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by Carol Brzozowski

December 18, 2019

Exhaustion after swimming signals need for investigation

Many swim coaches and instructors blame exhaustion on swimmers having trouble with the timing of their inhaling or exhaling, but a lack of cardiovascular strength, muscular conditioning, medical conditions, and inefficient technique all should be considered.

Nutrition, hydration, and sleep inadequacies are general factors for shortness of breath in the pool, says Eugene Chung, chair-elect of the American College of Cardiology Sports and Exercise Council.

Certain strokes can make some swimmers tired but not wear out other swimmers, says Sarasota Tsunami Masters Coach and Waddle’s Adult Swim Academy owner Jeff Waddle; it’s an individual, situational dynamic.

“I find freestyle to be cardio-easy but breaststroke wears me out,” he says. “Everyone has their favorite stroke, one they are at ease with and results in less exhaustion. Poor stroke technique will always make one tired.”

There’s also the mental factor.

“Swimming takes focus to coordinate all the elements and contributes to exhaustion,” Waddle says.

Waddle advises swimmers to consult with a U.S. Masters Swimming–certified coach or Adult Learn-to-Swim instructor to help correct inefficiencies.

“You can’t see yourself in the water,” he says. “If you get a video, you’re not going to know what to look for. In working with the right instructor, swimmers can safely create swim sets and practices to build up smartly to minimize injury. It takes time, dedication, and a smart plan to manage exhaustion and build endurance.”

Coaches can’t give medical advice, but they do consider medical issues to ascertain a swimmer’s capabilities, Waddle says.

One of Waddle’s swimmers disclosed having had a lung surgery, and Waddle used the information to coach the swimmer to use a snorkel due to compromised lung capacity.

If the general reasons why a swimmer experiences shortness of breath are in check, but the symptoms are out of proportion to their conditioning level, doctors investigate other causes, says Chung, who is based at the University of Michigan Medical Center.

“If there’s a history of reactive airway disease or exercise-induced asthma, there could be wheezing with exertion that would guide further testing and treatment,” he says. “If there is any hint of something cardiac such as chest discomfort, easy fatigue, shortness of breath that is new, or palpitations, we would do further investigation.”

Doctors may use a stress test to provoke an arrhythmia, Chung says.  For those with potential risk factors for coronary disease, stress testing with or without adjunctive imaging modalities could help assess the presence of potential blockages, he adds.

Other tests may include echocardiograms to evaluate heart function.

“If a swimmer’s symptoms are thought to be related to an arrhythmia, we could attach an ECG patch monitor to the chest for up to 14 days,” Chung says. That allows doctors to corroborate symptoms with the rhythm at the time of symptoms.

The most common arrhythmia—atrial fibrillation or AFib—is an irregular “chaotic” beating of the heart’s top chambers and is associated with high-intensity endurance sports, Chung says. 

For infrequent symptoms, doctors can attach an implantable loop recorder under the skin through a minor procedure. A patient can swim once the wound is healed, usually within two weeks.

The monitor remains under the skin with a three-year battery life, allowing doctors to pick up potentially rare arrythmias that might be associated with symptoms.

Whether a swimmer should cut back or eliminate practice depends on the symptoms and the swimmer’s medical context, Chung says.

The bottom line: Listen to your body.

“If there is significant chest discomfort with swimming, it’s reasonable to hold off swimming while we evaluate further,” Chung says.


  • Health and Nutrition