With mountain climbing becoming a popular activity, those who plan to climb must prepare for fitness and medical risks, writes Ahmad Taufik Jamil
MOUNTAIN climbing is fast gaining popularity as a recreational activity. Each new exploration gives you a new experience, which makes this activity exciting.
While some people take it lightly, mountain climbing requires preparation, both physical fitness and medical, to ensure safety. Mountain climbing is not without its risks, before, during and after a climb.
This guide serves as preparation for a climb up Mount Kinabalu.
BEFORE YOU GO
Conduct a pre-travel consultation and risk assessment. Do a medical assessment, preferably four to six weeks before the climb to assess your medical condition, and to discuss the risks of the climb.
See a doctor as early as possible. If you have a medical condition, this allows for early treatment and stabilisation of your condition. In some situations, vaccination may be required to prevent infectious diseases.
BUILD FITNESS
You must be physically fit to climb one of the highest mountains in Southeast Asia. The altitude is 4,095m above sea level with the length of the trail about 8km. Prepare at least three months before you climb.
There are three types of training involved:
1. Improve cardiovascular fitness
Fitness is supremely important for a climb. Many climbers fail to reach the summit because of a lack of cardiovascular fitness. To prepare, include brisk walking, running, stair climbing or cycling in your routine. Do them gradually and regularly.
The recommended duration of training exercise is 150 minutes per week of moderate intensity exercise (e.g. brisk walking) or 75 minutes of high intensity exercise (e.g. running) or a combination of both.
Divide it over four to five days of 20-30 minutes per day. You may start with 90 minutes per week of moderate intensity exercise (e.g. brisk walking). Increase the duration and intensity over weeks and months until you reach the recommended duration of training.
2. Build muscle strength
You need to increase muscle strength, especially in your lower limbs. Focus on quadriceps, hamstring, gluteus and calf muscles. You may include muscle endurance training as well.
3. Learn and improve technical climbing skill
Technical skill is gained by climbing a hill or mountain. Start with low hills like Broga Hill (400m) in Semenyih and increase the altitude gradually over weeks and months. Try to do a mountain climb every fortnight or month.
WHEN YOU GET THERE
RISK OF AIR TRAVEL
The risks involved in a short-haul flight from Kuala Lumpur to Kota Kinabalu are low. Make sure you are fit to fly. Some medical contraindications would be myocardial infraction within two weeks of coronary bypass surgery.
Deep-vein thrombosis and pulmonary embolism is an issue in long-distance flights (over four hours). Maintain hydration, walk every hour and use compression socks below knees to prevent this.
HYDRATION AND NUTRITION
Our body requires two to three litres of water per day. However, during exercise, we need between half a litre to two litres per hour. The amount of fluid required depends on body size, weather, humidity and perspiration rate.
Make sure you are hydrated before the climb. During the climb, drink 150ml-200ml fluid every five to 20 minutes, depending on your body’s needs. Take along three litres of water, combining mineral water and energy drink. If you need more, you may refill at the hut along the trail, but make sure you purify the water before drinking to prevent food poisoning.
Bring carbohydrates that can be easily chewed during climbing, like energy bars or gels. Taking more carbohydrate than protein and fat is good during climbing. Carbohydrate can be metabolised with less oxygen. You need 30 to 60g of carbohydrate per hour of the climb.
Traveller’s diarrhoea is the most common health problem among travellers. It occurs in 30 - 70 per cent of travellers. There is risk if you want to try street food in Kota Kinabalu or Kundasang.
About 80 to 90 per cent of diarrhoea cases are caused by bacteria. Others are caused by virus and protozoas.
To avoid diarrhoea:
✶ Eat or drink from clean restaurants.
✶ Eat freshly-cooked food and avoid stale ones.
✶ Peel fruit after washing them.
✶ Wash your hands before and after eating, preferably with 60 per cent alcohol.
✶ Disinfect untreated water by halogens or other methods.
✶ Avoid drinking untreated, unboiled and iced water.
✶ Avoid street food, including peeled fruit.
✶ Avoid raw food, salad and unpasteurised milk.
ALTITUDE SICKNESS
Altitude sickness includes acute mountain sickness (AMS), high altitude cerebral edema (HACE) and high altitude pulmonary edema (HAPE).
The risk of getting altitude sickness is higher if you climb more than 2,500m up. Acclimatisation is key to prevention. Avoid a rapid ascent. The biggest concern is hypoxia-low oxygen at high altitudes.
Some are prone to altitude sickness and fitness level has nothing to do with it. Headache is the main symptom of AMS. Other symptoms includes dizziness, fatigue, insomnia, loss of appetite, nausea, vomiting. AMS may progress to HACE.
HACE is a continuum of AMS. Symptoms are ataxia, confusion, seizure, altered consciousness and coma. Death may occur within 24 hours if not treated.
HAPE may occur by itself or in conjunction with AMS and HACE. Symptoms are difficulty in breathing, cough, chest tightness and low effort tolerance.
It is important for team members to monitor symptoms in the group. Early detection of the condition is important. Since Mount Kinabalu is more than 3,500m, AMS is common, ranging from mild to severe. To prevent this, go no higher than 2,500m on the first day. For altitude above 2,500m, the rate is 300-500m ascent per day.
As prophylaxis or prevention, take T. acetazolamide orally for those in the moderate to high risk category, 125mg twice a day, beginning the day before ascent, until you reach the summit.
Any illness at altitude is altitude illness until proven otherwise. Never ascend if AMS/HACE/HAPE symptoms are present. Stay at the altitude, and get some treatment. If symptoms become worse after treatment, immediate descent is required.
MALARIA
Southeast Asia, especially Borneo, is listed by the World Health Organisation as endemic area for malaria because it is a densely forested region. Transmission by its primary vector, Anopheles balabacensis, usually occurs at an altitude below 2,000m above sea level.
If you are travelling from KK airport to Kinabalu Park by car, the risk of getting bitten by mosquitoes is very low. Kinabalu Park is at 2,000m above sea level, anopheles is non-existent at this altitude.
In my opinion, malaria prophylaxis for climbers of Kinabalu is unnecessary. But if your itinerary includes other areas, especially low lands where malaria is endemic, then malaria prophylaxis is necessary.
AFTER YOU RETURN
If you experience fever, headache or diarrhoea after returning home, please see a doctor.
IN YOUR MEDICAL KIT
TAKE these medicines along for your climb. It’s better to be prepared than be caught empty-handed in an emergency.
Painkillers (paracetamol or voltaren)
Anti-vomiting tablets
Antihistamines
Anti diarrhoea tablets
Oral rehydration salts
Diamox and dexamethasone
Blister treatment - prevention is better
Kit for small wounds and abrasion
Insect repellent containing DEET
*The writer, Ahmad Taufik Jamil is Universiti Teknologi Mara’s public health consultant and exercise physician.