Trekking with a medical condition: what to tell us, and what to ask a doctor

Asthma, heart conditions, diabetes, pregnancy, a replaced joint. None of these is automatically a no — but each changes the route, and one of them changes the insurance.

By Sabina Adhikari · 6 min read · Updated 1 August 2026

People frequently do not mention a condition because they are afraid of being told no. The result is that we plan the wrong trip and find out at 3,500 m.

Telling us changes the plan, not the answer. In most cases there is a route that works; occasionally there is not, and it is much better to know that in an email than on a ridge.

This is not medical advice. It is what we need to know and what to take to a doctor who understands altitude.

What altitude does, in one paragraph

Above about 2,500 m there is progressively less oxygen available with each breath. A healthy body compensates by breathing faster and deeper and, over days, by making changes to the blood. That adaptation is what acclimatisation days are for.

Any condition that already limits oxygen delivery — lungs, heart, blood — makes that compensation harder. Any condition affected by dehydration, cold, exertion or disrupted sleep is also relevant, because trekking involves all four. That is the whole principle. Everything below follows from it.

Common conditions and what usually happens

Asthma. Frequently fine on the standard routes with medication carried and a spare inhaler. Cold, dry air and dust are triggers, so pace and layering matter. Tell your guide where the inhaler is.

Heart conditions. This needs a cardiologist's opinion specific to altitude and exertion, not a general fitness sign-off. Low routes below 2,000 m — the Royal Trek, Ghandruk, Pokhara day walks — are a different proposition from anything above 3,500 m.

Diabetes. Manageable with planning. Cold affects insulin storage, exertion affects requirements, and lodge meals are carbohydrate-heavy and served at unpredictable times. Bring more supplies than the trip length and keep them in your daypack, not the porter's load.

Replaced joints and arthritis. Descent is the issue, not altitude. Poles, shorter days and a porter change this substantially. Ask your surgeon about sustained downhill walking specifically.

Pregnancy. Guidance generally advises against sleeping at significant altitude, and the sensible reading is to keep low. Pokhara day walks, Bandipur, Chitwan and boats make a genuinely lovely trip without going high. Ask your own doctor and tell us what they say.

The insurance clause that catches people

Undeclared pre-existing conditions are the second most common reason a claim is refused in Nepal, after the altitude cap.

Declare everything, including things you consider historic or controlled. The premium may rise. A refused claim after a helicopter evacuation costs several thousand dollars.

Some policies also reduce altitude limits or exclude trekking above certain ages. Read that clause specifically rather than assuming.

What we do with the information

Choose a route with the right maximum altitude and the right descent profile, which is usually a different trek rather than the same one done slowly.

Build shorter days, add nights, and pick lodges with easier access and warmer rooms.

Brief your guide, confidentially, on what to watch for and where your medication is. Guides carry a first-aid kit and an oximeter; they are not clinicians, and knowing the specifics is what makes them useful.

And occasionally advise against the trip you asked for and suggest another. That conversation has never cost us a client who was glad to be told afterwards.

Walk it with us

Private departures on your dates, guided by the people who wrote this page.

Permits & TIMS ServiceSame-day serviceFrom Rs 700 service fee · See dates →Ghandruk Gurung Village Trek3 days · 2,012 mRs 30,700 · See dates →Royal Trek4 days · 1,730 mRs 37,400 · See dates →Pokhara Highlights Day TourFull day · private carRs 9,200 · See dates →

Questions we get asked

Will you refuse to take me?

Rarely, and only where the risk is serious and the route cannot be changed to manage it. Far more often we suggest a different trek. We would rather lose the booking than be four days up a valley with a problem we could have foreseen.

Is my information kept private?

Yes. It goes to the person planning your trip and, in relevant summary, to your guide. Nowhere else.

Can I trek at altitude with high blood pressure?

Often, with medication and monitoring, and it is a question for your doctor rather than for us. Altitude can raise blood pressure, so bring a plan rather than an assumption.

What if a condition develops after I book?

Tell us. We can usually change the route, and it is far easier before the permits are issued.

Are there routes with road access throughout?

The Royal Trek and Ghandruk are both close to road access for most of their length, and Pokhara day walks are all within an hour of a hospital. That proximity is a legitimate part of planning.