The role of the European Swimming Federations in the protection of athletes’ health and the promotion of health in the general population

Abstract

Objective

To determine the profile of the medical personnel, priorities and activities/researches of the European National Swimming Federations respect to the protection of their athletes’ health and their role in the promotion of health in the general population.

Method

A cross-sectional descriptive survey was circulated among the 51 European National Swimming Federations requesting information regarding the profile of the medical personnel of the federations, the importance they place on the health of their athletes, the promotion of health in their societies and about the activities/research programmes that they engage in to promote health.

Results

The results show that 58.9% of the European National Swimming Federations have doctors and 64.1% have physiotherapists. For 51.2% of federations the top priority is the performance of their elite athletes and only 10.2% of them have as a priority to improve the health of the general population.

Conclusions

Overall, European National Swimming Federations have appropriate medical personal within their federation or National teams. However, they have reported that health promotion is not a top priority for them. There is a need to improve their general health promotion programmes. Plans and strategies could be implemented in order to promote health in the general population.

Resumen

Objetivo

Determinar el perfil del personal médico, las prioridades y las actividades/investigaciones de las federaciones nacionales de natación europeas respecto a la protección de la salud de sus atletas y su papel en la promoción de la salud en la población general.

Método

Un estudio descriptivo transversal se distribuyó entre las 51 federaciones nacionales de natación europeas solicitando información en relación con el perfil del personal médico de las federaciones, la importancia que estas daban a la salud de sus atletas, la promoción de la salud en sus sociedades y sobre los programas de actividades/investigación que dedican a la promoción de la salud.

Resultados

Los resultados muestran que el 58.9% de las federaciones nacionales de natación europeas tienen médicos y el 64.1% tienen fisioterapeutas. Para el 51.2% de las federaciones la principal prioridad es el rendimiento de sus deportistas de élite y solo el 10.2% de ellas tienen como prioridad mejorar la salud de la población general.

Conclusiones

En general, las federaciones nacionales de natación europeas tienen personal médico adecuado dentro de sus federaciones o de sus equipos nacionales. Sin embargo, han informado que la promoción de la salud no es una prioridad para ellas. Hay una necesidad de mejorar sus programas de promoción de la salud general. Planes y estrategias podrían ser implementados con el fin de promover la salud en la población general.

Resumo

Objetivo

Determinar o perfil da equipe médica, as prioridades e as atividades/pesquisas das federações nacionais de natação europeias a respeito da proteção da saúde dos seus atletas e seu papel na promoção da saúde na população em geral.

Método

Um estudo descritivo transversal foi distribuído entre as 51 federações nacionais de natação europeias, solicitando informações sobre o perfil da equipe médica das federações, a importância que davam para a saúde de seus atletas, a promoção da saúde em suas sociedades e sobre os programas de atividades/pesquisas dedicados à promoção da saúde.

Resultados

Os resultados mostram que 58.9% das federações nacionais de natação europeu têm uma equipe médica e 64.1% têm fisioterapeutas. Para 51.2% das federações, a principal prioridade é o desempenho de seus atletas e apenas 10.2% têm como prioridade melhorar a saúde da população em geral.

Conclusões

Em geral, as federações nacionais de natação europeias têm uma equipe médica adequada dentro de suas federações ou equipes nacionais. No entanto, relataram que a promoção da saúde não é uma prioridade para elas. Há uma necessidade de melhorar os seus programas de promoção da saúde em geral. Planos e estratégias poderiam ser implementadas, a fim de promover a saúde da população em geral.

Introduction

The promotion of health in European countries through sport has become more prominent in the last decades and a focus of interest by some international sport federations, continental sport federations and national sport federations. Access to sport is increasingly recognised as a right. The creation in 2008 of the Department of the Sport for Development and Peace within the United Nations is evidence of this trend to use sport as a tool to improve health.

The participation levels at international swimming events have increased significantly over the last 20 years.¹ Only 46 national federations participated in the first edition of the Fédération Internationale de Natation (FINA), Swimming World Championships (25m) in 1993; 168 national federations participated in the 12th edition of the FINA Swimming World Championships (25m) in 2014, in Doha, Qatar.

In the study “Competing with injuries: injuries prior to and during the 15^th FINA World Championships 2013 (aquatics)”, Mountjoy et al.² highlights the importance of the protection of all the elite athletes’ health at and prior to international swimming events. It concluded that there is room for improvement particularly in preventing illnesses and injuries and specifically a need for research out of competition.

Since the 2009 FINA World Championships (Aquatics), Mountjoy et al.³ studies have been conducted during each FINA World Aquatic Championships in relation to injury and illness, indicating an interest in the area of the protection of the elite athletes’ health. However, the lack of studies on the role of national swimming federations (NSF) in the field of health promotion among the general population begs one question: Is the promotion of health in the general population a priority for the European NSF. Recent statistics in England have shown how, in 2015, less than three years after the London 2012 Olympic Games, the number of people swimming at least once a week had declined by over 390000 annually.⁴

UEFA has carried out a study to find out about the existence of policies or programmes promoting healthy lifestyle. It was conducted amongst football clubs rather than national football federations but it is an example of sport organisation that is trying to promote health in the general population through their fans and spectators.⁵

To the best of our knowledge, our study, addressed to European Swimming Federation (ESF) regarding their medical structure personnel and priorities and activities of in the area of protection of health and promotion, is the first study on the activities of national sports federations in the area of health promotion.

Method

Sample

The health representatives or designated person of each NSF were invited to participate in a detailed descriptive transversal survey, assuring the anonymity of the respondents and respecting the applicable regulations of the European Union in relation to data protection.

An invitation was emailed to the president/contact person for each of the NSF on 1 October 2014 introducing the concept and objective of the survey, and a web link to access the survey was provided. The survey was also circulated in person (at the FINA Swimming World Championships 2014 (25m)/FINA Aquatics Convention in Doha held on from 29 November to 1 December) to all the NSF with the same instructions and guidance on the study.

The NSF were asked to submit their response online or in paper. If a question was unanswered, it was excluded from the analysis. Data was collected retrospectively between October 2014 and February 2015.

Experimental design

The survey was available in English, Spanish, French, and Russian and administrated via online survey software (Survey Monkey, http.//www.surveymonkey.net for the Russian version and limesurvey, https://www.limesurvey.org/ for the English, Spanish and French version). The NSF were asked: To confirm whether or not they had certain medical personnel within their NSF and national team; to rate the importance of eleven indicated topics in relation to health promotion; to report their programs’ guidelines and research in relation to indicated health promotion's topics; and to rate the importance of health promotion in their NSF. The questions were designed and pilot tested by six experts (two sport scientists, one physician, one sport medicine specialist, one sport lawyer, one sport journalist/international relations).

Statistical analysis

The raw data was exported and analysed independently by the research team. To calculate the overall medical personnel of each NSF, each time the recipient was required to answer Yes, No or Not Available. Points were awarded as following: Yes: 2 points, No: 1 point and Not Available: 0 point. The same answer structure was used to evaluate the health programmes, guidelines and research in relation to indicated health promotion topics.

To calculate the importance of health promotion and of topics in relation to health promotion, the health representative or designed person was required to rank, in order of importance, the 11 indicated health promotion topics. Points were awarded as follows: Top priority: 5, Very important: 4, Important: 3, Low importance: 2, Not important: 1, Do not know: 0. The same answer structure was used to rate the overall importance of health promotion in their NSF.

Results

The response rate was 76% (39 of the 51 NSF replied). It is important to note that not all of the NSF have the same financial resources, facilities and medical personnel; some of even fall into the category developing countries. Of the 39 NSF that responded to the survey, nine are from countries that are classified as developing countries. The identification of the nine developing countries is based on data from the International Statistic Institute who define developing countries based on their National Gross Income (GNI) per capita and per year.⁶

The results concerning the medical personnel profile are presented in Fig. 1. These results could be taken as indicating that the ESF do recognise the need for certain qualified medical personnel within their NSF.

Fig. 1.

Percentage of medical personnel in the NF or the national team of the 39 European NFs.

The results in relation to the health of the general population show a lot of room for improvement; just 10.2% of the NSF consider the health of the general population a priority of their federation. The top priority of the NSF is the fight against doping (66.6%). Results concerning their health priorities are presented in Table 1.

Table 1.

Importance rating of various topics for the 39 European National Federation of Swimming.

Topics (n total: 39)	Do not know		Not important		Low important		Important		Very important		Top priority
	Nr	%	Nr	%	Nr	%	Nr	%	Nr	%	Nr	%
Fight against doping	1	3	0	0	1	2.5	2	5.1	8	20.5	26	66.6
Top performance of elite swimmers	1	3	0	0	1	2.5	3	7.6	13	33.3	20	51.2
Health of your elite athlete	1	3	0	0	1	2.5	3	7.6	14	36.0	19	48.7
Image as a safe sport	1	3	0	0	1	2.5	7	17.9	11	28.2	18	46.1
Increasing elite athletes	1	3	0	0	1	2.5	6	15.3	15	38.4	15	38.4
Increasing certified officials and coaches	1	3	0	0	4	10.2	6	15.3	17	43.5	10	25.6
Image as an enjoyable physical activity	1	3	0	0	1	2.5	9	23.0	18	46.1	9	23.0
Increasing recreational athletes	1	3	3	7.6	2	5.1	11	28.2	13	33.3	8	20.5
Health recreational athletes	1	3	0	0	4	10.2	16	41.0	10	25.6	7	17.9
Increasing spectators and fans	1	3	1	2.5	4	10.2	14	35.8	13	33.3	5	13.8
Health of the general population	2	5	1	3	3	7.6	15	38.4	13	33.0	4	10.0

The programmes based around drowning prevention (preventing/learn to swim/life guard programmes) are by far the most prevalent of the programmes run by the NSF (64.1%) (Table 2).

Table 2.

Number and percentage of the 39 European National Federation of Swimming with programmes, guidelines, or research activities on the indicated topics.

Topic (n total: 39)	N	Percent
Ambassador athletes promoting health	6	15.3
Drowning prevention/learn to swim/life guard	25	64.1
Obesity or overweight	8	20.5
Inclusion of the elderly	11	28.2
Pre-participation medical examination	7	17.9
Prevention of chronic diseases in the general population	2	5.1
Return-to-play after injury	4	10.2
Injury surveillance during championships of your NF	12	30.7
Injury prevention by exercise-based programmes	10	25.6
First aid (e.g. Doctor onsite)	12	30.7

Discussion

The fact that the most common medical personnel are physiotherapists (64.1% of the NSF have a physiotherapist) indicates that NSF are concerned about injury prevention, recovery and rehabilitation.

The study shows that NSF have certain commonalities in terms of health promotion within their sport and there is a potential for them to exchange certain knowledge, experience and data with the goal of raising the level of health promotion/protection amongst their swimmers. Input from Ligue Européenne de Natation (LEN) and perhaps, FINA, would be required in order to structure and facilitate this transfer of knowledge. The study “Injury prevention strategies at the Fédération Internationale de Football Association 2014 World Cup: perceptions and practices of the physicians from 32 participating teams”, McCall et al.⁷ highlighted the importance of information sharing amongst National Federations’ medical personnel.

The importance placed on doping is to be expected since this is a top priority issue for the governing bodies of swimming who are required, pursuant to the World Anti-Doping Agency |Code⁸ to take anti-doping measures during their international events and on an out-of-competition basis.

Of the 51.1% NSF that consider top performance of the elite athletes a top priority, 65% also consider the health of the elite athlete a top priority, 30% very important, and 5% important. These results show that, on balance, NSF recognise a link between health and performance of their elite athletes.

The very low pre-participation medical examinations levels could be explained by swimmers in NSF having a consistent medical follow up by their medical personnel and, more particularly, with their own physiotherapist, thereby making the need for a specific pre-participation medical examination less necessary. The study of Dijkstra et al.⁹ confirms that it is the physiotherapist who is responsible for rehabilitation and exercise and liaises with the coach to return the athlete to full sporting activity. We could also assume that the same situation is happening in relation to the injury prevention and the return-to-play after injury programmes. However, it would be interesting to conduct a future study to confirm which tasks and programmes are implemented by particular medical staff.

The findings of the study show that the health of recreational athletes is of relatively low importance for the NSF; it ranked 8th out of the 11 issues. Mountjoy et al.¹⁰ commented that the lack of health promotion policies for recreational athletes is a missed opportunity on the part of national and international sports federations and there is a need to create policy to support and motivate NSF and International Federation to address the health and welfare of non-elite athletes. NSF seem not to focus significantly on the category of recreational athletes; only 20.5% listed increasing the number of recreational athletes as a top priority issue.

Promotion of health among the general population was ranked as the lowest priority issue for the NSF. The NSF are possibly missing an opportunity to increase the overall popularity of their sport among certain demographics.

One such development opportunity is amongst the elderly population. Statistics show that the age profile in Europe is increasing.¹¹ Only 28.2% of NSF reported to have programmes for the elderly. However, LEN has introduced the programme “Healthy Ageing and Master Swimming (HAMS)”¹² aimed at developing an awareness of swimming and increasing general participation in the over 60 age category by organising a number of Swimming Pool Open Days throughout Europe. Perhaps this “top down” approach will increase swimming participation rates among the elderly and encourage the NSF to implement similar programmes of their own.

The study's findings show that NSF are particularly active in the area of drowning prevention. Drowning prevention programmes are of benefit to recreational athletes and the general population. These programmes (preventing drowning/learn to swim/life guard programmes) are by far the most prevalent of the health programmes run by the NSF (64.1%).

ESF could leverage their drowning prevention programmes and use them not only to protect health/prevent death but also to grow swimming participation levels in their country and potentially identify elite athletes of the future. This is a model that has been implemented by the United States of America National Federation, drowning prevention programme. Its motto “Saving Lives, Building Champions”¹³ highlights the dual purpose of the programme.

Furthermore, the “LEN for United Nations International Children's Emergency Fund (UNICEF)”¹⁴ programme was jointly implemented by the ESF, UNICEF and some NSF and focuses on health promotion through swimming worldwide. This programme promotes safe water and sanitation on a national and local level and financing solidarity operations. However, even if these programmes are using swimming to generate funds for the programs’ activities, some of the beneficiaries of these programmes are in fact located outside of Europe and are not necessarily involved in swimming. It would be interesting to understand why this strategic approach has been implemented by LEN. Although there are benefits for the developing nations, the programmes do not directly help the development of swimming in developing countries but do improve health. Perhaps, the motivation is due to a desire on the part of LEN and the participating NSF to get involved in more wide ranging corporate social responsibility activities the benefits of which go beyond the sphere of swimming.

Overall, European NSF have appropriate medical personnel within their NSF or national team. However, they have reported that health promotion is not a top priority for them. European NSF need to improve their general health promotion programmes. Plans and strategies could be implemented in order promote health in the general population and it is encouraging that LEN has taken some steps in this direction.

Ethical disclosures

Protection of human and animal subjects

The authors declare that no experiments were performed on humans or animals for this study.

Confidentiality of data

The authors declare that no patient data appear in this article.

Right to privacy and informed consent

The authors declare that no patient data appear in this article.

Conflict of interest

The authors declare no conflict of interest.

Acknowledgements

The authors highly appreciate the co-operation of the European National Swimming Federations and their staff who responded to this survey providing data for this study.