# An empirical study on the relationship between state anxiety, acute mountain sickness, oxygen saturation, and rating of perceived exertion among graduate students during high-altitude mountaineering

## TL;DR

This study explores how graduate students' anxiety, physical symptoms, and exertion levels change during a high-altitude climb.

## Contribution

The study provides new empirical insights into the interplay between anxiety, AMS, and exertion in graduate students during high-altitude mountaineering.

## Key findings

- AMS symptoms and perceived exertion increased significantly during the climb.
- Pre-climb anxiety and changes in exertion were strongly linked to post-climb anxiety.
- Changes in oxygen saturation had limited impact on anxiety levels.

## Abstract

In recent years, as participation in high-altitude mountaineering has expanded, high-altitude climbing has increasingly become a challenging form of practical activity among university students, particularly among graduate students who experience high levels of academic and research-related stress. However, the physiological and psychological responses of this population in high-altitude environments remain insufficiently examined by systematic empirical research.

This study examined changes in state anxiety (STAI-Y1) before and after a 3-day high-altitude mountaineering expedition at 2,726–5,396 m and analyzed its relationships with acute mountain sickness (AMS), arterial oxygen saturation (SpO₂), and rating of perceived exertion (RPE) in graduate students. Additionally, it aimed to provide empirical evidence to help identify high-risk individuals and improve pre-ascent preparation and psychological support in high-altitude mountaineering.

A total of 15 graduate students were recruited for a 3-day mountaineering expedition. The STAI-Y1 was administered before and after the climb. During the ascent, SpO₂ was measured using a portable finger pulse oximeter, AMS was assessed using the Lake Louise Acute Mountain Sickness Score (LLS), and subjective fatigue was recorded via the Borg 6–20 RPE scale. Data on AMS and summit success were documented throughout the journey. Paired t-tests, between-group comparisons, and multiple linear regression were employed to analyze post-climb STAI-Y1 scores.

Following the climb, LLS scores increased from 0 to 5.7, SpO₂ decreased from 94 to 88%, and RPE rose from 6 to 19 (p < 0.001). In contrast, STAI-Y1 scores showed a non-significant decrease from 46.5 ± 12.9 to 43.9 ± 14.1 (p = 0.603). STAI-Y1 scores were higher in the AMS group and in non-summiters than in their respective comparison groups (p < 0.05). Multiple regression analysis indicated that pre-climb STAI-Y1 (β = 0.916) and the change in RPE (ΔRPE; B = 2.798) were significantly positively associated with post-climb STAI-Y1, whereas the change in SpO₂ (ΔSpO₂) was not significant.

Short-term high-altitude mountaineering imposed considerable physiological strain and induced AMS symptoms, yet overall state anxiety did not increase significantly. Increases in RPE were also significantly associated with changes in state anxiety, whereas changes in SpO₂ had only a limited impact on state anxiety.