How I Hike in Colorado With POTS (and Why Altitude Changes Everything)
Hiking again after developing Postural Orthostatic Tachycardia Syndrome (POTS) wasn’t something I jumped back into overnight—especially not in Colorado, where altitude adds a whole extra layer of complexity. But over time, with the right approach (and a lot of patience), hiking became possible again—and even enjoyable. Here’s how I started to hike again in Colorado with POTS.
This is what worked for me. It’s not medical advice—just my experience navigating trails, altitude, and energy with POTS. As you read this, take what resonates and leave the rest. The goal isn’t to follow a perfect system—it’s to start recognizing your own patterns and building a way of traveling that works with your body, not against it.
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Why Altitude Changes Everything Hiking With POTS
Colorado hiking isn’t just hiking—it’s hiking at elevation.
- Denver sits at ~5,280 ft (1,609 m)
- Many trails start at 7,000–10,000 ft
- Alpine hikes can exceed 12,000 ft
At higher elevations, there’s less oxygen available, which can:
- Increase heart rate
- Exacerbate dizziness and fatigue
- Make hydration and electrolyte balance even more critical
For me, altitude amplified my POTS symptoms early on—but interestingly, I also recovered while living at high elevation. Even now, I find hiking at sea level significantly easier. After being at sea level for a while, I need to ease into hikes at altitude again.
My Turning Point: I Didn’t Start With Hiking
At my lowest point, I wasn’t able to walk around the block without having a flare. Before I ever set foot on a trail again, I spent months working through the CHOP Protocol.
As a reminder, the CHOP Protocol includes:
- Starting with recumbent exercises (for me, this was mainly rowing)
- Gradually building endurance and moving towards non-recumbent exercises (for me, mainly biking)
- Strength training days
Only after I had a solid cardiovascular base did I even consider hiking again.
That foundation made all the difference.
As always, this is based on my personal experience—not medical advice. Everyone’s body (and POTS journey) is different, so be sure to check with your healthcare provider before starting a new exercise program.
How I Slowly Returned to Hiking with POTS (My Personal Progression)
I didn’t go from zero to mountain summits. My progression was slow—and honestly, a bit unconventional.
1. I Started With Downhill-Only Hiking
This was a game changer, and honestly, a pretty unusual way to start with my walks and hikes. I started hiking again during Covid in 2020. We spent Covid in the mountains of Colorado, giving us plenty of opportunity for outdoor activities without risk of further infection.
This wasn’t something I planned. One day, I had my husband drop me off at the top of the road on the local ski mountain. I walked the 20 minutes or so down the mountain to our cabin. What I found:
- Walking downhill is far less taxing on my heart rate
- It let me reintroduce hiking without triggering symptoms
- I was able to walk further than I could on flat ground, without a flare
I started mixing in these downhill walks with my rowing and biking workouts. My go-to walks:
- Walking the Fraser River Trail one way from Winter Park mountain to Fraser
- Taking a lift up or getting a ride up Granby Ranch and walking down
I’m not saying this is the way—just that it worked for me.
2. Then Flat Trails at Altitude
Once downhill felt manageable, I progressed to:
- Flat walking paths
- Short durations
- Controlled pacing
This helped me adapt to altitude without adding incline stress. While I had somewhat limited flat options in the area, I found some dirt roads that I walked on a regular basis. In winter, when Grand Lake was safely frozen, I used that for some of my walks too.
3. Finally, Short Uphills
Only after building confidence did I start adding uphills. We were living on the side of a mountains, so these were easy to find. I started with:
- Short, gradual climbs (5-10 minutes uphill max to start)
- Rolling roads or trails (Monarch Lake was one of my go-to trails)
- Plenty of breaks
- Turnaround flexibility
The day I was finally able to walk the 45 minutes or so up to the top of the top of the mountain was a huge accomplishment, especially when I ended at 9,200 feet (2,800 meters) of elevation.
Even now, I still approach elevation gain strategically. And, I have days when don’t feel up to hiking up mountains.
What Helped Me to Hike with POTS the Most (Beyond Training)
These were the biggest differentiators for me:
Strength Training (Huge)
When I first started my POTS training, I wasn’t able to go to the gym. I did body weight exercises, yoga, and used a pilates reformer machine. Between that and my rowing, I thought I had regained a decent amount of my strength.
Then I joined a gym, where I lifted 2-3 days per week, focusing on legs and core. I very quickly started to see results:
- Improved my circulation and overall stamina
- Reduced the severity of POTS flares
- Made uphill sections far more manageable
A few months later, we took our 1st vacation abroad since Covid, spending a few weeks on Croatia’s coast and islands. Because I was finding it quite easy to walk and hike at sea level, we decided to tackle Sveti Ilija, “the mountain” to climb near Korcula. After numerous breaks and 2,280 feet (about 700 meters) of elevation gain, I made it to the top (using compression calf sleeves and tights).
Compression Gear
I started using compression tights and calf sleeves to help with my circulation and reduce POTS symptoms, as soon as I knew I had POTS. I tested out various options, from compression tights to shorts, calf sleeves to socks. I wasn’t able to tolerate using medical grade compression or having compression on my feet. This is purely my personal preference. I ended up using:
- 2XU high-waisted compression tights or shorts (depending on weather)
- Doc Miller Calf sleeves
I highly recommend testing out different options to see what works for you.
In my case, the compression gear helped reduce symptoms, especially on steeper and longer hikes. I now do some hikes without compression wear, but I am strategic about this. These are typically easier hikes or hikes at lower elevations.
Hydration + Salt
I can’t overstate this. My normal routine is to:
- Bring more water than I think I need
- Always pack salty snacks and electrolytes
- Have extra water in the car for after my hike
Hydration isn’t just about drinking more water—salt plays a key role. If I’m still feeling thirsty despite drinking plenty, it’s often a sign I need more electrolytes to actually retain that fluid.
Talk to your doctor about the appropriate amount of water and salt/electrolytes to use.
Heat Awareness
Even now:
- Hot days are significantly harder
- I plan early morning hikes whenever possible on hot days
- I take breaks out of the sun on hot days
- Wearing a hat and loose-fitting, lightweight and light-colored clothes (sun-shirt with hood, lightweight hiking pants) on hot days helps me to regulate heat, dehydration, and reduces sun exposure
What I Still Have to Manage (Even Now)
Recovery doesn’t mean “no symptoms ever again.” On good days, I’ve hiked 10-14 miles (16-22 km) with significant elevation gain. This doesn’t mean I have no longer have POTS.
For all of my hikes, I still:
- Pace myself carefully (even more carefully at altitude)
- Stay consistent with hydration and salt intake
- Avoid peak heat when possible
- Acknowledge when I am having an off day, and may need to reschedule or shorten a hike
I have occasional hiking days where I feel fine when I start, but despite doing “everything right”, I feel nauseous part way through the hike. If my nausea doesn’t go away after sitting down and taking a break in the shade, I cut the hike short. While I’ve tried pushing through these occasional episodes, I’ve learned that it’s better to simply acknowledge that I am not up to hiking that day.
What works for me may not work for you—always follow your doctor’s guidance and adjust based on your body.
Tips for Hiking in Colorado With POTS (If You’re Visiting)
If you’re traveling to Colorado and want to hike, here’s what I’d suggest:
1. Don’t Make Colorado Your Starting Point
If you’re not already walking or hiking regularly at sea level or a lower altitude, be sure to start there first.
Altitude is not forgiving. Colorado is not the place to start walking or hiking unless you’ve adapted to the altitude.
2. Acclimate at Lower Elevations First
Once you’re comfortable hiking, consider traveling to lower Colorado elevations first. Spend a few days or your whole first visit in places like:
- Denver
- Boulder
- Glenwood Springs
- Grand Junction
Let your body adjust to the roughly mile high elevation before heading higher.
3. Start With Easy Front Range Trails
There are so many great beginner-friendly options with beautiful views of the mountains.
- Wide paths
- Lower elevation
- Flexible turnaround points
You don’t need a summit for it to “count.” I’ve compiled some of my favorite easy hikes around Boulder, Colorado, with minimal elevation gain.
4. Progress Gradually
Think in stages:
- Flat → rolling → uphill
- Short → moderate → longer
And always give yourself permission to turn back. When you’re ready to progress beyond Colorado’s front range, Rocky Mountain National Park has a wonderful selection of easy and more challenging hikes to choose from.
5. Build in More Time Than You Think
Everything takes longer at altitude.
Plan for:
- More breaks
- Slower pacing
- Flexible itineraries
- Bring along more water and electrolytes than you might need at sea level
6. Trekking Poles (A Surprising Help)
Trekking poles ended up being one of those small changes that made a noticeable difference for me.
After walking for more than 60-90 minutes, I’d notice my fingers getting stiff and a bit swollen. This is common with POTS. When I added in trekking poles, this added arm movement helped me improve circulation to my hands and avoid these symptoms, even on hikes lasting 3-4 hours.
Using poles does slightly increase my heart rate. This makes sense as you’re engaging your upper body more with poles. But I’ve found the trade-off worth it.
The trekking poles also:
- Take pressure off your legs on descents
- Improve balance (especially helpful on uneven trails)
- Help with pacing and rhythm
Like everything with POTS, it’s about finding your own balance. For me, trekking poles are now a regular part of my hiking setup—especially on longer or more technical trails.
READ MORE: 12 Tips for Hiking with Chronic Illness
The Biggest Mindset Shift
For me, hiking with POTS required redefining what success looks like.
It’s not about:
- Finding the next highest peak or
- The longest mileage
It’s:
- Listening to your body
- Predicting how far I can go while finishing feeling okay (not wrecked)
- Being able to go out again tomorrow
I’ve taken to doing long-distance hikes, like the Fisherman’s Trail in Portugal, or parts of the South West Coast Path in England. These are all about pacing, avoiding post-travel fatigue.
Final Thoughts on Hiking with POTS in Colorado
Hiking in Colorado with POTS is absolutely possible—but it looks different.
It’s slower. More intentional. More adaptive.
But the payoff? Standing on a quiet trail, breathing in that mountain air, knowing you found your way back to something you love—it’s worth every step.
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