Hypothesised mechanisms of swimming-related death: A systematic review
Abstract
BACKGROUND: Recent reports from triathlon and competitive open-water swimming indicate that these events have higher rates of death compared with other forms of endurance sport. The potential causal mechanism for swimming-related death is unclear. OBJECTIVE: To examine available studies on the hypothesised mechanisms of swimming-related death to determine the most likely aetiologies. MATERIAL AND METHODS: MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews (1950 to present) were searched, yielding 1950 potential results, which after title and citation reviews were reduced to 83 possible reports. Studies included discussed mechanisms of death during swimming in humans, and were Level 4 evidence or higher. RESULTS: A total of 17 studies (366 total swimmers) were included for further analysis: 5 investigating hyperthermia/hypothermia, 7 examining cardiac mechanisms and responses, and 5 determining the presence of pulmonary edema. The studies provide inconsistent and limited-quality or disease-oriented evidence that make definitive conclusions difficult. CONCLUSIONS: The available evidence is limited but may suggest that cardiac arrhythmias are the most likely aetiology of swimming-related death. While symptoms of pulmonary edema may occur during swimming, current evidence does not support swimming-induced pulmonary edema as a frequent cause of swimming-related death, nor is there evidence to link hypothermia or hyperthermia as a causal mechanism. Further higher level studies are needed.
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Cardiac arrhythmias appear to be the most likely cause of death related to swimming events.
“The available evidence is limited, but cardiac arrhythmias appear to be the most likely cause of death related to swimming events.”
From Nutrition-Related Adverse Outcomes in Endurance Sports Competitions: A Review of Incidence and Practical Recommendations (2020) · cites this paper as [63]
There is a theoretical relationship between body water balance and the development of cardiac arrhythmias.
“Although the mechanisms of cardiac arrhythmias are not clearly defined, there is a theoretical relationship between body water balance and their development [63].”
From Nutrition-Related Adverse Outcomes in Endurance Sports Competitions: A Review of Incidence and Practical Recommendations (2020) · cites this paper as [63]
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Additional file 1 of Hypothesized mechanisms of death in swimming: a systematic review
Yao, Y., DiNenna, M. A., Chen, L., Jin, S., He, S., & He, J. (2024) · Figshare · doi:10.6084/m9.figshare.26659204
Additional file 2 of Hypothesized mechanisms of death in swimming: a systematic review
Yao, Y., DiNenna, M. A., Chen, L., Jin, S., He, S., & He, J. (2024) · Figshare · doi:10.6084/m9.figshare.26659207
Steins, H. (2026) · Wilderness and Environmental Medicine · doi:10.1177/10806032251414379
- Authors
- Asplund, C. A., & Creswell, L. L.
- Affiliations
- Georgia Southern University (US)
- University of Mississippi Medical Center (US)
- Corresponding author
- Asplund, Chad A
- Venue
- British Journal of Sports Medicine
- Publisher
- BMJ
- Published
- 2016-03-03
- Volume
- 50
- Issue
- 22
- Pages
- 1360-1366
- ISSN
- 0306-3674 (ISSN-L)
- 1473-0480
- OpenAlex
- W2291863725
- Cited by
- 30
- References
- 28
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 6 · 2023: 2 · 2021: 4 · 2020: 3 · 2019: 3 · 2018: 3 · 2017: 2 · 2016: 1
- FWCI
- 0.52
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- British Journal of Sports Medicine (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Effects of Exercise
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Sports injuries and prevention
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Injury Epidemiology and Prevention
- Keywords
- drowning, triathlon, open water swimming, cardiac arrhythmias, pulmonary edema, hypothermia, hyperthermia, endurance sports
- MeSH terms
- Arrhythmias, Cardiac, Cause of Death, Humans, Pulmonary Edema, Swimming
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