Health, Risk and Adaptation in Extreme Open Water Swimming: A Qualitative Study of Channel Swimmers

Participation in extreme open water swimming, including channel swimming, has increased markedly, yet health research has focused largely on quantifying risks rather than understanding athletes' lived experiences. This study explored how experienced channel swimmers perceive health issues, prevention strategies, and recovery across preparation, performance, and post-swim phases. A qualitative, interpretive study was conducted using semi-structured interviews with 30 swimmers who had completed at least two Oceans Seven channel swims. The study was conducted between April and September 2021. Interviews were transcribed verbatim and analysed using reflexive thematic analysis. Themes were developed inductively to capture physical, psychological, and management-related aspects of health. Three interconnected themes were identified: (1) physical and physiological lived experience, (2) psychological and cognitive journey, and (3) proactive and reactive management. Pain, injury, and hypothermia were widely normalised as inherent to the sport, and chronic musculoskeletal problems were routinely managed rather than avoided. Notably, swimmers located maximum danger within the swim itself, while several of the most serious consequences—including swimming-induced pulmonary edema, pneumonia, and prolonged neurological symptoms—emerged only after completion. Psychological challenges included in-swim cognitive impairment, recognised only retrospectively, and post-swim emotional lows linked to the removal of a defining goal rather than to failure. Health management relied heavily on experiential knowledge, with swimmers using individualised strategies for preparation, real-time decision-making, and recovery. Recovery was viewed as an active, holistic process and a critical learning phase informing future swims. Health in channel swimming is understood by athletes as a dynamic, adaptive process shaped by experience and community norms. These findings informed the development of TIDE (Training and Resilience, Intensity and Stress, Decision-making and Coping, Evolution and Feedback), a non-linear framework conceptualising marathon swimming as a continuous feedback loop in which each swim shapes preparation for the next. TIDE offers clinicians, coaches, and event organisers a framework for identifying, where an athlete’s adaptive cycle is overwhelmed or temporarily disrupted, and provides a basis for formalising the experiential knowledge that currently protects only the most experienced swimmers as participation continues to grow.