Swimming: Healthy Exercise, Health Risks

Although public health officials tend to emphasize swimming safety in May and June as swimming pools open, this is a good time to review swimming-related health care concerns.

In pools, good hygiene is critical to prevent spread of illness. Urine in pools has been in the news lately, and the pool's “chlorine smell” is one way to gauge a pool's cleanliness. Pools that have a strong odor (often described as a chlorine smell) actually reflect reactions between disinfectants and unwanted organic matter (perspiration, body fluids, urine, sunscreen and personal care products). These reactions create smelly disinfection byproducts; it's not clear if disinfection byproducts are dangerous to human health, but studies are underway. Advise patients to always shower before entering the pool for approximately 1 minute, and never to urinate in the water.

The CDC offers a large array of handouts and informational sites about pool safety (hyperlink to https://www.cdc.gov/healthywater/swimming/swimmers/steps-healthy-swimming.html). Many address topics 1 would expect to see including safe swimming and general pool safety. Some others are specific to unique situations like choosing swim diapers or swim pants, which give pool users a false sense of security, and animals in the pool. Some of the documents are available in Spanish.

Swimmers can develop numerous pool-related health care problems, so retail health care clinicians should be vigilant:

· Swimmers have an increased risk of rhinitis and lacrimal duct obstruction if they swim in chlorinated pools with high levels of disinfection byproducts.

· The most common recreational water illness—occuring in up to 80% of swimmers—is diarrhea caused by cryptosporidium, giardia, norovirus, shigella,Pseudomonas aeruginosa, orEscherichia coli.

Chlorine kills most of the other infectious agents quickly, but cryptosporidium can survive for up to 1 week in a pool and affects 25 of every thousand swimmers annually.

· Swimmers may also contract skin, ear, respiratory, neurologic, or wound infections from the same organisms.

· Many patients develop dry or itchy skin after swimming; they should shower after they exit the pool and use emollients.

· Algal bloom is an abundant growth of algae in natural waters (not pools) that harms people and animals. Algal bloom can cause skin irritation, coughing and sneezing, gastrointestinal symptoms, numbness, and vertigo.

· Public shower rooms are often the perfect environment for the fungus that causes athlete's foot. Patient should wear shower shoes in public showers.

· Finally, injuries are common in pools and water parks, and retail health care providers can expect to see injuries including cuts, bruises, and contusions to lips and teeth. These are especially prevalent in water parks.

Retail health care providers should have a high index of suspicion for these problems in people who swim for fun or exercise, and treat accordingly. Retail health care providers should advise patients to exercise care when they swim in natural waters or in pools. In natural waters, advise patients to abide by public health advisories and to avoid swimming in areas where water is discolored, heavily infested with algae, or foamy. Advise them to bathe their pets, especially dogs, after they exit the water. Advise pool swimmers to refresh their knowledge of appropriate hygiene annually.

Many people who swim, especially children and those who only swim occasionally, or are unaware of good swimming etiquette and pool rules and regulations. Health care providers should encourage patients to educate themselves, and whenever possible, reinforce basic hygiene. Swimming is an excellent form of exercise, and healthcare providers should encourage safe swimming as a low-impact aerobic exercise.

References

CDC. 2017. Healthy swimming: steps of healthy swimming. Online: https://www.cdc.gov/healthywater/swimming/swimmers/steps-healthy-swimming.html. (Accessed March 2, 2017).

Gallè F, Dallolio L, Marotta M, et al. Health-Related Behaviors in Swimming Pool Users: Influence of Knowledge of Regulations and Awareness of Health Risks.Int J Environ Res Public Health. 2016 May 19;13(5).

Giampaoli S, Romano Spica V. Health and safety in recreational waters.Bull World Health Organ. 2014;92(2):79.

Suppes LM, Canales RA, Gerba CP, Reynolds KA.Cryptosporidiumrisk from swimming pool exposures.Int J Hyg Environ Health. 2016;219(8):915-919.

Zheng Q, Jmaiff Blackstock LK, Deng W, Wang H, Le XC, Li XF. Keep swimming but stop peeing in the pools.J Environ Sci(China). 2017;53:322-325.