Stand up paddle boarding (SUP) as a new form of rehabilitation of individuals with acquired brain injury (ABI) 6. 3.

Author: Jasna Vešligaj Damiš

Keywords: swimming, adapted aquatics, aquatic activities, therapeutic water exercise, swimmers with disabilities


Stand up paddle boarding, otherwise known as SUP, once an ancient method of transportation is now a sport that is easy and appropriate for everyone who wants to explore the nature paddling. Nevertheless, it is also a unique opportunity for developing a rehabilitation program, practising interesting sports, rehabilitation exercise for the whole body, exploring nature and way of meeting new people and sharing experience (Hammer, 2011, Walker, Nichols, & Forman, 2010).

It is sports enjoyed by young kids, men, women, older adults and people of all sizes, disabled and everyone in between. Saying it is appropriate for the whole family we should not forget our four-legged companions as paddle boarding is a fun way to spend time with our dogs.

Standing, paddling and taking the pleasure in observing the nature we were honestly surprised that our users got used to balancing and gained control over the paddle boards very quickly. Even though having fun is important, safety is always our priority as any sport may lead to injuries (Walker, Nichols, & Forman, 2010). Boards should be appropriate length and width, hull type and we should have accessories like a paddle, PFDs (Personal flotation devices) and a leash. Our service users were capable to learn how to maintain control of the boards and confidently floated around in just half an hour. With a lower centre of gravity and a life vest on, which adds buoyancy they did not fear much and falling in off a board when they lost balance was the best thing they could possibly do. As they fell on the soft life vest they faced their fear of water and slowly overcame it and enjoyed, even more, when they got on the board the next time.

And last but not least SUP stands out amongst sports for being a very sociable, calming and engaging with nature activity (Hammer, 2011, Schram, Hing, Climstein, 2016). As we quietly float together crossing lakes we have the unique opportunity to explore and learn about the beautiful nature of Slovenia.

Photo: Jasna V.D., users of Center Naprej, Hoška gramoznica, 2017

Photo: Jasna V.D., users of Center Naprej, Hoška gramoznica, 2017

Why is stand up paddle boarding appropriate for persons with acquired brain injury (ABI)?

  1. Because SUP is a fun full body workout activity (Green, 2016, Ruess et al., 2013).
  2. It is a great sport for everyone.
  3. We can stimulate brain activity exploring rivers, lakes, sea bays...
  4. We have an opportunity to observe the local scenery from a new angle. SUP gives us a wider view than we would get on land so we can see and experience the hidden side of the rivers and lakes we already know.
  5. Lying on the board with eyes closed, listening to the sounds of the sea allows us to escape the urban confines and reconnect with nature.
  6. Service users with severely impaired vision and those with other disabilities that prevent them from standing, go on the board with assistants who choose an appropriate size of board for two.
  7. It offers a very effective workout. The constant wobbling of the board means that all our muscles are working to keep the balance of our body (Schram, Hing, Climstein, 2016). It’s also good for rehabilitation of our service users, to offset the loss of balance which often comes with acquired brain injury.
  8. It is a fantastic full-body workout. We practice relaxation and at the same time we facilitate injury rehabilitation. Almost every muscle in the body is working during paddle boarding. Because of the balance required, leg muscles are struggling attempting to stabilize our centre of gravity, while the arms, back, shoulders and higher abdominal muscles are used to push the paddle in the water. The core, back and abdominal muscles are constantly at work to maintain our balance. Therefore paddle boarding increases our strength; improve our balance and endurance (Schram, Hing, Climstein, 2016, Vojska, 2017). If we spend enough time in the water paddling quickly we would get a good cardio workout. It is also a good way to burn off excess weight and build lean muscles that would help us in reducing strain on the lower back and the knees (Green, 2016).
  9. SUP is an extremely fun and enjoyable activity that could replace in some ways therapeutic work indoors (Schram, Hing, Climstein, 2016).
  10. We can go paddle boarding alone or with friends. It’s very easy to chat to friends paddling alongside.
  11. We would never forget the unique experience while boarding as a group.
  12. Stand up paddle boarding may reduce stress. Floating on water naturally, soothes the body, it is an exercise for mind and muscles. That is why we would recommend this powerful natural stress buster.
  13. We gain a completely different and more beautiful perspective of the nature around us when we stand on the board.
  14. It is quite a “green” activity as we need just a board and a paddle. We do not need an engine, fuel and we do not make noise or disturb wild creatures in their natural habitat.
  15. SUP offers us a lot of opportunities – to engage in conversation with friends, to exercise outdoors or even get an adrenaline adventure.
  16. It is relatively easy to learn and practice, and it is probably the only activity which can be equally enjoyable for everyone.

General advice and instructions for stand up paddle boarding with individuals with acquired brain injury


  • Start out in flat, calm water – the most appropriate locations are lakes, sea surface without waves or safe gravel pits.
  • Safety check access to the water as it should enable us to go in and out safely.
  • Prepare the service users appropriately for the activity (what is expected to happen, safety instructions, accessories etc.) Prepare a risk assessment for the activity.
  • Prepare the equipment. We should be careful when choosing a proper board (all round, solid). We should adapt the volume in order to fit our weight – we should add 110 to our weight and we would get the appropriate volume for us. We should not forget the accessories such as paddle, PFD (personal floatation device), leash and proper clothes (t-shirt, baseball cap, sunscreen) and fluids.

Basic Paddle Board Equipment

  • Stand up paddle board
  • Leash
  • Paddle
  • Sunscreen
  • Baseball cap
  • UV protection t-shirt
  • Water bottle
  • Dry bag
  • PFD (personal floatation device)
Photo: Jasna Vešligaj Damiš, users of Center Naprej, Drage, Croatia, 2017

Photo: Jasna Vešligaj Damiš, users of Center Naprej, Drage, Croatia, 2017

Educational approach

1. Teaching service users how to stand up on the paddle board their first time out

  • First, we have to teach the service users how to step on the board, how to attach their leash, to squat on the board in order for them to be able to stand.
  • Gradually we teach service users how to stand up, how to gain balance and after they have developed these skills we focus on teaching them how to paddle and turn the board in the desired direction.
  • We always teach our service users where the water is deep enough (at least 80cm) to prevent them from hitting the bottom when they fall. They start out on their knees and take a few strokes on each side of the board until they reach deeper water, then they slowly stand up with one foot at a time trying to balance.

2. Teaching service users to stand on the paddleboard

  • The right combination for gaining balance - being upright on the board, feet shoulder width apart, knees slightly bent placing our head in the centre of the board.
  • We should balance with our hips, so head and shoulders stay still, keeping eyes on the horizon, not on our feet.
  • We should be careful positioning our service users on the board as they should not place their body in the front of the board as the nose will drop in the water and as soon as they start paddling they will fall. If they stand far back on the board, the tail will drop into the water and the speed will decrease. They should stay in the middle of the board with their feet parallel to the stringer – about shoulder width apart with knees slightly bent, and back completely upright.

3. Teaching service users to paddle (stroke techniques)

  • As soon as service users feel comfortable on the board we start teaching them how to use the paddle
  • We use adjustable paddles, take the rider’s height and add 15 - 20cm to determine the correct paddle length.
  • They paddle as they grip the top of the paddle with one hand and place their other hand at a comfortable distance about one - third down the paddle. They should keep their arms straight as they extend the paddle forward for each stroke. When paddling on the right side of the board right hand stays lower when switching sides we reverse our hand position.
  • They should start paddling keeping their lower shoulder to the front and the top shoulder back in order to reach far out to the front, preferably – 30 – 50cm ahead as it is the most important thing for making a good stroke. They push the paddle down with their whole upper body moving it from the nose to the tail and then as it reaches the point of their ankles they take the paddle out, quickly put their body upright again, throwing their hips forward and shoulder backwards. They should not use their arms but use the whole upper body to push the blade deep into the water and pull through. Using upper body and shoulder rotation for power would make the board move faster. They should keep the paddle upright and closer to the sides of the board, moving their core forward using hips and legs to pull the paddle. As hips move forward board slides faster. This technique is appropriate for those who are physically and mentally capable of completing it. Otherwise, we can simplify it in order to ensure the safety of the users and let them enjoy the paddling.
  • In order to paddle in a straight line, they should take a few strokes (3-5) on one side then switch to the same number of strokes on the other. Usually, in the beginning we are able to complete fewer strokes that are also shorter. At this point in time, the most important tasks are keeping balance and getting used to the board.

And a frequently asked question: How to hold a sup paddle properly?

We should hold the paddle so that its angle should face away from us. As there are many kinds of paddles with differently placed angles we provide you with a simple way to show you the correct way. When faced the right way the blade will lift and allow us to move faster with less effort (derived from Please see the photos below:

Figure 11 and 12: Paddle height and paddle position. Adappted from:

Figure 11 and 12: Paddle height and paddle position. Adappted from:

Falling into the water

  • Spend time to prepare the users for the possibility of falling into the water. Give them instructions when losing balance to try falling into the water rather than on the boards as it is safer.
  • Users have their boards attached to them using a leash. In the event of fall, they should release the paddle for safety reasons, swim back to the board and then push the board forward with hands to the paddle.

Turning the board

Once users are able to paddle forward and keep the balance we move on to turning the board. This is an important lesson as they need to know how to go back to the shore. We start lessons when the board is still, making a 180-degrees turn as this is the easiest turn. They should keep a low stance and pull, towards the tail or backwards, while twisting and leaning to the desired side with their torso. The important thing is keeping the balance and the core still as the board may become unstable.

Photo: Jasna Vešligaj Damiš, users of Center Naprej, Gams Bad, Austria, 2017

Photo: Jasna Vešligaj Damiš, users of Center Naprej, Gams Bad, Austria, 2017

Paddling faster

If the service users are successful in learning the basic stroke techniques and safety measures we continue the learning process with teaching them how to paddle faster completing more and longer strokes (3-5 on the left side and 3-5 on the right side).

These are the basic lessons that we teach our users. We could always upgrade our knowledge to knee paddling, advanced turn techniques, one-leg, squat paddling, squat paddling, exercising on the board.

We focus on the learning techniques finding a calm body of water, once we have learned to paddle there we could explore seas where the waves are slightly bigger.

Always remember: Start with providing a thorough stand up paddle boarding and swimming training for your assistants before teaching your users.

Photo: Jasna Vešligaj Damiš, users of Center Naprej, Velenjska plaža, 2018

Photo: Jasna Vešligaj Damiš, users of Center Naprej, Velenjska plaža, 2018

The Benefits of Stand up Paddle Boarding

Figure 13: SUP - complete workout Adapted:

Figure 13: SUP - complete workout Adapted:

  • SUP is having fun outdoors: a little safe sun exposure is great for our body’s need of vitamin D. Our body needs vitamin D that keeps our bones strong by helping our body absorb calcium and phosphorus (Green, 2016).
  • We can practice stand up paddle boarding almost everywhere: in the sea (near the coast, in lagoons, bays, in the open sea...), in lakes, gravel pits, rivers, watercourses, streams, ponds and even pools.
  • It is an extraordinary activity that enables paddlers to get the benefits of a full-body workout (Schram, 2015).
  • SUP improves our overall fitness, it is great workout, which is one of the reasons that top athletes involved in various sports practice it as part of their routine or as part of the rehabilitation process.
  • When paddling we train our muscles, “burn” calories, increase our heart rate. Movement relaxes muscles, and releases endorphins (pleasure hormone) in the body, which alleviates the effects of stress and makes us feel better (Schram, Hing, Climstein, 2016, Green, 2016).
  • SUP is a full-body workout. As paddlers we use different muscle groups. We need to learn to balance which trains core muscles and fingers. SUP strokes require movements of hips and shoulders similar to those in golf, tennis or baseball.
  • The back muscles are of crucial importance and constantly at work as they maintain the posture and stabilize the upper part of the body (Schram, 2015).
  • The abdominal muscles are at work when paddling, they are used to propel the paddleboard into the water and work together with the back muscles attempting to maintain our balance (Schram, Hing, Climstein, 2016).
  • Paddling strengthens and trains the muscles of the spine, as well as the triceps and biceps. Our buttocks, thigh and calf muscles are also working hard in order to keep our body upright (Schram, 2015).
  • SUP improves our motor skills, strength, endurance, coordination and mobility (Schram, 2015).
  • SUP activates both sides of the body. Thus, the users (persons with acquired brain injury) also activate their weaker (affected) side of the body, as a result of that they extend the shortened muscles of this side and rotate the core, which is extremely important for their rehabilitation (Ruess et al., 2013).
  • SUP as mental training. Practicing SUP affects our mental health and mental fitness (Schram, Hing, Climstein, 2016). Stand up paddle boarding can alleviate stress levels and mental tension. On the boards we can get closer to nature and its beauty as it is scientifically proven to have a relaxing effect. SUP enables our overwhelming mind to rest. The released endorphins improve our mood.
  • Stand up paddle boarding stands out as a very sociable activity. This is a fun and safe way to spend time with friends (Schram, Hing, Climstein, 2016).
  • SUP is a great opportunity to find adventures, explore and discover wilderness and reconnect with nature. It is a way of travelling and conquering interesting places (Green, 2016).
  • SUP is also a popular activity for competitions (Schram, Hing, Climstein, 2016).
  • Age is not a barrier for those who want to stand up paddle board. It does not matter whether we are young or old, it is suitable for everyone. It offers relaxed recreation and everyone can learn to do it. We can see children, teenagers, pregnant women or our grandparents on the boards.
  • SUP is also appropriate for practising by persons with disabilities, and we do practice SUP at Center Naprej!
Photo: Zvonka Novak, users of Center Naprej, Velenjska plaža, 2018

Photo: Zvonka Novak, users of Center Naprej, Velenjska plaža, 2018


Green, D. (2016). “ACE-Sponsored Research: Can Stand-Up Paddleboarding Stand Up To Scrutiny?” ProSource. American Council On Exercise. August 2016.

Hammer, S. (2011). Catch the wave of stand-up paddling The Providence Journal, Sep. 5, 3.

Maja Vojska (2017). Aktivnosti, ki ti učinkovito pomagajo izboljšati ravnotežje. derived from C, Kristen KH, Eckelt M, Mally F, Litzenberger S, et al. (2013) Stand up Paddle Surfing-An Aerobic Workout and Balance Training. Procedia Engineering 60: 62-66.

Schram B. (2015). Stand up paddle boarding : an analysis of a new sport and recreational activity. PhD Thesis. Gold Coast: Bond University.

Schram B, Hing W, Climstein M. (2016) The physiological, musculoskeletal and psychological effects of stand up paddle boarding. BMC Sports Science, Medicine and Rehabilitation 8: 32.

Walker, C., Nichols, A., & Forman, T. (2010). A survey of injuries and medical conditions affecting stand-up paddle surfboarding participants. Clinical Journal of Sports Medicine, 20(2), 144.