Can you train for high altitude at sea level?

You can't replicate altitude but you can maximise the fitness you bring to it. A strong aerobic base gives your body more to work with when oxygen availability drops. Acclimatisation happens on the trek itself by ascending slowly and giving your body time to adapt.

How do you train with knee pain for hiking?

Progressive loading is the evidence-based approach. Start with exercises that load the knee in a controlled range — step-ups, single leg squats, hip strengthening. Build the capacity of the joint gradually rather than avoiding load. Avoiding load entirely does not prepare the joint for the demands ahead.

How many days a week do you need to train for a serious trek?

Three well-structured sessions per week is genuinely enough if one is a long aerobic session, one is strength-focused, and one maintains your cardiovascular base. Consistency over months matters more than volume in any single week.

April 15, 2026 · Nepal prep

Training for Thorong La Pass — My Honest Preparation Story

I didn't plan this. My employer runs a custodian award for people who have genuinely lived out the vision, mission, and values of the business. I won it. The prize was a place on an organised group trek to the Annapurna Circuit, crossing Thorong La Pass at 5,416m in October 2026.

I've always said I wanted to do something like this. But "wanted to" and "actually doing it" are very different things. Winning the award made the decision for me. Once I knew I was going, I was locked in. That's honestly the most useful thing about an external commitment — it removes the option of quietly backing out.

Here is my honest starting point. I'm a physiotherapist with four years of clinical experience. I'm sort-of training for a half-marathon, running three times a week when life with two kids under five allows. I have done very little hiking. There is a 30-minute stair hike near my house in Auckland. That is basically it.

The hardest physical things I've done are pre-season rugby league training and a half-marathon. Neither is quite the same as six to eight hours of hiking at 5,000 metres with a pack on your back. I know this. I'm under no illusions.

The unknown is what gets me. I've never been at high altitude. I've never walked for that long with that much elevation. I've heard stories from people who have. Those stories humble me more than any fitness test has.

What I am actually working with

The fitness baseline

Running three times a week minimum, building toward a half-marathon. The aerobic base is there. Since turning 30 I've noticed my strength declining noticeably though. That's not a complaint, it's just what happens. The issue is that I keep saying I need to add strength training and then not doing it.

Realistic weekly training availability: three sessions. Two kids under five, church commitments two evenings a week plus Sunday mornings, a full-time physio job, and a few side projects running in parallel. Three sessions is what is actually going to happen most weeks. I'm building a preparation plan around that reality, not around an ideal version of my schedule that doesn't exist.

The knee situation

I've had ACL reconstruction on both knees. Both are fine for running. But there is a persistent issue with my left knee — sharp pain on steep inclines and declines, loaded in a flexed position. I'm pretty confident it's patellofemoral pain. The cartilage behind the kneecap getting irritated under load on a gradient.

I haven't had it formally assessed recently. My approach is consistent with what the research supports: progressive load to build capacity, and trust the body to adapt to the demands placed on it. The joint needs to be loaded to become capable of handling load. That's the principle. But you have to apply it carefully.

As a physiotherapist I know exactly what Thorong La Pass means for this particular problem. The circuit involves serious elevation gain and serious elevation loss on consecutive days. Steep downhill is where patellofemoral pain is worst. If my knees are not ready, they will become the limiting factor long before my lungs or my legs give out.

So the strength training I keep saying I need to do is not optional for this challenge. It is the most important part of my preparation. I know this. Writing it down makes it harder to ignore.

Why a physiotherapist is more nervous about this, not less

You might expect that having a clinical background makes something like this less daunting. It doesn't really. If anything it makes me more aware of what can go wrong and more realistic about the gap between where I am now and where I need to be.

I know what happens to the patellofemoral joint under repeated load on steep terrain over multiple days. I know what sustained exertion at altitude does to recovery and how much longer things take to heal when your body is already under stress. I know that altitude sickness is genuinely hard to train for because the only real preparation is acclimatisation on the way up. Fitness helps. It doesn't protect you.

What my background does give me is a framework for preparing properly. I know which training adaptations actually matter for this, which exercises will protect my knees on descent, and how to build load progressively without getting injured before I even get to the start line. That part is useful. I just have to actually do the work.

The training approach — 3 sessions a week, built around real life

This is not a programme designed for someone with unlimited time. It is built around three sessions a week because that is what is actually available. The goal is to arrive at Thorong La Pass with a solid aerobic base, knees that are prepared for repeated load on steep terrain, and enough experience carrying a pack to know what my body does under that weight.

Session 1 — The long session (weekend)

One longer aerobic session per week, done on a weekend morning when childcare is available. Starting at 60 to 90 minutes and building to three to four hours by the final weeks before Nepal. Duration matters more than intensity here. The adaptation I need is the ability to keep moving for a long time.

Crucially, this session needs to involve hills and eventually a pack. Running on flat ground is good aerobic training but it doesn't prepare the knees and hips for the specific mechanics of loaded hiking on steep terrain. Those are different movement patterns under different loads. From week six, this session gets a pack and finds the steepest terrain Auckland has to offer.

Session 2 — Strength training (non-negotiable for the knees)

One dedicated strength session per week focusing on the lower limb. Not heavy lifting in the gym sense. Single leg stability, hip strength, and knee loading in controlled ranges. The kind of work that is boring to do and genuinely important.

Key exercises: single leg squats, step-ups starting low and building height progressively, Romanian deadlifts, calf raises, hip abductor work in side-lying and standing. The goal is not bigger legs. It is building the capacity of my left knee to handle load in flexion, on a gradient, over and over again, without pain.

If a patient came to me presenting with patellofemoral pain and told me they had a demanding multi-day trek at altitude in six months, this is exactly what I would prescribe. I'm prescribing it for myself. I should probably have started six months ago.

Session 3 — Running (maintaining the base)

The third session stays as running. It maintains the aerobic base I've already built, supports the half-marathon goal running in parallel, and keeps weekly training volume consistent without adding too much structure.

Over time, some of these runs will shift to hill runs or trail runs as Nepal gets closer and the specificity needs to increase. Flat road running does not prepare your body for six hours of climbing. At some point the training has to start looking like the event.

The gear question

I've bought zero gear. The plan is to purchase almost everything in Kathmandu, where gear is significantly cheaper than at home. I've heard enough from experienced trekkers to know this is a legitimate approach for most items — sleeping bags, base layers, trekking poles, gaiters. The market in Kathmandu exists precisely because so many people are passing through and outfitting for treks.

The one thing I'm thinking carefully about is boots. With my knee history and the patellofemoral pain on steep terrain, the wrong boots could make an existing problem significantly worse. Boot fit affects how load is transferred through the ankle and into the knee. I'll be using the HikeCalc boot fit calculator to work out my sizing before I arrive in Kathmandu, so I know exactly what I'm looking for before I'm standing in a shop being sold to.

What altitude sickness taught me about humility

The thing that surprised me most in researching this trek was altitude sickness. Not the existence of it — I knew about it vaguely — but the reality of it. Genuinely hard to prepare for. Does not discriminate based on fitness. Shows up in unpredictable ways.

Very fit people get altitude sickness. People in the best shape of their lives have had to turn back from passes lower than Thorong La. The accounts from people who have attempted this specific crossing are humbling. My clinical background gives me zero advantage at 5,000 metres. My body will respond to altitude the same way any other body does.

The preparation for altitude is largely acclimatisation on the trek itself. Ascending slowly, giving the body time to adapt, recognising symptoms early, and not pushing through signals that should make you stop. I'm reading everything I can about the physiology. I'll write a separate article on it. For now, it's the part of this challenge that keeps me honest about how serious it is.

What I want when I get to the top

I'm not focused on a time or a pace or a performance metric. What I want when I cross Thorong La Pass is to be present. To notice what's actually happening around me. To not be so completely wrecked that I miss the moment I've spent six months preparing for.

That framing is actually useful for the training too. The goal isn't peak performance. It's arriving capable enough to actually experience the thing I'm doing. That feels like the right target. Everything else is just getting to that point.

Following along

I'll be documenting this preparation as it happens. Training updates, gear decisions, what the calculators say versus what reality looks like when I'm actually on the trail. The next articles will cover the physiology of altitude acclimatisation, how to choose a sleeping bag for conditions above 5,000m, and a detailed pack weight breakdown for the Annapurna Circuit.

If you're preparing for something similar or just interested in following the process, the blog is where it'll be. Read more preparation articles →

Check your pack weight →Use the backpack weight calculator to plan your target pack weight before you buy gear.

Frequently asked questions

Can you train for high altitude at sea level?: You can't replicate altitude but you can maximise the fitness you bring to it. A strong aerobic base gives your body more to work with when oxygen availability drops. Acclimatisation happens on the trek itself by ascending slowly and giving your body time to adapt. Fitness helps. It doesn't protect you.
How do you train with knee pain for hiking?: Progressive loading is the evidence-based approach. Start with exercises that load the knee in a controlled range — step-ups, single leg squats, hip strengthening. Build the capacity of the joint gradually rather than avoiding load. Avoiding load entirely does not prepare the joint for the demands ahead. If you have a specific diagnosis, get advice from a physiotherapist who understands your history.
How many days a week do you need to train for a serious trek?: Three well-structured sessions per week is genuinely enough if one is a long aerobic session, one is strength-focused, and one maintains your cardiovascular base. Consistency over months matters more than volume in any single week. Six months of three sessions beats three months of six sessions, most of the time.

Matt Jenkinson

Physiotherapist, Auckland NZ

Building HikeCalc to prepare for the Thorong La Pass, Nepal, October 2026.