CHAPTER 97

Training for Wilderness

Adventure
ROBERT B. SCHOENE

For a couple million years, humans have survived in wilderness

environments. It is only in the last few millennia that socialization
has led to what we call civilization. Modern life has formed a
construct for human existence that has largely overcome the need
for survival competence. However, there are still populations that
rely on physical capabilities and resourcefulness to survive on
planet Earth, most of which is still wilderness (Figure 97-1).
Many people now seek their ancestral origins with an ineffable call to return to oceans, mountains, deserts, and rivers in
all corners of the globe. It is this yearning to seek alternately
both solitude and fellowship with other kindred spirits that takes
us from what we call civilization to wilderness. Some persons
are prepared with skills to thrive in the wild, whereas others
wander unprepared to endure the unavoidable physical stresses
that one may encounter.
This chapter addresses the physical and psychological challenges faced in the wilderness and attempts to offer insights into
the best ways to prepare for survival, enjoyment, and the ability
to thrive.

Mental Awareness
Especially during the past two decades, there has been growing
interest in seeking adventure to experience wilderness via guided
trips, group ventures, and solo forays. The press and popular literature have recounted these experiences for the general public,
many of whom would otherwise have little concept of adventure
and attendant risks. The romantic notion of rafting a remote river,
trekking in the Himalayas, or riding a camel in the Sahara Desert
does not often anticipate the possibility of 2 weeks in torrential
rain on a cold river, biting snow and altitude illness, contaminated
food and diarrhea, or even a camel bite. The western traveler is
often a person who comes from a comfortable home who assumes
that he or she will be cared foror even rescued, if necessary
and then transported home with a minimum amount of inconvenience to be able to recount his or her adventures with persons
who are similarly ignorant of the actual risks.
It is safe to assume that to enjoy the wilderness, one must
accept that occasional hardships are frequent aspects of adventures. Therefore, self-reliance or group reliance is critical, and a
modicum of medical and survival skills must be obtained. Reading
the great tales of survival and studying survival theories can be
helpful, but mental preparation cannot be taught solely in the
classroom and library; it must be learned and then practiced until
one becomes experienced. Thus, one should strive to learn, to
know oneself, accept the risks of the adventure, and become a
strong member of the team; being unprepared may put many
participants at risk.

Physical Conditioning
Wilderness adventures require a wide range of physical capabilities. Rather than being a specialized endeavor where one particular form of conditioning will ensure success, wilderness travel is
varied and at many times unpredictable, and requires strength,
flexibility, endurance, speed, and mental resourcefulness. Each
of us begins our training with a different dose of each of these
characteristics and must do our best to optimize them. Having
the strength to pull a colleague out of a crevasse or drag oneself
with a broken ankle up a steep trail may be essential for survival.
1928

Having the reflexes and speed to avoid rockfall or grab a teammate before he or she falls into a river may mean the difference
between life and death. Having the endurance to hike for days
out of the mountains to initiate a rescue for an injured friend will
minimize that friends exposure to cold or heat.
Speed training is essential. Strength and flexibility training are
covered in Chapter 98. This chapter deals primarily with aerobic
fitness and exercise physiology with an emphasis on high-altitude
fitness, because adaptation and exercise performance in that
environment carry with them concepts universally applicable to
all wilderness endeavors.

AEROBIC FITNESS
The best way to be prepare for any form of wilderness venture
is to be in the wilderness on a regular basis. However, for most
persons who are not professional river or mountain guides, it is
not possible to be active in these terrains every day. Thus, we
need to improvise and incorporate physical training into our busy
schedules so that when we enter the wilderness, we are
prepared.
The concepts of aerobic fitness are similar for champion and
recreational athletes. The parts of the engine are the same; it
is the quality and fine-tuning that are different. Three essential
 2max),
characteristics are maximum oxygen consumption ( VO
lactate or anaerobic threshold, and efficiency. These factors are
interrelated in a way that results in effective performance, and
each is trainable. The interrelationships result in improved endurance, the most important overall factor for enjoyment and survival in the wilderness.34

MAXIMUM OXYGEN CONSUMPTION

 2 ) is defined by the Fick equation:
Oxygen consumption ( VO
VO2 = Cardiac output Extraction of oxygen
Cardiac output is equal to heart rate multiplied by stroke volume.
Oxygen extraction is the difference between the content of
oxygen of the arterial and mixed venous blood (i.e., the amount
of oxygen that is used as blood traverses tissue beds). The metabolic response of exertion is limited by cardiac output and the
limits of oxygen extraction, both of which can be modulated with
 2max and its various considerations are
training. The role of VO
discussed by Levine.40
 2max is the fingerprint of an individuals physiology. It is
VO
a reproducible marker of fitness in an individual that varies
depending on training, altitude, and illness. The many genetic
 2max
factors (i.e., polygenic) that contribute to a persons VO
make it highly unlikely that any one individual could be endowed
 2max is influenced by both
with all of these genes.60 Ones VO
inherited and environmental factors.8 What remains to be
explained is the observation that, among sedentary subjects in
family groups who were maintained on a supervised aerobic
exercise program for 20 weeks, there was great variability in how
 2max could be improved7 (Figure 97-2). The improvemuch VO
 2max ranged from negative values to 30% improvement in VO
ment, and these various levels of improvement were grouped in
family clusters. Further data from this series of studies looked at
age, race, gender, and initial fitness and found that all subjects
 2max, but with a great deal of variability
experienced gains in VO

For online-only figures, please go to www.expertconsult.com

and little correlation among the aforementioned factors that contributed to those gains. It is clear that there are limits in training
 2max. In other words, a normal individual with
to improve VO
 2max of 42cc/kg/min may be able to improve his or her
a VO
 2max to the high 40s cc/kg/min but will never be able to
VO
approach the 75 to 85cc/kg/min range of high-performance
middle- to long-distance athletes, who chose their parents well.
What parts of ones aerobic capacity can be trained? Considering the Fick equation, it becomes apparent that an increase in
cardiac output, improved extraction of oxygen, or both will
 2max. In fact, both things happen, but it is clearly
improve VO
the heart that can be trained more by increasing its stroke volume
and improving its muscular strength.20,25 Thus, the heart rate
necessary to achieve an appropriate cardiac output for any given
metabolic rate is lower in the trained state as compared with the
untrained state. Although maximum heart rate does not change
with training, resting and submaximal heart rates are lower and
can be used as simple markers to monitor training. Although the
elements of oxygen extraction somewhat improve, the hearts
stroke volume conveys increased ability to perfuse large volumes
of muscle mass such that, with training, there are increased capillary and mitochondrial densities and optimization of the components of oxidative metabolism.3,24,29,30
It is fascinating to put human physiology in perspective
with the rest of the animal kingdom. Normal humans in the age
 2max somewhere around
range of 20 to 40 years have a VO

200

Number of subjects

180
160
140
120
100
80
60
40
20

0
00
>1

00

010
80

080

0
60

060

0
40

040

0
20

20
0-

<0

Delta VO2max (mL/min)

FIGURE 97-2 Distribution of 481 subjects by classes of increase () in

 2 max) as compared with baseline
maximum oxygen consumption ( VO
levels. (From Bouchard C, An P, Rice T, etal: Familial aggregation of
VO(2max) response to exercise training: Results from the HERITAGE
Family Study, J Appl Physiol 87:1003, 1999.)

SUSTAINABLE THRESHOLD
Exercising at the highest possible sustainable workload results in
the best individual performance. The point in progressive exercise above which the level of intensity cannot be sustained has
been given many names. Anaerobic, ventilatory, and lactate
thresholds are the most commonly used terms, although none
clearly defines the phenomenon well. At any given point of
training or health, the threshold is fairly reproducible. The term
lactate threshold (LT) will be used for sake of this discussion. It
 2maxcan
is important to understand that the LTmore than VO
be trained to move to a higher level of intensity; this translates
into a functional increase in endurance and performance, whether
in athletic endeavor or wilderness adventure.
The onset of unsustainable work intensity essentially involves
a shift of fuel supply within the cell. At workloads below the LT,
free fatty acids are the primary oxidative fuel. Above the LT,
when the oxidative turnover of free fatty acids cannot keep up
with the demand for adenosine triphosphate, glycolysis occurs.
Muscle glycogen is broken down as fuel, with lactic acid being
produced at a rate beyond the bodys ability to use it.33,49 Blood
lactate levels correlate with intensity of work and thus are
inversely correlated with the duration of a competitive event
(Figure 97-3).
For example, a 10,000-m runner may have only a slightly
elevated blood lactate level as compared with the resting level
as he or she slowly depletes muscle glycogen; alternatively, an
800-m runner will have a markedly elevated blood lactate concentration at the end of the race, because glycolytic signaling is
invoked early at high levels of exertion. With sustained aerobic
training, use of free fatty acids, which is abundant, is shifted to
higher intensities and functionally spares muscle glycogen. The
point at which lactate starts to rise in the blood is quite variable,
 2max in untrained indi
but usually occurs at about 60% of VO
viduals; in highly trained individuals, this point may come at 75%
 2max. In the trained individual, this difference is
to 85% of VO
due both to improved convection of oxygen with increased capillary density as well as to distribution of muscle fiber types with
improved oxidative efficiency.
Lactate has often been portrayed as the culprit that leads to
fatigue. However, two misconceptions about this need to be
corrected. First, as long as there is blood flow, the LT is actually
not associated with mitochondrial hypoxia or anoxia. Anaerobic
metabolism is not occurring. Convection of oxygen to the cell,
and diffusion gradients from the blood across the cell membrane
1929

CHAPTER 97 Training for Wilderness Adventure

FIGURE 97-1 View in the Khumbu region of Nepal, with Mt Everest,

Mt Lhotse, and Mt Ama Dablam appearing most prominent. (Courtesy
Robert B. Schoene.)

40cc/kg/min, and accomplished endurance athletes have one in

the range of 70 to 85cc/kg/min; alternatively, some large
mammals have extraordinarily high aerobic capacities. For
 2max values that range from 134cc/kg/
instance, horses have VO
min in standardbred horses2 to 160cc/kg/min in thoroughbreds.38,43 The North American pronghorn antelope is said to have
values as high as 300cc/kg/min. Although thoroughbred horses
were bred several hundred years ago to be great aerobic athletes,
the antelopes evolutionary strategy is to have exercise capabilities that optimize its chance of preserving the small family groups
that live on an open plain full of predators (i.e., the pronghorn
can run sustainably at 80.5km/hr [50mi/hr]).
 2max correlate with being able to go faster, last
Does VO
longer, jump higher, climb faster, or survive better in the wilderness? The answer is yes and no. Certainly, the high-performance
endurance athlete needs to have a large aerobic capacity, but,
 2max and pereven in this group, there is heterogeneity in VO
formance. This indicates that there are other components of
physical characteristics that translate into endurance and performance and that are also influenced by training. Most athletic
events attract athletes that share certain phenotypic characteristics
that, as with animals in nature, result in some homogeneity; in
addition, among people who venture into the wilderness
including even among elite high-altitude climbersthere is a
great deal of phenotypic heterogeneity. Regardless of the lack of
 2max and performance in the
a strong correlation between VO
wilderness, there is one precept that is sacrosanct: the body must
translate energy expenditure into sustainable and efficient
mechanical output.

7.0
6.9
Muscle pH

PART 12 SPECIAL POPULATIONS AND CONSIDERATIONS

7.1

6.8
6.7
6.6
6.5
6.4
6.3
0

10

15

20

25

30

35

40

Muscle lactate + pyruvate (mmol/kg wet wt)

20 min recovery
8 min recovery
4 min recovery
1 min recovery
0.1 min recovery

5-11 min at 50%-75% VO2max

Exhaustion at 100% VO2max

FIGURE 97-3 An original figure redrawn from data from Sahlin and colleagues (Figures 1 and 2, p. 46) showing the linear relationship between
the amount of muscle lactate and pyruvate as compared with muscle
pH. Data are combined from different exercise intensities and different
durations of recovery after exercise to exhaustion. (From Robergs RA,
Ghiasvand F, Parker D: Biochemistry of exercise-induced metabolic
acidosis, Am J Physiol Regul Integr Comp Physiol 287:R502, 2004; and
Sahlin K, Horris RC, Nylind B, et al: Lactate content and pH in muscle
samples obtained after dynamic exercise, Pflgers Arch 367:143, 1976.)

into the cytosol and from the cytosol into the mitochondria, are
adequate to supply oxygen for oxidative phosphorylation.
Second, it is not accumulation of lactic acid that causes muscle
fatigue or pain during exhaustive exercise. More likely, muscle
fatigue is accumulation of the associated hydrogen ion when
progressively increasing amounts of pyruvate being delivered to
the mitochondria cannot undergo oxidation, thus leading to the
generation of lactic acid and the associated hydrogen ion.

Improving Human Performance

In highly specialized athletes such as cyclists, the muscle mass

involved in the effort has been shown to be progressively
recruited in a way such that the oxidative stress is balanced and
shared.13,15 As much as 25% of the cyclists muscle mass can be
spared on a rotating basis, which reduces the oxidative stress of
muscle fibers, thus prolonging the onset of the LT. This phenomenon may perhaps be a way to acquire more endurance, delay
fatigue, and promote efficiency. Furthermore, with a finite fuel
supply, this strategy would preserve glycogen stores and delay
the onset of glycolysis (and thus the production of lactate).
Functioning at the edge of performance requires delicate
juggling of aerobic and anaerobic metabolism. This success translates into activities like running an efficient marathon, where 10%
of the activity may be anaerobic, or being able to hike as quickly
as possible out of the high mountains to effect a rescue for a
fallen colleague without collapsing from fatigue.
The crux of cellular oxidative metabolism is convection of
oxygen to the cell by the circulation, diffusion of oxygen across
the cell membrane into the cytosol, and then diffusion of oxygen
into the mitochondria. The actual diffusion gradient necessary to
get oxygen to the mitochondria is on the order of 2 to 3mmHg
at each of these steps.52 Thus, perfusion rather than hypoxemia
per se is a limiting factor. Therefore, one of the most important
adaptive steps is augmenting blood flow through angiogenesis
of the microcirculation. In this regard, in two studies, highly
trained cyclists and triathletes with comparable values of
 2max were exercised at 88% of their maximum aerobic capacVO
ity until fatigue.13,14 There were two patterns that showed a
shorter and longer time to fatigue. The athletes with more endurance had a substantially greater capillary density than did the
athletes who fatigued earlier, despite comparable maximum
aerobic capacities. Because both groups were highly trained, it
is not clear whether, in certain athletes, there is some inherent
propensity for greater signaling of angiogenesis that comes from
training. The authors speculated that this augmented perfusion
may be important not only for the convective phase of oxygen
but also for providing a greater volume of the effluent portion
of metabolic byproducts. Another study looked at subtle factors
that contribute to fatigue at very high levels of exercise and found
that very small changes in energy expenditure when a person is
 2max can lead
at exercise intensities of greater than 80% of VO
to rapid onset of fatigue.44 Therefore, it is critical for an athlete
whether on the field or in the wildernessto know the location
of his or her edge so there is some reserve for optimally finishing an activity.

MALLEABILITY OF THE LACTATE THRESHOLD

TRAINING EFFECT ON THE LACTATE

THRESHOLD

Understanding the top end of the bodys physiology is only the

beginning of understanding the translation of energy potential
into endurance, efficiency, and performance. This next section
stresses the importance of sustainable work, which is the key to
engaging in any wilderness endeavor. Sustainable work is defined
as the level of exertion that can be sustained for many minutes,
hours, or days. It is an intensity of exertion that is below ones
LT. Levels of intensity above the LT are reserved for more explosive events in sport or flight of less than a few minutes duration.
Examples in track and field are the 100- to 1500-m events. In the
wild, the short spurt of energy exerted by a cheetah to capture
prey is above the animals LT and not sustainable, which is why
the gazelle sometimes wins.
The ability of a muscle to sustain work is related to its oxidative
capacity. This capacity is quite malleable, and depends on the level
of the muscles activity while it is engaged.19,28 Among high-level
athletes, oxidative capacity can be several-fold greater than among
untrained individuals. Functionally, then, high-level athletes have
 2max levels, and can perform sustainable work
inherently high VO
at a much higher percentage of their maximum capacity. For
example, an international cyclist may have a maximum work capacity of 550 watts and be able to sustain 450 watts of work during
an hour-long hill climb. This is an extraordinary level of work
output. A more usual and quasi-sedentary individual may have a
maximum workload of 200 watts and be able to sustain 50% to
60% of that work intensity, which is considered to be normal.

Much has been written since the late 1970s about plasticity of
the LT. It behooves any athlete to be able to perform at the
highest percentage of his or her maximum aerobic capacity. One
of the first studies to look at the effect of aerobic training on the
LT involved nine sedentary men who performed 9 weeks of
supervised endurance training for 45 minutes per day for 4.1 days
per week.16 There was a comparable untrained control group.
The exercise group increased its LT by 44% expressed as absolute
 2, and 15% expressed as VO
 2max. VO
 2max also increased
VO
25%. Maximum work rate increased 28%, with decreases in the
ventilatory equivalent seen at submaximal levels of work. The
volume of work was similar in the test group, so the study did
not answer the following questions (Figure 97-4): How much
volume is necessary to induce these changes? If some work is
good, is more or less better?
The focus of studies then became the effect of volume versus
intensity of work on the aforementioned variables, all of which
had important implications for performance. As understanding of
endurance training expanded, there was emerging and ongoing
interest in the effects of other types of training, such as interval
training (IT), which for many years had been a standard training
technique for athletes. IT can take many forms, but is usually
described as a series of intense training bouts above the LT,
interspersed with recovery periods. Middle distance and endurance athletes perform some level of endurance (i.e., below LT)
training every day and then add IT sessions 2 to 3 days per week.

1930

Test 1
Test 2

14
Blood lactate (mmol/L)

Time (min)

16

12

Pre
Post

75

*
50

10

25

0
Con

6
4
2
0
80

130

180

230

280

330

380

430

Power output (watts)

FIGURE 97-4 Training moves the lactate threshold to a higher level
of sustainable work.

Historically, with IT, the time and volume of training have been
thought to be able to be markedly reduced. The thinking has
been that very intense exercise levels signal greater changes in
muscle oxidative capacity, which otherwise would not be stimulated by endurance-oriented aerobic training. Most studies have
been done in athletes who were already engaged in active training, so one of the questions that arose was whether IT could
add further benefits to performance for athletes who were already
performing at a highly trained level.
Several studies have looked at a number of variations on the
IT theme and its effect on performance, LT, serum lactate, time
to exhaustion, muscle physiology, and so forth. One study
enrolled seven trained male distance runners and added 3 days
of intense levels of training (i.e., >95% heart rate maximum) per
 2max,
week for 8 weeks.1 The results showed no change in VO
but there was improvement in 10,000-m times, increased time to
exhaustion on a set treadmill pace and incline, decreased serum
lactate concentrations at 85% and 90% maximum heart rate, and
correlations of the decrease in lactate with improvements in
performance times. In another study among recreationally active
young males, a mere six bouts of four to seven all-out Wingate

FIGURE 97-6 Cycle endurance time to fatigue before and after a

2-week sprint training protocol (training group; Sit) or equivalent
period without training (control; Con). Values are given as mean
standard error of the mean for 8 subjects. Individual data are also
plotted for all subjects in each group. *p < 0.05. (From Burgomaster
KA, Hughes SC, Heigenhauser GJ, et al: Six sessions of sprint interval
training increases muscle oxidative potential and cycle endurance
capacity in humans, J Appl Physiol 98:1985, 2005.)

tests spread out over 2 weeks (with recovery days in between)

resulted in a 100% increase in cycle endurance time, with muscle
biopsies showing a 26% increase in muscle glycogen and a 38%
increase in citrate synthase, both markers of muscle oxidative
capacity10 (Figures 97-5 and 97-6).
These two studies provide an interesting contrast in that
intense training improved the already trained athletes somewhat
and the modestly trained recreational athletes a great deal.
Another study divided 16 active young males into intense IT
and endurance training groups that were followed for 2 weeks.
The time commitment for the two groups was 2.5 hours and 10.5
hours, respectively. Training results for both groups were similar
in that they showed improved time trial times and similar changes
in markers of oxidative capacity and buffering capacity in muscle
biopsy samples after the training intervention23 (Figure 97-7).
In a study of a somewhat similar design and intent with more
outcome variables, this same investigative group showed comparable improvements in performance, endurance time, and oxidative markers in muscle biopsies9 (Figure 97-8). After 4 weeks
of speed IT in a group of healthy recreationally active subjects,
similar findings resulted when compared with those of an endurance group, and the muscle-capillarytofiber ratio was similar
in both groups.31
Thus, training intensity was heralded as an important part of
overall training.13 From a practical standpoint, for busy lives,
80

*
500

250

750 kJ time trial (min)

750
[Glycogen] (mmol-kg1 dw)

Sit

70
60
50
40
0
SIT

0
Pre

Post

ET
Pre
Post*

Condition
FIGURE 97-5 Muscle glycogen concentration measured in resting
biopsy samples obtained before and after a 2-week sprint training
protocol. Values are given as mean standard error of the mean for
8 subjects. dw, Dry weight. *p < 0.05. (From Burgomaster KA, Hughes
SC, Heigenhauser GJ, et al: Six sessions of sprint interval training
increases muscle oxidative potential and cycle endurance capacity in
humans, J Appl Physiol 98:1985, 2005.)

FIGURE 97-7 750-kJ cycling time trial performance before (Pre) and
after (Post) 6 sessions of sprint interval training (SIT) or endurance
training (ET) over 2 weeks. *p 0.05 as compared with pretraining
values (main effect for time). The lines denote individual data for 8
subjects in each group. (From Gibala MJ, Little JP, van Essen M, etal:
Short-term sprint interval versus traditional endurance training: Similar
initial adaptations in human skeletal muscle and exercise performance,
J Physiol 575:901, 2006.)

1931

CHAPTER 97 Training for Wilderness Adventure

100

TRAINING INDUCED RIGHT SHIFT IN LACTATE CURVE

Muscle glycogen (mmol kg1 dw)

PART 12 SPECIAL POPULATIONS AND CONSIDERATIONS

750
Pre
Post*

600

450

300

150

0
0 min

60 min
SIT

0 min

60 min
ET

FIGURE 97-8 Muscle glycogen concentration measured at rest and

during cycling exercise that consisted of 60 minutes at 65% peak
oxygen consumption before (Pre) and after (Post) 6 weeks of sprint
interval training (SIT) or 6 weeks of endurance training (ET). Values are
given as mean standard error of the mean (n = 10 per group). dw,
Dry weight. *Main effect for condition (p < 0.05) such that post-training
(Post) > pretraining (Pre). Condition (Pre and Post) Time (0 and 60
minutes) interaction (p < 0.05) such that Post 60 minutes > Pre 60
minutes in both groups. (From Burgomaster KA, Howarth KR, Phillips
SM, etal: Similar metabolic adaptations during exercise after low
volume sprint interval and traditional endurance training in humans, J
Physiol 586:151, 2008.)

efficiency of training may be an important consideration; thus,

this is a significant finding.
These studies are only a few of the better examples of a large
body of literature looking at endurance versus intense or interval
styles of training. For wilderness activities, the lessons are crucial.
Endurance training in the classic sense is the core of training
philosophy, but the adventurer also wants to be able to perform
at the highest sustainable level that can be created by following
a training routine that is reasonable and realistic (i.e., compatible
with ones other life responsibilities). If it can be accommodated,
inclusion of 2 to 3 days of IT per week can be an important
addition to endurance training.
From a practical standpoint, how does one perform IT? First,
if one has never done that type of training, it is important to
realize that it is an intensity of exercise that is not particularly
comfortable. Thus, when exercising for minutes at a time above
LT, at about 40 seconds into the exercise interval, it will feel like
it is time to stop. One should design an IT session and stick to
it, especially through the last few seconds. Intervals can easily
be incorporated into ones usual routine. Always include an
aerobic warm up and cool-down period. Whether on a bike or
on foot, on a trail or road, find a modest hill that takes 1 to 2
minutes to sprint up, then slowly jog down and repeat. Start
out with a single interval, and then, over the course of a few
weeks, build up to 10 intervals. Improvement and familiarity with
the new territory of anaerobic training will come rapidly. Start
out with one interval day per week, and then increase to two
interval days per week over a couple of months. It is felt important to not train above LT every day, because adequate recovery
time is essential.
There are a couple of ways to achieve recovery between
intervals. One can arbitrarily state that there will be a certain
number of intervals of 1 to 2 minutes duration, with 2 to 3
minutes between intervals assigned for recovery. For instance,
one can run 400-m intervals and walk 200m between each of
them. Whatever one does, my best advice is to stick to it compulsively. A more physiologic way to recover is to use a heart
rate monitor. Make sure that, at the end of each interval, nearmaximum heart rate is attained. Maximum heart rate is a persons
1932

actual maximum heart rate rather than the 220 beats/min minus
age number that is often used but is only vaguely accurate.
Determination of maximum heart rate is actually not as easy as
it sounds, because most people do not reach it in a reproducible
manner. The heart rate at a true anaerobic interval could be
considered maximum heart rate, or one can do a formal cardiopulmonary exercise test during which a trained observer can look
 2max. At the end of each
for the heart rate at a plateau of VO
interval, one should walk or cycle slowly until a certain desired
post-recovery heart rate is achieved, at which point the next
interval may begin. Determining the recovery heart rate will likely
take some trial and error. It should be defined as the heart rate
after recovery from which the next interval can be done at very
close to the previous pace. For example, one may run 400-m
intervals and reach a maximum heart rate of 180 beats/min and
then undergo a recovery walk. Then, for example, when a heart
rate of 110 beats/min is reached, the next interval is started. There
are obviously much less rigorous ways to perform interval work,
but engaging in the creative design process will make ones
workouts more fun and varied.

EFFICIENCY OF MOVEMENT
In the final step to understanding movement over ground or
water, energy must be turned into work with some degree of
efficiency (i.e., using the biomechanics of the body to optimize
the energy generated by oxidative metabolism). Most of that
biomechanical efficiency is inborn. There are many athletes who
are so efficient that their excellent performance may be achieved
with a less-than-elite aerobic capacity. By the same token, there
 2max levels and high
are many individuals with prodigious VO
LTs with suboptimal biomechanics such that their transformation
of energy to movement prohibits them from performing at an
elite level. This is contrasted with high-altitude mountaineers
 2, whose
who have high (but not extraordinary) levels of VO
efficiency of movement and high LTs somehow allow them to
move quickly and efficiently for hours.
A fascinating example of efficient energy expenditure comes
from a study at 4700m in Tibet, where the authors did maximal
exercise testing for 17 Tibetans native to the area and 14 recently
 2max
migrated Han Chinese. Although the Han had higher VO
values than did the Tibetans (i.e., 36 versus 30cc/kg/min), the
Tibetans generated significantly higher work output (i.e., 176
 2 levels, LTs at higher
versus 150 watts) at those maximum VO
 2max (i.e., 84% versus 62%), and lower blood
percentage of VO
lactate concentrations.22 There is ongoing speculation as to
whether these characteristics are genetic or adaptive; however,
regardless of the mechanism of these differences, the Tibetans
appear to be ideal work machines at high altitude, and they are
able to perform more efficient work with less energy expenditure. Thus, the question arises: Can we train ourselves not only
to be more fit but also more efficient (i.e., the perfect adaptation
for the wilderness adventurer)?
There are a number of studies demonstrating thatwith
aerobic, anaerobic, and resistive trainingmodest improvements
in work efficiency can be attained. In a previously cited study,31
speed endurance training in competitive runners resulted in 5.7%
to 6.6% lower oxygen consumptions at three set levels of speed
on a treadmill compared with endurance-trained runners. In
another training study in runners comparing endurance and
interval training for 4 weeks,6 many of the measured variables,
 2max, were unchanged. The most notable finding
including VO
was that, at maximum energy expenditure (which was unchanged
between the two groups), velocity was significantly higher in the
runners who had used IT, suggesting greater running economy.
Although the topic of exposure to intermittent hypoxia will be
discussed more later in this chapter, it is worthy of brief mention
to note that, in one study, college track athletes were randomly
assigned to 29 days of low-altitude normoxia, constant simulated
high altitude (3000m), or nocturnal hypoxia. Although there
 2max, hemoglobin, endurance, or LT,
were no changes in VO
the athletes exposed to intermittent nocturnal hypoxia showed
about 5% improvement in running economy at a high race speed.
The mechanisms for these improvements are only speculative,
but some insight may be gained from a study looking at work

Aging and Training

As one ages, wisdommore than speedin the wilderness may
be ones saving grace, but it does not preclude ongoing commitment to conditioning. There is a wealth of literature about the
effects of aging on muscle and aerobic performance; a brief
summary is important to include here, because so many of us
will continue to venture into the wilderness. It is difficult to
define old age, but one could say that it begins with the later
part of the sixth decade, when there seems to be an inexorable
decrease in aerobic capacity and strength. There is another phase
of aging, called senescence, when there is a profound and irretrievable decline in mitochondrial function, muscle mass, and
cardiac compliance. The topic of master athletes and the underlying physiologic mechanisms accounting for the decline in aerobic
capacity with age despite rigorous training are also important
areas for aging wilderness adventurers to consider.56
Almost all organs involved in exercise show declining elasticity and flexibility with age. For example, in the lungs, there are
decreased compliance and elastic recoil, decreased respiratory
muscle strength, greater gas exchange heterogeneity, and
decreased chemosensor sensitivity. These changes result in a
greater work of breathing with exercise, impingement on
expiratory flow limitation, enhanced tachypnea with smaller
tidal volume, higher-frequency breathing pattern, and potential
hypoxemia.
The heart also loses elasticity as the ventriclas stiffen and
impair end-diastolic filling. In addition, there is a reduction of
maximum heart rate. This reduction can be minimized if one
continues to train into older age. The oft-quoted maximum heart
rate of 220 beats/min minus age is but a gross approximation
taken from the cross-sectional data of mostly unfit individuals.
There is a decline in peripheral vascular compliance, which may
play a role in further hindering blood flow and oxygen delivery.48
Some of the earlier data also suggested a linear decline in
 2max beginning sometime during the third decade of life,17,32
VO
but subsequent studies have shown that little reduction in
 2max occurs from the age of 20 years to the mid 50s if athletes
VO
continue active training47,57 (Figure 97-9).
The cross-sectional data certainly reflect the changes in lifestyle that come with families, jobs, and geography. Although
 2max declines in everyone at a certain point, the decline is
VO
probably a result of decreases in oxygen delivery and cardiac
output as well as a decrease in oxygen use with declining mitochondrial function, especially among the truly elder.5,39,54
It also used to be thought that, after a certain age, neither
strength nor aerobic capacity can be improved.4,18 However,
many studies over the last two decades have clearly shown that
older individuals who are otherwise healthy can train and
improve both strength and aerobic capacity. The earlier studies
were of rather low intensity and duration, whereas later studies
showed that substantial gains could be made with higher intensity and longer duration of training. These gains can translate
into practical function in any wilderness environment.
 2max between masters and sedComparing the decline in VO
entary subjects more than 60 years old, Rogers and colleagues51
showed that, with ongoing aerobic training, older individuals

CHAPTER 97 Training for Wilderness Adventure

70

60
VO2max (mLkg1min1)

efficiency in highly trained cyclists. The investigators looked at

work related to caloric expenditure and found a positive correlation with type I (aerobic) muscle fiber types taken from thigh
muscle biopsies.15 Of note was the large range (i.e., 32% to 76%)
of type I fibers in these athletes. One of the potential mechanisms
of energy cost saving with intense training of any type may be
a decrease in ventilatory demand and thus the work of breathing,
which, although modest, may be critical to performance.21 The
addition of explosive strength to normal endurance training in
competitive runners as compared with ongoing endurance training resulted in improved 5000-m times, which correlated with
the improvement in running efficiency. It has even been suggested that ongoing training and competition by a repeat Tour
de France winner have resulted in improved efficiency.13 Although
the improvements in efficiency are modest in most of these
studies, such improvements may be critical not only to competitive athletes but also to survival in a wilderness environment.

50

40

30

20
20

30

40

50

60

70

80

Age (yrs)
 2 max) of older
FIGURE 97-9 Maximum oxygen consumption ( VO
endurance athletes who continued to train at a high ( ), moderate
( ), or low intensity ( ) after 10- and 20-yr follow ups (present study).
Curves for athletes ( ) and untrained healthy persons ( ) are crosssectional norms. (From Heath GW, Hagberg JM, Ehsani AA, et al:
A physiologic comparison of younger and older endurance athletes,
J Appl Physiol 51:634, 1981.)

 2max from 10% to

could decrease the decline per decade in VO
5%. Kohrt and colleagues37 took 110 untrained men and women
between the ages of 60 and 71 years, measured their prestudy
 2max, and then had them perform 9 to 12 months of walking
VO
or running 4 days per week for 40 minutes per session at 80%
of their predicted maximum heart rates. Men and women
improved their maximum values by 26% and 23%, respectively;
when they were divided into three equal age groups, there also
was similar improvement. In terms of improvements, these values
are comparable with those seen among younger subjects. Conley
and colleagues12 engaged sedentary healthy men and women
between the ages of 65 and 92 years in 4 months of both aerobic
 2max testing, Cybex strength
and strength training and used VO
measurements, muscle biopsies, and nuclear magnetic resonance
spectroscopy to measure creatine phosphate dynamics were
determined before and after training. They compared the results
of these subjects with those of healthy controls, and found
substantial improvements in all of the outcome variables, which
were equal in percentage improvement to those obtained with
younger subjects.
These studies are a few of many that have confirmed two
important facts: (1) older individuals can be trained in both
endurance and strength to a degree comparable with those of
younger subjects; and (2) individuals who continue to train
throughout life can slow the inevitable rate of decline in aerobic
capacity. As is true for younger individuals, it is the total amount
of work done that is the important factor for the making of
aerobic gains; the American Academy of Sports Medicine recommends approximately 250 to 300kcal per session. The energy
expended is a combination of duration and intensity that must
add up to the recommended total. In other words, 40 to 50
minutes of moderate walking would be comparable with 20 to
30 minutes of jogging or slow running for these elder groups.

High Altitude and Exercise

During the summer of 1968 in Mexico City, three world records
were set in track and field, and one favored American miler was
soundly defeated. Tommie Smith (200m), Lee Evans (400m),
and Bob Beamon (long jump) set records that stood for decades.
Jim Ryun, the favorite in the 1500m, was beaten by Kip
Keino from Kenya. Aside from the fact that the first three were
1933

EFFECT OF HIGH ALTITUDE ON EXERCISE

The next two sections of this chapter cover the effects of altitude
on exercise as well as the positive and negative aspects of training at high altitude (Figure 97-11). Both topics have important
implications for wilderness travel, much of which occurs in the
cold, thin air. Chapter 1 covers the broad topics of high-altitude
acclimatization and illness.
Anyone who has sojourned quickly to 3000m or higher
cannot exert themselves without dyspnea and exercise limitation.
With acclimatization over time, the limitations discovered at
3000m can be diminished or eliminated.27 At altitudes of 3500
to 8000m, sea-level performance can not be attained despite
prolonged adaptation. Although the fraction of oxygen in the
earths atmosphere is constant at 0.2093, the barometric pressure
and thus the content of oxygen decreases as one ascends. For
example, with some variation depending on the weather, the
barometric pressure at sea level is approximately 760mmHg,

FIGURE 97-11 Mt Ama Dablam in the Khumbu region of Nepal.

(Courtesy Robert B. Schoene.)

whereas, at the summit of Mt Everest (as measured by Chris Pizzo

on October 23, 1981), the barometric pressure is 253mmHg.
Thus, at the summit, there is approximately one-third of the
amount of oxygen available for aerobic activity as compared with
sea level.59 With less oxygen available in the air, there is a
decrease in oxygen availability at each step of the delivery of
oxygen from air to the lungs to the blood to the tissues and
 2max
mitochondria. As a climber ascends, his or her VO
decreases55,58 (Figure 97-12), and the speed of ascent decreases.
One of the limiting factors is the increased work of breathing
that occurs for any given level of energy expenditure. For
example, the ventilatory equivalent is almost four times greater
at 6300m than it is at sea level.11,53 Thus, blood flow necessary
to perfuse the muscles of respiration is stolen from the muscles
of locomotion. Furthermore, because of a diffusion limitation of
oxygen from air to the blood at high altitude, the higher one
ascends, the greater the amount of oxygen desaturation with
exercise (Figure 97-13).

60

Maximal O2 uptake (mL/min/kg)

PART 12 SPECIAL POPULATIONS AND CONSIDERATIONS

serendipitously some of the greatest sprinters and jumpers of all

time, part of their advantage may have been the slightly thinner
air at the altitude of 2200m (Figure 97-10).
Alternatively, Jim Ryun and the American middle-distance
hopes were dashed. The burning questions then became the
following: Was Ryun not acclimatized to the higher altitude? Was
there something special about Keinos being born and raised at
that altitude in Kenya? These questions set off an intense interest
in high-altitude training, which was thought to be the answer for
improved aerobic performance. Initially no one thought of any
potential deleterious effects of training at higher altitudes. As has
been discussed previously, training at such altitudes does not
allow one to reach the intensity of training that is necessary for
improved aerobic fitness and higher sustainable workloads.
Prudent investigators started a series of studies to answer these
questions more precisely. In fact, before the 1988 Seoul Olympics, the American road cycling coach wanted to take the team
to an altitude of more than 3700m for 2 weeks right before the
games, which were to be held close to the altitude of sea level.
Fortunately, he was prevailed upon to not do so. By that time,
it was clear that there was a decrease of intensity of work that
athletes were able to do at those altitudes. High intensity of
work, as has been noted previously, is needed for greater
gains in aerobic capacity and beneficial alteration of the lactate
threshold.

Sea
level

1981 Expedition

50

Summit of
Mt Everest

40

Pugh et al.
(1964)
30

20

10

Basal O2 uptake

0
0

50

100

150

Inspired Po2 (torr)

FIGURE 97-10 Peter Norman, Tommie Smith, and John Carlos at the
1968 Medal Award Ceremony for the 200 in Mexico City at an altitude
of 2200m (7218 feet).

1934

FIGURE 97-12 Maximum oxygen (O2) consumption plotted against

inspired partial pressure of oxygen (Po2). The present data ( ) are
contrasted with measurements ( ) made previously by Pugh.48a Note
that, although the curve derived from the data in the present study is
only slightly shifted to the left, because of the steepness of slope, gain
in maximum oxygen uptake at extreme altitudes is substantial. (From
West JB, Boyer SJ, Graber DJ, etal: Maximal exercise at extreme
altitudes on Mount Everest, J Appl Physiol 55:688, 1983.)

100
Sea level

Arterial O 2 saturation (%)

90

80

70

6300 m air

60

6300 m 16% O2

50
6300 m 14% O2
40
0

300

600

900

1200

2400

Work rate (kg/min)

FIGURE 97-13 Arterial oxygen (O2) saturation against work rate for
four conditions studied. Note the steeply falling oxygen saturation as
work rate was increased when the inspired partial pressure of oxygen
was very low. This can be explained by diffusion limitation of oxygen
transfer across the bloodgas barrier. (From West JB, Boyer SJ, Graber
DJ, etal: Maximal exercise at extreme altitudes on Mount Everest, J
Appl Physiol 55:688, 1983 and Sutton JR, Reeves JT, Wagner PD, etal:
Operation Everest II: Oxygen transport during exercise at extreme
simulated altitude, J Appl Physiol 64:1309, 1988.)

The body goes through a complex series of adaptations that

do their best to optimize delivery and use of oxygen, despite
less availability. The breadth of acclimatization involves a progressive increase in ventilation that is immediate and goes on for
weeks; an improvement in ventilation and perfusion match in
the lungs and thus gas exchange, which occurs over the course
of several hours; an increase in oxygen-carrying capacity as a
result of an increase in red blood cell production through erythropoiesis that occurs within 10 to 14 days; and an improvement
in tissue oxidative capacities over a number of weeks to months.
For persons going to high altitudes, the most important thing
to remember is that everyones rate of adaptation at each of these
steps is different, which results in a range of time for adaptation.
Thus, when on a trek, everyone with enough time to do so
should adapt well and be equal in terms of acclimatization and
fitness; however, it is difficult to predict who will be a slow versus
fast adapter. Sometimes the individual who feels less well at the
beginning may be the best acclimatized at the end.
In terms of training for high-altitude ventures, other than being
generally fit, there is not much a lowlander can do to prepare.
Chapter 1 suggests rates of ascent to minimize the chances of
getting altitude illnesses. These rates are similar to those needed
for people to gain acclimatization and fitness. The most common
mistake is to take too little time for a trip to the Himalayas or
the Andesor even a weeklong ski trip to Colorado. A rigid
schedule that does not allow sufficient time for acclimatization
is dissatisfying at best and dangerous at worst. Having been preexposed to high altitude before going on a challenging trek is
always beneficial, but usually not feasible or practical.46 Such
issues have become important considerations for military personnel, who may need to ascend rapidly for certain operations.45

HYPOXIC TRAINING
Interest in training at high altitude for low-altitude athletic events
has not abated over the last two decades. What started as a positive assumption turned into an area of intense research to try to
answer whether living or training at high altitude is beneficial for

low-altitude competition. Some of these principles apply not only

to competitive events but also to travel and adventure to high
altitudes. The purpose of altitude training and intermittent
hypoxic training is to induce some physiologic adaptation
from hypoxia that is presumably beneficial to endurance
performance.
When it finally dawned on trainers and coaches that full-time
hypoxic exposure might not be beneficial, a number of methods
were tried to get enough hypoxic exposure without having too
much. Levine and Stray-Gundersen41 set out on a prolonged
series of experiments in accomplished runners. The study design
included four groups: (1) athletes who lived and trained at low
altitude (LLTL); (2) those who lived high and trained high (LHTH);
(3) those who lived low and trained high (LLTH); and (4) those
who lived high and trained low (LHTL). Part of the rationale for
such a design was to test the hypothesis that training at high
altitude does not allow an athlete to achieve as intense a training
effect as he or she could achieve at lower altitude. The altitude
exposure of the LHTL group was 4 weeks of 20 hours per day
at 2500m. The upshot from these series of studies was that the
 2max and 5000-m times were in
athletes who improved their VO
the LHTL group, and this improvement correlated with those who
 2max correhad an erythropoietic response: the increase in VO
sponded precisely with the increase in oxygen-carrying capacity.
However, even in the LHTL group, there were responders and
nonresponders, which were differentiated by improvements in
5000-m race time. The responders improvements corresponded
with whether they had an erythropoietic response. Levine contends that there is a threshold (i.e., specific hypoxic dose) that
is necessary to inducing these responses and that, in a number
of previous studies, the dose may not have been long or high
enough.42 In his discussion, he reminds the reader that the
mechanism of response to hypoxia is signaled by hypoxiainducible factor-1 and that this protein is one of the most
evanescent proteins of gene transcription described in the body:
when the hypoxic stimulus is removed, hypoxia-inducible factor1 disappears within milliseconds. Thus, all subsequent gene
transcription ceases, and no further growth factors (e.g., erythropoietin) are stimulated. The hypoxic exposure must be intense
and sufficiently prolonged to keep the cycle going. Not everyone
responds, and the gains are minimal among those who do. So
is it all worth it?
Many athletes think it is worth it. The urge to excel has led
to hypoxic sleeping tents that can be purchased. With such a
tent, the athlete can sleep in his or her bed and dial in progressive altitudes for weeks of natural acclimatization and blood
doping. This trend has led to a number of studies of intermittent
hypoxia (i.e., normobaric or hypobaric) to see if effects similar
to those obtained at true altitude could be found. Julian and
colleagues35 exposed athletes to progressive normobaric hypoxia
(i.e., a fraction of inspired oxygen of 0.11%) for 2 weeks for 70
minutes each day and found no changes in performance or
erythropoietic markers. Using normobaric hypoxia (i.e., a fraction
of inspired oxygen of 14.5%) for 6 weeks, Zoll and colleagues61
divided runners into two groups: LLTL and LLTH. They looked
 2max and time to exhaustion) and muscle
at performance (i.e., VO
biopsies to evaluate markers of hypoxic transcription and oxidative phosphorylation. With the LLTH design, the researchers
 2max (5%), a remarkable
found a modest improvement in VO
improvement in time to exhaustion (26%), and substantial
increases in the transcription factors and markers of oxidative
phosphorylation. Gore and colleagues26 exposed athletes to a
simulated altitude of 4000 to 5500m for 3 hours per day on 5
days per week for 4 weeks and found an increase in erythropoietin but no increase in markers of red-cell production. With a
similar design, this same research group studied swimmers and
found no improvement in swimming times with the intermittent
hypoxia.50 They concluded that the hypoxic dose was not
adequate enough.
Not all intermittent hypoxic studies have been negative. Katayama and colleagues36 exposed a small group of runners to a
simulated altitude of 4500m for 90 minutes per day three times
per week for 3 weeks. In the hypoxic group, they found improvements in running time and time to exhaustion as well as lower
 2 levels at submaximal exercise levels, with no other changes
VO
1935

CHAPTER 97 Training for Wilderness Adventure

MAXIMAL EXERCISE ON MT EVEREST

in hemodynamic or hematologic variables. Thus, the authors

contended that this type of exposure led to an improvement in
running efficiency. However, they did not offer give any insight
into the mechanism of improvement.
So, are all of these manipulations much ado about nothing?
There seems to be a benefit in performance for some athletes
who are responders, but clearly the dose and duration of the
hypoxic exposure have to be adequate. That dose is a tedious
one to attain, and such efforts may only be worthwhile for highly
competitive athletes. As for those who venture into the mountains, remember to go slowly and enjoy the scenery.

Artificial Training Methods:

Blood Transfusion
With the advent of competitive wilderness events (e.g., endurance high altitude races, X-games, speed climbs), the use of
dangerous and arguably unethical methods to improve ones
performance has inevitably emerged. This is not surprising given
the presence of such methods in other sports for decades or
perhaps even centuries. Although there is no role for such interventions in wilderness activities or competitions, a short comment
on one of the most egregious approaches is warranted.
There is a surfeit of information on blood transfusions
(doping) and erythropoietic medications.19a,23a,49a The interest in
enhancement of performance by increasing oxygen-carrying
capacity with extra red blood cells was brought to attention via
the 1968 Mexico City Olympics and then into the 1970s, when
certain middle-distance Scandinavian track athletes were suspected of blood doping. Subsequent data supported the benefit

of increased red blood cell mass and improved aerobic

performance.8a Such augmentation was achieved by either autologous or allogeneic transfusions, and later when recombinant
erythropoietin (EPO) was developed. Administration of this drug
was rampant in a number of sports venues, most notoriously
European cycling. Although the benefit of increased red cell mass
was acknowledged, the philosophy that, If some is good, more
is better led to fatal complications in a number of young athletes,
because the downside sequelae of increased red blood cell mass
were increased blood viscosity, strokes, and death.
Both the scientific community and international sports governing bodies have rallied to try to prevent such abuse and minimize
the physical risk to young, vulnerable athletes. Detection of both
blood doping and EPO has reached a scientific level of sophistication such that most athletes, when properly screened, can be
discovered.
It is the opinion of this author that to summit Mt Everest,
win a high-altitude endurance race, or be publically acclaimed
as a champion in an extreme sport, one should compete and
perform within the boundaries of fair means. To do otherwise clearly sometimes incurs unacceptable risks of injury and
death, because the wilderness environment in and of itself
can accentuate dehydration, hemoconcentration, and subsequent
medical consequences, including death. As emphasized earlier,
one should go to the wilderness for enjoyment, fellowship,
and self-fulfillment.

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