Wilderness Preparticipation Evaluation and Considerations for Special Populations

Abstract

Children, older adults, disabled and special needs athletes, and female athletes who participate in outdoor and wilderness sports and activities each face unique risks. For children and adolescents traveling to high altitude, the preparticipation physical evaluation should focus on risk assessment, prevention strategies, early recognition of altitude-related symptoms, management plans, and appropriate follow-up. As the risk and prevalence of chronic disease increases with age, both older patients and providers need to be aware of disease and medication-specific risks relative to wilderness sport and activity participation. Disabled and special needs athletes benefit from careful pre-event planning for the potential medical issues and equipment modifications that may affect their health in wilderness environments. Issues that demand special consideration for female adventurers include pregnancy, contraceptive use, menses, and ferritin levels at altitude. A careful preparticipation evaluation that factors in unique, population- specific risks will help special populations stay healthy and safe on wilderness adventures. The PubMed and SportDiscus databases were searched in 2014 using both MeSH terms and text words and include peer-reviewed English language articles from 1977 to 2014. Additional information was accessed from Web-based sources to produce this narrative review on preparticipation evaluation for special populations undertaking wilderness adventures. Key words include children, adolescent, pediatric, seniors, elderly, disabled, special needs, female, athlete, preparticipiation examination, wilderness medicine, and sports.

Athletes at High Altitude

“…70 Certain underlying medical conditions including a history of prematurity with respiratory distress syndrome, pulmonary hypertension, congenital cardiovascular or pulmonary abnormalities, current respiratory infection, trisomy 21, and obstructive sleep apnea increase a child's risk of AMS. 32,47 Children who develop severe altitude illness including HAPE should be evaluated for underlying cardiopulmonary abnormality. 32,47 Diagnosis of AMS can be more difficult in children than in adults.…”

“…32,47 Children who develop severe altitude illness including HAPE should be evaluated for underlying cardiopulmonary abnormality. 32,47 Diagnosis of AMS can be more difficult in children than in adults. Fussiness is a common symptom of AMS in preverbal children, as well as symptoms of decreased appetite, gastrointestinal symptoms, and lack of playfulness.…”

“…It is important to remember that use of these medications is based on clinical experience not on primary studies in children. 32…”

“…30,31 A higher rate of spontaneous abortion has been suspected but not consistently supported by evidence. 32 However, women at increased risk of spontaneous abortion are advised to avoid travel to high altitude. 30 Increased risk of IUGR and preeclampsia at high altitude are thought to be related to relative hypoxia.…”

“…30 Because of the lack of data on exercise in pregnancy at high altitude, formal recommendations vary. The American College of Obstetricians and Gynecologists endorses exercise at altitudes up to 1830 m. 16,18,32 The Society of Obstetricians and Gynaecologists of Canada cited no adverse effects with moderate exercise at 1800 to 2500 m and recommends acclimatization prior to exercise above 2500 m. 18,32 These recommendations are for healthy women with healthy pregnancies; women with high-risk pregnancy conditions such as hypertension, preeclampsia, IUGR, anemia, diabetes, and maternal smoking should avoid exercise at high altitude. 31 Given the lack of data in this area, pregnant women should be cautious regarding exercise and should be sure to make any decisions in consultation with their obstetric provider.…”