Swimming: exercise with unique life-long benefits

Swimming: exercise with unique life-long benefits

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Highlights:

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• Swimming is one of the most popular physical activities, which carries all the benefits of on-land activities but provides some unique advantages
• Due to the exercise being carried out in a "weightless" state, swim training is less strenuous than other types of exercise and can be easily adopted by elderly frail people
• Swimming is particularly beneficial for cardiovascular and pulmonary health, with additional benefits for general well-being
• Though longevity effects in humans are not well-studied, it was shown that swimming could save around three years of life
• Experiments in rodents show that swimming can activate sirtuin 1 and 3 genes, which is closely related to the extended lifespan

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Introduction: Uniqueness of swimming

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Physical fitness and well-being strongly depend on regular physical activity, which is an inseparable part of healthy aging. Regular exercise has been shown to improve muscle strength, organ function, and cognitive abilities in the elderly. Swimming, though another form of exercise, drastically differs from other traditional activities that require weight-bearing. As extremities and most of the body are underwater, swimming occurs in a nearly zero-gravity situation. Thus, it has a minimal impact on vulnerable joints, such as the hip, knee, or ankle. This leads to a lower injury prevalence and expands the exercise applicability to older frail people.

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Health benefits associated with swimming

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At the moment, swimming is frequently and unfortunately omitted from the studies of physical activity effects. Most studies exploring the connection between physical activity and health focus on interventions, such as walking, cycling, running, or aerobics classes (1,2). Also, a majority of existing studies on swimming are focused on professional athletes and improving their performance.

However, the body of research targeted at improving the general population's health through swimming exercise is slowly growing. The benefits of this type of exercise for the aging population are of particular interest. Due to its safety, weight-bearing environment, and decreased heat load, swimming is especially beneficial for the elderly and targets many age-related conditions. Also, swimming proficiency tends to decline slower than, for example, running performance. Swimming and other aquatic exercises (such as aqua-aerobics or aqua-jogging) are some of the most popular ways of meeting physical activity recommendations (3).

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From existing research (4), regular swimming can improve several physical parameters:

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• endurance,
• muscle strength,
• and maximum oxygen consumption.

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Chase et al. (1) compared the health aspects of swimming with exercise alternatives and sedentary behavior, including more than 10 thousand women and more than 35 thousand men aged 20-88 years. The results showed that, though all types of physical activity produced health benefits, swimming and running achieved the highest scores in duration tests. Regarding physical health, swimming was shown to be particularly beneficial for cardiovascular, pulmonary, musculoskeletal, and neurological systems.

Neck-depth immersion in water results in relief of vasoconstriction (narrowing of blood vessels) and release of nitric oxide, both of which carry out a cardioprotective role (5). Swimming tends to slightly increase blood pressure in normotensive individuals, but it seems to normalize pressure in people with hypertension (2,6). Aquatic exercise is also one of the most widely used forms of cardiac rehabilitation in heart failure and coronary heart disease (7,8).

Of interest are specific effects of swim training on blood lipids and insulin sensitivity. In a systematic review, Delevatti et al. analyzed eight studies on the effects of prolonged aquatic training (8-24 weeks) (9). All studies demonstrated significant improvement regarding at least one parameter among lipid profile characteristics or blood glucose.

The pulmonary system can also benefit from water immersion. Swimming-based exercises have long been used as rehabilitation for individuals with chronic obstructive pulmonary disease. In a Cochrane review by McNamara et al., five studies were analyzed, with interventions ranging from four to twelve weeks (10). Though little information was available for long-term interventions, the studies provided limited evidence of the advantages of water-based training over land-based ones.

One of the prominent age-related problems is difficulties with body balance, resulting from neural system dysfunctions. These can be further burdened with age-related sarcopenia, leading to a significantly increased risk of falls and traumas. In a population-based cohort study of more than one and a half thousand men, the researchers examined the link between physical activity and the incidence of falls (11). Swimming demonstrated a significant protective effect and improvement in movement. Several other studies described that regular swimming could support balance in coordination by the elderly (12–14).  

Except for the main effects discussed above, swim training can also improve multiple musculoskeletal conditions (15), help manage osteoarthritis and strengthen bone structure (16), and improve the mobility of individuals with neurological diseases (such as Parkinson's disease and multiple sclerosis) (17).

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Aquatic sports, brain health, and well-being

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An abundant amount of evidence shows that physical activity, in general, positively impacts brain health and well-being (18,19). Swimming, as one of the most popular types of exercise, has immense potential in relation to this. In a study by de Oliveira et al., swimming was able to improve anxiety, stress, and self-esteem parameters in older women (20). However, there is still a lack of data on the specific effects of swimming on mental health, which hopefully will be covered by future research.

Mental health is not the only area of brain health where swimming is of interest. It was shown to improve cognitive function, with research implying long-term benefits (21). In the elderly, swimming exercise was shown to be a positive moderator of cognitive aging (22). Regular older swimmers had significantly better executive function than their sedentary peers of the same age and gender. And in people with dementia, swim training improved their well-being and reduced their psychological symptoms, especially in those who were engaged in aquatic exercise before (23).

Depending on the setting, aquatic exercise can add social, emotional, and cultural benefits. Though indoor swimming can be a more convenient option for many, outdoor swimming has multiple perceived well-being benefits, ranging from mental health improvement and injury symptom reduction (24) to a feeling of connectedness to nature and deep relaxation (25). Group aquatic activities can be a way to improve socialization and decrease perceived loneliness.

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Can swimming prolong life?

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Though all the benefits discussed above are directly related to increasing health- and lifespan (thus promoting longevity), there is scarce research on this specific topic. However, it was shown that swimming is inversely associated with all-cause mortality in men (26). Similar results were demonstrated by Oja et al. (27) in a cohort study of over 80 thousand British adults. Swimming was associated with a reduced risk of all-cause mortality of 28%. The Copenhagen City Heart Study results – a prospective study of more than eight thousand participants – demonstrated that life expectancy gained from swimming is 3.4 years compared to the sedentary group (28).

As for decreasing biological age, there is even less evidence. The mechanism behind that might be the epigenetic changes in known anti-tumor and anti-inflammatory genes, as a study of elite swimming athletes shows (29). A small study on non-professional swimmers showed that swim training could slow the aging rate in 30-35 years old (30). However, this data is extremely limited and incomplete and requires more robust confirmation.

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Insights from animal studies

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A bit more understanding of molecular mechanisms behind swimming can be obtained from animal studies. The study of continuous swimming training (31) demonstrated that rats involved in this exercise had increased levels of two proteins – PGC-1α (peroxisome proliferator-activated receptor gamma-coactivator 1 alpha) and SIRT3 (sirtuin 3). Both proteins are known to participate in energy metabolism and mitochondrial biogenesis, and upregulation of sirtuins has been commonly associated with longevity. Cardioprotective effects of swimming were associated with upregulated antioxidant capacity and improved Ca²⁺ handling in aged female rats with heart abnormalities (32). Another study addressed the age-related pathological changes in the hippocampus, which often lead to cognitive problems. Astudy (33) showed that swimming exercise stimulated longevity-related SIRT1 pathway and brain survival pathway in rats. However, this research is yet to be proven to be translatable to humans, the current data points toward putative mechanisms behind the benefits of swimming.

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What to advise your clients?

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• Explain to your clients the benefits of regular swimming exercise. Help them choose the best type of swimming exercise - solitary swimming or group exercises.
• Highlight the benefits and risks of different swimming media, depending on if it is an indoor pool or open water. Explain the strategies to minimize the risks, such as making informed choices about a place for swimming and using proper equipment (i.e., ear plugs, buoys for inexperienced swimmers).
• If there are any swimming communities in your area, you can suggest your client join them for more robust motivation and additional socialization benefits. Another good option might be to enroll in a swimming course.
• Multiple wearables on the market can support tracking your client's swimming progress, such as fitness trackers (i.e., Fitbit), smartwatches (i.e., Apple Watch), or even goggles (Form Smart Swim Goggles).
• Assess the associated health risks, depending on your client's condition. The chosen swimming exercise routine and its intensity should be adjusted according to the current health condition. While, for example, high-intensity swimming might be recommended to prevent cardiovascular problems and obesity, low intensity should be preferred for older people with already existing cardiovascular problems.
• Swimming can be modified to swimming in cold or thermal water, which requires additional health considerations.

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Conclusions

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Swimming is one of the unique exercise activities known to humans and one of the least strenuous when done properly. Incorporating swimming into your client's longevity routine would benefit not only their physical health, mental health, and general well-being.

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References

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2. Mohr M, Nordsborg NB, Lindenskov A, Steinholm H, Nielsen HP, Mortensen J, et al. High-Intensity Intermittent Swimming Improves Cardiovascular Health Status for Women with Mild Hypertension. BioMed Res Int. 2014;2014:1–9.
3. Lazar JM, Khanna N, Chesler R, Salciccioli L. Swimming and the heart. Int J Cardiol. 2013 Sep;168(1):19–26.
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