A progressive build-up of physical activity prior to the pilgrimage is advisable, to condition the body and mind for the physical and mental demands of the pilgrimage.

Walking a few miles a day would be sufficient preparation to optimise exercise tolerance.

Transport has improved considerably, with efficient train and bus routes now available along parts of the pilgrimage course for those who find walking long distances difficult.

Anyone travelling for Hajj should be adequately immunised.

A certificate of the quadrivalent meningococcal ACWY vaccine is required for visa attainment.

Those at high risk should be offered the influenza vaccine. Pneumococcal, typhoid, hepatitis A, hepatitis B, MMR, and polio immunisations should all be up to date.

Women may wish to delay their menses using medication.

Pilgrims with chronic disease must carry sufficient medicines for the journey and prescription details. A diagnostic summary small enough to fit into a travel pouch would enable a rapid assessment in the 141 established primary medical centres or 24 hospitals within the immediate vicinity of the Hajj.

Pilgrims with diabetes mellitus need to be advised to eat regular meals, check blood sugars often, and maintain medication compliance.

If on insulin, they will need a letter for transport of needles and syringes through airports.

They should be reminded about hypoglycaemic awareness, and should carry appropriate foods when performing the pilgrimage rites to prevent exertion-induced hypoglycaemia.

Good footwear is important, however the type must be religiously permitted according to the pilgrim’s school of Islamic law.

Blistering heat in the day is common while walking, and thus feet are prone to blisters. If bare-footed (not recommended) then the risk of infection, burns, and cuts, especially in pilgrims with diabetes, is high. 

The heat during Hajj (>40 degrees celsius in summer months) carries risks of heat exhaustion and heatstroke.

To avoid this, patients should be reminded of simple practical measures: avoiding prolonged exposure to the sun, drinking and carrying plenty of fluid, using unscented sunscreen, and keeping one’s head covered where possible (men cannot directly cover their heads during Hajj, but can use a white umbrella to deflect sunlight).

During the Hajj, men may get their head shaved and women may shorten their hair.

The razors used by street barbers may not always be clean and thus pilgrims should insist on a new razor blade, to reduce the chance of blood-borne virus exposure (for example, HIV, and hepatitis B and C).