In Austria, more than 10 million hikers and skiers annually visit moderate altitudes. Nevertheless, there is little information on the frequency of cardiovascular diseases in mountaineers and the exercise responses during physical activity in the mountains. The prevalence of cardiovascular diseases was determined by an inquiry of 527 mountain hikers and 785 alpine skiers. Two groups (n = 35) performed step tests at low altitude (600 m) and at high altitude (2000 m and 3500 m). Exercise responses to hiking and skiing were recorded in the subjects of the third group (n = 10). Hiking and skiing at moderate intensity evoked moderate cardiovascular and metabolic responses which are also well tolerated by persons with non-severe cardiovascular and respiratory diseases. Low fitness, increasing altitude and intensity increased exercise responses, thereby enhancing the probability of cardiovascular events. A high degree of fitness based on regular training decreases exercise responses and improves exercise tolerance.