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HEAD IN THE CLOUDS; HOW TO COPE WITH CLIMBING AT ALTITUDE
There are a cascade of physiological and psychological responses to exercising at altitude. Andy Lane and
Greg Whyte explain how climbers can prepare effectively for living and exercising at altitude.
At A Glance
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The acute response to altitude is a cascade of physiological and psychological changes which make
exercise feel much harder than the equivalent at sea-level.
Strategies for managing responses to altitude for individuals and groups are outlined;
Practical methods are given for managing the acute response to altitude.
Living and exercising at altitude has pronounced psychological and physiological effects. With less oxygen
available for use, these effects are not surprising. Responses to altitude occurring at altitudes over 1500
metres above sea level include increased; heart rate, ventilation, oxidative stress, dehydration, glycogen
depletion, and decreased exercise capacity and immune function. In the initial stages, exercise simply feels
harder than that performed at the same pace at sea level1. Climbing is a physically demanding activity2
requiring both strength and endurance. Altitude exacerbates the physiological demands. If climbers perceive
that these increased demands outweigh their perceived ability to cope, then climbing at altitude represents a
stressful task.
This article discusses the physiological and psychological effects of high altitudes on performance. We
describe strategies that can be used to reduce these effects.
Physiological and Psychological affects of altitude
Rapids ascents to heights of more than 3000m cause many physiological responses triggered by hypobaric
hypoxia associated with a reduction in barometric pressure leading to a reduced partial pressure of oxygen.
Arterial oxyhaemoglobin saturation decreases and may produce a set of mal-adaptive physiological and
psychological disorders, known as Acute Mountain Sickness (AMS). AMS involves experiencing
breathlessness, headache, insomnia, dizziness and abnormal tiredness, and mood disturbances. Other
effects are visual disturbances, adverse changes in cognitive functions, mental reasoning, concentration,
working memory, postural stability, sensory motor coordination, eye-hand coordination, and neuromuscular
control. AMS includes 2 major, life threatening conditions; High Altitude Pulmonary Edema (HAPE) and High
Altitude Cerebral Edema (HACE). Treatment for these conditions must be immediate to avoid long-term injury
and fatality. The primary treatment for HAPE and HACE is evacuation to lower altitude/sea level as rapidly as
possible. Other associated health issues with moderate altitude (up to 3000m) and in particular high altitude
include cold injury ranging from non-freezing cold injury and frost bite to hypothermia. Of note, sun burn is a
major issue at altitude that can have significant negative consequences for the health of the climber.
For a given altitude, AMS symptoms usually show maximal effects during the first or second day of exposure
and then recede rapidly in those that adapt (responders). AMS symptoms can reappear if climbing continues
too fast or may persist in those that fail to adapt (non-responders). The number of symptoms, severity and
rapidity of the onset and duration of high altitude symptoms vary between individuals3. Pronounced changes
that occur include alterations in mood states including irritability, hostility, depression and anxiety4. Figure 1
shows changes in mood states reported in previous research. The message is clear, the higher the altitude,
the more pronounced the effects on emotional and cognitive processes 5.
Increased
sleepiness,
fatigue,
anxiety, anger,
depression,
confusion,
tension,
paranoid
ideation,
reduced
vigour,
friendliness
Emotional and
cognitive
deterioration
Increased
sleepiness,
fatigue,
reduced vigour
Increased
sense of
sleepiness
0
1000
2000
3000
4000 5000 6000
Altitude metres
7000
8000
Figure 1. Emotional and cognitive changes to living and exercising at altitude
Strategies to manage the effects of altitude
There are a number of strategies that can be used to manage the experience of climbing at altitude. Of the
plethora of factors found to influence how people adapt to altitude, possibly the most convincing are the
effects of experience. Whilst this might seem an extremely obvious statement, the precious mechanisms
through which experience assists coping efforts are not clear. It is possible that repeated exposure to altitude
leads to physiological changes which make repeated exposure to altitude much easier however; evidence
indicates the physiological acclimatisation to altitude is relatively transient (1). It could be that individuals
expect to experience the acute physiological responses and change their behaviour accordingly. This
explanation would suggest that people exercise less intensely or gauge the exercise-rest ratio effectively6.
Figure 2 shows improvements in mood states from a group of elite biathletes who attended two training camps
at an altitude of 2000m. In the second camp, some four months after the first camp, athletes reported feeling
more vigorous and less fatigued.
10
9
8
7
6
5
4
3
2
1
0
Cam p 1
Cam p 2
Anger
Calmness
Depresion
Fatigue
Happiness
T ension
Vigour
Figure 2 Improvements in mood states as athletes gain experience of managing the effects of altitude
The issue of whether successful adaptation is driven by physiological or experiential mechanisms is a
question best answered in academic circles. Practically, climbers should look to maximise the benefits of
experience of altitude. Each trip to altitude represents a learning opportunity. The perceptual nature of stress
is an important issue to consider here. Climbers need to believe that they can manage the physiological
effects. We will look at strategies that can enhance these beliefs in ability to cope. We focus on factors that
are readily available to change for the climber. These strategies can be considered and developed at sea level
and then used when climbing at altitude. The climber should reflect on their effectiveness and then revise the
plans accordingly for subsequent climbs.
Specific strategies
•
Preparation
•
Emotional Intelligence
•
Social support
•
Role play
•
Video
•
Positive self-talk
•
Visualising Success
1. Preparation
When planning a trip to ascent to a height of above 2000m, it is essential that each individual is aware of the
effects of altitude and AMS symptoms in particular. As the symptoms of altitude are similar to symptoms of
fatigue, it is important to know when they likely altitude effect will begin. Therefore it is important to indicate
which parts of the climb will feel harder. This approach can be as simple as noting the various heights of
landmarks on the trip. Knowing that an individual is at altitude should impact on how they interpret symptoms
of fatigue. At altitude, it is important not to dismiss such feelings or try to work through them in a cavalier
manner. It is important to accept that cardio respiratory responses will be elevated more than usual, and to
work within these boundaries. The key aspect of preparation is to anticipate how you will feel at altitude. After
you have recognised how hard it might feel (and as you gain experience, this exercise become easier), you
can begin to develop plans on how to cope.
2. Emotional Intelligence
Identifying emotions that influence performance and how such emotions change over time is a key to learning
how to manage emotions7. Accurate assessment of the emotional states that other people are feeling is also
important. All climbers in a group expedition will experience the potential stressor associated with altitude
simultaneously. Assessment of emotions can be done in a multitude of ways, such as the use of self-report
scales or a more user-friendly approach using an open-ended diary type approach. The diary method is a
valid method in research and provides valuable data. This approach is especially valuable when the purpose
of data collection is to conduct a needs analysis for a subsequent intervention 8.
Assessment of emotions should start by asking the climber to think carefully about a situation when they
performed at altitude. If the climber has not performed at altitude, then it is important to describe the likely
effects of altitude, and ask the climber to recall such similar experiences. Admittedly, these experiences will
not have been performed at altitude, but they represent a starting point. In essence, we are asking the climber
to recall a situation which was extremely demanding physically and where they questioned whether they could
cope with the challenge. We have provided an example of open-ended diary in Figure 3. It helps if the climber
spends some time rehearsing this situation in their mind, and tries to remember how they felt. The climber
then writes (or narrates) down all of the emotions they experienced. They should also rate how they
performed in the situation to allow comparisons between successful and unsuccessful performance. For
example, I could not concentrate because I felt nervous, started thinking negatively and started feeling
emotionally drained and fatigued. Of course, sometimes mood is affected by situation outside performance
and we should be aware of the effects of these also. Lastly, we should be aware if our emotions have a
positive or negative on others. A self-talk diary is helpful to record emotion. We cannot change our emotions
immediately, but we can change the dialogue that runs through our mind when we experience emotions.
Figure 3. Extract from an open-ended diary of a climber at the start of 10 –day trip
Day
Day 1
What happened today?
How did I feel?
How did I feel effect
How do I think others
what I did?
felt?
Climbed to 2500m and slept the
Felt pretty good. Excited
I expected to feel really
Felt others were positive
night in tents
at the start. Found
excited and tired. Really
also. Noticed a couple of
breathing very difficult
good to get going and had
gripes near the end.
once we reached 2000m;
to relax in the early
Everyone seemed positive
legs struggled on the
stages.
and laughed these off.
final climb. Real burning
Important to keep spirits up.
sensation. Felt in control
though. Focus on each
step at a time.
Day 2
Climbed to 4000m and slept the
Felt good. Tired at the
Expected to feel similar to
Others were less up beat
night in tents.
start. Sleeping at altitude
start of trip. Frustration led
than yesterday. I would say
takes it out of you. Felt
me to losing focus and
that some struggled today.
exhausted early on.
probably was awful
Suggest we need to focus on
Started getting a little
company for others.
what we can control.
frustrated by how tired I
felt. Started questioning
whether I brought the
right sleeping bags.
Started blaming things
for fatigue. Eventually
relaxed when realised I
would get through the
day.
3. Social support
Social support is possibly a part of emotional intelligence. It relates to how effective we can be in terms of
providing support for others. Interestingly, providing support for others has been found to be an effective
strategy for enhancing our own emotions: we improve our own mood by the act of trying to improve others
mood states. Whilst aspects of climbing are highly individual, it is also important to recognise that climbing
occurs in a social context. Safety reasons dictate this point. Evidence shows how important the social
environment is in terms of maintaining a positive experience. If the social environment is characterized by
boredom due to the lack of environmental stimulation and interaction with the same individuals, a lack of
privacy, and a reductions in food choice and general control over a situation. In a study that investigated
climbers at altitudes from 3810 m to 5000 m over a 35-days mountaineering expedition, results indicated that
climbers became more hostile, constrictive, anxious, obsessive-compulsiveness, paranoiac, and depressed9.
The strategy for managing the collective emotions of a group is not straightforward. One approach is for each
member of the team to keep a watchful eye on other members. It is unlikely that team members will want to
admit that they have the symptoms of attitude sickness for a number of reasons. Acknowledging that you are
suffering from altitude sickness might threaten an opportunity to participate in possibly once in a lifetime
opportunity. For example, given the months of preparation and financial investment climbers make to climb
Mount Everest, it should not be surprising that individuals will try to tough out the symptoms of mountain
sickness. This would clearly threaten their potential participation. Individuals may not want to show symptoms
of weakness. In a case study of a climber who had AMS noted:
“In the early stages, all group members struggled with the effects of increased altitude, including
breathlessness, dizziness, headaches, and sleeping difficulties. I was bloated and heavy, my clothing
was uncomfortable…..I avoided using oxygen available in the hotel. I dared not show weakness”
“I hoped others were experiencing the same, but I didn’t ask I was disguising my unnatural symptoms,
forcing myself to act naturally. I became a confused listener. Unknown to me, colleagues had noticed
and were preparing to take action”. 10
Given conflicting motivational clashes, it is important for group members to develop a sense of team
cohesiveness. At baseline before the climb has started, frank and open discussions should be held on the
possible effects of altitude. Trust, honesty and co-operation between all members of a group of climbers is
vital especially due the dangerous nature of climbing. Regular meetings should be held to foster
‘togetherness’ and acquaint each team member with his or her responsibilities. Creating an open
communication channels and monitoring the psychological well-being of members should be seen as the
responsibility of all involved.
Role play
Role-Play can be a very effective method of working with emotions and can also be an enjoyable activity for
those taking part. Role-play works effectively when a situation described in the daily diary is re-enacted. A
good starting point is to deal with specific emotions that are frequently experienced in the person or group of
persons you’re working with. For example, fatigue and depression are typically experienced at altitude and
simulating these emotions allows for teaching strategies to recognise and identify their combined effects. The
act of identifying these issues helps break down barriers related to hiding the effects of altitude described
previously.
Watching success (use of video, DVD, IPOD…..)
Watching others who have been successful is a powerful method of raising confidence. Once a task has been
achieved by someone, viewers make judgements on whether they can do that task also. Showing people
models of success generates the message that: “If he/she can do that, then so can I”. It is a powerful
message and a very effective way to initiate behavioural changes.
Video taped of successful past expeditions can be extremely helpful to develop an awareness of the
challenges that could be faced. Through anticipating these challenges, people could define psychological
skills for future expeditions. It is important to accurately identify the difficulties to be faced. Models that are
similar to the observer are the most powerful. A novice climber watching an elite climber will not identify the
difficulties of the task. The elite climber will make difficult skills look simple. A novice who watches someone of
a similar skill level to themselves will be able to identify with the difficulties more accurately. With this in mind,
it is important that watching videos of climbers managing the effects of altitude are discussed in detail.
Positive self-talk
A skill that arguably relates to all strategies described above is the use of positive self-talk. Positive self-talk is
a technique that can be used to enhance skilled performance and control emotions. It makes use of an
athletes’ powerful inner voice. With appropriate repetition, self-talk can positively alter an athlete’s belief
system. Task relevant focuses on what the climber should be concentrating on at a specific moment of the
climb. This can enhance skilled performance by directing attention to the appropriate cues. By contrast, moodrelated self-talk is focused on how the athlete feels. If an individual feels they are failing due to internal
reasons this is likely to impact on mood and motivation. For example, a climber at 4000 m will feel fatigued the
higher she/he climbs. If the climber attributes fatigue to fitness levels saying to themselves “I just am not fit
enough” this could be both de-motivating and depressing. Alternatively, if the climber attributes his fatigue to
the attitude and understands that this response is part of the challenge of performing at altitude, they will be
likely to stay more positive. This should lead to developing strategies to incorporate appropriate rests into the
climb. It should also lead to focusing on relaxing, reducing unnecessary tension. To support this process,
positive self-talk statements should be developed and reinforced before starting the climb. For example, when
fatigue increases, the climber should tell themselves: “I feel fatigued because of the attitude but I know this is
only temporary, and my body is adapting to this. I know it takes a little while for it to adapt but this is the worst
it is going to get.”
Visualising Success
A strategy that is worth doing alongside positive self-talk and which is also supported through watching video
is visualising success. Imagery helps athletes cope with difficult situations. Climbers should try to anticipate a
difficult situation, and visualise coping with it successfully. An important part of this process is to imagine
successfully tackling a number of factors that make the task difficult. As indicated when discussing the use of
video to boost confidence, it is important to develop an accurate assessment of the difficulties of the task.
Although it is important to visualise success, it is equally important not to underestimate the difficulty of the
task. This can create a false sense of self-confidence. For example, climbers should imagine coping
successfully with the toughest part of the climb, the highest altitude, when feeling exhausted, but also having
to focus specifically on the next part of the climb.
Summary
Climbing at altitude is about managing physiological and psychological stressors. Climbers should anticipate
the potential to experience difficulties with altitude and plan accordingly. Much of the planning can be done at
sea-level. Climbers should see themselves as active-learners and accept that they might not cope with the
additional demands altitude imposes. Experiences of climbing at altitude serve as highly valued learning tools
for future coping efforts. Reflection of how well a person coped should be done in relation to engagement in
preparation strategies. Strategies such as imagery, self-talk, emotional intelligence training, and providing
social support should enhance confidence in being able to manage the demands of climbing at altitude.
Andy Lane is Professor of Sport and Learning at the University of Wolverhampton.
Greg Whyte is Professor of Applied Physiology at Liverpool John Moores.
1
The physiology of training, Elsevier, 2006. 163-191.
Eur. J. Appl. Physiol. 1997; 76: 174-180.
3 Sports Med, 1993; 16:97-125.
4 J Sports Scie, 2004, 22, 886-897
5 Mood and human performance: Conceptual, measurement, and applied issues, 2007, Hauppauge, NY:
Nova Science, (pp249-264).
6 High Altitude Medicine & Biology 2002, 3(4), 116, 457.
7 Wilderness and Environmental Medicine, 2007, 18, 2, 127-132.
8 Mood and human performance: Conceptual, measurement, and applied issues, 2007, Hauppauge, NY:
Nova Science. 221-236.
9. Aviation, Space and Environmental Medicine, 1982, 53 (2): 122-126
10 Paper presented at the 2006, British Association of Sport Sciences Conference, Sept 2006, University of
Wolverhampton.
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