Swimming helps to prevent drowning and promotes heart health. This also applies to children with congenital heart defects., iStockphoto.com | SolStock © iStockphoto.com | SolStock

Exercise Capacity and Sports

Learn to Swim!

Too Many Children with Congenital Heart Defects Are Non-Swimmers

Scientific name of the study

Nationwide Survey Reveals High Prevalence of Non-Swimmers among Children with Congenital Heart Defects

Diving, jumping, gliding through the water – few forms of exercise are as easy to learn and as good for you as swimming. Having fun in the water is proven to strengthen the body and immune system. It exercises the heart muscle. It stimulates the cardiovascular system and sets important metabolic processes in motion. Swimming also builds body awareness and self-confidence. And if you know how to swim, you're less likely to drown or nearly drown.

  • Good to know

    Non-swimming Can Have Dramatic Consequences

    DLRG water rescue at the Baltic Sea beach.

    Drowning is the second leading cause of death among children and teens under the age of 15. In 2022 alone, the German Life Saving Association (DLRG) recorded 355 drowning deaths in Germany, including 46 children and adolescents.

    While there were significantly fewer drowning accidents in 2021, the year of the pandemic, the DLRG's summer statistics for 2023 showed an upward trend.

    In 2022, a total of one hundred near-drowning accidents required hospital treatment. In about 7.5 percent of the cases, the surviving children and teenagers suffered from subsequent health problems. The main reason for all accidents: minimal or no swimming training for children aged four and over.


894 National Registry Participants Answered Key Questions

Being able to swim is of vital importance. But how many children with a congenital heart defect learn to swim? When do they start? And how safe do they feel in the water? The pediatric cardiologist Professor Christian Apitz from the University Hospital in Ulm, the sports scientist Claudia Niessner from the Karlsruhe Institute of Technology, the pediatric cardiologist Professor Jannos Siaplaouras from Fulda, and the psychologist Paul Helm from the National Register of Congenital Heart Defects wanted to explore these questions.

894 participants in the National Registry answered the researchers' questions. The survey results were compared with those of a representative comparison cohort of 4,569 heart-healthy peers who had participated in the motor skills module of the nationwide KiGGS study.

Not as Comfortable with the Wet Element as Their Heart-Healthy Peers

The results were alarming, says Claudia Niessner: "Basically, we see too many non-swimmers among all children. Among children with congenital heart defects, however, the proportion of non-swimmers was four to five times higher than in the heart-healthy comparison group. One in six children with a congenital heart defect is unfamiliar with the wet element; among children with severe congenital heart defects, it is one in five.

  • Good to know

    Percentage of Non-Swimmers

    The DLRG advises: Non-swimmers should always be supervised within arm's reach, even if they are wearing flotation devices, or life jackets.

    4.3 percent of children with healthy hearts in the KIGGS study could not swim. In contrast, the number of children with congenital heart defects was almost four times higher, at 16 percent.

    In the group of children with mild heart defects, there were only slightly more non-swimmers (5.6 percent) than in the KIGGS comparison group. However, in children with moderate congenital heart defects, the proportion was 18 percent, and in children with severe congenital heart defects, it was as high as 20.4 percent.


Lack of Exercise Is the Higher Risk

An earlier study by the research team showed that children with congenital heart defects are not active enough. The German Society for Pediatric Cardiology and Congenital Heart Defects (DGPK) has responded by incorporating the study into its guideline "Exercise in congenital and acquired heart disease".

"It is important that we accompany and advise young patients and their parents accordingly. Otherwise, overprotection on the part of doctors or parents increases the risk that children will develop secondary and lifestyle diseases such as obesity, and complications due to lack of exercise, from which they will later die far too early," says Professor Jannos Siaplaouras.

There is Little to Be Said Against Swimming

Professor Christian Apitz emphasizes that there is little to be said against regular exercise and swimming, even in the case of severe congenital heart defects: "Swimming is a popular endurance sport with positive effects on heart and lung function. For most patients with congenital heart defects, swimming is well suited as a non-competitive recreational sport, preferably in pools with lifeguard supervision.

Guided and supervised fun in the water should therefore be easily accessible to everyone. Only rarely is this not advisable. In particular, if children have a tendency to faint or feel dizzy, for example in the case of cardiac arrhythmia or relevant residual findings, a specialist consultation and assessment should be carried out beforehand".

Identify and Remove Barriers

Swimming needs to be learned early on. This was the case for most swimmers with congenital heart defects. The vast majority (98.8 percent) learned to swim between the ages of four and 12.

"Typically, learning to swim begins between the ages of four and six. However, this is an age at which young patients with severe congenital heart defects, such as the Fontan heart, often have to undergo surgery or catheterization. Learning to swim is then too often postponed or, in the worst cases, skipped altogether," observes National Register psychologist Paul Helm.

A Matter of Health, Quality of Life, and Survival

Sport has also been shown to promote cognitive, emotional, and psychosocial development. "This is also true for children with disabilities, so-called syndromes, associated with congenital heart defects. This makes it all the more important to offer inclusive programs that take into account the special needs of patients and allow them to participate in swimming with healthy peers," says Paul Helm.

Because there are too few of these, the German Association for Children with Heart Diseases (BVHK) has been organizing family weekends with swimming lessons for the past two years. "Such projects should definitely set a precedent and be supported in the long-term," says Claudia Niessner.The researchers are also concerned that an increasing number of public swimming pools are limiting their operations or even closing due to increased energy costs. In addition, the lack of staff at schools and swimming facilities is hampering access to swimming lessons.

According to the researchers, this is an untenable situation. After all, the ability to swim is a matter of health, quality of life, and survival.

  • Scientific Details of the Study

    Swimming helps to prevent drowning and promotes heart health. This also applies to children with congenital heart defects. © iStockphoto.com | SolStock
    Swimming helps to prevent drowning and promotes heart health. This also applies to children with congenital heart defects.

    Learn more about the study design, materials and methods, and background on the study.


    • 31.5.2023

      Nationwide Survey Reveals High Prevalence of Non-Swimmers among Children with Congenital Heart Defects.

      Apitz C, Tobias D, Helm P, Bauer UM, Niessner C, Siaplaouras J

      Children (Basel, Switzerland) 10, 6, (2023). Show this publication on PubMed.

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