The Wilderness Athlete and Adventurer

Introduction

Wilderness sports differ from traditional sports in several ways.
Participation levels of athletes may vary: professional, sponsored, and paid athletes; athletic individuals and adventurers; and intermittent recreational participants.
The setting of wilderness sports is often austere, remote, and not regulated by organized bodies as traditional sports are.
Participants range in age from children to older adults and seniors.
Typically, there is no distinction in participation between male and female participants in wilderness sports.
Competition does occur but is often an individual endeavor to achieve a personal best.
It is probable that 90% or greater of athletes are not professional.
Other important distinctions are that wilderness sports are typically not team sports, except for certain exceptions such as team-based overland adventure races and the team concept that applies to accomplishing common goals such as in climbing sports and events.
Participants may be those with disabilities, pregnant females, or individuals who may have chronic health conditions, particularly older adults, who may be affected by conditions or environments where they occur (e.g., wilderness sports/adventures occurring at high altitudes).
Although it is difficult to quantify participation in wilderness sports participation, primarily because of lack of tracking data, overall participation has increased in recent years.
Approximately half of all Americans participated in at least one outdoor activity in 2014, which equates to over 141 million individuals collectively participating in approximately 12 billion outdoor outings.
Increase in ski and snowboard sales, including backcountry equipment, as well increase in the sales and development of companies in the climbing and mountain biking industries support the increasing participation in wilderness and adventure activities.
Accordingly, providers must understand how wilderness sports differ from traditional sports, particularly to evaluate and advise participants in the setting of a preparticipation evaluation (PPE) and to understand and manage injuries and illnesses occurring as a result of the activities.
International travel or remote domestic travel is common in wilderness sports/adventures and calls for unique considerations:
- Travel insurance is available for international travel.
- Insurance is also available, as are global positioning system (GPS)–locating devices, in the event search and rescue services are warranted.
- Travel-specific disease prevention utilizing preventive practices, vaccines, and occasionally medications (Traveler’s Health at www.cdc.gov ) is helpful.

Although it is difficult to comprehensively enlist all wilderness and adventure activities, examples of general categories of wilderness sports are illustrated in Table 16.1 .

Table 16.1

Examples of General Categories of Wilderness Sports ^a

Wilderness Event Category	Sport/Adventure
Climbing sports	Rock
	Ice
	Mixed rock and ice
	Mountaineering/alpinism
Snow sports	Backcountry skiing
	Backcountry snowboarding
	Glacier travel
Water sports	River running (kayaking or rafting)
	Surfing
	Open water swimming
Cycling sports	Mountain biking
Endurance/trekking events	Hiking
	Backpacking
	Trekking
	Trail running (ultra-marathons)
	Overland adventure racing

a Note: This is not an inclusive list.

Terminology

Wilderness: A wild and uncultivated region such as a forest or desert, which is generally uninhabited or inhabited only by wild animals, and in which travel by land or water by humans can be considered a sport or adventure.
Backcountry: Refers to areas outside of controlled borders in wilderness regions, such as out of bounds at ski resorts for skiing/snowboarding or, perhaps, areas that could be out of cell phone or Internet range; can be applied to any wilderness sport.

Preparticipation Evaluation for the Wilderness Athlete and Adventurer

Overview

The PPE is an evaluation of athletes or sports participants before participation in a sport, an event, or an adventure.
PPE is common in traditional and organized sports, specifically high school or collegiate sports, where it is often required despite limited supporting evidence.
PPE for wilderness sports is performed less frequently compared with that for traditional sports, but recent literature offers guidance and methodology for clinicians who perform PPEs for wilderness sports.
Common reasons an athlete or adventurer may request a PPE may include a requirement from an agency or a guide service, a training course in outdoor education or wilderness skills, or individually requested based on personal goals and/or medical conditions.

Examples of important considerations for the PPE for the wilderness athlete/adventurer are outlined in Table 16.2 .

Table 16.2

Simplified List of Important Considerations for PPE of a Wilderness Athlete or Adventurer

Consideration	Rationale for Consideration
Travel	Domestic vs. international will yield different health concerns Insurance policies for health and emergency issues abroad are available
Immunizations	Important for international travel in endemic areas, as well as in certain domestic areas
Chronic medications	Additional supplies or pharmacy refills before travel depending on location and event demands
Prophylactic medications	Helpful in both endemic international areas and certain domestic remote backcountry areas Antibiotics Pain management Wound care General illness (e.g., diarrhea, nausea/vomiting, respiratory symptoms, and rashes)
General physical conditioning	Fitness and conditioning base vs. need for specific activities in a healthy athlete/adventurer
Nutrition	Adequate caloric replacement for the desired activity, considering lightweight, easily tolerated foods that include elements of healthy fats, carbohydrates, and proteins Other nutritional supplementation (e.g., vitamins) may be considered, given the nature of prepared or dehydrated foods and inability to carry perishables or heavy meat products
Altitude	Acclimatization, history of altitude illness, weather, and elemental exposure
Hot environments	Heat exposure issues History of heat illness Cooling abilities Sun protection Hydration
Cold environments	Cold exposure issues History of cold illness Frostbite Layered clothing Prevention of heat loss and sweating
Presence of chronic disease	Stabilization/optimization of health conditions May need medical specialty consultation Diagnostic data during PPEs may be helpful in certain cases, such as evaluation of iron levels, before travel to altitude and assessment of chronic disease stability (e.g., diabetes; CAD; valvular heart disease; COPD; and thyroid, hepatic, or renal disease)

CAD, Coronary artery disease; COPD, chronic obstructive pulmonary disease; PPE, preparticipation evaluation.

Laboratory data may be desired to ensure stability and optimization of chronic health conditions.
Moreover, specialty consultation may be helpful in assessment of cardiovascular health (e.g., exercise treadmill stress test), pulmonary function and capacity, and gastrointestinal or musculoskeletal health.

Setting, Timing, and Structure of a Wilderness Sports/Adventure PPE

Can be office-based or conducted in a private setting; sometimes Internet or phone consultation.
Virtual appointments are reasonable and becoming more common.
Ample duration should be allowed before the event for completion of immunizations and additional evaluation, which may include further diagnostic testing. A minimum of 6 weeks is mostly sufficient.
Providers should be prepared to perform a wilderness PPE, borrowing principles from traditional sports PPE and modifying with variables such as unique preparticipation planning, prolonged physical and mental demands, and other extrinsic challenges such as environment, regional location, and remoteness.
As in most health evaluations, medical history is the most important factor during the PPE for wilderness sports.
Physical examinations may be more important in the presence of chronic health conditions and previous illness or injury associated with wilderness adventures.

Ethical, Legal, and Administrative Considerations of a Wilderness Sports/Adventure PPE

Should follow typical Health Insurance Portability and Accountability Act (HIPAA) procedures
Utilized as an evaluation for a planned event but should also incorporate typical features of a wellness visit, including immunizations, status of chronic conditions, and assessment of medications
Literature is available to guide inexperienced providers, but referral to a trained provider may be valuable in more challenging medical and environmental scenarios.
Specialty consultation may be pertinent to further evaluate chronic health conditions such as heart disease (may need an electrocardiogram [ECG] or stress test), pulmonary disease (may need pulmonary function tests, including provocative examinations), and gastrointestinal disease (may need updated colonoscopy or unique dietary plans).
See e-Fig. 16.A for an example of a health history form that could be used by a provider performing a PPE for wilderness sports or adventures.

e-Figure 16.A, Example of a PPE health history form for a wilderness sports/adventure PPE.

Chronic Health Conditions and Wilderness Sports and Adventures

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