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International Journal of Religious Tourism and
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The Physiological Effects of Walking Pilgrimage
Volume 7(i) 2019
Introduction
Although contemporary pilgrimage comes in many
forms, a conventional definition involves a bodily
journey to a holy or sacred destination. Indeed, the
physical element was an integral part of early Christian
pilgrimage, and many have compared the suffering of
the pilgrim during the journey to the suffering of
Christ.[1] In other traditions the physical suffering may
be seen as a form of bodily sacrifice or even a
remembrance of the physical suffering of ancestors, as
is the case with both the Hajj,[2] and Native American
pilgrimages such as the Trail of Tears.[3] Many
pilgrims and scholars have pointed to physical hardship
or suffering as a catalyst for spiritual renewal. Bodily
practices and gestures are theologically and practically
important in both Eastern and Western religious
traditions.
That bodily awareness informs the pilgrim’s
experience along the Camino has been suggested
previously.[4] Despite the connection between physical
activity and psycho-spiritual well-being, few studies
have focused on the physiology associated with these
physical/spiritual practices. Some have examined
walking as spiritual practice, acknowledging that the
body plays a crucial role, but without reporting the
actual measured changes in physical exertion.[5] In this
article, I will explore the physical stresses and
adaptations associated with walking pilgrimage as
experienced primarily along the Camino de Santiago.
There exist excellent reviews regarding the physiology
of walking, such as Walking to Health by Jeremy
Morris and Adrianne Hardman.[6] In addition, many
guidebooks for the Camino provide detailed
descriptions of the topography of the route, and
practical advice about the physical demands of the
Camino. This article, however, focuses on describing
the Camino in terms of the challenge it presents to the
pilgrim body, the adaptation of the pilgrim body to that
challenge, and how physiological challenges and
adaptations may inform the Camino experience.
Technical Description of the Camino de
Santiago
In order to understand the physiological stress of
walking along the Camino de Santiago, it is necessary
to describe the pilgrimage trail and the typical pilgrim
in technical terms. First, the Camino de Santiago is a
collection of routes that lead to the cathedral in
Santiago de Compostela, north-west Spain, where,
according to tradition, the remains of Saint James the
Apostle are buried. Paths lead to Santiago from all
directions: the north (Camino Ingles and the Camino
del Norte), the south (Camino Portuguese), and the
west (Camino Finisterre). The most commonly-walked
route, however, is from the east; it is called the Camino
© International Journal of Religious Tourism and Pilgrimage
ISSN : 2009-7379
Available at: http://arrow.dit.ie/ijrtp/
M. Brennan Harris
William & Mary, Williamsburg VA
mbharr@wm.edu
M. Brennan Harris presents in ‘The Healthy Body’ his kinesiological research
conducted on the Camino de Santiago, examining the effects of walking pilgrimage on
the self-identified experience of well-being in pilgrim bodies.
Key Words: pilgrimage, hiking, kinesiology, walking, Camino, Camino de Santiago,
cardiovascular, musculoskeletal, metabolic, stress, injury, blisters, long-distance
walking, journey pilgrimage .
~ 85 ~
1. John Gordon Davies, Pilgrimage Yesterday and Today:
Why? Where? How? (London: SCM, 1988).
2. Robin M. Taylor, ‘Holy Movement and Holy Place:
Christian Pilgrimage and the Hajj,’ Dialog 50/3 (2011):
262-270.
3. Anton M. Pazos, ed., Redefining Pilgrimage: New
Perspectives on Historical and Contemporary
Pilgrimages (Burlington: Ashgate, 2014), 188.
4. Janneke Peelen, ‘Bodily Learning: The Case of
Pilgrimage by Foot to Santiago De Compostela,’
Cultural Styles of Knowledge Transmission: Essays in
Honour of Ad Borsboom (ed. Jean Kommers and Eric
Venbrux; Amsterdan: Aksant Academic, 2008), 108.
5. Sean Slavin, ‘Walking as Spiritual Practice: The
Pilgrimage to Santiago De Compostela,’ Body & Society
9/3 (September 01, 2003): 1-18.
6. Jeremy N. Morris and Adrianne E. Hardman, ‘Walking to
Health,’ Sports Medicine 23/5 (1997): 306-332.
Physiological Challenges of a Walking
Pilgrimage
Cardiovascular Stress
Pilgrims along the Camino walk at many different
speeds for a variety of reasons including the load
carried, the terrain, and the pace of their companions.
As such, one’s companions tend to be those other
pilgrims that are comfortable walking at the same pace;
often, those walking with others walk at the pace of the
slowest member of the group. Ultimately, it appears
that despite all these variables, pilgrims adjust their
speed to maintain a consistent relative intensity. In
other words, they speed up or slow down based on how
hard it feels. This is evidenced by one of our studies in
which pilgrims wore heart rate monitors to evaluate the
intensity of their walking. Individuals tended to walk at
approximately 56 percent of their maximal intensity,
which represents a relatively low stress on the
cardiovascular system of the pilgrim’s body.[11] As
such, most individuals possess the necessary
cardiovascular fitness to walk the Camino, although
some will walk it more slowly than others. In addition,
because of the relatively low intensity and
subsequently low stress on the cardiovascular system,
pilgrims completing the Camino are likely to
experience only modest improvements in
cardiovascular fitness. To date there are only two
published studies in the medical literature that have
specifically measured changes in cardiovascular
function among pilgrims on the Camino de Santiago.
[12] Our study showed modest improvements in
cardiovascular fitness among a relatively young subject
group participating in a 758-km traverse of the Camino
Frances, whereas Remy Bemelmans et al. showed no
improvement in vascular fitness among an older group
of pilgrims walking 280 km over twelve days. There
has also been a letter to the editor published in Revista
Espanola de Cardiologia about a study which followed
twenty-one low risk patients with cardiovascular
disease along the Camino over six days.[13] The authors
Harris The Physiological Effects of Walking Pilgrimage
~ 86 ~
Frances and runs from the border between France and
Spain to Santiago. Contemporary pilgrims typically
begin at either Saint-Jean-Pied-de-Port on the French
side or Roncesvalles on the Spanish side. The distance
from these two points to Santiago is between 750 to
800 kilometres depending on the precise route taken.
This represents a considerable journey by foot. The
Pilgrim’s Office in the cathedral at Santiago recognizes
pilgrims who can document by way of a pilgrim’s
credencial (or passport) that they have walked at least
100 km, by providing a compostela or certificate. As a
result, most individuals attempt to cover at least the
100 km distance. Furthermore, the statistics compiled
by the Cathedral represent only those that have met this
minimum distance requirement. In 2016, the Pilgrim’s
Office in Santiago reported that 277,854 pilgrims
completed the Camino and received a compostela;
91.42 percent of those completed the journey on foot.[7]
Roughly one quarter of pilgrims (25.83 percent)
reported their starting point as the town of Sarria,
which represents the final 116 km of the Camino
Frances. The next most commonly reported starting
point (12.11 percent of pilgrims) is from Saint-Jean-
Pied-de-Port. The balance of pilgrims start at other
points on the Camino Frances, or walk other routes to
Santiago (36.63 percent of pilgrims).[8] On foot, these
distances represent walking an average of 23 km per
day, for from 5 to 33 days. The average Camino
pilgrim walks every day. With the average walking
speed of humans being approximately 5 km per hour,[9]
that means walking 4 to 5 hours per day. For reference,
the typical distance walked by individuals in one day
as part of their daily activity is approximately 8.3 km.
[10] Therefore, despite the relatively slow pace of most
pilgrims, walking the Camino represents a significant
(2.7 fold) increase in physical activity, and a
considerable stress on the body.
7. ‘Informe estadístico Año 2016 Oficina del Peregrino,’
accessed 27 August, 2018. https://
oficinadelperegrino.com/wp-content/uploads/2016/02/
peregrinaciones2016.pdf.
8. Ibid.
9. R. C. Browning et al., ‘Effects of Obesity and Sex on the
Energetic Cost and Preferred Speed of Walking,’
Journal of Applied Physiology 100/2 (2006): 390-398.
10. David R. Bassett Jr. et al., ‘Pedometer-Measured
Physical Activity and Health Behaviors in U.S. Adults,’
Medicine & Science in Sports & Exercise 42/10 (2010):
1819-1825.
11. M. Brennan Harris and Michelle R. Wolf,
‘Cardiovascular Disease Risk Following a 758 km
Pilgrimage,’ International Journal of Sports Medicine
34/8, (2013): 727-731.
12. Remy H. H. Bemelmans et al., ‘Vascular and Metabolic
Effects of 12 Days Intensive Walking to Santiago De
Compostela,’ Atherosclerosis 212/2 (Oct, 2010): 621-
627; Harris and Wolf, ‘Cardiovascular Disease Risk
Following a 758 km Pilgrimage,’ 727-731.
13. Rafael Rubio and Valeriano Sosa, ‘El Camino De
Santiago in the Service of Cardiovascular
Rehabilitation,’ Revista Espanola De Cardiologia 61/4
(Apr, 2008): 435-436.
International Journal of Religious Tourism and Pilgrimage Volume 7(i) 2019
~ 87 ~
This advice is consistent with our previous calculations
indicating that the average pilgrim walks
approximately four to five hours per day covering a
distance of 23 km per day for anywhere from four to
five days to 30 days or more, depending on the starting
point and pace. Although it is possible to take days off
from walking, most pilgrims along the Camino tend to
walk some distance every day with at most one rest-
day each week. This represents a significant
physiological challenge, not in the form of
cardiovascular stress, but rather as a high metabolic or
energetic challenge as well as a constant, repetitive
stress on the joints, ligaments, tendons, bones, muscles,
and even the skin.
The metabolic challenge can be calculated from the
estimated intensity based on earlier studies and the
average time and distance covered by pilgrims during a
typical pilgrimage along the Camino. The amount of
energy it takes is also dependent on the size of the
individual. However, based on these factors, it can be
estimated that the average pilgrim nearly doubles his or
her daily caloric expenditure during an average day of
walking. In order to sustain this level of metabolic
activity, it is necessary for pilgrims to greatly increase
their daily caloric intake. How pilgrims accommodate
this need for increased caloric intake varies. For some
pilgrims, especially those travelling abroad, finding
food can be a challenge due to culinary differences and
language barriers, which may result in inadequate food
intake. However, some pilgrims consider the
pilgrimage a gastronomical journey[16] as much as a
spiritual one, and encounter no issues achieving
adequate caloric intake.[17] Indeed many pilgrims
undertake the journey as part of a package tour, which
ensures more than adequate access to food.
Nevertheless, the two studies that have been published
measuring the physiological effects of walking the
Camino have reported significant decreases in body
weight and body fat during either a twelve-day[18] or
thirty- to thirty-two-day pilgrimage,[19] suggesting that
the individuals in these studies experienced a caloric
of this letter suggested that their findings indicated
some improvement in cardiovascular fitness, although
participants also completed a two-month walking
program prior to the Camino.
The possible improvement in fitness is important to
note as some studies suggest a correlation between
physical fitness and self-reported psychological as well
as spiritual well-being. The underlying mechanism for
this relationship is based primarily on the physiological
responses to exercise, including neural and hormonal
adjustments such as increases in dopamine, serotonin,
epinephrine, and norepinephrine. Additionally, there is
a vast amount of literature on the euphoric effects of
acute exercise, focusing primarily on release of
endorphins.[14] Furthermore, most of these changes are
increased with increasing intensity of exertion, and do
not occur if a specific threshold for intensity is not
reached. Indeed, as evidenced by unpublished data
from our study, individuals who began the Camino
with a very high level of fitness actually experienced a
drop in cardiovascular fitness during their pilgrimage,
which was likely due to the lower exercise intensities
they experienced compared to their normal exercise
routines. Therefore, walking the Camino at low to
moderate intensities is likely to elicit only modest
improvements in cardiovascular fitness and the
associated underlying physiological mechanisms, and
these changes would therefore play a small role in
altering the overall self-perception of the pilgrim’s
experience.
Metabolic Stress
While exercise intensity does not represent a
significant challenge to most pilgrims on the Camino,
the greatest physical stress in this form of walking
pilgrimage is the overall volume of exercise
experienced, due to the long duration and regularity of
the activity. Advice from the American Pilgrims on the
Camino, a confraternity dedicated to the route, states
daily distance on the Camino will depend on
your personal desires and abilities but you must
remember that to walk some distance, say 20
km, one day is one thing - to do it day after day
for several weeks or a month is something else
entirely.[15]
14. Marni N. Silverman and Patricia A. Deuster, ‘Biological
Mechanisms Underlying the Role of Physical Fitness in
Health and Resilience,’ Interface Focus 4/5 (2014): 1-12.
15. ‘American Pilgrims on the Camino: FAQs,’ accessed 16
February 2015. http://www.americanpilgrims.com/
camino/faqs.html.
16. Gemma Canoves and Raul Suhett de Morais, ‘New
Forms of Tourism in Spain: Wine, Gastronomic, and
Rural Tourism,’ Tourism and Agriculture: New
Geographies of Consumption, Production and Rural
Restructuring (ed. Rebecca Maria Torres and Janet
Hemshall Momsen; London: Routledge, 2011), 205.
17. Canoves and de Morais, ‘New Forms of Tourism in
Spain,’ 205.
18. Bemelmans et al., ‘Vascular and Metabolic Effects of
12 Days Intensive Walking to Santiago De
Compostela,’ 621-627.
19. Harris and Wolf, ‘Cardiovascular Disease Risk
Following a 758 km Pilgrimage,’ 727-731.
the reasons pilgrims embark on the journey in the first
place. In any case, the pilgrim is confronted with his or
her physiological limits and begins to lighten the load.
This response is a behavioural modification adjusting
to the physiological stress. Other strategies include
buying more sophisticated backpacks to distribute the
loads more evenly, or even using a cart or stroller to
push or pull their possessions along. The weight of
these possessions can sometimes be painful, and
pilgrims undertaking the journey with little preparation
will soon find that they become sore from carrying
any unnecessary and/or unaccustomed load.
Continuing with a load that is too heavy may result in
the development of pain and even injury. However, if
appropriate adjustment is made, pilgrims will be able
to continue on through the pain without injury. Over a
period of days they will begin to adapt and experience
an increase in musculoskeletal strength that allows
them to carry their load much more easily. This
improvement in muscular fitness may, in turn, elicit
improved psychological factors as the pain begins to
subside and the pilgrim begins to feel stronger.
Alternatively, the individual may need to rely on other
means of transporting packs. This may become a
lesson learned by pilgrims about their physiological
limits and indeed their humanness itself. While it may
be possible to avoid this issue by shipping items or
participating in a commercially-organized venture,
ultimately the walking pilgrim must carry his or her
body the minimum distance of 100 km to obtain their
compostela.
Injury
Interestingly, it appears that participation in walking
pilgrimage is more likely to result in injury rather than
adaptation of the musculoskeletal and integumentary
systems. Previous examinations of walking for fitness
have suggested that no further improvements in muscle
strength or joint flexibility are thereby gained.[23]
Perhaps this is due to the quotidian nature of walking
as a daily activity. Preliminary data from our own
studies even suggest that some individuals experience
a decline in muscular strength, presumably due to the
fact that in walking along the Camino, some pilgrims
experience a less dynamic range of motion than during
their regular daily routine (fewer stairs for instance).
Instead, the many pilgrim accounts and numerous on-
line guides indicate that the overload caused by the
constant repetitive nature of walking pilgrimage results
in injuries to the tendons, joints, and skin in the form
of tendonitis, arthritis, and blisters. These types of
Harris The Physiological Effects of Walking Pilgrimage
~ 88 ~
deficit. It is unclear how this negative energy balance
ultimately affects the pilgrimage experience. Studies
have clearly shown that the human brain is particularly
susceptible to changes in energy balance.[20] As a
result, feelings of hunger may evoke a particular
physiological and psychological response that deepens
the perceived spiritual experience through enhanced
interoception.[21] Therefore, the feelings of hunger may
demand from the pilgrim a greater awareness of the
body and its inherent limitations.
Musculoskeletal Stress
Overload and adaptation
As stated above, perhaps the greatest stress to the
pilgrim body during a walking pilgrimage is the
constant, repetitive stress on the musculoskeletal and
integumentary (skin) systems. Most people today are
simply not used to walking for four to six hours a day,
let alone doing so day after day. As a result, the
walking pilgrimage significantly overloads these
systems, eliciting a physiological response followed
either by adaptation or injury. It is also important to
note that the equipment and baggage pilgrims bring
with them on their journey has a major influence on the
stress that they undergo. It is readily apparent that the
more weight a pilgrim carries with them, the more
work the pilgrim will have to do. Indeed previous
studies on individuals participating in long-distance
hiking along the Appalachian Trail and Pacific Coast
Trail show an increase in paresthesia, or numbness and
tingling, in proportion to increasing pack weight.[22]
However, intensity can be adjusted by slowing down
the pace. For pilgrims carrying their belongings with
them, it is difficult to avoid the stress on the muscles
and bones as they move the load from one destination
to another. This is readily apparent to most pilgrims
within the first day of walking. There are numerous
reports of the many items left behind as pilgrims
previously overburdened with stuff shed the
unnecessary items. To that end many pilgrims wax
philosophical on the meaning of leaving behind
baggage; some suggest that that this is indeed one of
20. Ignacio Amigo and Alicia J. Kowaltowski, ‘Dietary Re-
striction in Cerebral Bioenergetics and Redox State,’
Redox Biology 2 (2014): 296-304.
21. A.D. (Bud) Craig, ‘Interoception: The Sense of the
Physiological Condition of the Body,’ Current Opinion
in Neurobiology 13/4 (2003): 500- 505.
22. L. Stewart Anderson et al., ‘The Impact of Footwear and
Packweight on Injury and Illness among Long-Distance
Hikers,’ Wilderness & Environmental Medicine 20/3
(2009): 250-256.; David R. Boulware, ‘Backpacking-
Induced Paresthesias,’ Wilderness & Environmental
Medicine 14/3 (2003): 161-166. 23. Morris and Hardman, Walking to Health, 306-332
International Journal of Religious Tourism and Pilgrimage Volume 7(i) 2019
~ 89 ~
Environmental Stress
Other factors to consider with regard to the physical
challenges of walking pilgrimage are the
environmental conditions that the pilgrim may
encounter, including changes in temperature, altitude,
and even increased exposure to sunlight. An
individual’s Camino trek may take place during any
time of the year. Additionally, the weather is variable
along the path. Heat and cold represent physiological
stressors in and of themselves, and their effects may be
exacerbated during exercise. Heat is generated during
exercise by working muscles, and when the external
temperatures are also high, this can result in increased
stress on the body. The primary mechanism of
thermoregulation by the human body is sweating and
its resultant evaporative heat loss. Sweating without
adequate fluid intake will result in physiological stress
in the form of dehydration. Thus the pilgrim can
experience significant fluctuations in body temperature
and body water levels.
Hyperthermia
Examinations of the role of body temperature on
endurance performance suggest that hyperthermia is
one of the key limiting factors,[29] although this seems
to occur mainly to higher-intensity, competitive
activities. Nevertheless, pilgrims walking the Camino
during the summer can experience average daily
temperatures as high as 35oC, depending on the route
taken, and this, coupled with exercise, can represent a
significant thermal load. Hyperthermia results in a
decrease in muscular performance which is due, in
part, to central nervous system fatigue as indicated by
the individual’s inability to voluntarily elicit a maximal
muscular contraction.[30] Hyperthermia also affects the
brain and ultimately perception. Furthermore,
unchecked hyperthermia in the form of heat stress and
heat stroke can result in permanent neurological
damage.[31]
injuries are the most likely reasons that pilgrims stop
and either rest and recover, or end their journey.
Although no published data exist to indicate how many
pilgrims experience these types of injuries, 47 percent
of a sample of 107 pilgrims who completed the
Camino in the summer of 2014 reported at least one of
these injuries.[24]
Indeed, like the rates of injury reported in studies of
long distance hikers,[25] the rates of injury are probably
under-reported in our survey, as only individuals who
completed the pilgrimage completed the survey.
Speculation on the popular website Caminoforums.com
suggests that 20-30 percent of the pilgrims attempting
the full Camino Frances do not complete the journey,
due to some physical injury.[26] Much space is taken up
in various guidebooks and on internet forums on how
to avoid walking-related injuries. Interestingly, some
previous work looking at whether experience and
conditioning in long distance hikers can reduce injury
has not shown that these factors influence either the
frequency or type of injuries.[27] Indeed, our own
unpublished data shows no correlation between the
number of pilgrimages previously completed or
experience in backpacking, and reports of injury.[28]
Based on the evidence cited above, it appears that the
walking pilgrimage experienced by individuals along
the Camino involving long-duration and high-
frequency activity leads the typical pilgrim close to the
physiological limits of their muscles, joints, tendons,
and skin. Once again, by flirting with the limitations of
their bodies and even experiencing pain or injury,
pilgrims’ awareness of their humanity increases, and
this awareness likely impacts their emotional and
spiritual experience.
24. M. Brennan Harris and Taylor M. James, unpublished
data; cf. Sang-cheon Choi et al., ‘Injuries Associated
with the 580 km University Student Grand Voluntary
Road March: Focus on Foot Injuries,’ Journal of Korean
Medical Science 28/12 (2013): 1814-1821. The rates
from our unpublished data are consistent with, if not
lower than, this study reporting foot blisters in 95 percent
of the 142 Korean college students participating in the
University Student Grand Voluntary Road March, a
route consisting of walking 580 km over 21 days with a
small to medium pack.
25. Timothy B. Gardner and David R. Hill, ‘Illness and
Injury among Long-Distance Hikers on the Long Trail,
Vermont,’ Wilderness & Environmental Medicine 13/2
(6, 2002): 131-134.
26. ‘How Many Who Set Out to Complete the Entire 800km
Camino Frances do so? Camino De Santiago,’ accessed 6
February 2015. http://www.caminoforums.com/camino-
frances/2986-how-many-who-set-out-complete-entire-
800km-camino-frances-do-so.html.
27. Gardner and Hill, ‘Illness and Injury among Long-
Distance Hikers on the Long Trail, Vermont,’ 131-134.
28. M. Brennan Harris and Taylor M. James, unpublished
data.
29. Michael J. Joyner and Edward F. Coyle, ‘Endurance
Exercise Performance: The Physiology of Champions,’
The Journal of Physiology 586/1 (2008): 35-44.
30. L. Nybo and B. Nielsen, ‘Hyperthermia and Central
Fatigue during Prolonged Exercise in Humans,’ Journal
of Applied Physiology (Bethesda, Md.: 1985) 91/3 (Sep,
2001): 1055-1060.
31. Shoshana Burke and Menachem Hanani, ‘The Actions
of Hyperthermia on the Autonomic Nervous System:
Central and Peripheral Mechanisms and Clinical
Implications,’ Autonomic Neuroscience 168/1 (2012): 4
-13.
particularly in the Pyrenees, where some pilgrims have
lost their lives due to the weather conditions.[36] It is
more likely that pilgrims experience mild hypothermia
by getting caught in the rain on a cool day without
warm or waterproof clothing. Physiological changes
that occur in individuals experiencing hypothermia can
be severe and life-threatening, and even mild
hypothermia elicits a significant stress response. Mild
hypothermia occurs when core body temperatures drop
approximately 2oC, and the symptoms can include
shivering, increased blood pressure, amnesia, and poor
judgement.[37] This, in turn, could lead to further
consequences. Clearly, walking pilgrimage, although
innocuous-sounding at first, can place the pilgrim in
unexpected environments that reveal the relatively
narrow range of temperatures which the human body
can tolerate.
Altitude
Another potential environmental stress that pilgrims
along the Camino may encounter is the effects of
altitude. Most of the Camino in Spain takes place at
low altitude, but the first stage of the traditional
Camino Frances from Saint-Jean-Pied-de-Port in
France to Roncesvalles in Spain crosses several
mountainous areas. Many consider this to be the most
difficult section of the Camino. The highest point on
this part of the route is the Col de Lepoder with an
elevation of just over 1400 metres. In most texts of
altitude physiology, this represents a relatively low
level physiological challenge. At 1400 m, the standard
barometric pressure drops to approximately 86 kPa
(648 mmHg) compared to 101 kPa (760 mmHg) at sea
level. This represents a 15 percent drop in the available
oxygen.[38] A drop in the atmospheric pressure results
in a reduction in the loading of oxygen to haemoglobin
in the blood, and ultimately a reduction in the amount
of oxygen available to produce energy for physical
activity. At these relatively low altitudes, a pilgrim
may experience only about a 2 percent drop in arterial
oxygen saturation levels from 98 percent at sea level to
96 percent. At rest, or at low to moderate levels of
exertion, an individual is unlikely to experience any
significant deleterious effects. However, performance
at higher intensities can be impaired, and pilgrims are
more likely to be working at these higher intensities as
they ascend the mountainous terrain. The physiological
response to working at these higher intensities with
Harris The Physiological Effects of Walking Pilgrimage
~ 90 ~
Although no studies have been published addressing
the extent to which hyperthermia is experienced by
pilgrims along the Camino, it is clear that exposure to
such an environmental stressor may be yet another
factor altering the overall perception and spiritual
experience of the pilgrim. Recent reviews of the effects
of hyperthermia and heat exposure on cognitive
function using various measures of task complexity
suggest that hyperthermia results in a decline in
cognitive function.[32] These reviews also indicate that
more research is necessary to distinguish differences
between passive (environmental) and active (exercise-
induced) hyperthermia, as positive exercise-related side
effects may blunt some of the cognitive impairment.[33]
Although the exposure to hyperthermia may represent
a potential danger, it is important to note that the
pilgrim will likely experience an adaptive response to
repeated thermal stress, resulting in acclimation to hot
environments. This acclimation typically results in
improved thermoregulatory function through
conservation of body water and improved sweating.[34]
However, there is little well-controlled research
examining the effects of acclimation on cognitive
function, and some studies show that indicators of
improved cognitive function are task specific (i.e. the
results depend on what type of cognitive function is
measured).[35] As a result, the pilgrim may handle the
physiological stress of heat better as he or she adapts to
the environment, and their overall perception of the
experience may be positively or negatively impacted.
Hypothermia
Alternatively, cold weather can also heighten the
physiological demand on the body, adding to the
metabolic load due to increased muscular stiffness,
shivering, and the dehydrating effect of breathing less
humid air. Although fewer pilgrims walk the Camino
during the winter months, it is possible to encounter
severe cold weather at other times of the year,
32. N. Gaoua, ‘Cognitive Function in Hot Environments: A
Question of Methodology,’ Scandinavian Journal of
Medicine & Science in Sports 20/3 (2010): 60-70.; Peter
A. Hancock, Jennifer M. Ross, and James L. Szalma, ‘A
Meta-Analysis of Performance Response Under Thermal
Stressors,’ Human Factors 49/5 (Oct. 2007): 851-877.
33. Gaoua, ‘Cognitive Function in Hot Environments: A
Question of Methodology,’ 60-70.
34. Nigel A. Taylor, ‘Human Heat Adaptation,’
Comprehensive Physiology 4 (2014): 325-365.
35. Gaoua, ‘Cognitive Function in Hot Environments: A
Question of Methodology,’ 60-70.
36. ‘Camino De Santiago Climate and Conditions: the Road
to Santiago,’ accessed 20 February 2015. http://
www.theroadtosantiago.com/camino-climate-and-
conditions.html.
37. John W. Castellani et al., ‘Prevention of Cold Injuries
during Exercise,’ 38/11 (Nov. 2006): 2012-2029.
38. ‘Altitude.Org | Altitude Air Pressure Calculator,’
accessed 26 February 2015. http://www.altitude.org/
air_pressure.php
International Journal of Religious Tourism and Pilgrimage Volume 7(i) 2019
~ 91 ~
affective disorder and depression.[42] Furthermore,
pilgrims on the Camino de Santiago may also fall into
a more regular pattern of light and dark exposure than
they experience in urban and indoor light
environments, in which exposure to light at night can
disrupt circadian rhythms and result in depression and
other mood disorders.[43] The Camino lends itself to
periods of daily physical activity followed by more
quiet evenings due, in part, to fatigue and to the house
rules in many of the albergues (pilgrim hostels with
communal sleeping arrangements) that keep regular
‘lights out’ times. As a result, despite the potential ill
effects of ultraviolet radiation, including sunburns, the
increased time spent outside in natural light may
improve the physical health and overall mood of the
pilgrim, providing a greater sense of well-being.
Comment on the Highly Fit
For the strongest and fittest, walking pilgrimage may
represent an activity that is considerably lower in
intensity, frequency, and duration than normal activity.
For instance, in some countries a postal worker who
delivers mail on foot walks a considerable distance
carrying a heavy load day in and day out. Other
professions requiring similar activity can approximate
the experience of walking pilgrimage, in which case
pilgrimage itself offers no additional physiological
challenge. The cardiovascular stress of walking a
pilgrimage would not overload the system of a
professional distance runner, for instance; if regular
training is discontinued during the pilgrimage, then the
runner would likely experience a decrease in fitness
during the walk. For an individual who lifts weights or
carries a heavy load on a regular basis, carrying only
their necessities on a pilgrimage may likewise be easy
and result in a negative adaptation. Such a decline in
fitness may result in negative psychological and
spiritual responses. Although a number of studies have
been conducted examining the link between physical
fitness, health and spiritual well-being, it is as yet
unknown how these factors might influence a pilgrim’s
experience. Undeniably there are a multitude of ways
these factors interact, and this is important to consider
as each pilgrim has something to learn from facing
physiological challenges whether negative or positive.
less oxygen available, results in increased breathing
(hyperventilation), higher heart rates, and an increase
in stress hormone levels, particularly norepinephrine.
Thus, the pilgrim exercising at altitude may experience
an increase in physical stress with elevated hormone
levels, which may increase awareness, and even
provide a sense of euphoria or greater well-being once
the initial challenge is overcome.[39]
Natural light
One final environmental factor to consider is exposure
to natural light. While this may not have been
uncommon for pre-modern pilgrims, the contemporary
pilgrim is much less likely in their daily routine to have
spent significant amounts of time outdoors. In a recent
meta-analysis of studies using different cohorts of
people, it was reported that the mean time spent
outdoors on weekdays was 1.04 hours[40] which would
be significantly less time than the pilgrim experiences
on a typical day. The increased time spend outdoors
can be both harmful and beneficial. Once again,
turning to the various Camino guidebooks, on-line
advice, and to scientific studies, it is well documented
that exposure to ultraviolet radiation can lead to skin
damage, necessitating appropriate clothing choices and
the use of sunscreen.
Recently, popular medical literature has begun to focus
on the beneficial effects of sunlight exposure in the
production of vitamin D, especially in light of the fact
that nearly fifty percent of the world’s population is at
risk for vitamin D deficiency.[41] Vitamin D is a major
factor in determining health, playing an important role
in preventing osteoporosis, some forms of cancer,
autoimmune diseases, and cardiovascular disease.
Therefore, increased exposure to sunlight may improve
the health of a pilgrim through this mechanism. A
second factor to consider as a result of increased
sunlight exposure is psychological health. Several
studies have shown that natural light improves seasonal
39. William P. Morgan, ‘Affective Beneficence of Vigorous
Physical Activity.’ Medicine & Science in Sports &
Exercise 17/1 (Feb. 1985): 94-100.
40. Brian L. Diffey, ‘An Overview Analysis of the Time
People Spend Outdoors,’ British Journal of Dermatology
164/4 (2011): 848-854.
41. Michael F. Holick, ‘Sunlight, Ultraviolet Radiation,
Vitamin D, and Skin Cancer: How Much Sunlight do we
Need?’ Advances in Experimental Medicine and Biology
810 (2014): 1-16.
42. Alan L. Miller, ‘Epidemiology, Etiology, and Natural
Treatment of Seasonal Affective Disorder,’ Alternative
Medicine Review: A Journal of Clinical Therapeutic 10/1
(Mar. 2005): 5-13.
43. Tracy A. Bedrosian and Randall J. Nelson, ‘Influence
of the Modern Light Environment on Mood,’ Molecular
Psychiatry 18/7 (2013): 751-757.
The rule of specificity should also be applied to other
aspects of training including: the equipment or gear
that the pilgrim plans to bring along during the
journey, dietary needs, and environmental challenges.
As recommended in guidebooks for the Camino and in
studies related to through-hiking as noted above, 46] the
beginning of the endeavour is not the best time to test
out new equipment! In order to know whether
footwear, backpacks, clothing, or other equipment
might cause problems on the pilgrimage, the pilgrim
should train with the same gear. This helps eliminate
potential problems on the Camino. Furthermore, to the
extent to which this is possible, in the interests of the
walking body’s nutritional needs, the pilgrim should
research food options available along the Camino and
make efforts to acclimatize beforehand. This may be
especially true for pilgrims with special dietary needs
such as vegans, or individuals with celiac disease.
Finally, the rule of specificity would suggest that
training in the same environmental conditions as will
be found on the pilgrimage would be optimal.
Obviously, this may not be possible depending on
where one lives and what time of year one plans to
begin their pilgrimage. However, if time permits, the
pilgrim may have the opportunity to train in weather
conditions similar to those expected on the trail, and
should take advantage of such opportunities. These
would be ideal training days to test out specific
clothing as well as potential hydration needs. For
instance, simply by determining the difference in body
weight before and after a training walk, while taking
into account any water ingested during the training will
give a good indication of an individual’s sweat rate and
hydration needs. By applying the criteria of specificity,
pilgrims should thus be able to adequately prepare for
the physiological challenges noted above.
Conclusion
In summary, the physiological challenges of a walking
pilgrimage as represented by the Camino de Santiago,
have a strong influence on the overall pilgrim
experience. For some, the physical challenge
represents a significant psychological barrier to
overcome, while for others it does not. Indeed other
long-distance hiking trails which one might use to
compare to the Camino are arguably more strenuous
due to terrain and lack of access to conveniences.
While numerous guidebooks and tourism ventures
suggest that anyone can walk the Camino, many of
these same guides also include sections on common
pitfalls: tendonitis, joint pain, blisters, dehydration, etc.
Understanding the physiological mechanisms behind
Harris The Physiological Effects of Walking Pilgrimage
~ 92 ~
Physical Training and Preparation
Given the challenges above and the information and
advice available to today’s pilgrim, many prepare
physically, not realizing that their physical preparation
may also prepare them for a spiritual journey. Training
the body for pilgrimage is as simple as training for any
physical activity and follows the basic rule of
specificity. The rule of specificity principally states
that the best way to prepare the body for a particular
physical task is simply to perform that task. For
example, the typical walking pilgrimage along the
Camino de Santiago represents a low- to moderate-
intensity walk, over a variety of terrains, lasting four to
five hours per day for five to 30 days. Therefore, the
best way to prepare for this walking pilgrimage is to do
low- to moderate-intensity walking over a variety of
terrain for four to five hours daily. In doing so, the
individual has matched the mode, the intensity, and the
duration of their pilgrimage journey. Therefore the
pilgrimage represents a bodily challenge not unlike
running a marathon as discussed in Janice Poltrick-
Donato’s article in this issue.
It is likely that not all pilgrims can or do train in a way
that precisely mimics the actual walking pilgrimage.
However, most pilgrims do not need to increase their
cardiorespiratory fitness through higher-intensity
training. As indicated earlier, the main physical issues
that tend to cause injury and stop pilgrims on their
journey are tendonitis and blisters. Therefore, the
training should aspire to address these issues.
Tendonitis or tendinopathy results from repetitive
motion under heavier-than-normal loads, resulting in
inflammation and degeneration of the tendons.[44]
Typically, tendonitis is due to a sudden increase in
load, or due to a biomechanical aberration such as an
abnormal gait or muscular imbalance.[45] In order to
address this issue the pilgrim must be aware of his or
her body and its movements, so as to identify possible
weaknesses. Once the problem area is identified, the
pilgrim can address it with the help of a professional,
or by strengthening the weak areas and gradually
working up to heavier loads or longer distances.
44. Yinghua Xu and George A. C. Murrell, ‘The Basic
Science of Tendinopathy,’ Clinical Orthopaedics and
Related Research 466/7 (2008): 1528-1538.
45. Constantinos N. Maganaris et al., ‘Biomechanics and
Pathophysiology of Overuse Tendon Injuries,’ Sports
Medicine 34/14 (2004): 1005-1017.
46. Anderson et al., ‘The Impact of Footwear and
Packweight on Injury and Illness among Long-Distance
Hikers,’ 250-256.
47. Julianne Holt-Lunstad et al., ‘Understanding the
Connection between Spiritual Well-being and Physical
Health: An Examination of Ambulatory Blood Pressure,
Inflammation, Blood Lipids, and Fasting Glucose,’
Journal of Behavioral Medicine 34/6 (2011): 477-488.
International Journal of Religious Tourism and Pilgrimage Volume 7(i) 2019
~ 93 ~
Bibliography
Anderson, L. Stewart, C. M. Rebholz, L. F. White, P.
Mitchell, E. P. Curcio 3rd, J. A. Feldman, and J. H.
Kahn. ‘The Impact of Footwear and Packweight on
Injury and Illness among Long-Distance Hikers.’
Wilderness & Environmental Medicine 20/3 (2009): 250-
256.
Bassett, David R. Jr., H. R. Wyatt, H. Thompson, J. C.
Peters, and J. O. Hill. ‘Pedometer-Measured Physical
Activity and Health Behaviors in U.S. Adults.’ Medicine
& Science in Sports & Exercise 42/10 (2010): 1819-
1825.
Bedrosian, Tracy A. and Randall J. Nelson. ‘Influence of the
Modern Light Environment on Mood.’ Molecular
Psychiatry 18/7 (2013): 751-757.
Bemelmans, Remy H. H., Blai Coll, Daniel R. Faber, Jan
Westerink, Paulus P. Blommaert, Wilko Spiering, and
Frank L. J. Visseren. ‘Vascular and Metabolic Effects of
12 Days Intensive Walking to Santiago De Compostela.’
Atherosclerosis 212/2 (Oct, 2010): 621-627.
Browning, R. C., Emily A Baker, Jessica A Herron, and
Rodger Kram. ‘Effects of Obesity and Sex on the
Energetic Cost and Preferred Speed of Walking.’ Journal
of Applied Physiology 100/2 (2006): 390-398.
Burke, Shoshana and Menachem Hanani. ‘The Actions of
Hyperthermia on the Autonomic Nervous System:
Central and Peripheral Mechanisms and Clinical
Implications.’ Autonomic Neuroscience 168/1 (2012): 4-
13.
Canoves, Gemma and Raul Suhett de Morais. ‘New Forms
of Tourism in Spain: Wine, Gastronomic, and Rural
Tourism.’ Pages 205-219 in Tourism and Agriculture:
New Geographies of Consumption, Production and Rural
Restructuring. Edited by Rebecca Maria Torres and Janet
Hemshall Momsen. London: Routledge, 2011.
Castellani, John W., A. J. Young, M. B. Ducharme, G. G.
Giesbrecht, E. Glickman, and R. E. Sallis. ‘Prevention of
Cold Injuries during Exercise.’ 38/11 (Nov. 2006): 2012-
2029.
Choi, Sang-cheon, Young-Gi Min, In-Soo Lee, Gi-Ho Yoon,
Bo-Ra Kang, Yoon-Seok Jung, Joon-Pil Cho, and Gi-
Woon Kim. ‘Injuries Associated with the 580 km
University Student Grand Voluntary Road March: Focus
on Foot Injuries.’ Journal of Korean Medical Science
28/12 (2013): 1814-1821.
Craig, A. D. (Bud), ‘Interoception: The Sense of the
Physiological Condition of the Body.’ Current Opinion
in Neurobiology 13/4 (2003): 500-505.
Davies, John Gordon. Pilgrimage Yesterday and Today:
Why? Where? How? London: SCM, 1988.
Diffey, Brian L. ‘An Overview Analysis of the Time People
Spend Outdoors.’ British Journal of Dermatology 164/4
(2011): 848-854.
Gardner, Timothy B. and David R. Hill. ‘Illness and Injury
among Long-Distance Hikers on the Long Trail,
Vermont.’ Wilderness & Environmental Medicine 13/2
(6, 2002): 131-134.
these bodily challenges can help pilgrims prepare for a
more rewarding journey, and also help them consider
how overcoming these challenges may be part of
discovering or rediscovering the physical nature of the
human body.
Although this article has focused on the physical
aspects of the Camino and their potential impact on the
overall pilgrim experience, it would be incomplete
without recognizing the likelihood that the relationship
is a symbiotic one. It is not possible to separate the
spiritual, psychological, and physical aspects of
pilgrimage as the overall journey is experienced in the
body. Indeed, numerous studies have investigated the
effects of spiritual practices such as prayer and
meditation on physiological parameters; a recent study
by Julianne Holt-Lunstad et al. demonstrates that
spiritual well-being is correlated with physical health.
[47] Therefore, the analysis of the physiological impact
of walking pilgrimage simply confirms that the
transformative journey occurs simultaneously with
physical changes in the pilgrim’s human body.
Morgan, William P. ‘Affective Beneficence of Vigorous
Physical Activity.’ Medicine & Science in Sports &
Exercise 17/1 (Feb. 1985): 94-100.
Morris, Jeremy N. and Adrianne E. Hardman. ‘Walking to
Health.’ Sports Medicine 23/5 (1997): 306-332.
Pazos, Anton M., editor. Redefining Pilgrimage: New
Perspectives on Historical and Contemporary
Pilgrimages. Burlington: Ashgate, 2014.
Peelen, Janneke. ‘Bodily Learning: The Case of Pilgrimage
by Foot to Santiago De Compostela.’ Pages 108-113 in
Cultural Styles of Knowledge Transmission: Essays in
Honour of Ad Borsboom. Edited by Jean Kommers and
Eric Venbrux. Amsterdan: Aksant Academic, 2008.
Rubio, Rafael and Valeriano Sosa. ‘El Camino De Santiago
in the Service of Cardiovascular Rehabilitation.’ Revista
Espanola De Cardiologia 61/4 (Apr, 2008): 435-436.
Silverman, Marni N. and Patricia A. Deuster. ‘Biological
Mechanisms Underlying the Role of Physical Fitness in
Health and Resilience.’ Interface Focus 4/5 (2014): 1-12.
Slavin, Sean. ‘Walking as Spiritual Practice: The Pilgrimage
to Santiago De Compostela.’ Body & Society 9/3
(September 01, 2003): 1-18.
Taylor, Nigel A. ‘Human Heat Adaptation.’ Comprehensive
Physiology 4 (2014): 325-365.
Taylor, Robin M. ‘Holy Movement and Holy Place:
Christian Pilgrimage and the Hajj.’ Dialog 50/3 (2011):
262-270.
Xu, Yinghua and George A. C. Murrell. ‘The Basic Science
of Tendinopathy.’ Clinical Orthopaedics and Related
Research 466/7 (2008): 1528-1538.
Harris The Physiological Effects of Walking Pilgrimage
~ 94 ~
Gaoua, N. ‘Cognitive Function in Hot Environments: A
Question of Methodology.’ Scandinavian Journal of
Medicine & Science in Sports 20/3 (2010): 60-70.
Hancock, Peter A., Jennifer M. Ross, and James L. Szalma.
‘A Meta-Analysis of Performance Response Under
Thermal Stressors.’ Human Factors 49/5 (Oct. 2007):
851-877.
Harris, M. Brennan and Michelle R. Wolf. ‘‘Cardiovascular
Disease Risk Following a 758 km Pilgrimage.’
International Journal of Sports Medicine 34/8, (2013):
727-731.
Holick, Michael F. ‘Sunlight, Ultraviolet Radiation, Vitamin
D, and Skin Cancer: How Much Sunlight do we Need?’
Advances in Experimental Medicine and Biology 810
(2014): 1-16.
Holt-Lunstad, Julianne, Patrick R. Steffen, Jonathan
Sandberg, and Bryan Jensen. ‘Understanding the
Connection between Spiritual Well-being and Physical
Health: An Examination of Ambulatory Blood Pressure,
Inflammation, Blood Lipids, and Fasting Glucose,’
Journal of Behavioral Medicine 34/6 (2011): 477-488.
Joyner, Michael J. and Edward F. Coyle. ‘Endurance
Exercise Performance: The Physiology of Champions.’
The Journal of Physiology 586/1 (2008): 35-44.
Maganaris, Constantinos N., M. V. Narici, L. C.
Almekinders, and N. Maffulli. ‘Biomechanics and
Pathophysiology of Overuse Tendon Injuries.’ Sports
Medicine 34/14 (2004): 1005-1017.
Miller, Alan L. ‘Epidemiology, Etiology, and Natural
Treatment of Seasonal Affective Disorder.’ Alternative
Medicine Review: A Journal of Clinical Therapeutic 10/1
(Mar. 2005): 5-13.
