Acclimatization & Conditioning
Terrestrial altitude can be classified into five categories. Low altitude is sea level to 5,000 feet. Here, arterial blood is 96 percent saturated with oxygen in most people. Moderate altitude is from 5,000 to 8,000 feet. At these altitudes, arterial blood is greater than 92 percent saturated with oxygen, and effects of altitude are mild and temporary. High altitude extends from 8,000 to 14,000 feet, where arterial blood oxygen saturation ranges from 92 percent down to 80 percent. Altitude illness is common here. Very high altitude is the region from 14,000 to 18,000 feet, where altitude illness is the rule. Areas above 18,000 feet are considered extreme altitudes.
Soldiers deployed to high mountainous elevations require a period of acclimatization before undertaking extensive military operations. The expectation that freshly deployed, unacclimatized troops can go immediately into action is unrealistic, and could be disastrous if the opposing force is acclimatized. Even the physically fit soldier experiences physiological and psychological degradation when thrust into high elevations. Time must be allocated for acclimatization, conditioning, and training of soldiers. Training in mountains of low or medium elevation (5,000 to 8,000 feet) does not require special conditioning and acclimatization procedures. However, some soldiers will have some impairment of operating efficiency at these low altitudes. Above 8,000 feet (high elevation), most unacclimatized soldiers may display some altitude effects. Training should be conducted at progressively higher altitudes, starting at about 8,000 feet and ending at 14,000 feet. Attempts to acclimatize beyond 17,000 feet results in a degradation of the body greater than the benefits gained. The indigenous populations can out-perform even the most acclimatized and physically fit soldier who is brought to this altitude; therefore, employment of the local population may be advantageous.
Symptoms and Adjustments
A person is said to be acclimatized to high elevations when he can effectively perform physically and mentally. The acclimatization process begins immediately upon arrival at the higher elevation. If the change in elevation is large and abrupt, some soldiers can suffer from acute mountain sickness (AMS), high-altitude pulmonary edema (HAPE), or high-altitude cerebral edema (HACE). Disappearance of the symptoms of acute mountain sickness (from four to seven days) does not indicate complete acclimatization. The process of adjustment continues for weeks or months. The altitude at which complete acclimatization is possible is not a set point but for most soldiers with proper ascent, nutrition and physical activity it is about 14,000 feet.
a. Immediately upon arrival at high elevations, only minimal physical work can be performed because of physiological changes. The incidence and severity of AMS symptoms vary with initial altitude, the rate of ascent, and the level of exertion and individual susceptibility. Ten to twenty percent of soldiers who ascend rapidly (in less than 24 hours) to altitudes up to 6,000 feet experience some mild symptoms. Rapid ascent to 10,000 feet causes mild symptoms in 75 percent of personnel. Rapid ascent to elevations of 12,000 to 14,000 feet will result in moderate symptoms in over 50 percent of the soldiers and 12 to 18 percent may have severe symptoms. Rapid ascent to 17,500 feet causes severe, incapacitating symptoms in almost all individuals. Vigorous activity during ascent or within the first 24 hours after ascent will increase both the incidence and severity of symptoms. Some of the behavioral effects that will be encountered in unacclimatized personnel include:
- Increased errors in performing simple mental tasks.
- Decreased ability for sustained concentration.
- Deterioration of memory.
- Decreased vigilance or lethargy.
- Increased irritability in some individuals.
- Impairment of night vision and some constriction in peripheral vision (up to 30 percent at 6,000 feet).
- Loss of appetite.
- Sleep disturbances.
- Irregular breathing.
- Slurred speech.
b. Judgment and self-evaluation are impaired the same as a person who is intoxicated. During the first few days at a high altitude, leaders have extreme difficulty in maintaining a coordinated, operational unit. The roughness of the terrain and the harshness and variability of the weather add to the problems of unacclimatized personnel. Although strong motivation may succeed in overcoming some of the physical handicaps imposed by the environment, the total impact still results in errors of judgment. When a soldier cannot walk a straight line and has a loss of balance, or he suffers from an incapacitating headache, he should be evacuated to a lower altitude (a descent of at least 1,000 feet for at least 24 hours).
Physical and Psychological Conditioning
The commander must develop a conditioning/training program to bring his unit to a level where it can operate successfully in mountain conditions. Priorities of training must be established. As with all military operations, training is a major influence on the success of mountain operations.
a. U.S. forces do not routinely train in mountainous terrain. Therefore, extensive preparations are needed to ensure individual and unit effectiveness. Units must be physically and psychologically conditioned and adjusted before undertaking rigorous mountain operations. Units must be conditioned and trained as a team to cope with the terrain, environment, and enemy situation. Certain factors must be considered:
- What are the climatic and terrain conditions of the area of operations?
- How much time is available for conditioning and training?
- Will the unit conduct operations with other U.S. or Allied forces? Are there language barriers? What assistance will be required? Will training and conditioning be required for attached personnel?
- What additional personnel will accompany the unit? Will they be available for training and conditioning?
- What is the current level of physical fitness of the unit?
- What is the current level of individual expertise in mountaineering?
- What type of operations can be expected?
- What is the composition of the advance party? Will they be available to assist in training and acclimatization?
- What areas in the U.S. most closely resemble the area of operations?
- Are predeployment areas and ranges available?
- Does the unit have instructors qualified in mountain warfare?
- What type equipment will be required (to fit the season, mission, terrain)?
- Does the unit have enough of the required equipment? Do personnel know how to use the equipment? Will the equipment go with the advance party, with the unit, or follow after the unitís arrival?
- Does equipment require modification?
- Do weapons and equipment require special maintenance?
b. When the unit arrives in the area of operations, all personnel require a period of conditioning and acclimatization. The time schedule should allow for longer and more frequent periods of rest. The rigors of establishing an assembly area exhaust most unacclimatized personnel. Water, food, and rest must be considered as priorities, ensuring sufficient amounts while individual metabolisms and bodies become accustomed to functioning at higher elevations.
c. Since the acclimatization process cannot be shortened, and the absence of acclimatization hampers the successful execution of operations, deployment to higher elevations must consider the following:
(1) Above 8,000 feet, a unit should ascend at a rate of 1,000 to 2,000 feet per day. Units can leapfrog, taking an extended rest period.
(2) Units should not resort to the use of pharmaceutical pretreatment with carbonic anhydrase inhibitors such as acetazolamide (Diamox). These drugs have side effects that mimic the signs and symptoms of AMS. Inexperienced medics may have difficulty recognizing the differences between the side effects of the drug and a condition that could possibly be life threatening. Additionally, these drugs are diuretics, which results in higher hydration levels (at least 25 percent increase per man per day). These higher hydration levels create a larger logistical demand on the unit by requiring more water, time to acquire water, water purification supplies, and, if in a winter environment, fuels for melting snow and ice for water.
(3) Carbonic anhydrase inhibitors such as acetazolamide are effective in the treatment of mild and severe AMS. These drugs should accompany attached medical personnel because they can treat the soldier suffering the symptoms of AMS and, although rest may be required evacuation may not be needed.
(4) Do not move troops directly to high altitudes even if allowances can be made for inactivity for the first three to five days before mission commitment. Moving troops directly to high altitude can increase the probability of altitude sickness. Even if inactivity follows deployment, the incidence of altitude sickness is more likely than with a gradual ascent.
d. Training on high-altitude effects can prevent psychological preconceptions. Soldiers who have lived on flat terrain may have difficulty when learning to negotiate steep slopes or cliffs, developing a sense of insecurity and fear. They must be slowly introduced to the new terrain and encouraged to develop the confidence required to negotiate obstacles with assurance and ease. They must be taught the many climbing techniques and principles of mountain movement. They overcome their fear of heights by becoming familiar with the problem. The soldier cannot be forced to disregard this fear.
e. Regardless of previous training and the amount of flat cross-country movement practice, the untrained soldier finds mountain movement hard and tiring. A different group of muscles are used, which must be developed and hardened. A new technique of rhythmic movement must be learned. Such conditioning is attained through frequent marches and climbs, while carrying TOE and special equipment loads. This conditions the back and legs, which results in increased ability and endurance. At the same time, the men acquire confidence and ability to safely negotiate the terrain. The better the physical condition of the soldier, the better the chance of avoiding exhaustion. Proper physical conditioning ensures the soldier is an asset and not a liability. The body improves its capacity for exercise, the metabolism becomes more efficient, and blood and oxygen flow quickly and effectively.
f. A physical fitness training program that gradually increases in difficulty should include marches, climbing, and calisthenics. This increases the soldierís endurance. Through a sustained high level of muscular exertion, the soldierís capacity for exertion is increased. Physical conditioning should include long-distance running for aerobic conditioning; calisthenics and weight training to strengthen the heart, lungs, abdomen, legs, back, arms, and hands; a swimming program to increase lung efficiency; and road marches over mountainous terrain with all combat equipment. Upon deploying to high elevations, caution must be exercised by units that are in superior physical condition. The heart rate, metabolism, and lungs must become accustomed to the elevation and thinner air. A conditioning program must be set up on site and integrated in gradual stages where acclimatization, conditioning, and mountaineering skills are realized.
g. Conditioning should begin with basic climbing. It is equally important to instill the will to climb. Confidence goes hand in hand with physical conditioning and skill development. Repetitive practice, to the point of instinctive reaction, is key to learning and maintaining climbing proficiency and technical skills. There are no quick and easy methods to becoming acclimatized and conditioned. Training should gradually challenge the soldier over an extended period and reinforce learning skills.