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The ‘H2O’ swimming slogan illustrates the life of the competitive swimmer as one that is driven by devotion and passion. For the aquatic team physician, this slogan begs the questions: What exactly do we know about the adaptations of the swimmer's heart to the years of endurance training? How is the elite swimmer's heart different to population norms? What else should we be doing to preserve the swimmer's health (figure 1)?
Swimming is rich with legendary stories of successful athletes: the eight Olympic gold medals of Michael Phelps, the renowned feats of Ian the ‘Thorpedo’ and the television success of Tarzan ‘Johnny Weissmuller’, who won both swimming and water polo Olympic medals. But sadly, not all careers have a fairy-tale ending as swimmers’ careers are often ended prematurely by preventable sport-related injury or illness. Although uncommon, elite swimmers also suffer from sudden cardiac death, as evident in the 2012 death of the 100 m breast stroke world record holder, Alexander Oen.
The Olympic Charter obliges all International Federations to encourage and support measures to protect the health of athletes. The Olympic Movement Medical Code further expands these health protection mandates, which are also reflected in the Fédération …