Why do we climb mountains? An exploration of features of behavioural addiction in mountaineering and the association with stress-related psychiatric disorders.

Common knowledge implies that individuals engaging in outdoor sports and especially in regular and extreme mountaineering are exceptionally healthy and hardened. Physical activity in outdoor environments has a positive effect on physical and mental health. However, regular and/or extreme mountaineering might share similarities with behavioural addictions and could thus also have a negative impact on health. In this cross-sectional web-based questionnaire study, we collected data on exercise and mountaineering addiction (Exercise Addiction Inventory; original and adapted version for mountaineering; Exercise Dependence Scale adapted version for mountaineering). Further surveyed parameters included mountaineering habits, Risk-Taking Inventory, Sensation-Seeking/Emotion Regulation/Agency Scale (SEAS), resilience, self-perceived stress, physical activity in metabolic units and mental health. Comparisons were performed between individuals with symptoms of addiction to mountaineering (MA) and individuals without symptoms of addiction to mountaineering or sports in general (CO) using non-parametric analyses. We analysed data from 335 participants, n = 88 thereof with addiction to mountaineering (MA) and n = 247 control participants (CO). The MA group scored significantly higher with regards to self-perceived stress (p < 0.001) and included a significantly higher number of individuals affected by symptoms of depression (p < 0.001), symptoms of anxiety (p < 0.001), symptoms of eating disorders (p < 0.001), alcohol abuse or dependence (p < 0.001), illicit drug abuse (p = 0.050), or current and history of psychiatric disorders (p < 0.001). Individuals with MA showed higher values in all SEAS subscales as well as increased risk-taking (p < 0.001). Regular and extreme mountaineering can display features of a behavioural addiction and is associated with psychiatric disorders. Behavioural addiction in mountaineering is associated with higher levels of sensation-seeking, emotion regulation, and agency, as well as increased risk-taking.

Effect of mental fatigue on performance, perceptual and physiological responses in orienteering athletes.

BACKGROUND: Mental fatigue seems to impair the athletes' performance; however, in sports with high cognitive demand, such as orienteering, this negative effect could be attenuated during the race. Therefore, this study investigated mental fatigue effect on performance, perceptual, and physiological responses in orienteers. METHODS: Fifteen male orienteers (30±8 years) participated in the study. Two conditions of cognitive tasks preceded the orienteering performance, performed randomly: 30 minutes of mental exertion (experimental condition [EXP]) by Stroop task, or 30 min without mental exertion (control condition [CON]). Orienteering performance was determined by the time required to perform the Orienteering race. The perceived recovery and motivation were evaluated in each condition, pre-cognitive task, and heart rate during the task. Perceived exertion (RPE) was measured pre- and post-orienteering race. Orienteering performance and perceived performance were measured immediately after the race. RESULTS: Orienteering performance and remain variables showed no significant differences between conditions (EXP versus CON) (P>0.05). Although a slight increase in performance-time was found in EXP (40.8±11.4 min) versus CON (38.4±13 min) (P=0.4; ES=0.20). RPE increase post-EXP (P<0.05; ES=0.96) but not post-orienteering race (P>0.05). CONCLUSIONS: Thirty minutes of the cognitive task did not significantly affect the perceptual and physiological responses but demonstrates the addition of 2.4 minutes to orienteering performance. Orienteers may cope with mental effort due to the cognitive demands and physical conditions required in orienteering.

Experiencia emocional subjetiva en deportistas extremos: estudio cualitativo / Emotional subjective experience in extreme sports participants: a qualitative study / Experiência emocional subjetiva em atletas extremos: um estudo qualitativo

Los participantes en deportes extremos usualmente han sido estudiados desde la perspectiva de riesgo. El presente estudio busca alejarse de dicha preconcepción y tiene como objetivo estudiar la experiencia subjetiva emocional. Se empleó una metodología cualitativa con diseño fenomenológico-hermenéutico tomando como herramienta un sistema de categorías construido a partir de los sistemas conversacionales. Los informantes fueron 8 deportistas extremos pertenecientes a un mismo grupo. Dentro de los deportes extremos se incluyen: escalada de montaña, rapel, puenting, montañismo y bungee jumping. Los resultados indican que el miedo es generador de libertad, puede ser útil, es gratificante y también es promotor de transformaciones personales. Esta investigación otorga valor teórico al porqué del involucramiento en deportes extremos

Participants in extreme sports have usually been studied from a risk perspective. The present study seeks to move away from this preconception and aims to study the emotional subjective experience. A qualitative methodology with phenomenological-hermeneutic design was used taking as a tool conversational systems. The informants were 8 extreme athletes belonging to the same group. Extreme sports included were: Mountain climbing, rappelling, bungee jumping, and mountaineering. The results indicate that fear is a generator of freedom, it can be useful, it is rewarding and it is also a promoter of personal transformations. This research gives theoretical value to the reason for involvement in extreme sports

Participantes em esportes radicais geralmente têm sido estudados a partir de uma perspectiva de risco. O presente estudo busca afastar-se desse preconceito e visa estudar a experiência emocional subjetiva. Uma metodologia qualitativa com desenho fenomenológico-hermenêutico foi utilizada, utilizando sistemas conversacionais como ferramenta. Os informantes eram 8 atletas extremos pertencentes ao mesmo grupo. Esportes radicais incluem: alpinismo, rapel, bungee jumping, montanhismo e bungee jumping. Os resultados indicam que o medo é um gerador de liberdade, pode ser útil, gratificante e também promotor de transformações pessoais. Esta pesquisa dá valor teórico ao motivo do envolvimento em esportes radicais

Physical and Physiological Determinants of Rock Climbing.

PURPOSE: Rock climbing performance relies on many characteristics. Herein, the authors identified the physical and physiological determinants of peak performance in rock climbing across the range from lower grade to elite. METHODS: Forty four male and 33 female climbers with onsight maximal climbing grades 5a-8a and 5a-7b+, respectively, were tested for physical, physiological, and psychological characteristics (independent variables) that were correlated and modeled by multiple regression and principal component analysis to identify the determinants of rock climbing ability. RESULTS: In males, 23 of 47 variables correlated with climbing ability (P < .05, Pearson correlation coefficients .773-.340), including shoulder endurance, hand and finger strength, shoulder power endurance, hip flexibility, lower-arm grip strength, shoulder power, upper-arm strength, core-body endurance, upper-body aerobic endurance, hamstrings and lower-back flexibility, aerobic endurance, and open-hand finger strength. In females, 10 of 47 variables correlated with climbing ability (P < .05, Pearson correlation coefficients .742-.482): shoulder endurance and power, lower-arm grip strength, balance, aerobic endurance, and arm span. Principal component analysis and univariate multiple regression identified the main explanatory variables. In both sexes, shoulder power and endurance measured as maximum pull-ups, average arm crank power, and bent-arm hang, emerged as the main determinants (P < .01; adjusted R2 = .77 in males and .62 in females). In males, finger pincer (P = .07) and grip strength also had trends (P = .09) toward significant effects. Finally, in test-of-principle training studies, they trained to increase main determinants 42% to 67%; this improved climbing ability 2 to 3 grades. CONCLUSIONS: Shoulder power and endurance majorly determines maximal climbing. Finger, hand, and arm strength, core-body endurance, aerobic endurance, flexibility, and balance are important secondary determinants.

Factors influencing protective equipment use by mountain bikers: Implications for injury prevention.

AIM: To assess the attitudes of mountain bikers to the use of protective equipment and quantify the use of such equipment. METHOD: This was a prospective cohort study using an online questionnaire, offered to bikers participating in a series of Enduro races. The attitudes towards various factors that might contribute to a rider's choice to use protective equipment were quantified based on their responses to the questions. The actual reported use of various types of protective equipment was the outcome measure. The correlations between the factors and actual use were analysed for statistical significance, to assess their relative importance. RESULTS: Equipment use was similar in racing and non-racing settings and could be increased. 55% had experienced an injury requiring a week or more off work. Perceptions of the benefits, costs, cues, comfort and potential injury severity proved to be well correlated with the choice to use equipment, while harm, danger and exposure to media influences did not.

Development of a Self-Administered Questionnaire to Detect Psychosis at High Altitude: The HAPSY Questionnaire.

Aims: Psychotic symptoms during exposure to high altitude (HA) have been linked to accidents or near accidents on the mountains. It is thus of great importance to directly identify psychotic symptoms in individuals who are exposed to HA quickly and reliably on the mountain, even in the absence of experienced medical personnel. Psychotic features at HA frequently include positive psychotic symptoms such as hallucinations, delusions, or disorganized thinking/speech. The aim of the current study was to develop the first self-administered questionnaire (High Altitude Psychosis [HAPSY] Questionnaire), which individuals may use in the future to self-assess altitude-related psychotic symptoms on the mountain. Methods: We utilized two existing self-rating questionnaires for psychotic symptoms (the Psychotomimetic States Inventory, PSI and the Cardiff Anomalous Perception Scale, CAPS) as the basis for a two-round Delphi process. As part of this process, additional statements were suggested by the 40 Delphi participants. Results: Eleven self-administered statements-all of them related to positive psychotic symptoms-were identified to be most useful for the self-detection of HA-related psychotic symptoms on the mountain. Conclusion: This is the first self-administered questionnaire that allows the identification of HA-related psychotic symptoms on the mountain. A subsequent validation study is needed to address the psychometric properties of this questionnaire. Clinical validation will have to be performed in a field study.

A German climbing study on depression: a bouldering psychotherapeutic group intervention in outpatients compared with state-of-the-art cognitive behavioural group therapy and physical activation - study protocol for a multicentre randomised controlled trial.

BACKGROUND: Besides classical approaches for treating depression, physical activity has been demonstrated to be an effective option. Bouldering psychotherapy (BPT) combines psychotherapeutic interventions with action-oriented elements from the field of climbing. The aim of this study is to investigate the effectiveness of BPT compared with a home-based exercise program (EP - active control group, superiority trial) and state-of-the-art cognitive behavioural therapy (CBT - non-inferiority trial). METHODS: The study is being conducted as a multicentre randomised controlled intervention trial at three locations in Germany. Participants are being randomised into three groups: BPT, CBT, or EP, each with a 10-week treatment phase. A power analysis indicated that about 240 people should initially be included. The primary outcome of the study is the Montgomery and Asberg Depression Rating Scale (MADRS) directly after the intervention. Additional measurement points are located three, six, and 12 months after the end of the intervention. The data are being collected via computer-assisted telephone interviews. Statistical analyses comprise regression analyses to test for the superiority of BPT over EP. To test for the non-inferiority of BPT and CBT, a non-inferiority margin of 1.9 points in the Patient Health Questionnaire (PHQ-9) and two non-inferiority margins for the MADRS (half of the two smallest Cohen's d values from the current meta-analyses) was predefined. The mean difference between CBT and EP is being used as a supplementary equivalence margin. DISCUSSION: This is the first study to investigate the effect of a bouldering psychotherapy (BPT) on outpatients' depressive symptoms compared with mere physical activity (superiority analysis) and state-of-the-art cognitive behavioural therapy (CBT, non-inferiority analysis). Methodological strengths of the study are the elaborated, multicentred, randomised, controlled design. Assessors are blinded with regard to group allocation which leads to high objectivity. The study is conducted in a naturalistic setting, which leads to high external validity. Methodological limitations might be the clinical heterogeneity of the sample, which may dilute the intervention effects. TRIAL REGISTRATION: ISRCTN12457760 (Registration date: 26 July 2017, retrospectively registered).

Personality characteristics of mountaineers - review of the literature. / Charakterystyka osobowosci wspinaczy wysokogórskich ­ przeglad literatury.

The following paper presents the existing body of research on personality traits (within the framework of personality trait theory and Marvin Zuckerman's sensation seeking theory) of individuals engaging in high-risk sports, especially mountaineering and alpinism. In the review, two perspectives of theoretical analysis were taken into consideration: a psychological (concerning reflections on non-pathological personality characteristics of mountaineers) and a psychopathological one (concerning research on hypothetically pathological dimensions of the following traits). In both psychological and psychopathological perspective, the importance of sensation/stimulation seeking (understood as one of the personality dimensions) and deficiency of trait anxiety were analyzed. Both determinants can be linked with type T personality. In addition, numerous studies suggest that traits such as neuroticism, extraversion and conscientiousness may play important role in personality regulation of mountaineers. The presented reflection was supplemented by early reports referring to possible psychopathological traits, which may hypothetically indicate some personality disorders. The authors highlight the limitations of previous studies and point out possible directions of future research, in particular - necessity of including motivational factors, associated with engaging in high-risk sport activities.

Impact of a 3-Day High-Altitude Trek on Xue Mountain (3886 m), Taiwan, on the Emotional States of Children: A Prospective Observational Study.

AIMS: Changes in emotions associated with mountain treks have rarely been reported. This study examined emotional state changes in sixth-grade elementary school students before and after a 3-day high-altitude mountain trek from the trailhead (2140 m) to Xue Mountain (3886 m) in Taiwan. METHODS: In June 2011, 201 students participated in the trek. The round-trip distance was 21.8 km. The age, gender, blood group, and family configuration of the participants were documented before the trek. A 36-item short-form survey instrument, including the Mood and Anxiety Symptom Questionnaire and the Positive and Negative Affect Scale for Children, was used to evaluate the participants' emotional states (happiness, anticipation, sadness, and anger). The participants answered the questionnaires 1 month before and 1 week after the trek. A Likert scale was used to evaluate individual items (range 1-4; from strongly disagree to strongly agree). We calculated scores for each index before and after the trek. The incidence and presentation of acute mountain sickness (AMS) among the participants was also studied and published previously. RESULTS: In total, 187 (112 boys and 75 girls) participants (mean age 11.9 ± 0.4 years) completed the trek and the survey. The sadness and anger scores (negative emotions) were significantly lower after than before the trek (39.5 vs. 36.6; p < 0.01). The happiness and anticipation scores (positive emotions) before and after the trek did not differ significantly (49.9 vs. 48.9; p = 0.11). No participant used AMS prophylaxis, while 78 participants met the AMS criteria. Negative emotions decreased more in those with AMS than without AMS (-4.6 vs. -1.8; p = 0.04), and the use of medications or acetazolamide did not alter the emotions. CONCLUSIONS: A 3-day high-altitude mountain trek can reduce children's negative emotions. Negative emotions decreased more in those with AMS, whereas medications or acetazolamide did not alter their emotions.

Doctor won't see you now: changing paradigms in mountain medicine.

The evolution in communication and digital technologies is revolutionising the practice of medicine. A physician is now able to oversee provision of healthcare at a distance. In this paper, we argue that practice of telemedicine is an essential and evolving aspect of high altitude and expedition medicine. We acknowledge the lack of international consensus, limited legislation as well as possible reservations towards telemedical practice. Given some unique social and medical aspects of participation in remote, high altitude expeditions we propose a number of guiding principles for those involved in provision of telemedical services for such endeavours.

Performance, Mood, and Anxiety During a Climb of Mount Everest.

Karinen, Heikki M., and Martti T. Tuomisto. Performance, mood, and anxiety during a climb of Mount Everest. High Alt Med Biol. 18:400-410, 2017. BACKGROUND: Various studies have shown the deleterious effects of high-altitude hypoxia on visual, motor, somatosensory, cognitive, and emotional function and also in intelligence tests, reaction time, speech comprehension, hand steadiness, visual contrast discrimination, and word association tests. Because optimal cognitive abilities may be crucial for mountain climbers' safety, this study was intended to evaluate the changes in cognitive performance, mood, and anxiety during an Everest expedition lasting almost 3 months. METHODS: A set of physiological (Lake Louise score, oxygen saturation), cognitive (Colorado perceptual speed [CPS] test, number comparison [NC] test), and emotional measurements (Profile of Mood States, anxiety responses, psychological inflexibility) were collected from nine climbers on a partly unsupported Mount Everest expedition at various time points during the course of the expedition at Everest Base Camp (EBC). For confidence intervals we used 95% simultaneous Bonferroni corrected interval (BCI) for the differences. RESULTS: During this expedition, the estimates of trait anxiety decreased 13% toward the end of expedition after successful summiting (p = 0.004). Simultaneously, fatigue appeared to diminish and the CPS speed results improved 13%. Most expedition members suffered mild symptoms of acute mountain sickness during the first days in the EBC, but this did not affect the speed or the number of mistakes made in the CPS or NC tests. In CPS test the differences between pretest and the physically most demanding period (EBC4, BCI: 0.01, 4.43) and between EBC1 and EBC4 (BCI: 0.57, 4.99), between EBC2 and EBC4 (BCI: 0.45, 4.88), and between EBC3 and EBC4 (BCI: 1.12, 5.55) were significant, showing ever improving results during the expedition. CONCLUSION: The most important finding in this study was that well-motivated and trained, self-selected individuals, who volunteer for a long-duration mission, are capable of maintaining high levels of performance, steady mood state, and a good level of vigor on a Mount Everest expedition lasting nearly 3 months.

Extensive Microhemorrhages of the Cerebellar Peduncles After High-Altitude Cerebral Edema.

Pichler Hefti, Jacqueline, Philipp Hoigné-Perret, and Raimund Kottke. Extensive microhemorrhages of the cerebellar peduncles after high-altitude cerebral edema. High Alt Med Biol. 18:182-184, 2017.-Neuromagnetic resonance imaging (MRI) of subjects who suffered from high-altitude cerebral edema (HACE) typically shows cerebral microhemorrhages (MH) of the corpus callosum, in particular the splenium, and supratentorial white matter. This is a case report of a 43-year-old male, who suffered from unusually prolonged severe ataxia and amnesia after having been rescued during the ascent to Mount Everest at 6400 m. MRI of the brain 63 days after the incident showed the typical MH in the corpus callosum, but, in addition, extensive MH were found in the middle cerebellar peduncles. These infratentorial MH might reflect the pronounced atactic gait disorder. This case describes the first HACE-associated MH in the cerebellar peduncles in a high-altitude mountaineer indicating a potential vulnerability of infratentorial brain areas to hypobaric hypoxia.

The effect of potential fall distance on hormonal response in rock climbing.

The aim of this study was to examine the effect of alterations in potential lead fall distance on the hormonal responses of rock climbers. Nine advanced female climbers completed two routes while clipping all (PRO-all) or half (PRO-½) of the fixed points of protection. Venous blood samples were analysed for total catecholamines, noradrenaline (norepinephrine), adrenaline (epinephrine), dopamine, lactate, cortisol and serotonin. Differences between the two conditions pre, immediately post and 15 min post climbing were assessed using a 2 × 3 repeated measures ANOVA. All hormones and blood lactate concentrations increased significantly (P < 0.05) immediately post climb, except for cortisol. Peak cortisol concentrations did not occur until 15 min post ascent. Further, significant interactions between climbing and clipping conditions were found for total catecholamines (890% of basal concentration in PRO-½ vs. 568% in PRO-all), noradrenaline (794% vs. 532%) and dopamine (500% vs. 210%). There were no significant interactions for adrenaline (1920% vs. 1045%), serotonin (150% vs. 127%) or lactate (329% vs. 279%). The study showed a greater catecholamine response with an increase in potential lead fall distance. The most pronounced increases seen in catecholamine concentration were reported for dopamine and noradrenaline.

The Thin Line: A Phenomenological Study of Mental Toughness and Decision Making in Elite High-Altitude Mountaineers.

Mental toughness (MT) is a key psychological variable related to achievement in performance domains and perseverance in challenging circumstances. We sought to understand the lived experiences of mentally tough high-altitude mountaineers, focusing primarily upon decisions to persevere or abort summit attempts. Phenomenological interviews were conducted with 14 mountaineers including guides, expedition leaders, and doctors (Mage = 44 years). A content analysis was employed to identify key themes in the data. Participants emphasized the importance of MT in extreme environments and described rational, flexible, and vigilant decision-making. Turning around without summiting was the toughest decision reported, with recognition of the thin line between persevering and overstretching. In contrast to much MT literature, mountaineers accepted limits, demonstrated restraint, and sacrificed personal goals to aid others. Costly perseverance was also reported with some mountaineers described as "too tough": overcompetitive, goal-obsessed, and biased decision-makers. These findings revealed both benefits and dangers of MT in mountaineering.

Medication Use Among Mount Everest Climbers: Practice and Attitudes.

Luks, Andrew M., Colin Grissom, Luanne Freer, and Peter Hackett. Medication use among mount Everest climbers: practice and attitudes. High Alt Med Biol. 17:315-322, 2016.-The lay public, media, and medical experts have expressed concern about the ethics of climbers using medications to improve performance and increase the odds of summit success while climbing at high altitude, but the true incidence of this practice remains unclear. We conducted an anonymous survey of climbers who have attempted to climb Mt. Everest to gather information about medication use and attitudes toward medication and supplemental oxygen use while climbing the mountain. One hundred eighty-seven individuals completed the survey, providing information about medication and oxygen use for 262 expeditions to Mt. Everest between 1963 and 2015, the majority of which occurred after the year 2000. The majority of respondents were male (82%) and from English-speaking countries (75%). Medications were used on 43% of climbs, with acetazolamide being the most commonly used medication. Reported use of dexamethasone, nifedipine, sildenafil, or tadalafil was uncommon as was use of multiple medications at the same time. The majority of respondents indicated that it was acceptable for climbers to use medications and supplemental oxygen to prevent altitude illness while climbing Mt. Everest. Opinions were more mixed regarding whether summiting without the use of medications or oxygen carried the same value as reaching the summit using those interventions. Our data suggest that less than one-half of Mt. Everest climbers use medications during their expedition, with the primary medication used being acetazolamide, for prevention of altitude illness. Given the limitations of the study design and preliminary nature of these data, further research is warranted to further clarify these issues.

Brief Working Memory and Physiological Monitoring During a High-Altitude Expedition.

Malle, Carine, Benoît Ginon, and Cyprien Bourrilhon. Brief working memory and physiological monitoring during a high-altitude expedition. High Alt Med Biol. 17:359-364, 2016.-Background: Various studies have shown the deleterious effects of high-altitude hypoxia on cognitive functions, including attention and memory. Since optimal cognitive abilities may be crucial for mountain safety, this study was aimed to assess the relevance of a brief working memory test to quickly assess cognition at high altitude. METHODS: A set of physiological and cognitive measurements were collected from four professional climbers at various time points during the course of an expedition to Shishapangma (8043 m). RESULTS: Progressive high-altitude exposure induced a classical physiological response (i.e., decreased SpO2 and increased heart rate). Except for the final ascent, no participants suffered from acute mountain sickness and perceived exertion remained low. With the exception of an increased number of night awakenings, reported sleep quality was good. No working memory decline was observed in any of the participants, even at the highest altitudes. CONCLUSION: Altogether, these findings show that the participants were properly acclimatized to altitude. They also highlight the technical feasibility of assessing cognitive functions all along high-altitude expeditions. The direct access of such tools on a smartphone may improve mountain climbing safety.