Neural Efficiency and Sensorimotor Adaptations in Swimming Athletes: A Systematic Review of Neuroimaging and Cognitive–Behavioral Evidence for Performance and Wellbeing

<b>Background/Objectives:</b> Swimming requires precise motor control, sustained attention, and optimal cognitive-motor integration, making it an ideal model for investigating neural efficiency-the phenomenon whereby expert performers achieve optimal outcomes with reduced neural resource expenditure, operationalized as lower activation, sparser connectivity, and enhanced functional integration. This systematic review examined cognitive performance and neural adaptations in swimming athletes, investigating neuroimaging and behavioral outcomes distinguishing swimmers from non-athletes across performance levels. <b>Methods:</b> Following PRISMA 2020 guidelines, seven databases were searched (1999-2024) for studies examining cognitive/neural outcomes in swimmers using neuroimaging or validated assessments. A total of 24 studies (neuroimaging: <i>n</i> = 9; behavioral: <i>n</i> = 15) met the inclusion criteria. Risk of bias assessment used adapted Cochrane RoB2 and Newcastle-Ottawa Scale criteria. <b>Results:</b> Neuroimaging modalities included EEG (<i>n</i> = 4), fMRI (<i>n</i> = 2), TMS (<i>n</i> = 1), and ERP (<i>n</i> = 2). Key associations identified included the following: (1) Neural Efficiency: elite swimmers showed sparser upper beta connectivity (35% fewer connections, d = 0.76, <i>p</i> = 0.040) and enhanced alpha rhythm intensity (<i>p</i> ≤ 0.01); (2) Cognitive Performance: superior attention, working memory, and executive control correlated with expertise (d = 0.69-1.31), with thalamo-sensorimotor functional connectivity explaining 41% of world ranking variance (r² = 0.41, <i>p</i> < 0.001); (3) Attention: external focus strategies improved performance in intermediate swimmers but showed inconsistent effects in experts; (4) Mental Fatigue: impaired performance in young adult swimmers (1.2% decrement, d = 0.13) but not master swimmers (<i>p</i> = 0.49); (5) Genetics: COMT Val158Met polymorphism associated with performance differences (<i>p</i> = 0.026). Effect sizes ranged from small to large, with Cohen's d = 0.13-1.31. <b>Conclusions:</b> Swimming expertise is associated with specific neural and cognitive characteristics, including efficient brain connectivity and enhanced cognitive control. However, cross-sectional designs (88% of studies) and small samples (median <i>n</i> = 36; all studies underpowered) preclude causal inference. The lack of spatially quantitative synthesis and visualization of neuroimaging findings represents a methodological limitation of this review and the field. The findings suggest potential applications for talent identification, training optimization, and mental health promotion through swimming but require longitudinal validation and development of standardized swimmer brain atlases before definitive recommendations.