Frisch H, Schobersberger W, Berghold F, eds. Jahrbuch 2003 der Österreichischen Gesellschaft für Alpin- und Höhenmedizin: Thema Projekt Silberpyramide: Freie Themen. Innsbruck: Österreichischen Gesellschaft für Alpin- und Höhenmedizin; 2003:41-52. Available from: https://alpinmedizin.org/at/themen/230-jahrbuch-2003. Google Scholar
Lechner K. Risikomanagement beim trekking [= Risk management while trekking]. [doctoral dissertation]. Aachen: Rheinisch-Westfälische Technische Hochschule, Inst für Arbeits- und Sozialmedizin; 2013. Google Scholar
Haunolder M. Trekkers with Preexisting Cardiopulmonary Diseases in the Everest Region. [doctoral dissertation]. Aachen: RWTH Aachen Technical University, Institute of Occupational and Social Medicine; 2020. Google Scholar
Haunolder M, Apel C, Bertsch D, et al. Cardiovascular risk profiles and pre-existing health conditions of trekkers in the Solu-Khumbu region, Nepal. Int J Environ Res Public Health. 2022;19(24):16388. doi: 10.3390/ijerph192416388. Google Scholar
Bradwell AR, Dykes PW, Coote JH, et al. Effect of acetazolamide on exercise performance and muscle mass at high altitude. Lancet. 1986;1(8488):1001-1005. doi: 10.1016/s0140-6736(86)91272-9. Google Scholar
Fulco CS, Muza SR, Ditzler D, et al. Effect of acetazolamide on leg endurance exercise at sea level and simulated altitude. Clin Sci (Lond). 2006;110(6):683-692. doi: 10.1042/CS20050233. Google Scholar
Lohmann M. Laborwerte verstehen: Blut-, Urin- und Stuhlanalysen: Normalwerte im Überblick: Fachbegrie und wichtige Abkürzungen. Murnau a. Staffelsee: Mankau Verlag; 2023. Google Scholar
Stalla GK. Therapielexikon Endokrinologie und Stowechselkrankheiten. Heidelberg: Springer Verlag; 2007. Google Scholar
Ewing JA. Detecting alcoholism: The CAGE questionnaire. JAMA. 1984;252(14):1905-1907. doi: 10.1001/jama.252.14.1905. Google Scholar
DA-GGSf Adipositas. Definition von übergewicht und adipositas [= Definition of overweight and obesity]. Martinsried: Deutsche Adipositas-Gesellschaft; 2023. Google Scholar
Roach RC, Hackett PH, Oelz O, et al. The 2018 Lake Louise Acute Mountain Sickness Score. High Alt Med Biol. 2018;19(1):4-6. doi: 10.1089/ham.2017.0164. Google Scholar
Unverdorben M, der Bijl A, Potgieter L, et al. Effects of levels of cigarette smoke exposure on symptom-limited spiroergometry. Prev Cardiol. 2007;10(2):83-91. doi: 10.1111/j.1520-037x.2007.06036.x. Google Scholar
Adir Y, Merdler A, Haim SB, Front A, Harduf R, Bitterman H. Effects of exposure to low concentrations of carbon monoxide on exercise performance and myocardial perfusion in young healthy men. Occup Environ Med. 1999;56(8):535-538. doi: 10.1136/oem.56.8.535. Google Scholar
Zander R. Cohb-onzentrationen im blut bei rauchern und nichtrauchern. In: Zander R, Mertzlufft FO, eds. Der Sauerstoff-Status des arteriellen Blutes: Interdisziplinäres Mainzer Symposium d. Angewandten Physiologie u. Klin. Anaesthesiologie, Mainz, 3./4. Oktober 1986. Mainz: Karger (Basel), 1986:183-186. Google Scholar
Thieme S, S Bosch. Kohlenmonoxid: Unterschätzte Gefahr für Patienten und Retter. Retten! 2017;6(3):218-229. doi: 10.1055/s-0042-124038. Google Scholar
Scharfenberg C, Lechner K, Giet S vd, et al. The need for specific first aid and emergency knowledge whilst trekking in remote areas – results of the ADEMED (Aachen DEntal and MEDical) Expedition to the Annapurna region, Nepal. Health Prom Phys Act. 2021;14(1):17-24. doi: 10.5604/01.3001.0014.8098. Google Scholar
Lechner K, Scharfenberg C, Hettlich EM, et al. Risk management and first aid knowledge of trekkers in Nepal. Health Prom Phys Act. 2020;13(4):21-24. doi: 10.55225/hppa.174. Google Scholar
Küpper T, Hettlich C, Horz H-P, et al. Dental problems and emergencies of trekkers –epidemiology and prevention. Results of the ADEMED Expedition 2008. High Alt Med Biol. 2014;15(1):39-45. doi: 10.1089/ham.2013.1108. Google Scholar
Robert Koch Institute. [Table of countries]. Epidemiol Bull. 2023;(14):134. Google Scholar
Basnyat B, Litch JA. Medical problems of porters and trekkers in the Nepal Himalaya. Wilderness Environ Med. 1997;8(2):78-81. doi: 10.1580/1080-6032(1997)008 Google Scholar
:mpopat]2.3.co;2. Google Scholar
Müller G, Lyssenko L, Giurgiu M, et al. How effective and efficient are different exercise patterns in reducing back pain? Eur J Phys Rehabil Med. 2020;56(5):585-593. doi: 10.23736/S1973-9087.20.05975-4. Google Scholar
Edinborough L, Fisher JP, Steele J. A comparison of the effect of kettlebell swings and isolated lumbar extension training on acute torque production of the lumbar extensors. J Strength Cond Res. 2016;30(5):1189-1195. doi: 10.1519/JSC.0000000000001215. Google Scholar
Park S, Min S, Park S-H, Yoo J, Jee Y-S. Influence of isometric exercise combined with electromyostimulation on inflammatory cytokine levels, muscle strength, and knee joint function in elderly women with early knee osteoarthritis. Front Physiol. 2021;12:688260. doi: 10.3389/fphys.2021.688260. Google Scholar
Mersmann F, Laube G, Marzilger R, Bohm S, Schroll A, Arampatzis A. A functional high-load exercise intervention for the patellar tendon reduces tendon pain prevalence during a competitive season in adolescent handball players. Front Physiol. 2021;12:626225. doi: 10.3389/fphys.2021.626225. Google Scholar
Samuel D, Rowe P, Hood V, Nicol A. The relationships between muscle strength, biomechanical functional moments and health-related quality of life in non-elite older adults. Age Ageing. 2012;41(2):224-230. doi: 10.1093/ageing/afr156. Google Scholar
Vincent KR, Vincent HK. Resistance exercise for knee osteoarthritis. PM R. 2012;4(5 Suppl):S45-52. doi: 10.1016/j.pmrj.2012.01.019. Google Scholar
Koukoutsi A. The use of hiking sticks in the mountains – recommendation of the Medical Commission of the Union Internationale des Associations D’alpinisme (UIAA). Health Prom Phys Act. 2020;4(13):18-20. doi: 10.55225/hppa.173. Google Scholar
Bohne M, Abendroth-Smith J. Effects of hiking downhill using trekking poles while carrying external loads. Med. Sci Sports Exerc. 2007;39(1):177-183. doi: 10.1249/01.mss.0000240328.31276.fc. Google Scholar
Fink C, Hoser C, Benedetto KP. [Sports capacity after rupture of the anterior cruciate ligament--surgical versus non-surgical therapy]. Aktuelle Traumatol. 1993;23(8):371-375. Google Scholar
Diano S, Horvath TL. Type 3 deiodinase in hypoxia: To cool or to kill? Cell Metab. 2008;7(5):363-364. doi: 10.1016/j.cmet.2008.04.008. Google Scholar
Ma Y, Freitag P, Zhou J, Brüne B, Frede S, Fandrey J. Thyroid hormone induces erythropoietin gene expression through augmented accumulation of hypoxia-inducible factor-1. Am J Physiol Rwgul Integr Comp Physiol. 2004;287(3):R600-607. doi: 10.1152/ajpregu.00115.2004. Google Scholar
Richalet JP, Letournel M, Souberbielle J-C. Effects of high-altitude hypoxia on the hormonal response to hypothalamic factors. Am J Physiol Regul Integr Comp Physiol. 2010;299(6):R1685-1692. doi: 10.1152/ajpregu.00484.2010. Google Scholar
Wright AD. Birmingham Medical Research Expeditionary Society 1977 Expediton: thyroid function and acute mountain sickenss. Postgrad Med J. 1979;55(645):483-486. doi: 10.1136/pgmj.55.645.483. Google Scholar
Adams WH. Erythrocyte 2,3-diphosphoglycerate and adenosinetriphosphate in cretins living at high altitude. Acta Haematol. 1976;56(1):14-18. doi: 10.1159/000207914. Google Scholar
Hillebrandt D, Gurtoo A, Küpper T, et al. UIAA Medical Commission recommendations for mountaineers, hillwalkers, trekkers, and rock and ice climbers with diabetes. High Alt Med Biol. 2023;24(2):110-126. doi: 10.1089/ham.2018.0043. Google Scholar
Küpper T, Schraut B, Rieke B, et al. Drugs and drug administration in extreme climates. J Travel Med. 2006;13(1):35--47. doi: 10.1111/j.1708-8305.2006.00007.x. Google Scholar
Admetlla J, Leal C, Ricart A. Management of diabetes at high altitude. Br J Sports Med. 2001;35(4):282-283. doi: 10.1136/bjsm.35.4.282-a. Google Scholar
Brubaker PL. Adventure travel and type 1 diabetes: The complicating effects of high altitude. Diabetes Care. 2005;28(10):2563-2572. doi: 10.2337/diacare.28.10.2563. Google Scholar
Hao K, Kong FP, Gao YQ, et al. Inactivation of corticotropin-releasing hormone-induced insulinotropic role by high-altitude hypoxia. Diabetes. 2015;64(3):785-795. doi: 10.2337/db14-0500. Google Scholar
Winterborn MH, Bradwell AR, Chesner IM, Jones GT. The origin of proteinuria at high altitude. Postgrad Med J. 1987;63(737):179-181. doi: 10.1136/pgmj.63.737.179. Google Scholar
Altschule MD. Runners’ hemoglobinuria – in men, dogs and horses. Pharos Alpha Omega Alpha Honor Med Soc. 1981;44(1):33. Google Scholar
Uhrig HT, Gainer BJ. A case of march hemoglobinuria. Mil Med. 1991;156(5):A9. Google Scholar
Abarbanel J, Benet AE, Lask D, Kimche D. Sports hematuria. J Urol. 1990;143(5):887-890. doi: 10.1016/s0022-5347(17)40125-x. Google Scholar
Timmermann LF, Ritter K, Hillebrandt D, Küpper T. Drinking water treatment with ultraviolet light for travelers – evaluation of a mobile lightweight system. Travel Med Infect Dis. 2015;13(6):466-474. doi: 10.1016/j.tmaid.2015.10.005. Google Scholar
Taylor DN, Houston R, Shlim DR, Bhaibulaya M, Ungar BL, Echeverria P. Etiology of diarrhea among travelers and foreign residents in Nepal. JAMA. 1988;260(9):1245-1248. Google Scholar
Pandey P, Bodhidatta L, Lewis M. Travelers’ diarrhea in Nepal: An update on the pathogens and antibiotic resistance. J Travel Med. 2011;18(2):102-108. doi: 10.1111/j.1708-8305.2010.00475.x. Google Scholar
Murphy H, Pandey P. Pathogens for travelers' diarrhea in nepal and resistance patterns. Curr Infect Dis Rep. 2012;14(3):238-245. doi: 10.1007/s11908-012-0253-9. Google Scholar
Murphy H, Bodhidatta L, Sornsakrin S, et al. Traveler’s diarrhea in Nepal – changes in etiology and antimicrobial resistance. J Travel Med. 2019;26(8):taz054. doi: 10.1093/jtm/taz054. Google Scholar
Cumbo TA, Basnyat B, Graham J, Lescano AG, Gambert S. Acute mountain sickness, dehydration, and bicarbonate clearance: Preliminary field data from the Nepal Himalaya. Aviat Space Environ Med. 2002 Sep;73(9):898-901. Google Scholar
Murdoch DR. Symptoms of infection and altitude illness among hikers in the Mount Everest region of Nepal. Aviat Space Environ Med. 1995;66(2):148-151. Google Scholar
Poudel KM, Poudel TR, Shah N, et al. Ascent rate and the Lake Louise scoring system: An analysis of one year of emergency ward entries for high-altitude sickness at the Mustang district hospital, Nepal. PLoS One. 2022;17(10):e0276901. doi: 10.1371/journal.pone.0276901. Google Scholar
Kubalova J. Recommendation of the UIAA Medical Commission. Vol. 1: 4 x 4 Health Rules for Mountaineers. Bern: Union Internationale des Associations d’Alpinisme; 2008. Google Scholar
Röggla G, Röggla M, Zeiner A, et al. [Amphetamine doping in leisure-time mountain climbing at a medium altitude in the Alps]. Schweiz Z Sportmed. 1993;41(3):103-105. Google Scholar
Fahrenkrug H, Klingemann HK. Alcohol and accidents in Switzerland – a critical review. Addiction. 1993;88(7):969-982. doi: 10.1111/j.1360-0443.1993.tb02115.x. Google Scholar
Cherpitel CJ, Meyers AR, Perrine MW. Alcohol consumption, sensation seeking and ski injury: A case-control study. J Stud Alcohol. 1998;59(2):216-221. doi: 10.15288/jsa.1998.59.216. Google Scholar
Gaudio RM, Barbieri S, Feltracco P, et al. Impact of alcohol consumption on winter sports-related injuries. Med Sci Law. 2010;50(3):122-125. doi: 10.1258/msl.2010.010007. Google Scholar
Schneider M, Bernasch D, Weymann J, Holle R, Bartsch P. Google Scholar
Acute mountain sickness: Influence of susceptibility, preexposure, and ascent rate. Med Sci Sports Exerc. 2002; Google Scholar
(12):1886-1891. doi: 10.1097/00005768-200212000-00005. Google Scholar
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Thomas Küpper, Christian Apel, Daniela Bertsch, Carina Cerfontaine, Michael van der Giet, Simone van der Giet, Maren Graß, Miriam Haunolder, Nicole M. Heussen, Nina Hundt, Julia Jäger, Christian Kühn, Audry Morrison, Lisa Timmermann, Knut Wernitz, Ulf Gieseler, Volker Schöffl, Sonja Musiol

This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.