Ben Schram

Profiling the sport of stand-up paddle boarding

Abstract Stand-up paddle boarding (SUP) is a rapidly growing activity where only anecdotal evidence exists for its proposed health and fitness benefits. The purpose of this study was to profile elite and recreational SUP with respect to anthropometric, physiological and musculoskeletal measurements. A total of 30 SUP participants (15 recreational, 15 elite) and 15 sedentary controls participated in this study. Elite and recreational (rec) SUP participants had significantly lower body fat than sedentary (sed) individuals, elite had significantly higher HDL and significantly lower triglycerides than other groups during lipid profiling (P > 0.05). There were significant differences (P > 0.05) between all groups in maximal oxygen uptake (elite 43.7, s = 5.89 ml · kg–1 · min–1 vs. rec 31.9, s = 7.7 ml · kg–1 · min–1 vs. sed 20.4, s = 3.7 ml · kg–1 · min–1) and anaerobic power outputs (35.7, s = 11.1 W vs. 25.0, s = 11.7 W vs. 13.5, s = 7.1 W). The elite group displayed significantly longer endurance than the recreational and sedentary group in the prone bridge (elite 253.4, s = 67.6 s vs. rec 165.6, s = 42.2 s vs. sed 69.7, s = 31.2 s), right-sided bridge (elite 107.9, s = 34.0 s vs. recreational 68.2, s = 24.1 s vs. sed 34.6, s = 15.5 s), left-sided bridge (elite 99.8, s = 24.9 s vs. rec 68.2, s = 27.2 s vs. sed 32.5, s = 15.2 s) and Biering Sorensen test (elite 148.8, s = 35.4 s vs. rec 127.2, s = 43.2 s vs. sed 71.1, s = 32.9 s). Elite SUP had significantly better static and dynamic postural control when compared to the other groups. This study demonstrates the anthropometric, physiological and musculoskeletal values representative of elite and recreational SUP. SUP appears to be associated with increased levels of aerobic and anaerobic fitness, increased static and dynamic balance and a high level of isometric trunk endurance.

Laboratory- and Field-Based Assessment of Maximal Aerobic Power of Elite Stand-Up Paddle-Board Athletes.

PURPOSE Stand-up paddle boarding (SUP) is a rapidly growing sport and recreational activity for which only anecdotal evidence exists on its proposed health, fitness, and injury-rehabilitation benefits. PARTICIPANTS 10 internationally and nationally ranked elite SUP athletes. METHODS Participants were assessed for their maximal aerobic power on an ergometer in a laboratory and compared with other water-based athletes. Field-based assessments were subsequently performed using a portable gas-analysis system, and a correlation between the 2 measures was performed. RESULTS Maximal aerobic power (relative) was significantly higher (P = .037) when measured in the field with a portable gas-analysis system (45.48 ± 6.96 mL · kg(-1) · min(-1)) than with laboratory-based metabolic-cart measurements (43.20 ± 6.67 mL · kg(-1) · min(-1)). There was a strong, positive correlation (r = .907) between laboratory and field maximal aerobic power results. Significantly higher (P = .000) measures of SUP paddling speed were found in the field than with the laboratory ergometer (+42.39%). There were no significant differences in maximal heart rate between the laboratory and field settings (P = .576). CONCLUSION The results demonstrate the maximal aerobic power representative of internationally and nationally ranked SUP athletes and show that SUP athletes can be assessed for maximal aerobic power in the laboratory with high correlation to field-based measures. The field-based portable gas-analysis unit has a tendency to consistently measure higher oxygen consumption. Elite SUP athletes display aerobic power outputs similar to those of other upper-limb-dominant elite water-based athletes (surfing, dragon-boat racing, and canoeing).

Reliability and concurrent validity of the iPhone® Compass application to measure thoracic rotation range of motion (ROM) in healthy participants

Background Several water-based sports (swimming, surfing and stand up paddle boarding) require adequate thoracic mobility (specifically rotation) in order to perform the appropriate activity requirements. The measurement of thoracic spine rotation is problematic for clinicians due to a lack of convenient and reliable measurement techniques. More recently, smartphones have been used to quantify movement in various joints in the body; however, there appears to be a paucity of research using smartphones to assess thoracic spine movement. Therefore, the aim of this study is to determine the reliability (intra and inter rater) and validity of the iPhone® app (Compass) when assessing thoracic spine rotation ROM in healthy individuals. Methods A total of thirty participants were recruited for this study. Thoracic spine rotation ROM was measured using both the current clinical gold standard, a universal goniometer (UG) and the Smart Phone Compass app. Intra-rater and inter-rater reliability was determined with a Intraclass Correlation Coefficient (ICC) and associated 95% confidence intervals (CI). Validation of the Compass app in comparison to the UG was measured using Pearson’s correlation coefficient and levels of agreement were identified with Bland–Altman plots and 95% limits of agreement. Results Both the UG and Compass app measurements both had excellent reproducibility for intra-rater (ICC 0.94–0.98) and inter-rater reliability (ICC 0.72–0.89). However, the Compass app measurements had higher intra-rater reliability (ICC = 0.96 − 0.98; 95% CI [0.93–0.99]; vs. ICC = 0.94 − 0.98; 95% CI [0.88–0.99]) and inter-rater reliability (ICC = 0.87 − 0.89; 95% CI [0.74–0.95] vs. ICC = 0.72 − 0.82; 95% CI [0.21–0.94]). A strong and significant correlation was found between the UG and the Compass app, demonstrating good concurrent validity (r = 0.835, p < 0.001). Levels of agreement between the two devices were 24.8° (LoA –9.5°, +15.3°). The UG was found to consistently measure higher values than the compass app (mean difference 2.8°, P < 0.001). Conclusion This study reveals that the iPhone® app (Compass) is a reliable tool for measuring thoracic spine rotation which produces greater reproducibility of measurements both within and between raters than a UG. As a significant positive correlation exists between the Compass app and UG, this supports the use of either device in clinical practice as a reliable and valid tool to measure thoracic rotation. Considering the levels of agreement are clinically unacceptable, the devices should not be used interchangeably for initial and follow up measurements.

Dual energy X-ray absorptiometry positioning protocols in assessing body composition: A systematic review of the literature

OBJECTIVES To systematically identify and assess methods and protocols used to reduce technical and biological errors in published studies that have investigated reliability of dual energy X-ray absorptiometry (DXA) for assessing body composition. DESIGN Systematic review. METHODS Systematic searches of five databases were used to identify studies of DXA reliability. Two independent reviewers used a modified critical appraisal tool to assess their methodological quality. Data was extracted and synthesised using a level of evidence approach. Further analysis was then undertaken of methods used to decrease DXA errors (technical and biological) and so enhance DXA reliability. RESULTS Twelve studies met eligibility criteria. Four of the articles were deemed high quality. Quality articles considered biological and technical errors when preparing participants for DXA scanning. The Nana positioning protocol was assessed to have a strong level of evidence. The studies providing this evidence indicated very high test-retest reliability (ICC 0.90-1.00 or less than 1% change in mean) of the Nana positioning protocol. The National Health and Nutrition Examination Survey (NHANES) positioning protocol was deemed to have a moderate level of evidence due to lack of high quality studies. However, the available studies found the NHANES positioning protocol had very high test-retest reliability. Evidence is limited and reported reliability has varied in papers where no specific positioning protocol was used or reported. CONCLUSIONS Due to the strong level of evidence of excellent test-retest reliability that supports use of the Nana positioning protocol, it is recommended as the first choice for clinicians when using DXA to assess body composition.

Epidemiology of Injuries in Stand-Up Paddle Boarding

Background: Stand-up paddle boarding (SUP) is a recreational activity and sport that has grown exponentially, with participation increasing from 1.1 million in 2010 to 2.8 million in 2014 in the United States alone. Despite this growth in participation, SUP remains underresearched with regard to injury epidemiology. Purpose: To investigate injury epidemiology (severity, location, type, mechanism) in SUP. Study Design: Descriptive epidemiology study. Methods: An open-source online survey was administered to active SUP participants internationally. The survey captured information relevant to demographics, participation, and injury history over the past 12 months. Results: Of 240 participants included in the data analysis, 67.1% were males, and 54.6% were involved in competition. Participants spent a mean 192.6 ± 179.5 hours participating in SUP per year, most commonly for fun and fitness (43.3%) at the beach or bay (63.0%). A total of 95 participants had sustained at least 1 injury. A total of 161 injuries were recorded, resulting in an injury rate of 3.63 (95% CI, 3.04-4.16) per 1000 hours of SUP. The shoulder/upper arm was the most frequently injured body location, accounting for 32.9% of all injuries, followed by the lower back (14.3%) and the elbow/forearm (11.8%). The most common injury types were to muscle/tendon (50.4%), joint/ligament (22.6%), and skin (14.2%). Endurance paddling was the most frequently reported mechanism of injury (34.5%), followed by contact with a paddler’s own board (20.1%) and sprint paddling (9.3%). Key risk factors for sustaining an injury were age >46 years, competitive status, and participating for >4.8 hours/week, as well as using SUP for racing. Conclusion: This is the first study to report injury epidemiology for SUP. It is evident that both sexes participate in SUP for fun, fitness, and competition. With regard to injuries, the shoulder, lower back, and elbow are the most injury prone; older age, competitive status, and longer hours of participation all influenced the chance of injury. Findings from this study provide the foundation for injury prevention strategies.

A performance analysis of a Stand Up Paddle Board marathon race.

Abstract Schram, BL, Hing, WA, Climstein, M, and Furness, JW. A performance analysis of a stand-up paddle board marathon race. J Strength Cond Res 31(6): 1552–1556, 2017—Stand-up paddle boarding (SUP) is a rapidly growing sport and recreational activity in which little scientific research exists. A review of the literature failed to identify a single article pertaining to the physiological demands of SUP competition. The purpose of this study was to conduct a performance analysis of a national-level SUP marathon race. Ten elite SUP athletes (6 male and 4 female athletes) were recruited from the Stand Up Paddle Surfing Association of Australia to have their race performance in the Australian Titles analyzed. Performance variables included SUP speed, course taken, and heart rate (HR), measured with a 15-Hz global positioning system unit. Results demonstrated that there was a variation in distance covered (13.3–13.9 km), peak speed (18.8–26.4 km·h−1), and only moderate correlations (r = 0.38) of race result to distance covered. Significantly greater amounts of time were spent in the 5- to 10-km·h−1 speed zones (p ⩽ 0.05) during the race. Peak HR varied from 168 to 208 b·min−1 among the competitors with the average HR being 168.6 ± 9.8 b·min−1. Significantly higher durations were spent in elevated HR zones (p ⩽ 0.05) with participants spending 89.3% of their race within 80–100% of their age-predicted HRmax. Marathon SUP races seem to involve a high aerobic demand, with maintenance of near-maximal HRs required for the duration of the race. There is a high influence of tactical decisions and extrinsic variables to race results. These results provide a greater understanding of the physiological demands of distance events and may assist in the development of specialized training programs for SUP athletes.Stand up paddle boarding (SUP) is a rapidly growing sport and recreational activity in which little scientific research exists. A review of the literature failed to identify a single article pertaining to the physiological demands of SUP competition. The purpose of this study was to conduct a performance analysis of a national level SUP marathon race. Ten elite SUP athletes (6 male, 4 female) were recruited from the Stand Up Paddle Surfing Association of Australia to have their race performance in the Australian Titles analyzed. Performance variables included SUP speed, course taken and heart rate, measured with a 15Hz GPS unit. Results demonstrated that there was a variation in distance covered (13.3km-13.9km), peak speed (18.8km/hr-26.4km/hr) and only moderate correlations (r=0.38) of race result to distance covered. Significantly greater amounts of time were spent in 5-10km/hr speed zones (p<0.05) during the race. Peak heart rate varied from 168-208bpm amongst the competitors with the average heart rate was 168.6±9.8bpm. Significantly higher durations were spent in elevated heart rate zones (p<0.05) with participants spending 89.3% of their race within 80-100% of their age-predicted HRmax. Marathon SUP races appear to involve a high aerobic demand, with maintenance of near max heart rates required for the duration of the race. There is a high influence of tactical decisions and extrinsic variables to race results. These results provide a greater understanding of the physiological demands of distance events and may assist in the development of specialised training programs for SUP athletes.

The physiological profile of male competitive and recreational surfers

Abstract Furness, J, Hing, W, Sheppard, JM, Newcomer, S, Schram, B, and Climstein, M. Physiological profile of male competitive and recreational surfers. J Strength Cond Res 32(2): 372–378, 2018—Surfing consists of both high- and low-intensity paddling of varying durations, using both the aerobic and anaerobic systems. Surf-specific physiological studies lack adequate group sample sizes, and V[Combining Dot Above]O2peak values are yet to determine the differences between competitive and recreational surfers. The purpose of this study was therefore to provide a comprehensive physiological profile of both recreational and competitive surfers. This multisite study involved 62 male surfers, recreational (n = 47) and competitive (n = 15). Anthropometric measurements were conducted followed by dual-energy x-ray absorptiometry, anaerobic testing and finally aerobic testing. V[Combining Dot Above]O2peak was significantly greater in competitive surfers than in recreational surfers (M = 40.71 ± 3.28 vs. 31.25 ± 6.31 ml·kg−1·min−1, p < 0.001). This was also paralleled for anaerobic power (M = 303.93 vs. 264.58 W) for competitive surfers. Arm span and lean total muscle mass was significantly (p ⩽ 0.01) correlated with key performance variables (V[Combining Dot Above]O2peak and anaerobic power). No significant (p ≥ 0.05) correlations were revealed between season rank and each of the variables of interest (V[Combining Dot Above]O2peak and anaerobic power). Key performance variables (V[Combining Dot Above]O2peak and anaerobic power) are significantly higher in competitive surfers, indicating that this is both an adaptation and requirement in this cohort. This battery of physiological tests could be used as a screening tool to identify an athletes weaknesses or strengths. Coaches and clinicians could then select appropriate training regimes to address weaknesses.

Combined Aorto-iliac and Anterior Lumbar Spine Reconstruction: A Case Series

ABSTRACT Background: Treatment options for aortic-iliac pathology may include endovascular repair and open surgical repair. Treatment options for degenerative disc disease (DDD) are varied but commonly include anterior reconstruction. When both the aortic-iliac and spinal pathologies are significant and surgical intervention is indicated for each pathology, the opportunity exists for concurrent treatment of both the aortic-iliac pathology and DDD in the same operation. The purpose of this case series was to document the safety and feasibility of a surgical strategy whereby a combined elective reconstructive procedure was performed for aortic and anterior lumbar spinal pathologies. Methods: The case histories of 5 patients who were treated for both spinal and vascular pathology are presented. Surgical outcome measures included operative time, blood loss, length of stay, and complications. Spine-specific outcome measures included Oswestry Disability Index, Roland Morris Disability Questionnaire, and visual analogue scores (back and leg). Results: The spinal reconstructions performed included 1 L4-5 total disc replacement (TDR), 1 L4-5, L5-S1 anterior lumbar interbody fusion (ALIF), 1 L5-S1 ALIF, and 2 hybrid procedures (L4-5 TDR with L5-S1 ALIF). Vascular reconstructions included 4 aorto–bi-iliac bypass grafts and 1 aortic tube graft. The average operative time was 365 minutes (ranging between 330 and 510 minutes), the average blood loss was 1699 mL (range between 1160 and 2960 mL), and the average length of hospital stay was 14 days (range from 8 to 22 days). There were no in-hospital complications, and all patients experienced significant improvement in both back and leg pain. One patient developed kinking of the iliac limbs of the vascular graft 1 year postoperatively, which was managed with endovascular stenting of the graft. Conclusions: Aortic-iliac pathology and DDD are significant pathologies often treated in isolation. This study illustrates that, despite its complexity, highly trained individuals in a specialized setting can perform combined surgery to achieve a satisfactory outcome for the patient. Level of Evidence: Level IV evidence.

Profiling Shoulder Strength in Competitive Surfers

The shoulder region has the highest incidence of acute injuries in the sport of surfing. Little is known about the strength profile at the shoulder in a surfing cohort. The primary aim of this study was to establish the reliability of a rotator cuff strength testing procedure for surfers with a secondary aim of providing a profile of internal and external rotation strength in a competitive surfing cohort. Shoulder internal rotation and external rotation isometric strength was measured using a hand-held dynamometer in 13 competitive surfers. Intra-class coefficient values ranged from 0.97 to 0.98 for intra-rater reliability and were lower for inter-rater reliability ranging from 0.80 to 0.91. Internal rotation strength was greater than external rotation strength bilaterally (dominant, p = 0.007, non-dominant, p < 0.001). No differences (p < 0.79) were found in internal rotation strength between the dominant and non-dominant arms. External rotation strength was weaker on the non-dominant arm compared with the dominant arm (p < 0.02). The non-dominant arm external rotation to internal rotation ratio (0.82 ± 0.15) was lower (p = 0.025) than the dominant arm (0.88 ± 0.14). The current procedure is reliable with the same clinician, and results indicate musculature asymmetry specific to the external rotators.

A Comparison of Aerobic Fitness Testing on a Swim Bench and Treadmill in a Recreational Surfing Cohort: A Pilot Study

The intermittent manner of surfing accentuates the importance of both the aerobic and anaerobic energy systems. Currently, the optimal method of assessing surfing-specific aerobic fitness is using a swim bench (SWB) ergometer; however, their limited availability presents a barrier to surfers wanting to know their maximal aerobic power (VO2peak). As a result, the aims of this pilot study were to determine the VO2peak of recreational surfers using a new commercial SWB ergometer and to propose and examine the feasibility of a regression model to predict SWB ergometer VO2peak values. A total of nine recreational surfers were assessed where body measurements were conducted followed by maximal aerobic capacity testing (swim bench and treadmill) to profile the cohort. Findings demonstrated that VO2peak values were significantly greater (p < 0.001) on the treadmill compared to the SWB ergometer (M = 66.01 ± 8.23 vs. 37.41 ± 8.73 mL/kg/min). Peak heart rate was also significantly greater on the treadmill compared to the SWB ergometer. Multiple regression analysis was used to produce a model which predicted SWB VO2peak values with an R2 value of 0.863 and an adjusted R2 value of 0.726. The physiological profiling of the recreational cohort coupled with a surfer’s predicted SWB VO2peak value will allow for identification of surfing-specific aerobic fitness levels and evidence-based training recommendations.