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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 6  |  Issue : 1  |  Page : 10-17

Awareness and practice of pre-trek physical conditioning among trekkers


1 Department of Musculoskeletal Physiotherapy, Sancheti Institute College of Physiotherapy, Pune, Maharashtra, India
2 Sancheti Institute of Orthopaedic Rehabilitation, Pune, Maharashtra, India

Date of Submission05-Sep-2021
Date of Acceptance16-Dec-2021
Date of Web Publication11-Feb-2022

Correspondence Address:
Dr. Nilima Bedekar
Sancheti Healthcare Academy, 11/12, Thube Park, Shivajinagar, Pune 411005, Maharashtra.
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jsip.jsip_13_21

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  Abstract 

Background: Evidence shows that downhill walking induces high compressive loads on the lower extremities due to repetitive eccentric contractions of muscles. There is inadequate evidence about pre-trek physical training as a predisposing factor for injuries that laid the foundation for this study. Hence, this study focuses on understanding the awareness and practice of pre-trek physical conditioning among trekkers. Materials and Methods: The study was a questionnaire-based survey. Trekking groups were approached. A specially designed questionnaire was validated by experts. The questionnaire was circulated to the trekking group members via Google Form. An online consent was taken prior. The response thus obtained was taken up for further analysis. Results: A total of 251 respondents within the age group of 15–60 years participated. Only 30% of them regularly performed warm-up and cooldown exercises. 66.1% did not undergo any pre-trek physical training. 53.4% were aware of its importance; only 40.2% were aware but not practicing regularly. Most of the participants were aware of pre-trek physical conditioning domains being aerobic, resistance, and flexibility training but only 11.3% were aware of balance training. 32.3% regularly performed practice treks by carrying a backpack. A total of 14.3% participants regularly practiced pre-trek physical training. Conclusion: Participants lack awareness about the importance of warm-up, cooldown exercises, and balance training as a pre-trek physical training domain. Most of the participants are aware of aerobic and resistance training domains. Only 14.30% of the total participants are engaged in pre-trek physical training regularly.

Keywords: Awareness, balance training, trekking


How to cite this article:
Chopda RR, Bedekar N, Shyam AK, Sancheti PK. Awareness and practice of pre-trek physical conditioning among trekkers. J Soc Indian Physiother 2022;6:10-7

How to cite this URL:
Chopda RR, Bedekar N, Shyam AK, Sancheti PK. Awareness and practice of pre-trek physical conditioning among trekkers. J Soc Indian Physiother [serial online] 2022 [cited 2022 Aug 8];6:10-7. Available from: http://www.jsip.ac.in/text.asp?2022/6/1/10/337583




  Introduction Top


Mountain trekking is one of the most popular recreational pursuits in the world.[1] It is a sport that is as versatile as it gets. It is a meditative activity that takes you through different terrains such as walking on narrow ridges, crossing glaciers, climbing rocks, and even walking through lush green meadows. Typically characterized by a long continuous exercise of low intensity,[1] a bout of mountain trekking can vary from a daylong hike up the hill to a 15-day arduous journey across the snow-capped mountains at high altitudes.

Hence, trekking is not limited to just one meaning. It mainly comprises long distance, uphill, and downhill walking across uneven and rugged terrain, posing a lot of challenges on novice and frequent backpackers.[2] With such a wide variety of terrains to choose from, the trekking experience caters to a big audience irrespective of their age, sex, and socioeconomical status. As mentally and physically challenging it appears, it gives a sense of achievement unmatchable to any sport in the world.

Evidence shows that this soft adventure sport has increased the risk of injuries and illnesses among many participants. The most common ones are load-induced musculoskeletal injuries such as stress fractures, joint sprains, shin splints, muscle strains, tendon or ligament damage along with overuse injuries, high-altitude mountain sickness, abrasions, and lacerations.[3] Most of the long-distance trekkers are aware of these potential risks but are often unable to diagnose and treat basic wilderness medicine conditions.[3] However, there are studies that recommend the trekkers to be well-equipped and prepared with a wilderness tool kit comprising of first-aid supplies, backpack carriage, and sufficient knowledge about wilderness medicine.[3],[4]

A study reports that the most contributing factors for musculoskeletal injuries and falls during trekking are the weight of the backpack, inadequate or no use of trekking poles, inadequate footwear, and the uneven terrain.[5] Carrying an external load during long-distance walking increases the load on the spine and joints of the lower extremity.[1],[6] Studies report that the larger the external load, the larger are the forces imposed on the joints. These forces are exaggerated mainly during downhill walking.[1],[6]

Downhill walking increases the compressive forces on the entire lower extremity leading to greater eccentric loading.[7] Repetitive eccentric contractions of the lower extremity muscles cause temporary exercise-induced muscle damage (EIMD) deteriorating the muscle endurance and leading to conditions such as iliotibial (IT) band syndrome, patellar tendonitis, and ankle sprains.[7],[8] Prevalence of lateral ankle sprains is highest during downhill walking as it puts the ankle in a plantar-flexed position stretching and weakening the anterior talofibular ligament causing micro to macro tears.[8] Downhill walking carrying an external load has been reported to increase the vertical ground reaction forces, shear forces, and patellar compressive forces by 3–4 times than level walking.[7],[8] Hence, the risk of injuries and illnesses is very high.

Evidence also proves that lower extremity joint loading during long-distance walking is strongly affected by the terrain and gradient of the slope.[9] Graded uphill and downhill walking continuously changes the ground reaction force patterns, substantially increasing hip joint loading, lower extremity power, and internal and external moments on the knee joint.[6],[9] This again increases the risk of musculoskeletal injuries which is determined mainly by the walking speed.[9] The walking speed is a product of step length and cadence which is continuously altered during uphill and downhill walking thereby increasing the lower extremity joint loading.[6],[9]

The amalgamation of all these factors is again EIMD that makes it difficult to perform even the simplest of activities on subsequent days due to residual muscle soreness and perturbations in muscle function.[7] Hence, studies suggest formulating any intervention that may help to minimize the negative effects of EIMD precipitated from trekking, helping in exercise participation in the days after the initial damaging bout, and reducing the risk and severity of injuries.

This indicates the need for every trekker irrespective of the altitude or terrain to undergo adequate pre-trek preparation. Every trekking group must ensure that all the trekkers have sufficient knowledge about wilderness medicine, first aid supplies, proper method of using trekking poles, and hiking boots along with a comprehensive pre-trek physical conditioning program.[3] Many studies have not highlighted the importance of pre-trek physical conditioning as a part of pre-hike preparations; however, this study focuses on increasing the awareness and practice of pre-trek physical conditioning among trekkers. An adequate pre-trek physical training program depending on the type of altitude and terrain will help in reducing the severity of load-induced musculoskeletal injuries and lower extremity joint loads.

A comprehensive physical conditioning program that includes resistance, cardiovascular, flexibility, and balance training along with a suitable backpack, trekking poles, and hiking boots will help to reduce the external loads and biomechanical alterations in the spine and lower extremity joints. This will help the knee and ankle joints to withstand the continuously changing vertical ground reaction and shear forces, thereby reducing the severity of EIMD. In fact, adequate pre-trek eccentric muscle conditioning of the lower extremities will minimize the negative effects of prolonged downhill and uphill walking on an uneven terrain, thereby helping in preventing the occurrence of musculoskeletal injuries.


  Materials and Methods Top


  1. Study design: Questionnaire-based study


  2. Sampling technique: Snowball


  3. Sample size: 251


  4. Materials: Self-made validated questionnaire (face validity)


  5. Inclusion criteria:
    • i. Trekking for more than 6 months


    • ii. Both male and female


  6. Exclusion criteria: Novice backpackers


Methodology

The study was a questionnaire-based survey, which was designed for the trekking population to understand the awareness and practice of pre-trek physical conditioning among trekkers. Approval for the study was taken from the institutional ethics committee. Participants were recruited from various trekking groups. As per the inclusion criteria, participants were recruited for the study after taking their consent. A self-made questionnaire was validated by experts in the field and sent to all the English-speaking subjects in a Google document form [Appendix][Additional file 1]. The questionnaire was sent online to 270 trekkers and response was received from 251. This questionnaire had covered questions regarding the trekking frequency of the subjects, their awareness about warm-up, cooldown exercises along with pre-trek physical training, its domains, and whether they actually implement it before every trek irrespective of high- or moderate-altitude treks. The questionnaire consists of 17 close-ended questions. The response of all the subjects was analyzed after data collection.


  Results Top


The data were analyzed by descriptive statistics. A total of 251 respondents participated in the study within the age group of 15–60 years. According to this study, only 30% of the total participants performed regular warm-up and cooldown exercises. 66.1% did not undergo any physical training before the main trek. 53.4% were aware of its importance, whereas 40.2% were aware but were not practicing regularly. Most of the participants were aware of pre-trek physical conditioning domains being aerobic, resistance, and flexibility training but only 11.3% were aware about balance training. Only 32.3% regularly performed practice treks by carrying the backpack as per the ideal weight. 14.3% of the total participants regularly practiced pre-trek physical training.

The responses obtained from the questionnaire are from [Table 1][Table 2][Table 3][Table 4][Table 5][Table 6][Table 7][Table 8][Table 9][Table 10][Table 11].
Table 1: Duration of involvement in trekking

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Table 2: Frequency of trekking

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Table 3: Preferred trekking type

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Table 4: Warm-up and cooldown

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Table 5: Awareness of importance of pre-trek physical training

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Table 6: Pre-trek preparations

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Table 7: Practice treks before main trek

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Table 8: Practice trek with backpack

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Table 9: Awareness of time duration

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Table 10: Awareness of pre-trek physical conditioning program

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Table 11: Practice of pre-trek physical training

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  Discussion Top


The popularity of recreational trekking is steadily increasing, thereby increasing the possibility of injuries and illnesses mainly load-induced musculoskeletal injuries due to long-distance uphill and downhill walking.[3] A study by Gardner and Hill[3] documents the pattern of injuries and illnesses among long-distance hikers and examines the role pre-trek physical conditioning, wilderness medicine knowledge in injury prevention and treatment. This study reported that pre-trek physical conditioning must be included along with other wilderness preparations to ensure adequate safety and preparedness during the trek. Hence, the authors of this study felt the need to document the awareness and practice of pre-trek physical conditioning among trekkers.

This study has found that most of the trekkers that participated in the study are not giving substantial importance to physical training before commencing the trek. Basic warm-up and cooldown exercises are sincerely performed by only 30% of the participants studied. Only 53.4% of the total participants are aware of pre-trek physical training, whereas 42.2% are aware but do not practice it regularly. This clearly states the lack of awareness and practice of pre-trek physical conditioning among the participants.

Many trekking guides have suggested the approximate duration of physical training before the main trek which is minimum 3–4 weeks for moderate-altitude treks and 6–8 weeks for high-altitude treks.[10] The results of this study show that 26.3% and 31.9% of the total participants only are aware of this time frame for moderate- and high-altitude treks, respectively.

When we consider pre-trek physical training, not only is the knowledge about exact duration and warm-up, cooldown exercises necessary but also the domains of physical training. As per the American College of Sports Medicine guidelines[11] for outdoor physical activity, physical training program must comprise four important domains being aerobic or cardiovascular training, resistance or strength training, flexibility training, and balance training. When the participants of this study were asked about their knowledge regarding pre-trek physical training as per the aforementioned domains, the authors found that 39.6% of the total participants were aware of aerobic training as an important domain, whereas only 11.3% considered balance training as a crucial component of pre-trek physical training. This finding implies lack of professional training and guidance required for trekking activity. A study by Bohne and Abendroth-Smith[1] states that prolonged uphill and downhill walking induces a high amount of compressive forces on the tibio-femoral and patella-femoral joints leading to ankle sprains, strains, shin splints, and fractures. In order to withstand these high loads and reduce the biomechanical alterations in the joints that may prone the trekker to load-induced musculoskeletal injuries, Bohne and Abendroth-Smith[1] have suggested that balance training with appropriate use of trekking poles on uneven terrain is crucial. This recommendation is also supported by another study by Howatson et al.,[7] which states that use of trekking poles on uneven terrain minimizes the compressive loads on the knee and ankle joints, thereby reducing the biomechanical alterations and enhancing balance, stability during downhill walking. However, the awareness of balance training using trekking poles is among only 18.9% of total participants studied. Hence, the authors of this study feel that the importance of balance training as a part of pre-trek physical training needs to be more emphasized.

Another important component of the trekking gear is the backpack that is carried for prolonged period of time during the trek. Evidences suggest that the weight of the backpack has a strong influence on joint loading.[12] Carrying a backpack and walking for long distances on an uneven terrain along with downhill walking imposes tremendous compressive forces on the spine and lower extremities increasing the injury risks. Schwameder et al.[6] in their study state that downhill walking increases the internal and external loads on the knee joint due to prolonged eccentric activity of the lower extremity muscles leading to temporary EIMD that takes several days to recover.

The results of this study show that only 32.3% of the total participants are aware and practice it in their pre-trek physical training program. Hence, the authors of this study recommend that every trekker must incorporate physical training carrying the backpack, practice walking on uneven terrain, go on practice treks frequently before commencing the main trek. This will help to withstand the high loads on the lower extremities and also reduce the impact of internal and external loads on the knee and ankle joints, thereby enhancing endurance for long-distance walking. Subsequently, the severity of injuries and illnesses will reduce.

Overall, the results of this study recommend a comprehensive physical training program before the main trek. Further, the importance of regular pre-trek physical training can be enhanced by implementing supervised professional training and guidance under skilled personnel such as physiotherapists, strength and conditioning coaches, and wilderness medicine experts.


  Conclusion Top


  1. The study concludes that the participants still lack awareness of the importance of warm-up and cooldown exercises before and after the trek.


  2. Most of the participants are aware of aerobic and resistance training domains but still lack knowledge about balance training as a part of pre-trek physical training.


  3. Only 14.30% of the total participants are engaged in pre-trek physical training regularly.


Clinical implications

The authors of this study feel that there needs to be an enhanced role of physiotherapists in ensuring adequate pre-trek physical training focusing mainly on eccentric conditioning of the lower extremity muscles.

Limitations of the study

Low sample size.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Bohne M, Abendroth-Smith J Effects of hiking downhill using trekking poles while carrying external loads. Med Sci Sports Exerc 2007;39:177-83.  Back to cited text no. 1
    
2.
Maeo S, Yamamoto M, Kanehisa H, Nosaka K Prevention of downhill walking-induced muscle damage by non-damaging downhill walking. PLoS One 2017;12:e0173909.  Back to cited text no. 2
    
3.
Gardner TB, Hill DR Illness and injury among long-distance hikers on the long trail, Vermont. Wilderness Environ Med 2002;13:131-4.  Back to cited text no. 3
    
4.
Welch TP Data-based selection of medical supplies for wilderness travel. Wilderness Environ Med 1997;8:148-51.  Back to cited text no. 4
    
5.
Anderson LS Jr, Rebholz CM, White LF, Mitchell P, Curcio EP 3rd, Feldman JA, et al. The impact of footwear and packweight on injury and illness among long-distance hikers. Wilderness Environ Med 2009;20:250-6.  Back to cited text no. 5
    
6.
Schwameder H, Roithner R, Müller E, Niessen W, Raschner C Knee joint forces during downhill walking with hiking poles. J Sports Sci 1999;17:969-78.  Back to cited text no. 6
    
7.
Howatson G, Hough P, Pattison J, Hill JA, Blagrove R, Glaister M, et al. Trekking poles reduce exercise-induced muscle injury during mountain walking. Med Sci Sports Exerc 2011;43:140-5.  Back to cited text no. 7
    
8.
Oscar LW, Tun-Hing L, Kai-Ming C The epidemiology of ankle sprain during hiking in uniformed groups. J Orthop Trauma Rehabil 2011;15:10-6.  Back to cited text no. 8
    
9.
Schwameder H, Lindenhofer E, Müller E Effect of walking speed on lower extremity joint loading in graded ramp walking. Sports Biomech 2005;4:227-43.  Back to cited text no. 9
    
10.
Shackall J How to Prepare for Your Trekking Adventure: Our 10 Step Training Guide; 2018. Available from: https://www.intrepidtravel.com/adventures/trekking-training-guide-tips/. [Last accessed on 2021 May 26].  Back to cited text no. 10
    
11.
Pescatello LS, General principles of exercise prescription. In: Deborah R, Arena R, Thompson PD. American College of Sports Medicine Guidelines. 9th ed. Baltimore, MD: Lippincott Williams and Wilkins; 2013. p. 162-90.  Back to cited text no. 11
    
12.
Thomas AT Effects of Pack Weight on Endurance of Long-distance Hikers (2013). Dissertations and Theses. 140.https://commons.erau.edu/edt/140  Back to cited text no. 12
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9], [Table 10], [Table 11], [Table 12], [Table 13], [Table 14]



 

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