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So I moved back from Colorado to North Carolina last summer for a 2 year grad program. I'm going to Peru at the end of the summer but am worried that I won't be able to train for the types of climbs I want to do in the Cordillera Blanca b/c I don't have access to the same mountains--so no long, 22 hour days at altitude, carrying a pack over uneven terrain, fighting the cold, front-pointing up steep snow, etc. I've been getting out to the AT with a pack on to do some 20+ mile days on the hardest sections of the AT I can find to try and simulate long days, and also doing a shit-load of stairs with a pack on. But how ready can I get? Would be interested in hearing how people in my area or in similar situations got ready for the likes of Artesonraju, Alpamayo, Huascaran, etc all while living in the flat-lands....

Not sure how applicable my experience. (I have multiple climbs in the Cascades, did Jeff and Middle SIster in a bit over 3 days last month. Have done some long days in the SE; hiked 75 miles in Sequoia/Kings Canyon in 5 days.) Sounds like you're doing what you need to do. Biggest elevation gains are trails up LeConte from Cherokee Orchard, Baxter Creek tr at Mt Sterling, Snake Den Ridge to AT at Mt Guyot spur(all Smokies), something up Mitchell. I maintain fitness with a bicycle and backpack. Have fun

Having sort of been in your situation (I'm an east coaster who went to Bolivia for a month on very short notice), I would say agree with edoc that physical conditioning is pretty much all you can do out East in terms of preparation. I would just emphasize that when it comes time for the actual trip, the importance of acclimatization cannot be overstated. For me, this was by far the biggest issue, and unfortunately one that you cannot prepare for by training back home. That said, you can begin your altitude preparation here, in a sense, by planning the trip carefully in such a way as to minimize the effects. Start by getting a Diamox prescription from your PCP. Don't wait until you feel like crap to take the diamox - start taking it while on the plane. Plan your trip with as much acclimatization as possible - 4-5 days MINIMUM, a week even better, if time allows. I know you're from Colorado and know something about altitude, but the Andes are a totally different story. Anyway, acclimatization strategies is not the topic here so I won't go into any further; my point is that in my experience, this is the single most difficult issue about high-altitude mountaineering, and your best preparation is a combination of maximum physical conditioning and an itinerary that emphasizes acclimatization as much as possible.

P.S. I have not been to Artensoraju but know people who have, and from everything I hear it should be amazing!