Hiking training: exercises for hills, descents and multi-day walks, and how to stay safe on the hill

Descents load your knees

Walking down a steep slope loads the knee much more than walking on the flat, and over 60% of hiking accidents in the Austrian Alps happened on the way down.

Sources 1, 2

Poles help on the way down

On a steep descent, poles cut the forces on the knee by 12 to 25%, and after a mountain walk they reduced soreness. On flat ground they didn't reduce the load on the knee.

Sources 3, 4, 5

Ankles and lower legs take the injuries

In Scotland's mountain rescues in 2024, 30% of injuries were to the ankle and 25% to the lower leg, and slips and trips were the commonest cause.

Source 6

Train with strength, stairs and your pack

In soldiers, strength and aerobic training with progressively heavier loaded walks improved loaded walking most, and 8 weeks of stair climbing raised fitness by 17% in sedentary young women.

Sources 7, 8

Fitness doesn't stop altitude sickness

Being fit doesn't appear to protect you above about 2,500 m, so go up slowly: above 3,000 m, the NHS advises sleeping no more than 500 m higher each night.

Sources 9, 10

Know how to get help

Check your skills, the weather and your gear before you go. In an emergency, dial 999 or 112 and ask for the Police, then Mountain Rescue.

Sources 11, 12

Long, steady effort

The NHS counts hiking as moderate activity, when you can talk but not sing, and walking up stairs as vigorous. The Compendium of Physical Activities rates hiking at a normal pace over fields and hillsides at 5.3 METs (metabolic equivalents, multiples of your resting energy use), cross-country hiking at 6.0, backpacking at 7.0 and hiking with a daypack at 7.8. Climbing can go on for hours, and how hard it feels depends on how fast you climb for your fitness.

Sources 13, 14, 15

Up and down use your legs differently

Going up, your hips, thighs and calves lift you, and the energy cost rises with your pack, your body weight, your speed and the gradient. Going down, your thigh muscles work by lowering you under control: on a 19% downhill ramp, peak loads at the knee were much higher than on the flat, which the researchers linked to kneecap pain and to the soreness trekkers get.

Sources 16, 1, 15

Footing and balance

Uneven ground, stones and wet grass ask a lot of your ankles and balance: slips and trips were the commonest cause of mountain rescue call-outs in Scotland in 2024.

Source 6

Carrying a pack

A pack carries best close to your body's centre of mass, and a hip belt takes weight off your shoulders.

Source 16

Who gets hurt, and howStrong evidence

Rescue and accident records count different things, so each figure keeps its own population.

• Scottish mountain rescue, 2024 (335 mountaineering incidents, 94% of them hillwalking): slips and trips were the commonest cause; 27% of the people helped were injured, most often at the ankle (30% of injuries), lower leg (25%), head (10%) and knee (6%), and fractures were the commonest type.
• Hiking accidents in the Austrian Alps, 2015 to 2021 (7,552 people): 7.1% were fatal; over 70% were falls, trips or stumbles, and over 60% happened on the descent. Women had more ankle and foot injuries, and men more heart problems.
• Hikers in 7 studies (17,757 injured people): the legs were the commonest site in all of them; blisters made up 8 to 33% of injuries, and ankle sprains were common.
• Teenagers and adults on 12-day treks at a US scout ranch (1,206 people): 7% were injured, and injury was linked with a heavier pack for their body weight, a body mass index over 30 and past injuries.
• Mountain hiking in the Alps: about 4 deaths per 100,000 hikers a year, about half of them sudden cardiac deaths.

Sources 6, 2, 17, 18, 19

Ankle sprainsEmerging evidence

Ankle sprains are among the commonest hiking injuries, and the ankle was the commonest injury site in Scottish rescues. Balance training cuts repeat sprains, as our ankle sprain guide explains.

Sources 17, 6

Knee pain on descentsEmerging evidence

Higher knee loads on the way down are one reason knees ache on descents. Poles reduce the load, and getting your thighs used to lowering work helps them cope (our reading of the research below). Our runner's knee and knee pain guides cover pain around the kneecap.

Sources 1, 3, 21

Sore legs after a big descentEmerging evidence

Lowering work makes muscles sore for a few days. Poles reduced soreness and markers of muscle damage after descents, and one bout of lowering exercise, such as a long descent, protects your muscles against damage from the next for weeks to months. Our muscle soreness guide explains why.

Sources 4, 20, 21

Blisters and load injuriesEmerging evidence

Blisters are common, and more so with heavy loads. In soldiers, heavier and longer load carriage brought stress fractures, foot pain, knee pain, back strain and rucksack palsy, numbness from straps pressing on nerves. Among 128 long-distance hikers, tingling and numbness became more common with a heavier pack. The NHS advises covering a blister with a soft plaster or padded dressing and not bursting it yourself, and our foot pain, plantar fasciitis and back pain guides cover the aches a heavy pack can bring.

Sources 17, 16, 22, 23, 24

FallsEmerging evidence

Of 405 people who fell while hiking in the Tyrol, the average age was 56 and 70% reported poor eyesight; most were carrying a backpack. Falls, trips and stumbles caused over 70% of Austrian hiking accidents.

Sources 25, 2

No prevention programme has been tested in hikersMixed evidence

We found no trial of a programme to prevent hiking injuries, sprains or knee pain, and no trial of poles to prevent falls or injuries. What follows is the best evidence there is: accident records, lab studies and soldiers carrying loads.

Sources 17, 26

Take care on the way downStrong evidence

Over 70% of 7,552 hiking accidents in the Austrian Alps were falls, trips or stumbles, and over 60% happened on the descent; in Scotland, slips and trips were the commonest cause of rescues. Mountain Rescue England and Wales notes that "many accidents occur towards the end of the day when both you and your phone are low on energy".

Sources 2, 6, 27

Lighter packsEmerging evidence

In 1,206 trekkers on 12-day treks, a heavier pack for their body weight was linked with injury. Among 128 long-distance hikers, tingling and numbness rose with pack weight, from 35% with packs of 4.5 to 9 kg to 69% with packs over 14 kg, though sprains didn't. In 15 experienced women hikers in a lab, a pack of 20% of body weight already changed their posture and raised shoulder discomfort and effort; the researchers suggested a limit of 30% for long walks, and at 30 to 40% their gait became less stable.

No trial sets a safe limit, so lighter is better. Our rucking page suggests starting at about 10% of your body weight and staying under about 30%, with the hip belt done up and the load close to your back.

Sources 18, 23, 28, 29, 16

Get your thighs used to descentsStrong evidence

After one bout of lowering (eccentric) exercise, muscles are protected against damage from the next; in one study the protection lasted at least 6 months and was gone by 9 to 12. So build some downhill walking or slow step-downs into your training before a big trip, starting small, so your first long descent isn't the first your thighs have done in months (editorial, built on that research).

Sources 21, 30

Ankles and bootsMixed evidence

No trial has tested ways to prevent ankle sprains in hikers. Balance training cuts repeat sprains, as our ankle sprain guide explains. Of 405 people who fell while hiking in the Tyrol, 61% wore ankle-height hiking boots with a profiled sole: that describes them, and doesn't show whether boots help or harm.

Source 25

Train for carrying a loadEmerging evidence

In soldiers, progressive strength training combined with aerobic training at least 3 times a week for at least 4 weeks brought large improvements in loaded marching, and adding progressively heavier loaded walks brought the largest; aerobic or strength training alone gave smaller, more variable gains. It's military research from 10 studies, and we read it as applying to multi-day hiking with a pack.

Source 7

Stairs and hills raise fitnessEmerging evidence

In 15 sedentary young women, 8 weeks of climbing a 199-step staircase at 90 steps a minute, 5 days a week, building from one climb a day to five, raised VO2 max (the most oxygen the body can use) by 17% and lowered LDL ("bad") cholesterol by about 8% compared with women who didn't train. In sedentary young adults, three brisk climbs of 60 steps a day, 3 days a week for 6 weeks, raised fitness a little.

Sources 8, 31

An aerobic baseStrong evidence

The NHS asks adults for 150 minutes of moderate activity a week, or 75 of vigorous, plus strengthening activities on at least 2 days. Most hiking is steady, moderate effort, so walking more is the base; our zone 2 cardio guide explains steady training, and our HIIT guide the harder sessions.

Source 13

Building up to a multi-day tripEmerging evidence

Our suggestion for a multi-day trek: 8 to 12 weeks of two strength sessions a week, one stair or hill session, and one longer walk that grows in time, terrain and pack weight. In the last 2 to 3 weeks, fit in one or two back-to-back long days with the full pack, then take a lighter final week. The structure is ours, built on the soldier and stair studies (editorial).

Sources 7, 8, 21

Heart health in the mountains: an associationEmerging evidence

In 179 men over 34 who died suddenly while hiking, a previous heart attack (17% against 0.9% of matched hikers), known coronary artery disease, diabetes and high cholesterol were more common, and regular mountain sport less common (31% against 58%). About half of the sudden cardiac deaths among hikers and skiers happened on the first day. That regular hill walking goes with lower risk is an association, but it's one more reason to build up before a big trip.

Sources 19, 15

Why descents are hard on kneesEmerging evidence

On a 19% downhill ramp, peak knee moments and muscle power were much higher than on the flat. That's the load behind sore knees and thighs after a long descent.

Source 1

What poles do on the way downEmerging evidence

On a steep 25° ramp, poles cut the peak and average forces on the knee by 12 to 25% in 8 men, mostly through the force taken by the poles and a more forward-leaning posture. In 15 experienced hikers carrying no pack, a day pack (15% of body weight) or an expedition pack (30%), poles reduced the loads at the ankle, knee and hip.

After a walk up and down Snowdon, 37 walkers who used poles had less soreness and kept more of their leg strength over the next 2 days. In 8 women with obesity, poles reduced markers of muscle and cartilage damage after 30 minutes of walking downhill.

Sources 3, 32, 4, 20

Less help on the flatEmerging evidence

On level ground, pushing harder on poles didn't reduce knee compression in 10 healthy adults. A review concludes that poles reduce the load on the legs but raise the work for your heart and lungs, and that with a heavy pack they may help balance and stability.

Sources 5, 26

With a knee replacementEmerging evidence

Surgeons who modelled the loads on replaced knees advised avoiding descents when hiking, "or at least use ski poles". Our knee replacement guide has more on exercise after surgery.

Source 33

Going down: our suggestions

Lengthen your poles a little for the descent, shorten your steps and slow down, and plant a pole with each step on steep ground. No trial has tested these tips; they follow from the load studies above (editorial).

Where and whenStrong evidence

The NHS says you can get altitude sickness at high altitude, usually more than 2,500 m above sea level, in places such as Mount Kilimanjaro, Everest and some places in the Alps, and that you can't get it in the UK. Symptoms usually start 6 to 10 hours after you arrive: a headache, loss of appetite, feeling or being sick, tiredness, dizziness and difficulty sleeping.

Source 10

Go up slowlyStrong evidence

The NHS's advice for lowering your risk:

• Travel or climb to a high altitude slowly, and spend a few days below 2,500 m before going higher.
• Above 3,000 m, try not to sleep more than 500 m higher than the night before, and have a rest day at the same height every 3 to 4 days.
• Try not to go from below 1,200 m to above 3,500 m in one day, or to fly straight to a high place; if you have to, rest for a day before going higher.
• Drink enough water, and don't drink alcohol while you're travelling or climbing.
• See a GP or travel clinic if you've had altitude sickness before or will be going up quickly.

Source 10

If you get symptomsStrong evidence

Tell someone you're with, rest at the same height until you feel better, and take painkillers or anti-sickness medicine if you need to. If symptoms get worse or don't improve after a day, go 300 to 1,000 m lower if you can.

Source 10

Fitness doesn't protect youStrong evidence

TravelHealthPro, the UK's travel health service, says acute mountain sickness affects about 9 to 25% of people who haven't acclimatised at 2,000 to 3,000 m and 35 to 50% at 3,500 to 4,500 m. "Physical fitness does not appear to protect against altitude illness", and how you did at altitude before is probably the best guide. It calls Kilimanjaro climbs in under 7 days a concern and advises always trekking with an experienced guide.

Source 9

HeatStrong evidence

Heat exhaustion brings tiredness, dizziness, a headache, feeling or being sick, heavy sweating with pale, clammy skin, cramps, a high temperature and intense thirst. Move to a cool place, drink and cool your skin: you should start to feel better within 30 minutes. To prevent it, the NHS advises more cold drinks, especially when you're active, light, loose clothing, avoiding the sun between 11am and 3pm, and avoiding extreme exercise.

Source 34

ColdStrong evidence

Hypothermia is a body temperature below 35°C, and frostbite can happen at 0°C or below. Carry spare clothing, a hat and gloves "even in summer", as Mountain Rescue England and Wales advises, wear several loose layers with a waterproof outer layer, and eat and drink regularly.

Sources 35, 36, 27

SunStrong evidence

Use sunscreen with a sun protection factor (SPF) of at least 30, and remember that sunlight reflected from snow and water is particularly dangerous for your eyes.

Source 37

Before you set offStrong evidence

AdventureSmart UK asks three questions before you set off: am I confident I have the knowledge and skills for the day, do I know what the weather will be like, and do I have the right gear? Mountain Rescue England and Wales adds: plan your route, check the mountain weather forecast, leave your route with someone, let the slowest in the group set the pace, and carry spare clothing, a hat and gloves, food and water, a map and compass, a torch, a whistle and a first aid kit.

Sources 11, 27

In an emergencyStrong evidence

Dial 999 or 112 and ask for the Police, then Mountain Rescue. Have the location, the casualty's name, age and injuries, the number in your group and your phone number ready, and don't move until the rescue team has contacted you. Register your phone with emergencySMS before you go, as Mountain Rescue England and Wales advises: it lets you contact 999 by text. The whistle signal is six long blasts in a minute, a minute's pause, then repeat.

Sources 12, 27

Skills and coursesStrong evidence

Mountaineering Scotland: "Enjoying Scotland's mountains safely means having the right skills and knowledge to cope with the conditions you're going to meet", with navigation courses and weather and avalanche forecasts. Mountain Training runs Hill Skills courses to "learn the skills needed for a safe day's hiking" and Mountain Skills courses for steep, rocky ground, and trains walking leaders.

Sources 38, 39

A heart condition, diabetes or high cholesterol

Sudden cardiac death while hiking was linked with a previous heart attack, coronary artery disease, diabetes and high cholesterol in men over 34. See your GP before a big trip, build up regular hill walking, and take the first day easy.

Sources 19, 15

New to exercise, or a yes on the PAR-Q+

The NHS advises speaking to your GP first if you haven't exercised for some time or have medical conditions or concerns. The Physical Activity Readiness Questionnaire for Everyone (PAR-Q+) asks about heart conditions, chest pain, dizziness, other long-term conditions and joint problems, and suggests a qualified exercise professional first if you're over 45 and not used to hard exercise; climbing hills and stairs is vigorous.

Sources 13, 40

Going above 2,500 m

See a GP or travel clinic first if you've had altitude sickness before or will be going up quickly. TravelHealthPro advises that "people with pre-existing medical conditions should consult with their healthcare provider prior to travel", and always trekking with an experienced guide.

Sources 10, 9

In pregnancy

TravelHealthPro advises avoiding high altitude in the first trimester, and reports the World Health Organization's view that sleeping above 3,000 m isn't advisable in pregnancy. Our pregnancy guide has the NHS advice.

Source 9

Knee arthritis or a knee replacement

Descents load the knee most, and poles reduce the load. Our knee arthritis and knee replacement guides cover exercise with a sore or replaced knee.

Sources 1, 3, 33

A previous ankle sprain

Repeat sprains are common, and balance training and a brace for sport cut them, as our ankle sprain guide explains.

On the hill: call 999 or 112

For an injury, illness or someone lost or overdue, dial 999 or 112 and ask for the Police, then Mountain Rescue.

Source 12

Heatstroke: call 999

The NHS says to call 999 for signs of heatstroke: still being unwell after 30 minutes of resting somewhere cool, being cooled and drinking; a very high temperature; hot skin that isn't sweating; a fast heartbeat; fast breathing or breathlessness; confusion and lack of coordination; a seizure; or loss of consciousness.

Source 34

Hypothermia and frostbite

Call 999 or go to A&E (accident and emergency) for hypothermia, such as shivering, pale cold skin, slurred speech, slow breathing, tiredness or confusion, and for frostbite with hard, frozen skin, swelling and loss of feeling, or blisters. Mountain Rescue England and Wales lists the signs to watch for in others: "Disorientation, confusion, shivering, tiredness, pale complexion and loss of circulation in hands or toes", adding that children and older people are especially at risk.

Sources 35, 36, 27

Altitude: get medical help straight away

The NHS says to get medical help immediately, and go 300 to 1,000 m lower if you can, if someone with altitude sickness feels very unwell, is confused, has problems with balance or coordination, sees or hears things that aren't there, is short of breath at rest, has a cough with frothy or bloody spit, has blue or grey skin, lips, tongue or nails, or is very sleepy or hard to wake.

Source 10

Sprains, knees and possible fractures

Call 999 or go to A&E if you heard a crack, the injured part has changed shape or points at an odd angle, it's numb or tingling, or the skin has turned blue or grey or is cold. Get help from NHS 111 if it's very painful or swollen, you can't put weight on it or walk more than a few steps, or a knee locks or gives way.

Sources 41, 42

Blisters

Get help from NHS 111 if a blister is very painful or keeps coming back, or looks infected: hot and filled with green or yellow pus, with red skin around it.

Source 24

Chest pain: call 999

Call 999 for sudden chest pain that doesn't go away, pain that spreads to your arms, neck, jaw, stomach or back, or chest pain with sweating, feeling sick, light-headedness or breathlessness.

Source 43

"Downhill is the easy part"Emerging evidence

Knee loads are much higher walking downhill, and most Austrian hiking accidents happened on descents.

Sources 1, 2

"Walking poles are only for older people"Emerging evidence

On descents, poles cut knee forces by 12 to 25% and reduced next-day soreness and strength loss in active walkers. On level ground they don't reduce the load on your knees.

Sources 3, 4, 5

"If you're fit, you won't get altitude sickness"Strong evidence

"Physical fitness does not appear to protect against altitude illness." A slow ascent does.

Source 9

"The safe pack limit is 20% of your body weight"Mixed evidence

No trial has set a limit. One lab study of women hikers suggested no more than 30%, with changes already at 20%, and heavier packs for your body weight were linked with injury on long treks: lighter is better.

Sources 28, 18

"High boots stop sprained ankles"Mixed evidence

No trial in hikers has tested it, and most of the people who fell in one Alpine study were already wearing ankle-height boots.

Source 25

"You can't train for hills without hills"Emerging evidence

Stair climbing raised fitness in trials, and practising loaded walks improved loaded walking in soldiers.

Sources 8, 31, 7

"You can't get altitude sickness on Ben Nevis"Strong evidence

True: the NHS says you can't get altitude sickness in the UK. UK hills still bring cold, changing weather and navigation risks, so plan as the mountain safety bodies advise.

Sources 10, 27, 38