Scientific Programme
Sports and Exercise Medicine and Health
IS-MH12 - ACSM-ECSS EXCHANGE SYMPOSIUM: GOING TO ALTITUDE WITHOUT GOING TO THE HOSPITAL
Date: 08.07.2026, Time: 16:45 - 18:00, Session Room: Auditorium C (STCC)
Description
Chair(s)
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Speaker A
Annalisa Cogo
university of ferrara, Centro Studi Biomedici Applicati allo Sport
Italy
Read CVECSS Rimini 2025: IS-MH12
Acclimatize properly before climbing: still a dogma?
The key point of high altitude is the progressive reduction of the Po2 all along the oxygen transport chain that induces the human body to activate compensation responses aimed to improve the tissue oxygenation. These specific responses, collectively referred to as acclimatization. Major responses to high altitude exposure involve the brain, lungs, heart, kidneys, and blood. Acclimatization improves the ability to live and exercise at altitude but the rates of acclimatization and physiologic responses to high altitude vary considerably between individuals. If acclimatization is poor, maladaptive responses occur, leading to some form of acute altitude illness. These are acute mountain sickness (AMS), high altitude cerebral edema (HACE), and high-altitude pulmonary edema (HAPE). AMS is the least severe form and occurs in approximately 10-25% of unacclimatized persons at altitudes >2500m. The risk of HACE or HAPE typically occurs at elevations >3000m. Apart from the possibility of developing AMS, at altitude there is a progressive decline in exercise and functional capacity that at higher altitudes is often associated with impaired cognitive performance. Altitude's effect on exercise performance depends on the degree of altitude, duration of hypoxic exposure, and the type and intensity of exercise. This performance decrement is directly related to reductions in V̇O2max that is reduced approximately by 1% reduction for every 100m above 1500m. The effect on aerobic performance is a function of both event duration and altitude. Furthermore, exercise can exacerbate symptoms of AMS, and any degree of high-altitude illness will almost certainly affect athletic performance. The athletes must know that a high level of aerobic fitness is not protective against development of AMS. In general, the slower the ascent, the greater the time for acclimatization and the lower the risk of altitude illness. The altitude at which someone sleeps is considered more important than the altitude reached during waking hours. The slow rate of ascent was inevitable in the last century when the altitude could be reached almost only on foot. Now it is possible to reach high altitudes with cable cars, planes or helicopters. This has reopened the problem of acclimatization especially for fast climbs. After a brief description of the relationship between terrestrial high altitude and human body, the role of acclimatization will be discussed and the non-pharmacological strategies for good acclimatization will be analyzed: different rates of ascent, pre-exposure to high altitude and the use of respiratory strategies. At the end of the talk, participants will understand the unique physiological challenges posed by high altitudes and be aware of the risk and how to reduce it.
Speaker B
Ben Levine
University of Texas Southwestern Medical Center at Dallas , Institute for Exercise and Environmental Medicine
United States
Read CVECSS Rimini 2025: IS-MH12
Altitude and the Heart: Friend or Foe?
The effect of altitude on the broader population extends beyond the risks of acute high altitude illness. On the one hand, epidemiological data from multiple places throughout the world suggest that individuals living in moderate to high altitude environments may be particularly long lived, with reduced risk from cardiovascular disease, though perhaps increased risks from pulmonary disease. The mechanisms for this apparent protection are uncertain, and could reflect direct effects of altitude acclimatization or improved life-style risk factors, especially increased physical activity. There also are risks for patients with pre-existing CV disease going to high altitude environments. Data from the Alps show that there is an elevated risk of high altitude hiking/skiing, comparable to competitive distance running at sea level, which is increased in older individuals and those with known coronary artery disease. Interestingly, the risk of sudden cardiac death can be substantially reduced by a gradual ascent profile, with at least one night sleeping at ~ 1500m. However as long as patients are stable without substantial provocable ischemia or arrhythmias, even patients with significant LV dysfunction can tolerate short term exposure to moderate altitude though an emergency management and evacuation plan is essential in such patients wishing to travel to remote high altitude areas. Ischemia and arrhythmias are likely slightly increased with acute exposure, but return to sea level baseline after acclimatization. Ensuring appropriate guideline directed medical therapy is essential to stabilize disease processes, and optimize coronary blood flow. These considerations were recently reviewed by both European (PMID: 29340578) and American Cardiovascular Societies (PMID: 34496612) . Intriguingly, very recent provocative data suggest that extreme hypoxia, equivalent to the summit of Mt. Everest, may induce myocardial regeneration through the DNA damage response and stimulation of HIF2. Clinical studies of this paradigm are currently ongoing.
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