The World's Highest Ultramarathon: Survival Guide

Physiotherapist and Bike Fit Expert, Michael Harrop offers his top tips to help you make it through a high altitude Ultramarathon.


In 2015 I worked at​‘La Ultra: The High’, considered to be one of the world’s toughest and highest ultra-marathons. The events range in distances from 111km, 222km and 333km, with the latter crossing three 5300+ metre mountain passes. 

Situated around Ladakh, high in the Indian Himalayas, athletes face extreme temperature swings of 10 to +40 degrees Celsius with narrow roads, clouds of dust and risks of landslides. The race is set continuously over 72 hours with most participants sleeping 2 — 4 hours per night. Medical support is essential to reduce the risk of developing life threatening HAPE or HACE (High Altitude Pulmonary or Cerebral Oedema). 

Here are my top tips for making it through this and other high altitude Ultramarathons: 

  • Acclimatization is essential. With the start point situated at 3500 metres most runners need 7 – 10 days to adapt to the change in oxygen levels, which are only 60% of compared to sea level. 
  • Protect yourself from the elements. In the mountains the sun can be very strong, so ensure you protect your eyes and skin with good sunglasses and factor 50 suncream. 
  • With dramatic temperature swings layers are essential. Base layers, running leggings, buffs, light gloves, waterproof run jacket and a lightweight puffer jacket allow you to add or remove them easily as required. Merino and natural fibre base layers are often considered best for warmth and reducing odour. Avoid cotton or anything, which takes longer to dry. 
  • Warmer clothing for evenings are essential. Due to the low oxygen levels the windows of the vehicles have to be left open while stationary, so expect to get cold. 
  • Make sure your footwear is tried and well tested. Consider 2 pairs of shoes in case of damage and also rotating shoes to reduce the chance of blisters or hotspots. 
  • Have a structured food and sleep plan for the race. Make sure you eat and drink every hour but plan for 4 – 5 larger meals to ensure you keep your calorie intake as high as possible. Your body can burn 400 – 600 calories an hour yet may be able to absorb only half of that so getting enough nutrition on board is a constant challenge. High calorie foods are absolutely necessary. One runner’s drink of choice was Coca Cola as he felt it was an easy way to get the calories on board especially as long distance running can also suppress your appetite. 
  • Rest and sleep when you can. Over a 3 day race runners may be sleeping 2 – 4 hours in total per day. Small catnaps can help boost energy levels. Again have a structured plan to try and manage the fatigue before it hits. Of course it can never be predicted, so have conversation with the support team before hand who can help recognise these signs and enforce rest when needed.