Mortality in Different Mountain Sports Activities Primarily Practiced in the Winter Season-A Narrative Review

Emergency Care for High-Altitude Trekking and Climbing

Introduction: High altitude regions are characterized by harsh conditions (environmental, rough terrain, natural hazards, and limited hygiene and health care), which all may contribute to the risk of accidents/emergencies when trekking or climbing. Exposure to hypoxia, cold, wind, and solar radiation are typical features of the high altitude environment. Emergencies in these remote areas place high demands on the diagnostic and treatment skills of doctors and first-aiders. The aim of this review is to give insights on providing the best possible care for victims of emergencies at high altitude. Methods: Authors provide clinical recommendations based on their real-world experience, complemented by appropriate recent studies and internationally reputable guidelines. Results and Discussion: This review covers most of the emergencies/health issues that can occur when trekking or during high altitude climbing, that is, high altitude illnesses and hypothermia, freezing cold injuries, accidents, for example, with severe injuries due to falling, cardiovascular and respiratory illnesses, abdominal, musculoskeletal, eye, dental, and skin issues. We give a summary of current recommendations for emergency care and pain relief in case of these various incidents.

Death Following a Skiing Incident: Severe Exsanguination Due to Rupture of the Left Renal Artery

With the growing popularity of winter sports, it is necessary to pay more attention to the types of traumatic injuries that a person can sustain in various incidents related to their practice. We present a case in which an adult man died as a result of a collision with a tree while skiing. Although the deaths are associated with different types and severity of craniocerebral injuries in the majority of the cases, here we are dealing with an abdominal injury with rupture of the stomach, pancreas, and left renal artery. The exact localization of the resulting traumatic injuries and the mechanism of their occurrence were examined. Both macroscopic autopsy findings (gross pathology) and histologically proven ones are presented and described. Presenting this case, we want to raise awareness of the different types of injuries received while skiing, as well as to emphasize the possibility of death in the absence of visible external injuries over the victim's body.

Characteristics of Fatal Accidents due to Exogenous Causes at Ski Resorts in Japan Over the Past 13 Years: A Retrospective Descriptive Study

INTRODUCTION

The characteristics of ski- and snowboard-related fatalities at Japanese ski resorts remain unknown. We aimed to analyze the characteristics of this in the current study.

METHODS

Using the Ski Resort Injury Report data for the 13-y period between the 2011-12 and 2022-23 seasons, we described the characteristics of fatal accidents due to exogenous causes.

RESULTS

Eighty-four subjects (48 skiers and 36 snowboarders) were analyzed. Males accounted for 73 cases of all 84 fatalities (86.9%), including 44 skiers (91.7%) and 29 snowboarders (80.6%). Skiers aged ≥50 y and snowboarders aged 20-35 y had the highest number of fatal accidents (32 and 18 cases, respectively). Regarding location, 26 fatal accidents occurred on slopes, and 58 occurred out of slopes (skiers, 11 and 37 cases; snowboarders, 15 and 21 cases, respectively). Among skiers, head and neck trauma accounted for the cause of death in 13 cases (27.1%) and asphyxiation in 11 cases (22.9%). Among snowboarders, head and neck trauma accounted for the cause of death in 14 cases (38.9%) and asphyxiation in 14 cases (38.9%).

CONCLUSIONS

Males, particularly those aged ≥50 among skiers and 20-35 among snowboarders, should be wary of the potential for injuries to the head, neck, and airway when skiing or snowboarding. In this study, traumatic deaths from crashing into trees and asphyxiation from deep snow immersion accidents accounted for approximately half of fatal ski accidents in Japan.

Urban climate and cardiovascular health: Focused on seasonal variation of urban temperature, relative humidity, and PM2.5 air pollution

Seasonal effects on subclinical cardiovascular functions (CVFs) are an important emerging health issue for people living in urban environment. The objectives of this study were to demonstrate the effects of seasonal variations of temperature, relative humidity, and PM2.5 air pollution on CVFs. A total of 86 office workers in Taipei City were recruited, their arterial pressure waveform was recorded by cuff sphygmomanometer using an oscillometric blood pressure (BP) device for CVFs assessment. Results of paried t-test with Bonferroni correction showed significantly increased systolic and diastolic BP (SBP, DBP), central end-systolic and diastolic BP (cSBP, cDBP) and systemic vascular resistance, but decreased heart rate (HR), stroke volume (SV), cardio output (CO), and cardiac index in winter compared with other seasons. After controlling for related confounding factors, SBP, DBP, cSBP, cDBP, LV dp/dt max, and brachial-ankle pulse wave velocity (baPWV) were negatively associated with, and SV was positively associated with seasonal temperature changes. Seasonal changes of air pollution in terms of PM2.5 were significantly positively associated with DBP and cDBP, as well as negatively associated with HR and CO. Seasonal changes of relative humidity were significantly negatively associated with DBP, and cDBP, as well as positively associated with HR, CO, and baPWV. This study provides evidence of greater susceptibility to cardiovascular events in winter compared with other seasons, with ambient temperature, relative humidity, and PM2.5 as the major factors of seasonal variation of CVFs.

Manual vs Mechanical Cardiopulmonary Resuscitation for Out-of-Hospital Cardiac Arrest on a Ski Slope: A Pilot Study

INTRODUCTION

The quality of cardiopulmonary resuscitation (CPR) is critical in increasing the probability of survival with a good neurologic outcome after out-of-hospital cardiac arrest. In an austere environment with a potentially salvageable patient, bystanders or first responders may need to provide chest compressions for a prolonged duration or during physically challenging transportation scenarios. Consequently, they may be at risk of fatigue or injury, and chest compression quality may deteriorate. The study sought to assess whether or not access to and utilization of a mechanical compression device (Lund University Cardiopulmonary Assist System) was feasible and not inferior to manual compressions while extricating and transporting a patient from a ski slope.

METHODS

Variable 3-person ski patrol teams responded to a simulated patient with out-of-hospital cardiac arrest in a nonshockable rhythm. Using a mannequin and CPR quality monitor, performance during manual CPR was compared with that of a mechanical compression device. This is a prospective, crossover analysis of CPR quality during extrication from a ski slope. Across 8 total runs, chest compression fraction, which is the proportion of time without spontaneous circulation during which compressions occurred, and high-quality CPR, as measured by appropriate rate and depth, were compared between the 2 groups. Extrication times between the 2 groups were also measured.

RESULTS

There was no difference in compression fraction between the manual (91.4%; 95% CI [86.8-96.1]) and mechanical arms (92.8%; 95% CI [88.8-96.8]) (P=0.67). There was an increase in the time performing high-quality CPR in the mechanical group (58.5%; 95% CI [45.8-71.2]) vs that in the manual group (25.6%; 95% CI [13.5-37.8]) (P<0.001). There was a statistically significant difference in the extrication times between the 2 groups, 7.6 ± 0.5 min in the manual group vs 8.6 ± 0.4 min in the mechanical group (P=0.014).

CONCLUSIONS

Mechanical CPR devices are noninferior for use in ski areas during initial resuscitation and transportation. Compared with manual CPR, mechanical CPR would likely improve the fraction of time performing high-quality CPR.

Sex differences in sledging injuries: a retrospective 10-season study from a Swiss level 1 trauma centre

Objectives

Sledging is a popular and traditional winter sport in Switzerland. This study examines injury patterns of patients who presented to a tertiary trauma centre in Switzerland following sledging trauma, focusing on sex differences.

Methods

Retrospective single-centre study over 10 winters (2012-2022), including all patients experiencing sledging-related trauma. Injury history was collected and analysed from the patient data and demographic information. The Abbreviated Injury Scale and the Injury Severity Score (ISS) were used to classify injury types and severity.

Results

193 patients were identified with sledging injuries. The median age was 46 (IQR 28-65), and 56% were female. The most frequent mechanism of injury was a fall (70%), followed by collision (27%) and other fall on slopes (6%). Lower extremities (36%), trunk (20%) and head/neck (15%) were the most frequently injured body areas. Fourteen per cent of patients were admitted with head injuries, whereas females were significantly more likely to present with head injuries than males (p=0.047). Males were significantly more often admitted with fractures to the upper extremities than females (p=0.049). The median ISS was 4 (IQR 1-5), without significant differences between males and females (p=0.290). The hospital admission rate was 28.5% for sledging-related injuries. The median length of stay for patients admitted to the hospital was 5 (IQR 4-8) days. The total cost for all patients was CHF1 292 501, with a median of CHF1009 per patient (IQR CHF458-CHF5923).

Conclusion

Sledging injuries are common and may result in serious injuries. The lower extremities, trunk and head/neck are frequently injured and could be specifically protected with safety devices. Multiple injuries were statistically more frequent in women compared with men. Males were significantly more often admitted with fractures to the upper extremities, and females were more likely to sustain head injuries. The findings can help to develop data-driven measures to prevent sledging accidents in Switzerland.

Winter Sports Injuries in Elite Female Athletes: A Narrative Review

There is a lack of reviews covering the topic of the parallel high prevalence of injuries in female winter sport elite athletes. We aimed to review the data on incidence and patterns of injuries in female athletes participating in official competitions of winter sports. We conducted a comprehensive literature search on epidemiological data and etiological information on alpine skiing, snowboarding, ski jumping and cross-country skiing. The most common location of injury was the knee among skiers and ski jumpers and the incidence of severe ACL events was 7.6 per 100 ski racers per season (95% CI 6.6 to 8.9) in female alpine skiers. Snowboarders and cross-country skiers were more affected in the ankle and the foot. The most common cause was contact trauma with stagnant objects. The injury risk factors include training volume, knee pre-injuries, the period of the season and the technical equipment. Females are at greater risk of suffering from overuse injuries during the competitive season, as opposed to male athletes who are more likely to suffer from traumatic injuries. Our findings can be used to inform coaches and athletes and to guide future injury prevention plans.

Epidemiology of sport climbing injuries caused by a climbing fall among climbers of the French Federation of Mountain and Climbing

BACKGROUND

Fall-related injuries (FRIs) are the most severe sport climbing injuries. The main objective of this study was to measure FRI prevalence and risk factors in a representative sample of climbers of the French Federation of Mountain and Climbing. The second objective was to explore FRI mechanisms.

METHODS

The study included 3919 climbers aged 16+. They were invited to fill out an online questionnaire where they reported sociodemographics, sport-related characteristics and whether they had sustained an FRI in the past 12 months (12-FRI), and over their entire career (ALL-FRI). The mechanisms of 12-FRI were asked for. Multivariable logistic regression analyses were performed to evaluate the association between sport-related characteristics and FRI.

RESULTS

Nine per cent of the participants reported a 12-FRI and 29% an ALL-FRI. No statistically significant effect of sex, context of climbing, or onsight level was observed on 12-FRI. Climbers with 0-3 years of experience (YE) were 1.7 (95% CI: 1.2-2.6) and 3.6 (95% CI: 2.2-6.3) times more likely to have sustained a 12-FRI compared with those with 5-8 YE and 14-23 YE, respectively. An interaction effect was found between YE and onsight level. Among climbers with 0-8 YE, those with a higher onsight level had a higher risk of 12-FRI. Natural falls, unexpected falls and static belaying were the most commonly reported 12-FRI mechanisms.

CONCLUSIONS

These results highlight that future FRI prevention programs should target priority-inexperienced climbers who have progressed rapidly. Climbers should be taught as a priority to stay focused while belaying even in the least difficult passage, and to belay dynamically.

Herz-Kreislauf-Stillstand im alpinen Gelände

Die Anzahl von Touristen und Freizeitsportlern in Bergregionen nimmt zu. Im Verhältnis dazu steigt auch die Zahl an Notfallsituationen wie Herz-Kreislauf-Stillstand. Wiederbelebungsmaßnahmen in diesen Umgebungsbedingungen sind anspruchsvoll. Eine besondere Bedeutung in diesem Rahmen hat die prolongierte kardiopulmonale Reanimation.

Risk Factors for Accidents and Close Calls in Junior Freeriders, Adolescent Alpine Skiers and Adult Freeriders-A Comparison

Understanding factors associated with risk-taking behavior, accidents and close calls could enhance prevention strategies and thus contribute to preventing serious injury or death in the long term. The following study aims to assess these factors in junior freeride athletes in comparison with competitive alpine skiers of similar age and adult freeriders. A cross-sectional questionnaire design was used to assess risk-related variables and potential associated factors. Accident and close call involvement did not significantly differ between the groups (p > 0.080). No significant relationships between gender and risk-related variables were found (|r| < 0.26). Precautionary behavior was higher in freeride adults and freeride juniors compared to alpine skiers (p < 0.001) and deliberate risk-taking was lower in freeride adults compared to junior freeriders and alpine skiers (p < 0.001). Regression analyses revealed that the association between self-objectification and accidents was stronger in freeride juniors compared to alpine skiers of similar age and freeride adults (p < 0.049). Although accidents and close calls were similar between groups, age seems to be an associated variable to deliberate risk-taking and precautionary behavior. The relationship between accidents and self-objectification in freeride juniors implicates a need for risk education in freeriders in the sensitive phase of adolescence beyond the mere presentation of environmental dangers.

Influence of Alpine Skiing on Health-Related Quality of Life and Physical Self-Concept in Physically Active Adults over 55 Years of Age

Background: Older adults have the highest rates of a sedentary lifestyle. Alpine skiing could be considered a suitable activity to encourage continued sports practice and improve the health of this population in winter. The aim of this study was to analyse the relationship between the practice of alpine skiing and health-related quality of life (HRQoL), physical self-concept (PSC), and sport motivation. Methods: The study design was cross-sectional and descriptive, involving 280 Spanish adults aged over 55 years and physically active (75.35% skiers). To assess physical activity, PSC, HRQoL, and sport motivation, we used the Rapid Assessment of Physical Activity Questionnaire (RAPA-Q), the Physical Self-Perception Profile (PSPP 30), the Health-Related Quality of Life (SF-36), and the Sport Motivation Scale (SMS) questionnaires, respectively. Results: In the skier’s group, higher values were found for PSC (p < 0.001; d = 0.64), the physical component of HRQoL (p < 0.001, d = 0.48), physical function (p < 0.001, d = 61), and intrinsic motivation (p < 0.001; d = 0.85). The practice of alpine skiing was associated with higher levels of the physical health component (ORadj = 2.13, 95% CI 1.18−3.95, p = 0.013), PSC (ORadj = 2.92, 95% CI 1.58−5.52, p < 0.001), and intrinsic motivation (ORadj = 2.24, 95% CI 1.22−4.23, p = 0.010). Conclusions: The practice of alpine skiing is positively associated with higher values of HRQoL, PSC, and intrinsic motivation, and based on the above, it seems that alpine skiing can contribute to healthy ageing and improve the quality of life of older adults.

Emergency Service Assistance for Injuries on Alpine Ski Slopes: A Cross-Sectional Study

OBJECTIVES

Injuries on alpine ski slopes have been described in cohorts of a reasonable sample size, but constant improvements in safety gear, increased use of airborne rescue, and safety measures during the coronavirus disease 2019 (COVID-19) pandemic mandate re-evaluation. Therefore, the purpose of this study was to evaluate skiing and snowboarding injuries, effectiveness of airborne rescue, and impact of the COVID-19 pandemic on a large sample size.

METHODS

Data on alpine injuries were prospectively collected from the state emergency services dispatch center in the state of Tyrol (Austria). A total of 10,143 patients were identified, with an average age of 33.5 years (SD = 20.36). The ski patrol was involved in 8,606 cases (84.9%) and some patients (n = 1,536; 15.1%) required helicopter rescue.

RESULTS

A total of 10,143 patients were identified from the dataset of the emergency dispatch center. The most frequently injured region was the knee (30.2%), and it was followed by the shoulder (12.9%), the lower leg (9.5%), and the head/skull (9.5%).

CONCLUSION

The present findings indicate that the most frequent site of injuries on alpine slopes is the knee, and life-threatening injuries are rare. Airborne rescue is very time-effective, however clinical studies with patient follow-up should be emphasized to determine the impact of airborne rescue on patient outcome. The present findings indicate that the duration of all rescue operations has been prolonged as a result of the introduction of safety measures during the COVID-19 pandemic.

Editorial on the Research Topic the 2nd Edition of Mountain Sports Activities: Injuries and Prevention

Mountain sports are continuously gaining popularity, currently fueled by the post-pandemic period expanding travel opportunities and the desire to escape the increasingly hot environmental conditions of urban areas—ambient temperature decreases by about 6 [...]

Intention to Engage in Mountain Sport During the Summer Season in Climate Change Affected Environments

Natural environments can make it easier to engage in regular physical activity, including mountain sport activities. However, global warming is expected to change natural environments, especially in mountainous regions with potential impacts on physical activity behavior. While there is some evidence of a reduced intention to engage in winter sport in climate change affected environments, little is known on the impact of climate change in mountain sports conducted in the summer season. Therefore, the present study aimed at comparing the effect of being exposed to a climate change affected scenario (CCA) to being exposed to a climate change unaffected scenario (CCU) on the intention to engage in summer mountain sport activities. Furthermore, we aimed to analyze the role of anticipated affective responses in the context of the Theory of Planned Behavior (TPB). Using a web-based experimental cross-sectional study design, participants were randomly allocated to scenarios of either CCA or CCU pictures. Participants were asked to complete questions about TPB variables and about affective responses referring to the displayed scenarios. Statistical analyses included tests on group differences and hierarchical linear regression analyses. TPB variables (intention to engage in summer mountain sport, attitude, and perceived behavioral control) did not show significant group differences between CCA (n = 155) and CCU (n = 156), p > 0.131; r < −0.10. Significantly lower anticipated affective valence was found in CCA compared to CCU, p < 0.001, r = −0.43. Affective valence did not significantly improve the TPB model, change in R² = 0.7%, p = 0.096. However, a higher affective valence was significantly associated with a higher attitude toward summer mountain sport, beta = 0.19, p < 0.001. Intention to engage in summer mountain sport was similar in the groups. Therefore, an immediate reduced engagement in mountain sport activities due to climate change seems unlikely in the summer season, although differentiated findings across various activities of summer mountain sport cannot be excluded. A reduced affective valence during summer mountain sport activities might occur in the presence of signs of climate change in the environment, which may lead to longer-term behavior changes in climate change affected scenarios also in the summer by repeated experiences of reduced valence.

Unchanged Fatality Rate on Austrian Ski Slopes during the COVID-19 Lockdown

Fatalities on ski slopes are very rare, with about one death per one million skier days. Whether the fatality rate is affected by substantial changes in the number of skier days and potentially associated alterations in the structure of the skier population is unknown. Thus, we compared the fatality rate on Austrian ski slopes in the winter season of 2020/21, when skiing activities were dramatically restricted during the COVID-19 lockdown, with those of the previous winter seasons. As a consequence of COVID-19 measures, the number of skier days dropped from over 50 million in previous years to 9.2 million skier days in the winter season of 2020/21. Still, the fatality rate (6.5 deaths/10 million skier days) was not different when compared to any of the seasons from 2011/12 to 2019/20. Despite the lack of international skiers and the reduction in skier days by more than 80%, the fatality rate remained surprisingly unchanged. The weather and snowfall conditions were on average comparable to those of previous winters, and, except for nationality, the composition of the skier population appears to have remained relatively unaltered. In conclusion, the fatality rate during downhill skiing is low and the absolute fatality numbers are primarily a function of the number of skier days.

Turbans vs. Helmets: A Systematic Narrative Review of the Literature on Head Injuries and Impact Loci of Cranial Trauma in Several Recreational Outdoor Sports

When in public, faith-based mandates require practising Sikh men to wear a turban which may not be covered by hats or caps. This makes it impossible for practising Sikhs to wear helmets and other protective headwear, mandatory in many countries and facilities for engagement in recreational pursuits (e.g., skiing) and on adventure outdoor recreation camps mandatorily run for school groups. The result is often social exclusion and ostracisation in the case of school children. Despite studies into the efficacy of protective helmets in some recreational outdoor activity settings, virtually nothing is known about the protective potential of turbans. This paper systematically reviews the extant literature on head injuries in several recreational outdoor activities and sports sectors (aerial, water, winter, wheeled and animal-based sports) and finds that the extant literature is of limited value when trying to understand the spatial distribution of trauma on the cranial surface. As the data do not permit to make inferences on the protective potential of turbans, future systematic, evidence-based epidemiological studies derived from hospital admissions and forensic examinations are required. Failure to do so perpetuates social exclusion and discrimination of religious grounds without an evidentiary basis for defensible public health measures.

High-altitude illnesses: Old stories and new insights into the pathophysiology, treatment and prevention

Areas at high-altitude, annually attract millions of tourists, skiers, trekkers, and climbers. If not adequately prepared and not considering certain ascent rules, a considerable proportion of those people will suffer from acute mountain sickness (AMS) or even from life-threatening high-altitude cerebral (HACE) or/and pulmonary edema (HAPE). Reduced inspired oxygen partial pressure with gain in altitude and consequently reduced oxygen availability is primarily responsible for getting sick in this setting. Appropriate acclimatization by slowly raising the hypoxic stimulus (e.g., slow ascent to high altitude) and/or repeated exposures to altitude or artificial, normobaric hypoxia will largely prevent those illnesses. Understanding physiological mechanisms of acclimatization and pathophysiological mechanisms of high-altitude diseases, knowledge of symptoms and signs, treatment and prevention strategies will largely contribute to the risk reduction and increased safety, success and enjoyment at high altitude. Thus, this review is intended to provide a sound basis for both physicians counseling high-altitude visitors and high-altitude visitors themselves.

Freeride Skiing-Risk-Taking, Recognition, and Moral Boundaries

Freeride skiing is an activity that is, or at least can be, quite dangerous. Risk-taking in high-risk sports has usually been understood within a psychological framework. Building on Pierre Bourdieu's sociology, this article highlights the social dimension of risk-taking in freeride skiing by scrutinizing values within a freeride culture. A central question in this article is: what kind of actions are given recognition and credibility in freeride skiing? The findings show that there is a clear link between risk-taking and credibility and that risk-taking might be seen as a form of capital. However, risk-taking's link to recognition is not straightforward—it is limited by the skiers' skill level. To further develop our understanding of the social dimension of risk-taking we use Michelle Lamont's theory of symbolic boundaries. By expanding the Bourdieusian understanding of social practice with Lamont's work, we gain insight into how risk-taking is socially regulated by social conventions within a subculture. This means that we in this article describe three social dimensions of risk-taking: (1) The link between risk-taking and recognition, (2) The limits of the risk-recognition nexus, and (3) The moral boundaries of risk-taking.

Sudden Cardiac Death Risk in Downhill Skiers and Mountain Hikers and Specific Prevention Strategies

Sudden cardiac death (SCD) still represents an unanticipated and catastrophic event eliciting from cardiac causes. SCD is the leading cause of non-traumatic deaths during downhill skiing and mountain hiking, related to the fact that these sports are very popular among elderly people. Annually, more than 40 million downhill skiers and mountain hikers/climbers visit mountainous regions of the Alps, including an increasing number of individuals with pre-existing chronic diseases. Data sets from two previously published case-control studies have been used to draw comparisons between the SCD risk of skiers and hikers. Data of interest included demographic variables, cardiovascular risk factors, medical history, physical activity, and additional symptoms and circumstances of sudden death for cases. To establish a potential connection between the SCD risk and sport-specific physical strain, data on cardiorespiratory responses to downhill skiing and mountain hiking, assessed in middle-aged men and women, have been included. It was demonstrated that previous myocardial infarction (MI) (odds ratio; 95% CI: 92.8; 22.8–379.1; p < 0.001) and systemic hypertension (9.0; 4.0–20.6; p < 0.001) were predominant risk factors for SCD in skiers, but previous MI (10.9; 3.8–30.9; p < 0.001) and metabolic disorders like hypercholesterolemia (3.4; 2.2–5.2; p < 0.001) and diabetes (7.4; 1.6–34.3; p < 0.001) in hikers. More weekly high-intensity exercise was protective in skiers (0.17; 0.04–0.74; p = 0.02), while larger amounts of mountain sports activities per year were protective in hikers (0.23; 0.1–0.4; <0.001). In conclusion, previous MI history represents the most important risk factor for SCD in recreational skiers and hikers as well, and adaptation to high-intensity exercise is especially important to prevent SCD in skiers. Moreover, the presented differences in risk factor patterns for SCDs and discussed requirements for physical fitness in skiers and hikers will help physicians to provide specifically targeted advice.

Editorial on the Special Issue on "Mountain Sports Activities: Injuries and Prevention"

Recreational outdoor activities like mountain sports are gaining large popularity all over the world and particularly in the Alpine regions [...].

Psychological Variables Related to Developmental Changes during Adolescence-A Comparison between Alpine and Non-Alpine Sport Participants

Alpine sport is a popular form of exercise and provides several skills that are potentially relevant for positive development during adolescence. However, empirical data on differences between alpine and non-alpine sport participants in variables related to developmental changes are lacking. Therefore, the primary aim of the present study was to analyze differences in self-esteem and additional variables between adolescent alpine and non-alpine sport participants. A comparison to non-regular exercisers was conducted for self-esteem. In a cross-sectional design, information on self-esteem, sensation seeking, agency, and emotion regulation was collected in 183 adolescents [(mean age: 15.4 (SD: 2.3) years, 71.0% female)]. Alpine sport participants reported significantly higher self-esteem compared to non-regular exercisers, p = 0.003, d = 0.95, but not compared to non-alpine sport participants, p = 0.774, d = 0.06. When controlling for sex and high-risk sport engagement, alpine sport participants showed a significantly higher experience of agency compared to non-alpine sport participants, p = 0.016, d = 0.46. We conclude that alpine sport participation is less relevant with regard to self-esteem compared to regular exercise. However, the characteristics of alpine sport might provide a trigger for higher experience of agency during sport participation, potentially helping to satisfy the increased need for autonomy and independence in adolescence.