Nutritional Assessment, Body Composition, and Low Energy Availability in Sport Climbing Athletes of Different Genders and Categories: A Cross-Sectional Study.

Climbing is an Olympic discipline in full development and multidisciplinary in nature, where the influences of body composition and nutritional status on performance have not yet been clarified despite the quest for a low weight in anti-gravity disciplines such as climbing. The present cross-sectional study aimed to conduct nutritional (3-day dietary diaries) and body composition (ISAK profile) assessments on sport climbing athletes by gender and climbing level during the months of February and March 2024. The t-test for independent samples and the Mann-Whitney U-test, as well as an ANOVA and the Kruskal-Wallis H-test, were used to compare the distributions of two or more groups, respectively, and Pearson's and Spearman's correlation coefficients were used to estimate the correlations between the different variables. The mean age of the 46 Spanish climbers (22 men and 24 women) was 30 years (SD: 9) with 7.66 years of experience (SD: 6.63). The mean somatotype of the athletes was classified as balanced mesomorph. Negative correlations were observed between fat mass variables and climbing level (p < 0.010), and positive correlations were observed with forearm circumference (p < 0.050). The mean energy availability (EA) was 33.01 kcal-kg FFM-1d-1 (SD: 9.02), with 55.6% of athletes having a suboptimal EA status and 35.6% having low energy availability (LEA). The carbohydrate and protein intakes were below the recommendations in 57.8% and 31.1% of athletes, respectively. There were deficient intakes of all micronutrients except phosphorus in males. These findings suggest that climbing athletes are at a high risk of developing low energy availability states and concomitant problems. Optimal nutritional monitoring may be advisable in this type of athlete to try to reduce the risk of LEA.

A Season at the Himalayan Rescue Association Aid Post in Manang.

The Himalayan Rescue Association (HRA) has operated high altitude clinics in Nepal for 50 years, with rising visitor numbers, especially from India, China, and Nepal. New roads have eased access and increased the speed of ascent in some areas. Our aim was to provide a description of the activities, clinical problems, and lecture attendees of the HRA aid post in Manang over one season. We also highlight the evolving challenges of providing healthcare and education in the high Himalayan region. We describe the clinical and educational activities of the HRA aid post in Manang from September 24 to December 1, 2023. Prospective clinical data collection included anonymized patient demographics and diagnoses. Lecture data were taken from the attendee register and by daily manual counts of lecture attendees. We saw 376 patients, 62% of whom were Nepalis. Infectious diseases (42%) and altitude illness (16%) were the most common problems. A total of 846 people from 47 countries attended the daily altitude lectures. Only 5% of attendees were Nepali. Electrical supply interruptions and limitations in medical evacuation options were among the challenges of providing care at a high altitude clinic and preventing altitude illness using educational lectures. Altitude illness remains a common and potentially life-threatening problem, with risks increased by rapid ascent enabled by new road access and by ignorance of risks of altitude among travelers, especially Nepalis. Language barriers in educational outreach call for novel approaches and interventions that will ensure the effectiveness of altitude education.

Assessing the Impact of Neuromuscular Electrical Stimulation-Based Fingerboard Training versus Conventional Fingerboard Training on Finger Flexor Endurance in Intermediate to Advanced Sports Climbers: A Randomized Controlled Study.

Competitive climbers engage in highly structured training regimens to achieve peak performance levels, with efficient time management as a critical aspect. Neuromuscular electrical stimulation (NMES) training can close the gap between time-efficient conditioning training and achieving optimal prerequisites for peak climbing-specific performances. Therefore, we examined potential neuromuscular adaptations resulting from the NMFES intervention by analyzing the efficacy of twice-weekly NMES-supported fingerboard (hang board) training compared with thrice-weekly conventional fingerboard training over 7 training weeks in enhancing climbing-specific endurance among intermediate to advanced climbers. Participants were randomly divided into the NMES and control groups. Eighteen participants completed the study (14 male, 4 female; mean age: 25.7 ± 5.3 years; mean climbing experience: 6.4 ± 3.4 years). Endurance was assessed by measuring the maximal time athletes could support their body weight (hanging to exhaustion) on a 20 mm-deep ledge at three intervals: pre-, in-between- (after 4 weeks of training), and post-training (after 7 weeks of training). The findings revealed that despite the lower training volume in the NMES group, no significant differences were observed between the NMES and control groups in climbing-specific endurance. Both groups exhibited notable improvements in endurance, particularly after the in-between test. Consequently, a twice-weekly NMES-supported fingerboard training regimen demonstrated non-inferiority to a thrice-weekly conventional training routine. Incorporating NMES into fingerboard workouts could offer time-saving benefits.

The effects of five weeks of climbing training, on and off the wall, on climbing specific strength, performance, and training experience in female climbers-A randomized controlled trial.

Recent research has elucidated the effects of strength training on climbing performance. Although local muscular endurance training of the upper-limbs and finger flexors is frequently suggested, there is currently insufficient evidence to support its impact on climbing performance and climbing-specific strength. Furthermore, there is no evidence on climbers' experiences related to training and the likelihood of consistent engagement. In addition, the effects of more climbing-specific strength training on walls with built in lights and adjustable angles have yet to be examined. The low percentage of studies involving female subjects, additionally, demonstrates a significant gap in understanding the specific effects of strength training on women in the context of climbing. The aim of this study was thus to assess the effects of five-week on-, and off-the-wall climbing training on climbing performance, climbing-specific strength, and training experience. Thirty-one female lower-grade to advanced climbers were randomly assigned to either a control group, an off-the-wall training or an on-the-wall training group. Apart from the training regimen, all groups followed their usual climbing and bouldering routine. Subjects trained at least twice a week. Bouldering performance, and maximum strength and muscular endurance of the finger flexors and upper-limbs were assessed before and after the intervention. Furthermore, rate of perceived exertion and discomfort, exercise enjoyment, and exercise pleasure were assessed during the first and last training session, as well as after two and a half weeks of training. Intrinsic training motivation was assessed after the last training session. The results showed trends towards positive effects of off-the-wall training on climbing-specific strength, and on-the-wall training on climbing technique. Furthermore, our finding revealed high exercise enjoyment and intrinsic training motivation for both on- and off-the-wall training. Hence, lower-grade to advanced female climbers should rely on personal training preferences.

Severe Hyperthermia in Mountaineering: Coincidence of Heat Stroke and Infection.

Heat illness is a condition that is sometimes seen in those undertaking physical activities. This case report focuses on a female hiker who developed heat stroke during a trek in the Dachstein region of Upper Austria. The patient's presentation was initially unclear and could only be confirmed by the use of a thermometer. This had a significant impact on the medical decision-making process during a complex rescue operation.

Contributions of Griffith Pugh to Success on Mt. Everest and His Impact on the Advancement of Altitude and Environmental Physiology.

Griffith Pugh, MD (1909-1994), was a pioneer in altitude physiology. During World War II, he developed training protocols in Lebanon to improve soldier performance at altitude and in the cold. In 1951 he was chosen to join the British Everest team as a scientist. In preparation, he developed strategies for success on a training expedition on Cho Oyu in 1952. Results from Cho Oyu led to the use of supplemental oxygen at higher flow rates during ascent than used previously (4 L/min vs 2 L/min) and continued use (at a reduced rate of 2 L/min) during descent, enabling increased performance and improved mental acuity. Oxygen was also used during sleep, leading to improved sleep and warmth. Adequate hydration (∼3 L/day) was also stressed, and a more appealing diet led to improved nutrition and condition of the climbers. Improved hygiene practices and acclimatization protocols were also developed. These strategies contributed to the first successful summiting of Mount Everest in 1953. Pugh was then appointed as the lead scientist for a ground-breaking eight-and-a-half-month research expedition where the team was the first to overwinter at high altitude (5800 m) in the Himalayas. This current work summarizes Pugh's scientific contributions as they relate to success on Mount Everest and in inspiring future altitude research by generations of successful researchers.

The Outcome of Walking Cold Patients with Potential Mild Hypothermia to Safety-A Mountain Rescue Case Series.

INTRODUCTION: Some experts recommend that ambulant hypothermic patients should be rewarmed, fed, and not permitted to exercise for 30 min because of concerns that afterdrop can cause cardiac instability. We investigated the outcome of ambulant hypothermic patients in a case series from mountain rescue teams in Great Britain. METHODS: A questionnaire was used to collect information on a series of adult patients with a clinical diagnosis of mild hypothermia. All patients were alert on the AVPU scale and evacuated by walking from the mountain. The outcome measures were survival or a change in management because of medical deterioration during evacuation. RESULTS: A series of 108 eligible cases were reported over a 5-year period. When rescuers arrived on the scene, 98 (91%) patients were stationary, and 10 (9%) were still mobile. Thirty-eight (39%) of the stationary cases were walked immediately off the mountain without any on-scene delay. In the remaining 60 (61%) stationary cases, the decision was taken to delay evacuation to provide food, drinks, and additional clothing. In 3 cases, the use of heat packs indicated an intention to actively rewarm. In cases where the on-scene time was reported, 27 (79%) were known to be mobile again within 20 min. All patients survived, and no adverse medical events occurred in all 108 cases. CONCLUSIONS: In this study, no adverse events occurred because of immediate mobilization, suggesting that in these cases, there appears to be minimal risk of early activity.

Altitude-Related Illness.

Altitude-related illness occurs as a result of inadequate acclimatization. The mainstay of prevention is a slow, graded ascent profile which gives the body time to respond to a low-oxygen environment. The diagnosis of these conditions is often difficult in resource-limited environments, so history and a physical exam are key in identifying patients who will require descent and evacuation. Treatment modalities such as supplemental oxygen, portable hyperbaric chambers, and medications, are all temporizing measures until the patient can be safely evacuated to a lower elevation.

Pathomechanics of lumbrical and flexor digitorum profundus muscle tears in climbers: A cadaveric model.

Lumbrical muscles originate on the flexor digitorum profundus (FDP) tendons and, during fist making, they move in the same direction when FDP muscle produces maximal proximal tendon gliding. Injuries of the bipennate lumbricals have been described when a shear force acts between the origins on adjacent tendons of the FDP, as they glide in opposite directions in asymmetric hand postures. Other structures of the deep flexors complex can be affected during this injury mechanism, due to the so-called quadriga effect, which can commonly occur during sport climbing practise. Biomechanical studies are needed to better understand the pathomechanism. A cadaveric study was designed to analyse the effects of load during the fourth lumbrical muscle injury mechanism. The amount of FDP tendon gliding and metacarpophalangeal (MCP) joint flexion of the 5th finger were calculated. Ten fresh-frozen cadaveric specimens (ten non-paired forearms and hands) were used. The specimens were placed on a custom-made loading apparatus. The FDP of the 5th finger was loaded, inducing isolated flexion of the 5th finger, until rupture. The rupture occurred in all specimens, under a load of 11 kg (SD 4.94), at 9.23 mm of proximal tendon gliding (SD 3.55) and at 21.4° (SD 28.91) of MCP joint flexion. Lumbrical muscle detachment from the 4th FDP was observed, from distal to proximal, and changes in FDP tendons at the distal forearm level too. The quadriga effect can lead to injury of the bipennate lumbrical muscles and the deep flexors complex in the hand and forearm.

Telomeric RNA (TERRA) increases in response to spaceflight and high-altitude climbing.

Telomeres are repetitive nucleoprotein complexes at chromosomal termini essential for maintaining genome stability. Telomeric RNA, or TERRA, is a previously presumed long noncoding RNA of heterogeneous lengths that contributes to end-capping structure and function, and facilitates telomeric recombination in tumors that maintain telomere length via the telomerase-independent Alternative Lengthening of Telomeres (ALT) pathway. Here, we investigated TERRA in the radiation-induced DNA damage response (DDR) across astronauts, high-altitude climbers, healthy donors, and cellular models. Similar to astronauts in the space radiation environment and climbers of Mt. Everest, in vitro radiation exposure prompted increased transcription of TERRA, while simulated microgravity did not. Data suggest a specific TERRA DDR to telomeric double-strand breaks (DSBs), and provide direct demonstration of hybridized TERRA at telomere-specific DSB sites, indicative of protective TERRA:telomeric DNA hybrid formation. Targeted telomeric DSBs also resulted in accumulation of TERRA foci in G2-phase, supportive of TERRA's role in facilitating recombination-mediated telomere elongation. Results have important implications for scenarios involving persistent telomeric DNA damage, such as those associated with chronic oxidative stress (e.g., aging, systemic inflammation, environmental and occupational radiation exposures), which can trigger transient ALT in normal human cells, as well as for targeting TERRA as a therapeutic strategy against ALT-positive tumors.

Inappropriate Acetazolamide Use for a Hiker Who Developed Acute Kidney Injury.

Prophylactic use of acetazolamide (ACZ) to prevent acute mountain sickness (AMS) is a common practice among high altitude travelers and mountaineers. With its use comes a possible risk of acute kidney injury (AKI). We present a case in which a 56-year-old male hiker in Grand Canyon National Park developed acute exertional rhabdomyolysis and subsequent AKI while taking prophylactic ACZ to prevent AMS. This medication was prescribed despite the hiker encountering only moderate altitude at Grand Canyon with a planned descent within <24 h. The resulting AKI was determined to be the combined result of acute exertional rhabdomyolysis and dehydration/hypovolemia, with the ACZ, a diuretic, as a contributing factor. Medical providers need to recognize the risks/benefits with ACZ use for AMS prophylaxis and avoid prescribing it to individuals whose altitude exposure and activity fall outside the clinical practice guidelines recommended for use.

Myoelectric manifestations of fatigue of the finger flexor muscles and endurance capacity in experienced versus intermediate climbers during suspension tasks.

Climbing is a physically demanding discipline, placing significant loads on the finger flexors. Notwithstanding the documented greater endurance capacity of experienced climbers, the mechanisms explaining these training-induced adaptations remain unknown. We therefore investigate whether two non-competing strategies - muscle adaptation and alternate muscle recruitment - may explain the disparity in endurance capacity in participants with different climbing experience. We analysed high-density surface electromyograms (EMGs) from 38 Advanced and Intermediate climbers, during suspension exercises over three different depths (15, 20, 30 mm) using a half-crimp grip position. From the spatial distribution of changes in MeDian Frequency and Root Mean Square values until failure, we assessed how much and how diffusely the myoelectric manifestations of fatigue took place. Advanced climbers exhibited greater endurance, as evidenced by significantly longer failure time (p < 0.009) and lower changes in MDF values (p < 0.013) for the three grip depths. These changes were confined to a small skin region (nearly 25% of the grid size), centred at variable locations across participants. Moreover, lower MDF changes were significantly associated with longer suspension times. Collectively, our results suggest that muscle adaptation rather than load sharing between and within muscles is more likely to explain the improved endurance in experienced climbers.

Cognitive-behavioural processes during route previewing in bouldering.

INTRODUCTION: In the Olympic climbing discipline of bouldering, climbers can preview boulders before actually climbing them. Whilst such pre-climbing route previewing is considered as central to subsequent climbing performance, research on cognitive-behavioural processes during the preparatory phase in the modality of bouldering is lacking. The present study aimed at extending existing findings on neural efficiency processes associated with advanced skill level during motor activity preparation by examining cognitive-behavioural processes during the previewing of boulders. METHODS: Intermediate (n = 20), advanced (n = 20), and elite (n = 20) climbers were asked to preview first, and then attempt two boulders of different difficulty levels (boulder 1: advanced difficulty; boulder 2: elite difficulty). During previewing, climbers' gaze behaviour was gathered using a portable eye-tracker. RESULTS: Linear regression revealed for both boulders a significant relation between participants' skill levels and both preview duration and number of scans during previewing. Elite climbers more commonly used a superficial scan path than advanced and intermediate climbers. In the more difficult boulder, both elite and advanced climbers showed longer preview durations, performed more scans, and applied less often a superficial scan path than in the easier boulder. CONCLUSION: Findings revealed that cognitive-behavioural processes during route previewing are associated with climbing expertise and boulder difficulty. Superior domain-specific cognitive proficiency seems to account for the expertise-processing-paradigm in boulder previewing, contributing to faster and more conscious acquisition of perceptual cues, more efficient visual search strategies, and better identification of representative patterns among experts.

Acute Coronary Syndrome at Altitude: Diagnostic Dilemma on Aconcagua Using Point-of-Care Ultrasound.

At the Plaza de Mulas medical tent, located at 4300 m (14,100 ft) along the Normal Route to the 6960 m (22,837 ft) summit of Aconcagua in Argentina, a Korean male in his 50s with no known medical conditions presented with lightheadedness and shortness of breath. He had taken sildenafil and acetazolamide that morning without improvement. Vital signs on arrival were notable for oxygen saturations in the high 60s with basilar crackles on lung auscultation, concerning for high altitude pulmonary edema. The patient was started on oxygen via nasal cannula and given dexamethasone. History was limited secondary to language barriers, but on review of systems the patient noted mild chest pressure. Bedside cardiac echocardiogram was performed, which revealed a septal wall motion abnormality. The patient was therefore given aspirin and clopidogrel and was flown to a lower trailhead, where he was met by local Emergency Medical Services. A 12-lead electrocardiogram revealed an anterior ST-elevation myocardial infarction, and the patient was taken emergently to the catheterization lab in Mendoza and underwent stent placement with a full recovery.

Measuring critical force in sport climbers: a validation study of the 4 min all-out test on finger flexors.

PURPOSE: The critical force (CF) concept, differentiating steady and non-steady state conditions, extends the critical power paradigm for sport climbing. This study aimed to validate CF for finger flexors derived from the 4 min all-out test as a boundary for the highest sustainable work intensity in sport climbers. METHODS: Twelve participants underwent multiple laboratory visits. Initially, they performed the 4 min intermittent contraction all-out test for CF determination. Subsequent verification visits involved finger-flexor contractions at various intensities, including CF, CF -2 kg, CF -4 kg, and CF -6 kg, lasting for 720 s or until failure, while monitoring muscle-oxygen dynamics of forearm muscles. RESULTS: CF, determined from the mean force of last three contractions, was measured at 20.1 ± 5.7 kg, while the end-force at 16.8 ± 5.2 kg. In the verification trials, the mean time to failure at CF was 440 ± 140 s, with only one participant completing the 720 s task. When the load was continuously lowered (-2 kg, -4 kg, and -6 kg), a greater number of participants (38%, 69%, and 92%, respectively) successfully completed the 720 s task. Changes of muscle-oxygen dynamics showed a high variability and could not clearly distinguish between exhaustive and non-exhaustive trials. CONCLUSIONS: CF, based on the mean force of the last three contractions, failed to reliably predict the highest sustainable work rate. In contrast, determining CF as the end-force of the last three contractions exhibited a stronger link to sustainable work. Caution is advised in interpreting forearm muscle-oxygen dynamics, lacking sensitivity for nuanced metabolic responses during climbing-related tasks.

A retrospective analysis of mission reports in the national Swedish Police Registry on mountain rescue 2018-2022: here be snowmobiles.

BACKGROUND: Increasing mountain activity and decreasing participant preparedness, as well as climate change, suggest needs to tailor mountain rescue. In Sweden, previous medical research of these services are lacking. The aim of the study is to describe Swedish mountain rescue missions as a basis for future studies, public education, resource allocation, and rescuer training. METHODS: Retrospective analysis of all mission reports in the national Swedish Police Registry on Mountain Rescue 2018-2022 (n = 1543). Outcome measures were frequencies and characteristics of missions, casualties, fatalities, traumatic injuries, medical conditions, and incident mechanisms. RESULTS: Jämtland county had the highest proportion of missions (38%), followed by Norrbotten county (36%). 2% of missions involved ≥ 4 casualties, and 44% involved ≥ 4 mountain rescuers. Helicopter use was recorded in 59% of missions. Non-Swedish citizens were rescued in 12% of missions. 37% of casualties were females. 14% of casualties were ≥ 66 or ≤ 12 years of age. Of a total 39 fatalities, cardiac event (n = 14) was the most frequent cause of death, followed by trauma (n = 10) and drowning (n = 8). There was one avalanche fatality. 8 fatalities were related to snowmobiling, and of the total 1543 missions, 309 (20%) were addressing snowmobiling incidents. Of non-fatal casualties, 431 involved a medical condition, of which 90 (21%) suffered hypothermia and 73 (17%) cardiovascular illness. CONCLUSIONS: These baseline data suggest snowmobiling, cardiac events, drownings, multi-casualty incidents, and backcountry internal medicine merit future study and intervention.

Risk of Cardiac Arrhythmias Among Climbers on Mount Everest.

Importance: Arterial hypoxemia, electrolyte imbalances, and periodic breathing increase the vulnerability to cardiac arrhythmia at altitude. Objective: To explore the incidence of tachyarrhythmias and bradyarrhythmias in healthy individuals at high altitudes. Design, Setting, and Participants: This prospective cohort study involved healthy individuals at altitude (8849 m) on Mount Everest, Nepal. Recruitment occurred from January 25 to May 9, 2023, and data analysis took place from June to July 2023. Exposure: All study participants underwent 12-lead electrocardiogram, transthoracic echocardiography, and exercise stress testing before and ambulatory rhythm recording both before and during the expedition. Main Outcome: The incidence of a composite of supraventricular (>30 seconds) and ventricular (>3 beats) tachyarrhythmia and bradyarrhythmia (sinoatrial arrest, second- or third-degree atrioventricular block). Results: Of the 41 individuals recruited, 100% were male, and the mean (SD) age was 33.6 (8.9) years. On baseline investigations, there were no signs of exertional ischemia, wall motion abnormality, or cardiac arrhythmia in any of the participants. Among 34 individuals reaching basecamp at 5300 m, 32 participants climbed to 7900 m or higher, and 14 reached the summit of Mount Everest. A total of 45 primary end point-relevant events were recorded in 13 individuals (38.2%). Forty-three bradyarrhythmic events were documented in 13 individuals (38.2%) and 2 ventricular tachycardias in 2 individuals (5.9%). Nine arrhythmias (20%) in 5 participants occurred when climbers were using supplemental bottled oxygen, whereas 36 events (80%) in 11 participants occurred at lower altitudes when no supplemental bottled oxygen was used. The proportion of individuals with arrhythmia remained stable across levels of increasing altitude, while event rates per 24 hours numerically increased between 5300 m (0.16 per 24 hours) and 7300 m (0.37 per 24 hours) before decreasing again at higher altitudes, where supplemental oxygen was used. None of the study participants reported dizziness or syncope. Conclusion and Relevance: In this study, more than 1 in 3 healthy individuals experienced cardiac arrhythmia during the climb of Mount Everest, thereby confirming the association between exposure to high altitude and incidence of cardiac arrhythmia. Future studies should explore the potential implications of these rhythm disturbances.