Can national swimming federations be agents for health promotion?

By Clarence Perez-Diaz and Juan Carlos De la Cruz-Márquez.

In this blog we capture the essence of what we may also submit as a research paper to a journal outside the BJSM.

Background: Participation in international swimming events have increased significantly over the last 20 years. While only 46 national swimming federations (NFs) participated in the first edition of the World Swimming Championships (25 m) organised by the International Swimming Federation (FINA) in 1993,[i] this swelled to 168 by the 12th edition in Doha, Qatar, 2014.[ii]

Objectives: We investigated whether this increase has been accompanied by the implementation of health promotion programmes for the benefit of swimmers and the general population. We also addressed the question, can National Federations be agents of health promotion? To try to answer these questions, the University of Granada, Spain, conducted a study among all of FINA’s 208 member National Federations. The objectives were to determine (i) the medical resources available to the NFs, (ii) whether they had developed programmes for health promotion; and (iii) where the protection of the health of swimmers and the general population ranked among their priorities.

Methodology: We used the approach of Mountjoy and Junge (2013)[iii] who studied all 35 IFs that participated in the Olympic Games of 2014 and 2016. We circulated an online survey among all the 208 member NFs of FINA as of 2015. We followed the guidelines of the Interfederal Commission Survey on the Importance of Medicine in International Sports Federations (FIMS, 2011).[iv] All NFs were considered because NFs members of FINA must meet the same sport requirements, administrative rules and guidelines and they receive the same support for participation in international events organised by FINA. The survey was addressed to the heads of the Medical Commission of each NF and was available from October 2014 until February 2015. The questionnaire included questions about each NF’s medical structure, available health resources, health promotion programmes, their priorities, problems and needs in relation to health promotion. Results: 135 NFs responded (response rate: 65%). 42% had a physiotherapist and 36% had a doctor. Regarding competitive swimmers, only 26% of NFs had injury surveillance programmes, 19% conducted pre-participation medical examinations and 18% used return-to-play after injury programmes. The results in relation to programmes directed towards the general population were as follows: 65% to prevent drowning, 29% to include the elderly in swimming, 20% to counter obesity and 11% to prevent chronic diseases. The highest health priority of the NFs was the fight against doping (4.1 ± 0.8 out of 5), followed by the health of the elite athlete elite (3.8 ± 1.6 out of 5) and increasing the number of elite athletes (3.5 ± 1.5 out of 5), while the health of the general population is their least important health priority (2.5 ± 1.8 out of 5). Conclusions and implications: Recreational sport can promote health and contribute positively to the health of the quality of life (Eime et al., 2010). [v] However, our study suggests that only a few NFs are active agents of health promotion. We believe that for NFs, the promotion of health in the general population is not a top priority. Currently their priority is the protection of the health of their elite athletes. With the exception of drowning prevention/learn to swim programmes, other health issues related to the general population are of very low importance to NFs. In general, FINA injury surveillance/prevention programmes have not yet been adopted by the NFs. The fight against doping as NF’s highest priority is an expected result since doping is a stated top priority issue for FINA. Further, all NFs must follow the World Anti-Doping Agency (WADA) code.[vi] In response to this blog, we invite responsible physicians in national federations of other sports to share their experiences in relation to their federation’s health promotion activities for the general population. Mountjoy and Junge (2013) suggest that the ‘Football for Health’ programmes of the International Federation of Football Association (FIFA) and the FINA ‘Swimming for All’ programmes are projects that could serve as model programmes. It is unlikely however that these are the only programmes of their type. It may be safe to assume that other national sports federations have or are developing strategies to use their sports to promote healthy lifestyles among the general population. The more information that sports federations can share among each other, the greater the opportunity for the development of effective initiatives.


[i]. Adrega, P. FINA World Swimming Championships (25m), 1993-2008 – A story of success, 2010. ( accessed June 2016)

[ii].FINA Aquatics World Magazine. 12 FINA World Swimming Championships (25m). 2015; 1: 17-19.

[iii]. Mountjoy M & Junge A. The role of International Sport Federations in the protection of the athlete’s health and promotion of sport for health of the general population. Br J Sports Med 2013;47(16):1023–7.

[iv]. International Sport Medicine Federation. Survey on the Importance of Medicine in International Sports Federations, 2011. (accessed May 2016).

[v]. Eime RM, Harvey JT, Brown WJ, Payne WR. Does Sports Club Participation Contribute to Health-Related Quality of Life? Med Sci Sport Exerc 2010;42(5):1022–8.

[vi].  The World Anti-Doping Agency. The World Anti-Doping Code 2015. Montréal: WADA, 2015.


Dr. Clarence Perez Diaz completed a PhD in Health Promotion in Sports Federations (2016) and is the holder of a Degree in Sports Science (2008) from the University of Granada and a Master of Advanced Studies in Sports Administration (2009) from the EPFL, Lausanne, Switzerland. She has worked for the International Swimming Federation (FINA) and is currently working for the International Sport Medicine Federation (FIMS).

Dr. Juan Carlos de la Cruz-Marquez (MD) Graduated in Medical Sciences (cum Laude, 1982) at the University of Granada. Specialist in Sports Medicine. He completed his PhD (Medicine) in 1986. He is Tenured Lecturer of Functional Anatomy in the Department of Physical Education and Sports (University of Granada) and has been Team Doctor of several elite teams.


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