How to Prepare for High-Altitude Trekking

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How to Prepare for High-Altitude Trekking

In October 2004 the music world suffered one of its biggest ever losses – veteran BBC Radio 1 presenter John Peel died of a heart attack in Cusco, Peru while on a working holiday.

If you’ve listened to or heard of Pink Floyd, Led Zeppelin, Billy Bragg or The Fall, you’ll have seen the great man’s hand behind music that remains relevant and important today.

In the days before the internet John Peel was the original ‘influencer’ with his music show.

John Peel

So, what’s a 61 year old man keeling over in a hotel got to do with trekking?

Altitude was a major factor in the newly-diagnosed diabetic DJ’s death.

The Peruvian city of Cusco is 3,399 metres above sea level, and you can go down with altitude sickness at anything over 3,000 metres.

Nearly everyone suffers when they arrive in the city thanks to this issue – we will discuss what to do when you start going to altitude at the end.

Cusco, Peru

Just about anyone can go down with altitude sickness, although the best way to deal with it is to be fit as a mountain goat, and to take steps to alleviate the problem in the days before you head off over those mountain passes.

Over this article we will look at steps everyone should take to prepare for trekking at altitude.

Let’s start at 4-6 months before you go.

Ditch the fags!

While teenagers think that smoking is ‘cool’ and ‘adult’, most adults who smoke think they were stupid as teenagers when they got addicted.

If you want to avoid complications from high altitude trekking then now’s the time to ditch the fags!

Your body starts recovering immediately you stop smoking and much of the tar, soot and gunk you put in your lungs goes in the months and years after you do.

Though smokers know the best fag of all is after a blast of exercise, when you do high intensity training you’ll hate every puff you ever took!

Failing that, as you gasp and groan up those mountain passes you will maybe realise what we’re talking about.

The theory behind fitness training

At altitude there is less oxygen available in the air than at sea level.

In order to manage life at heights it therefore makes sense to make the body more efficient.

How do you manage that?


In being fitter, so your heart beats more powerfully and your muscles can work better with less oxygen.

If you stress your body hard before a high altitude trek therefore it is better able to take what you throw at it.

This also works the other way – elite athletes such as Mo Farrow spend months every year training at high altitude ahead of their track and field events at sea level.

At low altitude their bodies deliver more oxygen to their muscles thanks to having had to adapt to a lower oxygen environment at altitude.

Cardio-pulmonary fitness

Having great cardiovascular (blood and heart) and pulmonary (lung) fitness can only come from stressing them.

Where it comes to preparing for a trek it makes sense to stress the muscles involved.

How? Get hiking!

On many guided treks such as Kilimanjaro, the Inca Trail and Everest Base Camp you will be carrying a few days’ supplies and trekking around 5-7 miles a day.

Route to Everest Base Camp

At sea level with at least double the available oxygen than at 3,000 metres plus, that mean you should feel comfortable after 14 miles of arduous hiking enough to get up and do it the next day.

Yes – arduous hiking.

The nastier, uglier the hills you can do in preparation the better.

If you live in a flat area, travel to an area where there are some beefy hills.

In Somerset, hit Exmoor.

In the Fens head to the Chilterns.

Let’s face it – the UK isn’t that huge and if you’re about to blast £5,000 on a trekking holiday then a little added expense and time in getting to those hills could make all the difference.

Jogging isn’t everyone’s favourite pastime and can hurt knees.

Even so, you can work on cardiovascular fitness through some hard running.

Try a five miler every week as well as the hiking.

Aim to come back a ball of sweat, breathing hard too.

If you can do interval training then this is a good way of stressing your system.

Interval training has been shown to be one of the best ways of getting fit and losing weight.

For someone planning a trek this can mean running for 10 minutes and walking for 10 minutes over up to an hour.

The NHS Choices website recommends one training session a week for runners – trekkers would do well to match that.


Strength is another important factor for your trek at altitude.

You will be carrying a certain load, no matter whether your tour is carrying much of your gear or not.

This might be waterproofs, snacks, fluids and warm clothing at a minimum but for less-assisted treks then you will be carrying more.

Once more, at altitude your body will be less efficient thanks to the low oxygen.

Your core muscles – lower back and stomach – as well as shoulders and legs will benefit from strength training.

Oh joy – this means crunches, pull-ups and press-ups!

As for your legs?

They will be getting plenty from the hiking and running, but squats (with weights) won’t harm you overall.

The final month

In the 4-6 months of physical preparation for the high altitude trek you should be building yourself up gently, pushing your limits gently (but not too gently!) as you go.

If you push too hard you could get a sports injury and this can set you back for weeks or longer.

Equally you should be pushing hard enough that you break a good sweat as you go each time.

Your target for the final month should be to hit maximum intensity ahead of the trek.

At a minimum you should be doing:

  • 3 x 45 minute hikes with a weighted pack
  • 1 x six hour hike
  • 2 x half hour runs
  • 3 x strength sessions a week

That’s no small endeavour but if you manage that you won’t harm yourself on the mountainside!

Advice once in-country

Ahead of the trek, try to spend a minimum of 2-3 days in a town or city at altitude – ideally above above 3,000 metres.

Cusco is a great place to acclimatise ahead of the Inca Trail.

Kathmandu isn’t anything as high at just over 1,400 metres, but if you can hang out in Lukla (2,860 metres) ahead of an Everest expedition for a few days you will feel the benefits higher up.

Build your height slowly as you go.

For the uninitiated, climbing 500 metres overall height a day is going to be easier on your body.

Being fit should ease the effects.

Peru has a wonderful if maligned herb called coca.

You won’t find it outside of South America as it is the herb from which cocaine is extracted and as such it is frowned upon.

Chewing coca leaves won’t have you high as a kite but is a mild stimulant like coffee and it has vitamins that help with altitude sickness.

It is legal in Peru and in other countries of South America where people live at height for that reason.

Coca plant

For other countries, and if you feel queasy about taking cocaine at any concentration (you could be in the military, police or another job you could lose having taken it) there are over the counter and prescription medications available to take for mild altitude sickness.

Speak to your doctor about these.

You will find that your body consumes far more water at high altitudes than it does at lower levels.

Listen to your body and drink as much water as you need!

As a general rule you’ve got enough water in you if you constantly need a small pee – you only get thirsty if you’re quite badly dehydrated.

Avoiding dehydration also means dialling back on the booze.

Don’t party at all for the first day or so at altitude and then go gently after that.

If nothing else it takes you less alcohol to get tipsy at height than at sea level so it pays to go easy anyway!

As a final note?

The best cure for altitude sickness is to get back down the mountain.

Even dropping 500 metres could sort you out – less than a reasonable day’s hike.

Altitude sickness

We can’t do an article on preparing for a high altitude trek without discussing altitude sickness and the worst conditions stemming from it.

At the end of the day anyone can get altitude sickness, whether or not they have been to 3,000 metres plus before.

You’re more likely to get it if you have had it before.

The symptoms of early stage altitude sickness are headache, nausea and vomiting, dizziness, tiredness, loss of appetite, and shortness of breath.

That will be how you feel on your first day in Lukla or Cusco.

The best thing for these symptoms are rest.

Lie about and read in your hotel/hostel.

Get used to walking and doing things at half the pace you did at sea level.

You should recover within 24 hours but if not, get to a doctor.

The worst symptoms are two serious conditions than can kill you.

The first is High altitude cerebral oedema (HACE), a swelling of the brain from lack of oxygen.

The other is High altitude pulmonary oedema (HAPE), a buildup of fluid in the lungs where you could literally drown without being immersed.

In both situations you need to descend to a safer height – at least 500 metres – as a first solution.

Look out for these symptoms and take action:


If you can get bottled oxygen then that’s another important step.

Medication will help too.

Insurance covering helicopter evacuation could well save your life.

If you have a pre-existing heart condition or are medicated for high blood pressure then discuss with your doctor before you go.

In some cases you may get sensible advice from your doctor that could ruin your holiday – sadly the scant evidence out there suggests those with certain heart conditions could get in trouble from being at high altitude and should not travel.

There are other people who may well do better in giving high altitude trekking a miss.

Given that diabetes can both affect the heart and comes hand in hand with other physical problems, this could well have been why John Peel didn’t come home alive.

If you have any serious  limiting physical condition it will help to see the doc before you sign up to a trek.

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