Introduction
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Wilderness sports differ from traditional sports in several ways.
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Participation levels of athletes may vary: professional, sponsored, and paid athletes; athletic individuals and adventurers; and intermittent recreational participants.
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The setting of wilderness sports is often austere, remote, and not regulated by organized bodies as traditional sports are.
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Participants range in age from children to older adults and seniors.
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Typically, there is no distinction in participation between male and female participants in wilderness sports.
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Competition does occur but is often an individual endeavor to achieve personal best.
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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/events.
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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).
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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.
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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.
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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.
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Accordingly, providers must understand how wilderness sports differ from traditional sports, particularly in order 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.
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International travel or remote domestic travel is common in wilderness sports/adventures and calls for unique considerations:
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Travel insurance is available for international travel.
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Insurance is also available, as are GPS-locating devices, in the event where search and rescue services are warranted.
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Travel-specific disease prevention utilizing preventive practices, vaccines, and occasionally medications (Traveler’s Health at cdc.gov) is helpful.
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While 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 *
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
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
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Preparticipation evaluation (PPE) is an evaluation of athletes or sports participants before participation in a sport, an event, or an adventure.
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PPE is common in traditional and organized sports, specifically high school or collegiate sports, where it is often required despite limited supporting evidence.
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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.
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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.
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Examples of important considerations for 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
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Domestic vs. international will yield different health concerns
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Insurance policies for health and emergency issues abroad are available
Immunizations
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Important for international travel in endemic areas as well as in certain domestic areas
Chronic medications
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Additional supplies or pharmacy refills prior to travel depending on location and event demands
Prophylactic medications
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Helpful in both endemic international areas as well as certain domestic remote backcountry areas
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Antibiotics
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Pain management
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Wound care
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General illness (e.g., diarrhea, nausea/vomiting, and rashes)
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General physical conditioning
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Fitness and conditioning base vs. need for specific activities in a healthy athlete/adventurer
Nutrition
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Adequate caloric replacement for the desired activity, considering lightweight, easily tolerated foods that include elements of healthy fats, carbohydrates, and proteins
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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
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Acclimatization, history of altitude illness, weather, and elemental exposure
Hot environments
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Heat exposure issues
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History of heat illness
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Cooling abilities
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Sun protection
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Hydration
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Cold environments
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Cold exposure issues
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History of cold illness
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Frostbite
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Layered clothing
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Prevention of heat loss and sweating
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Presence of chronic disease
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Stabilization/optimization of health conditions
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May need medical specialty consultation
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Diagnostic data during PPEs may be helpful in certain cases such as evaluation of iron levels before travel to altitude and assessment 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.
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Laboratory data may be desired to ensure stability and optimization of chronic health conditions.
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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
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Can be office-based or conducted in a private setting; sometimes Internet or phone consultation
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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.
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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.
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As in most health evaluations, medical history is the most important factor during PPE for wilderness sports.
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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
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Should follow typical Health Insurance Portability and Accounting Act (HIPAA) procedures
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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
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Literature is available to guide inexperienced providers, but referral to a trained provider may be valuable in more challenging medical and environmental scenarios.
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Specialty consultation may be pertinent to further evaluate chronic health conditions such as heart disease (may need an ECG or stress test), pulmonary disease (may need pulmonary function tests, including provocative exams), and gastrointestinal disease (may need updated colonoscopy or unique dietary plans).
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See eForm 16.1 for an example of a health history form that could be used by a provider performing a PPE for wilderness sports or adventures.
Chronic Health Conditions and Wilderness Sports and Adventures
Overview
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In general, key principles involve optimization and/or stabilization of chronic conditions before wilderness travel, sports, or adventures.
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Ensure access to medications used regularly or for disease exacerbations and include adequate supply for the same number of days of sojourn and additional 2–3 days of supply (or more) depending on potential travel itinerary changes, possibility of event prolongation, or loss of medication.
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Certain conditions may be affected more by specific environments, such as cold or hot temperatures or high altitudes, and others are more generalized.
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Some individuals with chronic health conditions or unexplained signs and symptoms may require more advanced diagnostic evaluation depending on the activity, duration of event, or required intensity (see the PPE section above).
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Table 16.3 illustrates a simplified list of chronic conditions and rationale for related issues experienced in wilderness sports/adventures.
TABLE 16.3Related posts:
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