A guide to staying well at high altitude

High places -- altitudes of 2,500m and above -- demand special respect and preparation. However, with proper planning and the right training, almost anyone can experience the exhilaration of rarefied air. Here are some ideas to help you to prepare, train, stay well and reach altitudes you would never have believed possible in the tallest mountain ranges of the world. It is often not practical to prepare by actually spending time up high, but you can train your heart and lungs for altitude, even at sea level. Do at least four hour-long sessions per week of full-effort aerobic exercise, such as running, biking or swimming. Find steep hills to climb wherever you can. And if you will be carrying a load, include this into your training regime. Rest If you will be flying or driving to altitude, the first thing you must do is rest. Spend two or three days doing as little as possible and drinking plenty of water – around four to six litres per day. Dehydration worsens altitude problems, as does drinking alcohol. Keep eating You may lose your appetite when first at altitude, but it is important to keep eating. You will burn more calories even at rest when up in the alpine cold: make sure you eat plenty of high-carb, slow-burning energy foods. Climb high, sleep low Above 3,000m, if the geography allows, do not ascend more than 300m a day. If you do, plan to sleep no more than 300m higher than you did the previous night until you are well acclimatised. Acclimatisation takes one to three days for any given altitude. Tough days, rough nights Nights may be tough at first. Breathing rate slows when you sleep and you may wake frequently feeling short of breath. Propping yourself up with your backpack to sleep half-sitting may help. Know the danger signs It is normal to have some headaches when you are first above 2,500m. Rest, drink and medicate as you would at sea level. Breathlessness is normal on exertion at altitude – but above 3,000m, watch for breathlessness when resting. A cough; a severe, persistent headache; nausea; loss of coordination or disorientation  all are signs of Acute Mountain Sickness (AMS). This potentially fatal condition demands rapid descent. Have a plan AMS symptoms often improve with a descent of 300 to 600m. Make sure your walking party has a plan of action for descent. Try folk (and Western) remedies Andeans have chewed coca leaves for thousands of years -- the alkaloids released relieve altitude symptoms. In the Himalayas, dried yak cheese is said to alleviate some altitude woes. Eating steak before arriving at altitude may increase iron levels and help produce blood cells to transport oxygen. Or take the pharmaceutical route: Acetazolamide (Diamox) before and during ascent helps acclimatisation. Now that you are prepared, here are five of the most beautiful -- and challenging -- high altitude journeys: Mt Kailash Kora, Tibet The faithful (and fit) make the 52km circumambulation in one day, but most trekkers take at least three days to circuit the mountain at altitudes of between 4,570 and 5,790m. Be glad you are not prostrating at every step like some pilgrims. Kala Patthar - Cho La - Gokyo Lakes, Nepal This classic circuit leads from fly-in Lukla to the best viewpoint over Mt Everest, Kala Patthar (5,644m). It then heads over Cho La Pass (5,330m) to Gokyo Valley. Stay hydrated with dudh chia (milk tea). Dolpo, Nepal Trek from Shey Gompa to Phoksundo Lake in the land of the snow leopard, and then on remote, ancient pathways to Jomsom. Altitudes range between 4,000-5,000m – be thankful for your yaks. Cordillera Huayhuash, Peru The 12-day 170km circuit of the most easterly range of the Andes is largely between 4,000 and 5,000m. Spectacular glacier-shrouded peaks here soar to 6,635m. Simien Mountains, Ethiopia This primeval range is cut through by deep river gorges and rises to the highest point in Ethiopia, 4,563m Ras Dejen. Approach the summit on rural pathways threading between 20 peaks over 4,000m.