Many of us make New Year’s resolutions. And we’ve done it for a long time, with resolutions having been recorded since the time of the Babylonians. And while some of them involve repaying old debts, most are attempts at bettering ourselves (losing weight, blogging more often, quitting smoking, etc).
As medical professionals, we all see the people who set out to become more healthy magically on Jan 1, and often we tell them that moderation is the key. We don’t want people to set goals too lofty that they then cannot meet, causing setbacks or ultimately failures. People shouldn’t expect 1 trip to the gym, or even 1 month to see hugely measurable goals. If you want 1 excursion to make that much of a difference, it has to be of the sort in this case report of a nearly 4 month-long backpacking trip. That is, the nearly ludicrous type.
Of course, the study participant (and investigator, natch) wasn’t a couch potato before his trip. He was an experienced backpacker, at 49. However, he wasn’t an elite athlete either, having a BMI of 29.37 before the trip. He also had Stage I hypertension at 132/98.
True to a resolution, he started out on the Appalachian Trail on Jan 3, finishing on May 1. In total, he hiked from Georgia to New Hampshire, completing 2669km. Anyone who has hiked part or all the AT knows that this is not an insignificant amount of work, even if he wasn’t quite Scott Jurek. In doing so, he lost only 11kg, totaling 13% TBW. However, he went from 25% body fat to 14.3% based on hydrostatic weighing, or 23.8% to 11.6% based on skinfold measuring. These were 43 and 51% changes, respectively. His BMI went down to 25.46, and all of his waist measurements also improved by a fair amount. He even improved his blood pressure to normal (124/78).
This all happened without changing the diet to a large degree. The total amount of calories was remarkably similar at the nearly halfway point as it was pre-hike, and at the 100 day mark the hiker was gorging on a resupply visit, consuming nearly 15% more calories. More remarkable was that a diet containing nearly 50% of the calories from fat (at times) still resulted in significant improvement in all lipid levels, including triglycerides, HDL, LDL, and total cholesterol.
So there you have it. All you have to tell your patients (or do yourself), is walk almost 23km per day. In the woods. With snow and rain. Add in another 120km of elevation change (give or take)* over the entirety of the trip and you’ve got a pretty good understanding of the difficulty of pulling this off.
- Devoe D, Israel RG, Lipsey T, Voyles W. A long-duration (118-day) backpacking trip (2669 km) normalizes lipids without medication: a case study. Wilderness Environ Med. 2009 Winter;20(4):347-52. [PMID 20030443]
- Alroy TT. Ultramarathoner becomes fastest to finish Appalachian Trail. CNN 2015
- Shuman S. AT Elevation Gain and Loss, by Section. “…based on total distance is 76% of the entire AT, and 120km is 76% of the total elevation change of 156km“
EBM Gone Wild