BACKGROUND: Open water swimming (OWS) in tropical environments poses significant risks of hyperthermia due to elevated water temperatures (Tw), impairing heat dissipation via conduction, convection, and radiation, leading to core temperature (Tc) rise, performance decrements, and exertional heat illnesses (EHI) or heat stroke (EHS). High-profile incidents, such as the 2010 Fran Crippen fatality (Tw *33°C), underscore the need for effective mitigation strategies. AIM: The present integrative review aimed to analyze the available evidence regarding heat mitigation strategies in OWS, including heat acclimation, precooling, percooling, postcooling, and organizational measures to reduce thermal strain and heat-related illnesses. METHODS: This integrative review was registered on PROSPERO (CRD42024511106). Searches in PubMed, SCOPUS, EMBASE, and Web of Science used Boolean terms: "open water swimming*" OR endurance* OR triathlon* OR "marathon swimming*" AND heat* AND sport AND athlete. Inclusion: English full-text articles on heat mitigation in healthy OWS athletes (both sexes, no age limit but excluding <18 years, thermogenic substances, non-athletes). Quality assessed via CASP tools. Studies selected December 2023-March 2024 using Rayyan (ID 870726) RESULTS: From 357 references (184 duplicates removed), 173 screened, 32 full-texts assessed, yielding 6 studies (narrative reviews, consensuses, perspectives). Key strategies: heat acclimation (cross-acclimation via cycling/running or post-training sauna); precooling (ice slurry, cold vests); percooling (cold fluid ingestion); postcooling (immersion, conductive materials); organizer measures (environmental monitoring, ice/fans, adaptive scheduling) CONCLUSIONS: OWS demands tailored percooling and acclimation to mitigate thermal stress. Event organizers should adopt evidence-based protocols for monitoring and adaptation. Gaps persist in OWS-specific data on multifactor environmental impacts and early EHI detection; prospective Tc-monitored trials are essential.
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