Freshwater sports and infectious diseases: A narrative review.

Freshwater sports involve a wide range of practices leading to contact with soil and water that can entail exposure to agents of potential infectious diseases. The pathogens can be multiple (bacteria, parasites, viruses, fungi), and be either well-known or more unfamiliar and exotic. We conducted a literature review to describe various infections contracted following exposure to water and mud during freshwater sport activities. Out of the 1011 articles identified, 50 were finally included. Our findings encompassed bacterial infections (leptospirosis and gastrointestinal infections); parasitic infections (schistosomiasis, cercarial dermatitis); viral infections (norovirus and other gastrointestinal viruses; seaweed contamination; and fungal infections. These infections were reported in various countries worldwide among diverse freshwater sport activities, including swimming, surfing, kayaking, as well as extreme sports such as adventure races and mud runs. Water sports in freshwater can expose participants to infectious risks according to geographical location and type of sport. Because regular sport practice is beneficial for health, freshwater sports should not be avoided due to potential exposure to pathogens; that much said, certain precautions should be taken. In addition to adoption of preventive measures, participants should be informed about infectious risks and seek medical advice if symptoms appear after exposure. Current guidelines for assessment of bathing water quality do not suffice to ensure comprehensive evaluation of freshwater quality. Event organizers are called upon to pay close attention to environmental factors and meteorological events, to conduct timely sensitization campaigns, and to enforce appropriate safety measures.

Body morphology and handgrip strength parameters of the female canoe slalom paddlers.

Introduction: Canoe slalom is a physically very demanding discipline, in which body constitution, body composition, and relative strength are significant factors in high performance. Although anthropometric and strength parameters are relatively well-studied in male athletes, there is a lack of evidence for any conclusions in women. Therefore, the objective of this study was to determine the morphology and upper-limb strength parameters of female canoe slalom paddlers and identify whether morphological differences exist between performance groups. Methods: Altogether, 63 female competitors of the 2023 ICF Canoe Slalom World Cup (n = 29) and 2023 ICF Canoe Slalom World Ranking Competition (n = 34) in Prague (Czech Republic) were examined with a battery of anthropometric tests, segmental bioimpedance analysis, and handgrip strength test. The athletes were divided into groups according to age and performance: elite athletes belonging to the world top 10 according to the ICF World Ranking (WORLD, n = 7), international-level athletes competing during the World Cup (ELITE, n = 22), international-level junior athletes competing in the World Ranking Race (JUNIOR, n = 17), and other lower performance-level athletes competing in the World Ranking Race (REST, n = 17). Results: Female slalom paddlers are, in general, of average body height (∼165 cm), lower body mass (∼60 kg), BMI (∼22 kg/m2), and body fat (∼20%) and without exceptional anthropometric dimensions and proportions. However, differences were detected when performance was factored in. Female paddlers belonging to the world TOP 10 have the largest circumferences of arms and forearms, and their somatotype is more mesomorphic, with a lower proportion of total body fat and a higher proportion of muscle mass. In addition, the WORLD group differs significantly in upper-limb strength. Discussion: The results shows the significance of muscular strength and power for canoe slalom athletes and the importance of well-developed musculature in operating the boat in the unstable environment. Being a successful female canoe slalom athlete requires a well-developed musculature, maximizing strength capabilities while maintaining a low body weight through limited hypertrophy of the lower limbs and a low level of body fat.

Strength and strength-related anthropometric parameters of the international level canoe slalom male paddlers / Fuerza y parámetros antropométricos relacionados con la fuerza de los hombres remeros de canotaje slalom de nivel internacional

SUMMARY: The aim of the study was to determine the differences in hand-grip strength and strength-related anthropometric parameters between the highest-performance international paddlers (HILP) and other international paddlers (ILP) in canoe slalom. In male competitors (n=48; 23 canoeists and 25 kayakers) who took part in the 2018 European championship event in canoe slalom in Prague, Czech Republic representing 15 European countries were measured hand-grip strength and strength-related anthropometric parameters two days prior the event. Differences between the group of HILP (medallists from Olympic Games, world championship and European championship in the previous three years and European championship finalists at the same time) and ILP were found. HILP have significantly higher forearm, arm and chest girths than ILP. Moderate or high practical differences and margin statistic differences were found also for hand-grip strength, body weight, body mass index and age. The consistently high-performing paddlers are heavier, have more muscular upper body and are stronger than the other group, while keeping their lower body lean. Therefore, regular upper-body strength training to all canoe slalom paddlers is important but caution is required because body weight over 80 kg may be a limiting factor.

RESUMEN: El objetivo del estudio fue determinar las diferencias en la fuerza de prensión manual y los parámetros antropométricos relacionados con la fuerza entre los remeros internacionales de alto rendimiento (RIAR) y otros remeros internacionales de canotaje en slalom. En hombres competidores (n=48; 23 piragüistas y 25 kayakistas) que participaron en el campeonato europeo de slalom en canoa de 2018, en Praga, República Checa, que representa a 15 países europeos, se midió la fuerza de agarre manual y los parámetros antropométricos relacionados con la fuerza dos días antes del evento. Se encontraron diferencias entre el grupo de RIAR (medallistas de Juegos Olímpicos, campeonatos del mundo y campeonatos de Europa en los tres años anteriores y finalistas del campeonato de Europa al mismo tiempo) y remeros internacionales. Los RIAR presentaban circunferencias de antebrazo, brazo y pecho significativamente más altas que los remeros internacionales. Además, se encontraron diferencias prácticas moderadas o altas y diferencias estadísticas en el límite para la fuerza de prensión manual, el peso corporal, el índice de masa corporal y la edad. Los remeros de alto rendimiento son más pesados, tienen la parte superior del cuerpo más musculosa y son más fuertes que el otro grupo, mientras mantienen la parte inferior del cuerpo esbelta. Por lo tanto, es importante el entrenamiento regular de fuerza de la parte superior del cuerpo para todos los remeros de piragüismo, sin embargo se requiere precaución debido a que el peso corporal superior a 80 kg puede ser un factor limitante.

The epidemiology of surfing injuries in a major Australian Centre - A ten year clinical audit.

INTRODUCTION: Australia is one of the largest surfing nations with over 10% of the population participating; yet there is a paucity of literature analysing the injuries from surfing participation, particularly injuries requiring orthopaedic care. This study retrospectively analyses surfing injuries presenting to a tertiary hospital Emergency Department over a ten-year period with aims of quantifying surfing injuries and investigating injury characteristics requiring orthopaedic input. METHODS: A retrospective clinical audit of presentations to Gold Coast Public Hospital Emergency Departments over a ten-year period was conducted using electronic hospital databases. Broad search teams were used to identify presentations, followed by exclusion based on relevance. Subsequent analysis of data was performed to investigate patient demographics and injury characteristics. RESULTS: A total of 2680 surfing related injury presentations were analysed. The median age was 30 years (range 2-77), with 455 females (17%) and 2225 males (83%). Lacerations were the most common injury type (37.9%), followed by ligament injury (21.3%), fractures (12.2%), and contusions (11.4%). The most common areas for lacerations were head/face (59.2%), lower limb (30%), and upper limb (26.5%). Dislocation rate was 4.9%, with shoulder dislocation (76.5%), and patella dislocation (12.1%) being the most common types. 1512 presentations (56.4%) required orthopaedic management. 93.5% did not require admission and were discharged. CONCLUSION: Over half (56.4%) of surfing injuries were orthopaedic in nature; requiring orthopaedic advice or management. Lacerations, ligament injury, fractures and dislocations were the most commonly managed injuries. This emphasises the importance of understanding the prevalence and characteristics of surfing injuries for an orthopaedic service.

Skimboarding: An Increasingly Recognized Cause of Life-Threatening Spinal Cord Injury.

Skimboarding is a sport that combines elements from aquatic and terrestrial sports and has gained popularity with increased riskier maneuvers. Spinal cord injuries associated with this sport have rarely been reported. Here we present a case of a previously healthy 44-year-old male with a life-threatening C2/C3 fracture and dislocation after a skimboarding fall. Traumatic facet dislocations in the cervical spine are usually consequent to high-energy transmission injuries, so it is difficult to explain the mechanism of injury in this clinical case. As this sport's practice continues to grow, our purpose is to emphasize that these injuries may occur with irreversible consequences as most of the damage occurs at the time of presentation, so the first step is to alert athletes and the community to prevent them.

Origin of the Fastest 5 km, 10 km and 25 km Open-Water Swimmers-An Analysis from 20 Years and 9819 Swimmers.

In elite pool swimmers competing at world class level, mainly athletes from the United States of America and Australia are dominating. Little is known, however, for the nationality of dominating swimmers in elite open-water long-distance swimming races such as the official FINA races over 5 km, 10 km and 25 km-held since 2000. The aim of this study was to investigate the participation and performance trends by nationality of these elite open-water swimmers. Race results from all female and male swimmers competing in 5 km, 10 km and 25 km FINA races between 2000 and 2020 were analyzed. A total of 9819 swimmers competed between 2000 and 2020 in these races. The five countries that figure most times among the top ten in 5 km, 10 km and 25 km races over the years were Italy, Germany, Russia, Brazil and the Netherlands. In 10 km races, considering the all the athletes from each country, male athletes from Germany, Italy, and France presented faster race times than the other countries. In 10 km, female athletes presented no significant difference among the countries. In 5 and 25 km races, there were no differences between countries, for male and female athletes. Moreover, comparing only the 10 best results (top 10) from each country, there were no differences between countries in 5 km, 10 km and 25 km, for male and female athletes. Men were faster than women for all three distances. In summary, male swimmers from Europe (i.e., Germany, Italy, France) are dominating the 10 km FINA races. In the 5 km and 25 km FINA races, there is no dominating nationality, but among the top five countries in the top 10 over the years, three are European countries.

Inter-Limb Jump Asymmetries and Their Association with Sport-Specific Performance in Young Male and Female Swimmers.

This study aimed to examine inter-limb jump asymmetries and their association with sport-specific performance in young swimmers. Thirty-eight (male, n = 19; female, n = 19) regional/national level young swimmers (age: 12.3 ± 1.2 years; height: 159.6 ± 8.2 cm; body mass: 52.5 ± 9.2 kg) participated in this study. Inter-limb asymmetries were assessed for single-leg countermovement jump (SLCMJ) and single-leg standing long jump (SLSLJ). Sport-specific performance was evaluated using front crawl (i.e., 50 m and 25 m) and front crawl kick (i.e., 50 m and 25 m). The kappa coefficient revealed a "slight" level of agreement (Κ = 0.156, 0.184, and 0.197 for female, male, and all, respectively) between the direction of asymmetry for SLCMJ and SLSLJ, indicating that asymmetries rarely favored the same limb during both tests. A paired sample t-test showed a significant difference (p = 0.025) between asymmetry scores obtained in SLCMJ and SLSLJ. No significant difference was found in asymmetry scores between males and females (p = 0.099 to 0.977). Additionally, no association between asymmetry scores and sport-specific performance was observed (p > 0.05). Our findings highlight the independent nature of inter-limb asymmetries derived from SLCMJ and SLSLJ among young male and female swimmers. Further, our results suggest no association between jumping asymmetries and sport-specific performance.

Influence of Anthropometric Characteristics on Ice Swimming Performance-The IISA Ice Mile and Ice Km.

Ice swimming following the rules of IISA (International Ice Swimming Association) is a recent sports discipline starting in 2009. Since then, hundreds of athletes have completed an Ice Mile or an Ice Km in water colder than 5 °C. This study aimed to expand our knowledge about swimmers completing an Ice Mile or an Ice Km regarding the influence of anthropometric characteristics (i.e., body mass, body height, and body mass index, BMI) on performance. We analyzed data from 957 swimmers in the Ice Km (590 men and 367 women) and 585 swimmers in the Ice Mile (334 men and 251 women). No differences were found for anthropometric characteristics between swimmers completing an Ice Mile and an Ice Km although water temperatures and wind chill were lower in the Ice Km than in the Ice Mile. Men were faster than women in both the Ice Mile and Ice Km. Swimming speed decreased significantly with increasing age, body mass, and BMI in both women and men in both the Ice Mile and Ice Km. Body height was positively correlated to swimming speed in women in the Ice Km. Air temperature was significantly and negatively related to swimming speed in the Ice Km but not in the Ice Mile. Water temperature was not associated with swimming speed in men in both the Ice Mile and Ice Km but significantly and negatively in women in Ice Km. In summary, swimmers intending to complete an Ice Mile or an Ice Km do not need to have a high body mass and/or a high BMI to swim these distances fast.

Comparison of Physiological Parameters During On-Water and Ergometer Kayaking and Their Relationship to Performance in Sprint Kayak Competitions.

PURPOSE: (1) To compare various physiological indicators of performance during a 5 × 1500-m incremental kayak test performed on an ergometer and on-water and (2) to analyze the relationships between these indicators and the actual competition performance of elite sprint kayakers, aiming to provide information to coaches for evaluating and planning training on-water. METHODS: A total of 14 male and female German elite sprint kayakers performed an incremental test both on an ergometer and on-water. The tissue saturation index of the musculus (m.) biceps brachii, oxygen consumption, ratings of perceived exertion, and levels of blood lactate were measured and compared with actual racing times. In addition, power output was monitored during ergometer testing only. RESULTS: Oxygen consumption during the fourth (P = .02; d = 0.32) and final (fifth; P < .001; d = 0.32) steps of incremental testing was higher on-water than on the ergometer. The tissue saturation index of the m. biceps brachii was approximately 21% higher at the end of the ergometer test (P = .002; d = 1.14). During the second (P = .01; d = 0.78), third (P = .005; d = 0.93), and fourth stages (P = .005; d = 1.02), the ratings of perceived exertion for ergometer kayaking was higher. During the final step, power output was most closely correlated to 200- (r = .88), 500- (r = .93), and 1000-m (r = .86) racing times (all Ps < .01). CONCLUSIONS: During high-intensity kayaking on an ergometer or on-water, the oxygen consumption and tissue saturation index of the m. biceps brachii differ. Furthermore, at moderate to submaximal intensities, the ratings of perceived exertion were higher for ergometer than for on-water kayaking. Finally, of all parameters assessed, the power output during ergometer kayaking exhibited the strongest correlation with actual racing performance.

The Relationship Between the Distribution of Training Intensity and Performance of Kayak and Canoe Sprinters: A Retrospective Observational Analysis of One Season of Competition.

Purpose: To evaluate retrospectively the training intensity distribution (TID) among highly trained canoe sprinters during a single season and to relate TID to changes in performance. Methods: The heart rates during on-water training by 11 German sprint kayakers (7 women, 4 men) and one male canoeist were monitored during preparation periods (PP) 1 and 2, as well as during the period of competition (CP) (total monitoring period: 37 weeks). The zones of training intensity (Z) were defined as Z1 [<80% of peak oxygen consumption (VO2peak)], Z2 (81-87% VO2peak) and Z3 (>87% VO2peak), as determined by 4 × 1,500-m incremental testing on-water. Prior to and after each period, the time required to complete the last 1,500-m stage (all-out) of the incremental test (1,500-m time-trial), velocities associated with 2 and 4 mmol·L-1 blood lactate (v2[BLa], v4[BLa]) and VO2peak were determined. Results: During each period, the mean TID for the entire group was pyramidal (PP1: 84/12/4%, PP2: 80/12/8% and CP: 91/5/4% for Z1, Z2, Z3) and total training time on-water increased from 5.0 ± 0.9 h (PP1) to 6.1 ± 0.9 h (PP2) and 6.5 ± 1.0 h (CP). The individual ranges for Z1, Z2 and Z3 were 61-96, 2-26 and 0-19%. During PP2 VO2peak (25.5 ± 11.4%) markedly increased compared to PP1 and CP and during PP1 v2[bla] (3.6 ± 3.4%) showed greater improvement compared to PP2, but not to CP. All variables related to performance improved as the season progressed, but no other effects were observed. With respect to time-trial performance, the time spent in Z1 (r = 0.66, p = 0.01) and total time in all three zones (r = 0.66, p = 0.01) showed positive correlations, while the time spent in Z2 (r = -0.57, p = 0.04) was negatively correlated. Conclusions: This seasonal analysis of the effects of training revealed extensive inter-individual variability. Overall, TID was pyramidal during the entire period of observation, with a tendency toward improvement in VO2peak, v2[bla], v4[bla] and time-trial performance. During PP2, when the COVID-19 lockdown was in place, the proportion of time spent in Z3 doubled, while that spent in Z1 was lowered; the total time spent training on water increased; these changes may have accentuated the improvement in performance during this period. A further increase in total on-water training time during CP was made possible by reductions in the proportions of time spent in Z2 and Z3, so that more fractions of time was spent in Z1.

Self-Selected Versus Standardised Warm-Ups; Physiological Response on 500 m Sprint Kayak Performance.

This study investigated the effectiveness of a self-selected (SS) warm-up on 500 m sprint kayak performance (K500) compared to continuous (CON) and intermittent high intensity (INT)-type warm-ups. Twelve nationally ranked sprint kayakers (age 17.7 ± 2.3 years, mass 69.2 ± 10.8 kg) performed CON (15 min at the power at 2 m·mol-1), INT (10 min at 2 m·mol-1, followed by 5 × 10 s sprints at 200% power at VO2max with 50 s recovery at 55% power at VO2max), and SS (athlete's normal competition warm-up) warm-ups in a randomised order. After a five-minute passive recovery, K500 performance was determined on a kayak ergometer. Heart rate and blood lactate (BLa) were recorded before and immediately after each warm-up and K500 performance. Ratings of perceived exertion (RPE) were recorded at the end of the warm-up and K500. BLa, heart rate, and RPE were generally higher after the INT than CON and SS warm-ups (p < 0.05). No differences in these parameters were found between the conditions for the time trial (p > 0.05). RPE and changes in BLa and heart rate after the K500 were comparable. There were no differences in K500 performance after the CON, SS, or INT warm-ups. Applied practitioners can, therefore, attain similar performance independent of warm-up type.

Dangers beyond drowning: craniomaxillofacial trauma in adult water activities.

PURPOSE: Water recreation is one of the most popular activities for both fitness and leisure. The dangers of water activities have mostly been examined in the context of drowning and general bodily injuries. Despite the existing research, little is known about adult maxillofacial injuries in these settings. METHODS: We accessed the National Electronic Injury Surveillance System in order to identify adult patients presenting to emergency departments with traumatic maxillofacial injuries secondary to a water-based sport or activity over the most recent 10-year period (2009-2018). Data collected included demographical information, anatomical location, mechanism of injury, and visit circumstances, as well as visit disposition. RESULTS: A total of 1350 total patients were identified as appropriate for study inclusion. Young, Caucasian male adults were the most common age group to present with maxillofacial injuries secondary to water sport activities. Surfing and water skiing were associated with lacerations, while diving board incidents posed a higher fracture risk. Patients participating in all water activities were more likely to be treated and released rather than admitted. CONCLUSION: There appears to be a distinct pattern profile for individuals who sustain maxillofacial trauma while participating in water sports: young, Caucasian males in particular. Additionally, specific activities may be associated with varying injury types. The results of this study may increase interest in legislature and patient counseling when seeking such activities.

Throwing performance in water polo is related to in-water shoulder proprioception.

Water polo players require a high level of upper-extremity strength, flexibility and coordination to achieve a peak level of throwing performance. Increased levels of shoulder proprioceptive acuity, strength and range of motion (ROM) have been previously associated with higher sporting performance. A coach-rating scale, used to quantify an athlete's kicking proficiency in soccer; was adapted in the current study to measure each coach's subjective expert opinion regarding athletes' throwing mechanics, velocity, and accuracy. To examine this hypothesis shoulder proprioception acuity of 18 water polo players was measured both in-water and on-land using an AMEDA apparatus and correlated with coach-rated throwing performance and clinical measures of shoulder strength and ROM. There was a moderate positive correlation between the in-water and the on-land proprioception acuity (r = 0.47, p < 0.05). The in-water score showing a strong positive correlation with coach rated throwing mechanics (r = 0.68, p < 0.05) and velocity (r = 0.75, p = 0.02), suggesting that superior proprioception acuity contributed to fast, mechanically-efficient throwing. These findings support the notion that in-water proprioceptive acuity is an important determinant of the throwing performance achieved by water polo athletes and its measurement may be a valuable adjunct to current athlete screening.

Cyclic movement execution and its influence on motor programmess.

OBJECTIVES: The aim of this study was to discover the relationship between the performance of different mechanical movements of rowers, and define its effect on the motor programs of the cyclic movement in athletes living in rural and urban areas. MATERIAL AND METHODS: Twenty-two male rowers participated in the experiment using a rowing ergometer (Concept2, USA). The experiment consisted of 3 tests examining the maximal power of the pull-ups (MPbpu). The movement mechanogram was registered with a specialized complex Noraxon's 3D MyoMotion (Noraxon Inc., USA). The software of the complex allowed calculation of the values of the joint angles from the accelerometer data. The Origin Lab 8.5 program was used for the mathematical and statistical processing of the signals from the mechanograms. RESULTS: It was found that all experiment participants had a stepped controlled increase in the power of single bar pull-ups leading to a corresponding proportional increase in the frequency of rowing - test 1 and, conversely, a stepped controlled increase in the rowing frequency accompanied by a proportional increase in the power of the bar pull-ups - test 2. The involuntary dependence of the power and the rate was due to the peculiarities of the central cyclic movement programming, according to which the forces and durations of the active and passive bar pull-ups phases were interconnected and regulated together. The voluntary power-rate dependence control led to the breakdown of these links in the motor program of cyclic movements and to the separate control of these parameters. CONCLUSIONS: Motor programs in cyclic movement may be created in the same pattern in tope level sport and recreation, as well in different environmental conditions - gym halls (movement simulators), professional and recreational water sport tracks.

Sex difference in long-distance open-water swimming races - does nationality play a role?

In open-water swimming events with non-elite swimmers held in the USA, but not in Europe, women were faster than men. We examined the sex difference in elite long-distance open-water swimming races and the role of nationality by investigating 7,468 swimmers competing in 5 km, 10 km and 25 km FINA races held between 2000 and 2016. More men participated in 10 km and 25 km than in 5km races. Men were faster than women and the sex difference was similar in all race distances. Swimming speed was faster for 5km than for 10km, which in turn was faster than 25km. There was a major effect of nationality on swimming speed at 5 km and 10 km, but not at 25km. No dominance of a particular nationality was observed for all race distances. In summary, men were faster than women in all FINA race distances from 5km to 25km but nationality played no role in the sex difference.

The relationship of wearing a wetsuit in long-distance open-water swimming with sex, age, calendar year, performance, and nationality - crossing the "Strait of Gibraltar".

AIM: The aim of the present study was to investigate the relationship of wearing a wetsuit with sex, age group, nationality, calendar year, and performance in crossing the "Strait of Gibraltar"(14.3 km). MATERIALS AND METHODS: A sample of 1,130 open-water (females, n=180, age 35.9±11.9 years; males, n=950, age 40.0±10.2 years) ultra-distance swimmers crossing the "Strait of Gibraltar" since 1950 was analyzed. RESULTS: Male, older, and Spanish swimmers used wetsuits more often than female, younger, and athletes of other nationalities, respectively, and the use of the wetsuit has increased during the past three decades. Swimmers with wetsuits were faster than those without. Male athletes aged 30-34 years were faster than athletes >60 years. Female athletes were younger than male athletes, and swimmers with wetsuits were older than those without. The Spanish were faster than the American swimmers and athletes from other nationalities, and the American swimmers were the oldest. CONCLUSION: In summary, swimmers were faster when using a wetsuit, and local Spanish swimmers were the fastest and also used wetsuits most frequently. Male and older swimmers used wetsuits more often than other swimmers, and the use of wetsuits has increased in the last three decades.

Knowledge of alcohol impairment in boaters in southern Illinois.

BACKGROUND: Alcohol is the leading contributor to boating deaths. Earlier literature estimates that 30-40% of people drink alcohol while boating. OBJECTIVE: The objective of this study was to directly approach boaters at the dock to assess the prevalence of alcohol consumption while boating, as well as their knowledge of alcohol impairment. METHODS: This was a cross-sectional survey of a convenience sample of boaters aged 21 years and older at Illinois lakes and rivers during July 2011. Participants completed a survey of alcohol use and impaired boating knowledge consisting of six multiple-choice questions. A χ(2) analysis was used to assess knowledge differences by demographic variables. RESULTS: Two hundred and ten people participated. Less than one fourth of participants correctly answered 4 of the 5 knowledge questions. Eighty-four percent correctly reported the watercraft blood alcohol legal limit. Eighty-one percent erroneously believed that it was more dangerous for the driver to be intoxicated than the passenger. There were no differences in knowledge by sex, education, boat ownership, or driver status. Seventy-six percent admitted to drinking alcohol while boating. Younger participants (aged 21 to 40 years) were significantly more likely to report drinking while boating compared with older participants (p < 0.05). CONCLUSIONS: A majority of participants imbibe while boating and with only a rudimentary understanding of the dangers. Designated drivers (for boating) campaigns might falsely imply imbibing-passenger safety. Public health officials should readdress the dangers of passenger drinking, especially with the younger age group, to help decrease alcohol-related morbidity and mortality.

Heat stroke risk for open-water swimmers during long-distance events.

Open-water swimming is a rapidly growing sport discipline worldwide, and clinical problems associated with long-distance swimming are now better recognized and managed more effectively. The most prevalent medical risk associated with an open-water swimming event is hypothermia; therefore, the Federation Internationale De Natation (FINA) has instituted 2 rules to reduce this occurrence related to the minimum water temperature and the time taken to complete the race. Another medical risk that is relevant to open-water swimmers is heat stroke, a condition that can easily go unnoticed. The purpose of this review is to shed light on this physiological phenomenon by examining the physiological response of swimmers during long-distance events, to define a maximum water temperature limit for competitions. We conclude that competing in water temperatures exceeding 33°C should be avoided.