This article analyzes whether climbing, a motor activity featured by upward movements by using both feet and hands, generation of new strategies of motor control, maintenance of not stable equilibrium and adoption of long-lasting quadrupedal posture, is able to modify specific brain areas. MRI data of 10 word-class mountain climbers (MC) and 10 age-matched controls, with no climbing experience were acquired. Combining region-of-interest analyses and voxel-based morphometry we investigated cerebellar volumes and correlation between cerebellum and whole cerebral gray matter. In comparison to controls, world-class MC showed significantly larger vermian lobules I-V volumes, with no significant difference in other cerebellar vermian lobules or hemispheres. The cerebellar enlargement was associated with an enlargement of right medial posterior parietal area. The specific features of the motor climbing skills perfectly fit with the plastic anatomical changes we found. The enlargement of the vermian lobules I–V seems to be related to highly dexterous hand movements and to eye-hand coordination in the detection of and correction of visuomotor errors. The concomitant enlargement of the parietal area is related to parallel work in predicting sensory consequences of action to make movement corrections. Motor control and sensory-motor prediction of actions make the difference between survive or not at extreme altitude. Hum Brain Mapp 34:2707–2714, 2013. © 2012 Wiley Periodicals, Inc.