Fitness: Preparing for Your Trek in Nepal

There are hundreds of treks one can choose from in Nepal, from short day hikes outside of Kathmandu or Pokhara to the Great Himalaya Trail, which runs the length of Nepal. Trekking in Nepal can be difficulty – some are easy and can be done by just about anybody while others require trekkers to be very fit and even have some mountaineering experience.

Regardless of the trek they choose, all travelers coming to Nepal should be in at least moderate physical shape before setting off on their trek. Trekking anywhere is physically demanding – but most treks in Nepal would be considered difficult by other countries’ standards because of the dramatic ascents and descents as well as high altitude. Being in bad shape makes for a miserable trek in the best-case scenario – and a serious injury or medical emergency in the worst case. So it’s best to prepare beforehand by getting in good physical shape to enjoy the experience of trekking in Nepal.

The amount of physical preparation necessary depends on the trek someone wants to do. The longer and higher the trek, generally the better shape that person should be in. For example: for 15-day, high altitude treks, like Everest Base Camp Trek or sections of the Annapurna Circuit, trekkers should be getting about 4-5 days a week of cardio exercise for at least a month beforehand. For lower-altitude and shorter treks near the Kathmandu valley being in good enough shape to walk for several hours should be enough. For more specific information on training and physical preparation, it is best to consult your doctor.

Medical Kits and Vaccinations options in Nepal

In trekking areas outside of Kathmandu, there are few options for good medical care. The most popular trekking destinations in Nepal are fairly remote and medical facilities, especially good ones, are scarce in these areas. It is a good idea for foreign trekkers to carry a small medical kit with them while trekking or traveling outside of Kathmandu.  This is a suggestion on the staples that any medical kit for trekking in the mountains should include, not a comprehensive list. Many of these can be purchased inexpensively in Kathmandu and Pokhara.

Travel/trekking medical kits should include: 

  • Basic first aid supplies (bandages, sterile cleaners, gauze, tape, etc)
  • Band-aids and blister care
  • Paracetamol and aspirin for pain relief. Ibuprofen for pain and fever relief as well as anti-inflammation.
  • Any prescription medicines that an individual is already taking
  • Rehydration salts in case of diarrhea – Loperamide (Imodium) is useful as well for temporary relief of symptoms
  • Antibiotics (like ciprofloxacin)
  • Antifungal cream
  • Cold tablets and nasal decongestant
  • Diamox – especially for treks above 3,500 meters

There are no required vaccinations to enter the country unless someone has travelled or lived in a country where yellow fever is prevalent – in which case travelers must show proof that they have been immunized. Otherwise, it is a good idea to look into and get the following vaccinations before coming to Nepal:

  • Hepatitis A
  • Typhoid
  • Tetanus
  • Other immunizations to consider getting: Hepatitis B, Japanese Encephalitis, Rabies, Influenza, Polio, Tuberculosis
  • Malaria tablets are only necessary if travelers plan on spending long periods of time in the lowland Terai, not for short trips or for travel in Kathmandu, or Pokhara, and definitely not for treks in the mountains.

*All travelers should consult with their doctor on their specific health requirements and preparations to best prepare for their trip to Nepal. All foreign travelers should also take out insurance to cover their medical costs in case of an emergency evacuation and treatment.

In Nepal Food, Water, and Hygiene

Nothing can derail a fun trekking holiday like traveler’s diarrhea. Water and cooking practices in Nepal are not always the cleanest, so it is important for travelers to take care to eat and drink from clean, hygienic sources.

Travelers in Nepal should only drink purified water. While bottled mineral water can be purchased all over Kathmandu and along popular trekking trails, plastic water bottles are a major problem in Nepal’s mountainous areas. Plastic water bottles have become one of Nepal’s worst sources of pollution: thousands are purchased every year by foreign trekkers and chucked along the trails or in villages unable to cope with so much trash, so they accumulate and pollute the environment – taking hundreds of years to decompose. So instead of relying on bottled water, foreign travelers should instead purify their own water. Boiling water is the easiest way to do this, and can be done in teahouses as well as on camping treks. Using purification tablets, water filters, and UV light treatments (like the SteriPen) are also good ways to purify water.

Foreign travelers should also watch the food they eat carefully. Foreigners should eat from clean hygienic places and consider avoiding certain foods that require more thorough cleaning or preparation, namely meats, dairy products, and fresh vegetables and fruits without a peel. Sticking to cooked dishes is a good rule of thumb in Nepal, especially out in villages. Foreigners should also wash their hands regularly while in Nepal, to help avoid ingesting germs or bacteria they come into contact with while out and about.

Animals and Rabies

Animals are everywhere in Nepal. Cows, dogs, and monkeys, yaks, mules, and horses are all animals foreign travelers in Nepal are very likely to encounter, almost always wandering freely. Rabies is prevalent in Nepal, and travelers would be wise to avoid close contact with dogs and monkeys in particular, the main carriers of the disease. Monkeys in temple areas are especially brazen, so travelers are also advised not to feed them. Foreign travelers should also be wary of petting farm animals, as many are not used to being handled by foreigners and are likely to bite, kick, or charge – which is exceptionally dangerous on narrow trails.

Altitude Awareness in Nepal

Many of Nepal’s trekking routes are at high altitudes, and its most popular ones – Everest Base Camp and sections of the Annapurna Circuit – go well above 2,500 meters (about 8,200 feet). The higher the altitude, the less oxygen is present, and the more difficult it is for people to survive. While falls and injuries are common injuries on any hiking trail in the world, high altitude treks presents unique risks that foreign trekkers are not always prepared for.

Altitude sickness describes the variety of health problems that can develop at high altitudes, also known as acute mountain sickness or AMS. AMS can become serious very quickly, and lead to comas or even death. It can affect anyone – from people who have never been at high altitude before to veteran mountaineers – so people must be alert for symptoms and take certain precautions while trekking in Nepal. Foreign trekkers should plan their trekking itinerary in a way that allows their bodies to adjust to the altitude as they go higher, a process called acclimatization. As long as trekkers don’t ascend faster than their bodies can adjust, they should be able to complete most treks in Nepal without developing altitude sickness.

That being said, there is no way to completely avoid feeling the altitude. Breathlessness, decreased appetite, and fatigue are common symptoms almost everyone experiences. So long as the body can recover when trekkers are resting, these are not problematic. Mild symptoms should serve as a signal for trekkers to stop ascending, and take some time to let their bodies adjust: nausea, exhaustion, dizziness, irritability, breathlessness (even while resting), headaches, and difficulty sleeping.   If these symptoms persist even on rest days, trekkers should descend in altitude to allow their bodies to recover. However if symptoms worsen or trekkers develop the following symptoms, trekkers need to descend to a significantly lower altitude immediately: severe headache that doesn’t go away with light medication, lack of coordination (walking as if drunk), confusion and strange behavior, constant breathlessness, a dry and irritating cough that may lead to coughing up pink froth, and vomiting. These symptoms indicate possible pulmonary or cerebral edemas, when liquid accumulates in the lungs or brain. Pink froth coughed up is a telltale sign of High-Altitude Pulmonary Edema (HAPE), while confusion, disorientation, and “walking drunk” are pretty clear indicators for High-Altitude Cerebral Edema (HACE).   These are extremely serious, life-threatening conditions and should be treated as medical emergencies. The only way to cure AMS is to descend to lower altitude.

While there is no way to 100% prevent against altitude sickness, there are measures trekkers can take to decrease their risks of developing it and better enjoy their treks. The most important step all trekkers should take is to make sure they do not ascend faster than their bodies can adjust to the altitude. Keeping an eye on themselves and on each other, trekkers should plan for their trekking itinerary to “climb high and sleep low,” as the old adage goes. Sleeping at a lower altitude than the highest point reached that day is key to helping the body adjust to new heights. When preparing for a big ascent, trekkers should also factor in additional acclimatization days – not exactly rest days, but days where the goal is to climb to a high point and then descend back to a lower altitude where their bodies had adjusted. Healthy bodies are better able to cope with the additional stress caused by altitude, so it is important for trekkers to stay hydrated, eat properly, and not smoke while on the trek. Aspirin can help with low-grade headaches, and Diamox can be used to help reduce mild symptoms of AMS. However, Diamox is not a cure for AMS, and if symptoms do not improve – for example, a headache that does not go away after taking Diamox and/or aspirin – it is a sign that the body is simply not adjusting and needs to descend. Ultimately the best way to prevent against developing AMS is to ascend at rate that allows the body to adjust and to watch for signs of more serious symptoms. 

Emergency Medical Treatment in Nepal

While in a few districts there are local health posts, these are spread out and small in number – so foreign trekkers should not count on these except for in mild cases. In cases of bad injuries or medical and altitude-related emergencies out on the trail, foreign trekkers are usually evacuated by helicopter to Kathmandu - and in some cases even on to hospitals in Thailand and Singapore if their condition is serious enough. Nepal International Clinic in Kathmandu and CIWEC clinic, which has branches in both Kathmandu and Pokhara, are two of the best clinics in Nepal. However, in extreme cases people must be sent on to better-equipped hospitals in other countries, namely Thailand and Singapore. The cost of these evacuations is enormous, and all foreign travelers should take out insurance (see our Insurance section) to cover them in case of these emergencies.

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