The purpose of this systematic review was to summarize longitudinal studies on swimming physiology and get implications for daily practice. A computerized search of databases according to the PRISMA statement was employed. Studies were screened for eligibility on inclusion criteria: (i) present two testing points; (ii) on swimming physiology; (iii) using adult elite swimmers; (iv) no case-studies or with small sample sizes. Two independent reviewers used a checklist to assess the methodological quality of the studies. Thirty-four studies selected for analysis were gathered into five main categories: blood composition (n=7), endocrine secretion (n=11), muscle biochemistry (n=7), cardiovascular response (n=8) and the energetic profile (n=14). The mean quality index was 10.58 ± 2.19 points demonstrating an almost perfect agreement between reviewers (K = 0.93). It can be concluded that the mixed findings in the literature are due to the diversity of the experimental designs. Micro variables obtained at the cellular or molecular level are sensitive measures and demonstrate overtraining signs and health symptoms. The improvement of macro variables (i.e. main physiological systems) is limited and may depend on the athletes’ training background and experience.