As I prepare to hike through the Dolomites, my training has entered its final stretch. At this point, I am not trying to cram in dramatically more miles or completely reinvent my routine. I am paying closer attention to the small decisions that help my body arrive strong, rested and ready to adapt.
That includes protein, hydration, sleep, strength, mobility, recovery and stress management. None of those choices seems particularly dramatic on its own. Together, they create the foundation for performance.
The closer I get to the mountain, the more I am reminded of something I often tell my patients:
Performance is not built in the big moment. It is built in the thousand small choices that come before it.
Denver Is Already Asking Your Body to Adapt
Living in Denver means living approximately 5,280 feet above sea level. At this elevation, the air still contains about the same percentage of oxygen as it does at sea level, but the lower atmospheric pressure means less oxygen is available with each breath.
Our bodies adapt to that environment over time. But living in Denver does not make us immune to the effects of traveling, sleeping or exercising at higher elevations.
As altitude increases, the body has to work differently to deliver oxygen to the brain and working muscles. Your breathing and heart rate may increase. Sleep may become more difficult. A pace that normally feels manageable can suddenly feel much harder.
Altitude can affect:
- Exercise capacity and endurance
- Breathing and heart rate
- Sleep quality
- Hydration and appetite
- Headaches and fatigue
- Concentration and decision-making
- Recovery between physically demanding days
Fitness can help you handle the activity itself, but it does not guarantee protection from altitude illness. A highly trained athlete can still become sick at elevation, while someone with a more moderate fitness level may acclimatize without significant symptoms.
Your fitness level and your response to altitude are not the same thing.
Altitude Tests More Than Your Lungs
We tend to think of altitude as a respiratory challenge, but breathing is only part of the story.
Your nervous system also has to respond to a changing environment. Your cardiovascular system works to move oxygen throughout the body. Your muscles must produce energy under more demanding conditions. Your brain still has to navigate, make decisions and assess risk, even when you are tired.
This matters on a mountain, but it also applies to everyday performance.
When the body is under physical stress, it may become harder to stay calm, think clearly and make good decisions. At higher elevations, fatigue, poor sleep, dehydration and reduced oxygen availability can compound one another.
That is why preparation should include more than cardiovascular training. Strength, recovery, hydration, nutrition, pacing and emotional regulation all contribute to your ability to respond well.
Willpower alone does not get you safely up a mountain. Preparation, pacing and respect for your body do.
Recovery Is Part of the Training
One of the easiest mistakes to make before a major physical goal is assuming that more training is always better.
Training creates a demand. The body then needs time and resources to adapt to that demand. If you repeatedly add stress without enough recovery, you may arrive at your goal depleted instead of prepared.
During this final phase of my Dolomites preparation, I am thinking about questions such as:
- Am I eating enough protein to support muscle?
- Am I consistently hydrating rather than trying to catch up later?
- Am I sleeping deeply enough to feel restored?
- Am I maintaining strength without creating unnecessary fatigue?
- Am I giving tight or overworked areas time to recover?
- Is my energy relatively consistent throughout the day?
- Am I responding to the signals my body is giving me?
A rest day is not a lost training day. Sleep is not separate from performance. Nutrition is not something to address after the workout.
These are part of the training.
Structural Health Matters Before Pain Appears
Preparing for a demanding hike is not only about cardiovascular endurance. The way your body moves can influence how efficiently it handles repeated physical stress.
A restriction, weakness or compensation in one area may change how movement travels through the rest of the body. A foot that is not moving well may affect the knee. Limited hip mobility may change how the lower back handles a climb. Fatigue in one muscle group may cause another area to take on more work.
These patterns do not always begin with significant pain. You may first notice that one side tires faster, your stride feels uneven, your balance changes when you are fatigued or recovery takes longer than expected.
A performance-focused structural evaluation may look at:
- Joint mobility
- Muscle function
- Balance and stability
- Movement patterns
- Areas of compensation
- Previous injuries
- Training load and recovery
The goal is not to chase perfection. It is to identify patterns that may be making movement harder than it needs to be.
Structural care is not only for treating an injury after it happens. It can also be part of helping an active body move comfortably and efficiently.
Your Nervous System Comes With You
Major physical goals can create excitement, pressure and anxiety at the same time.
You can strengthen your legs and improve your endurance, but you still bring your nervous system with you. Stress can affect sleep, concentration, muscle tension, appetite and recovery. It may also make it harder to distinguish between ordinary discomfort and a signal that something is wrong.
Supporting the nervous system does not have to be complicated. It may include:
- Protecting your sleep schedule
- Practicing slower, controlled breathing
- Reducing unnecessary demands before a major event
- Planning the route and logistics in advance
- Discussing fears instead of ignoring them
- Building enough time into the itinerary to avoid rushing
- Knowing when to stop, rest or turn around
Staying calm does not mean ignoring symptoms. It means maintaining enough awareness to make a thoughtful decision when conditions change.
Respect the Acclimatization Process
There is no workout that lets you skip acclimatization entirely.
The body needs time to adjust as sleeping elevation increases. The CDC recommends gradual ascent and avoiding a rapid increase in sleeping altitude, particularly once traveling above approximately 9,000 feet. Individual responses vary, so an itinerary that works for one person may still be too aggressive for another.
General strategies include:
- Ascending gradually when possible
- Scheduling lighter activity during the first days at elevation
- Avoiding a rapid increase in sleeping altitude
- Staying consistently hydrated
- Limiting alcohol when first arriving
- Pacing more conservatively than you would at home
- Eating regularly, even if appetite is reduced
- Paying attention to new or worsening symptoms
Headache, nausea, dizziness, unusual fatigue and difficulty sleeping can be signs of acute mountain sickness. Symptoms that are worsening should not be treated as a challenge to push through. Confusion, difficulty walking normally, severe shortness of breath at rest or a significant decline in mental status require immediate descent and urgent medical attention.
The mountain will still be there. Your health has to come first.
For current guidance, review the CDC’s recommendations for high-altitude travel and altitude illness.
The Preparation Is the Point
My Dolomites hike is a specific goal, but the lesson is much broader.
Your version of the mountain might be a race, an active vacation, returning to exercise after an injury, maintaining muscle as you age or simply having enough energy to keep up with your life.
In every case, the goal is not to fight your body all the way there. It is to give your body the resources and time it needs to build capacity.
That is one of the principles I appreciate most about functional medicine. We look at the complete picture and ask what may be missing, mismatched or creating unnecessary stress.
Small, appropriate inputs sustained over time can influence how the body meets a larger demand.
Is Your Body Ready for What You Are Asking It to Do?
If you are training consistently but struggling to recover, feeling unusually depleted or noticing that your body cannot keep up with your goals, pushing harder may not be the answer.
A performance-focused evaluation can help us look at the factors affecting your energy, strength, movement and recovery. Depending on your needs, that may include nutrition, sleep, laboratory testing, hormone and thyroid health, movement mechanics, structural care and an individualized recovery plan.
Your body is always adapting to what you ask of it. The question is whether it has the support it needs to adapt well.