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PINC & STEEL is more than just helping people after cancer, it is about giving hope, strength and courage.


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PINC & STEEL is more than just helping people after cancer, it is about giving hope, strength and courage.


Physiotherapists taking Exercise Rehabilitation onto the water for people affected by cancer

From hospital wards, surgery, and chemotherapy to balancing on a board, floating on the ocean. Cancer Rehab Physiotherapists in New Zealand and Australia are helping people make this remarkable transition. Going through cancer treatment can be a traumatic experience and providing a rehabilitation program that sparks joy in people's lives is transformative.

The PaddleOn Program has been running in New Zealand since 2015 and has helped hundreds of men, women and adolescents in their recovery from different types of cancer and cancer treatment. The program is delivered by Physiotherapists with experience in cancer rehabilitation, in association with qualified paddle board instructors. It is run in 10 locations throughout the North and South Islands and in NSW, SA and QLD in Australia. 

The program gives people the opportunity to learn a new skill on the water, this helps people gain confidence in their bodies and the transformations in exuberance, passion and joy are clearly evident.

Exuberance, passion and joy are consistently underrated in mainstream studies on physical fitness, health and functional performance. These qualities are not easy to measure and tend to fall off the radar in oncology exercise research that needs to be quantifiable and trackable. However, the visible results seen time and time again on the water are the most rewarding aspects for everyone involved in providing the PaddleOn Program. 


What is PaddleOn?The PaddleOn Program is an exercise rehabilitation program designed to introduce people affected by cancer to stand up paddling (SUP) in a safe, controlled environment. The program is divided into eight modules, which are specifically designed to break down the components of SUP and help improve balance, cardiovascular fitness, shoulder strength, core strength and flexibility.

The PaddleOn Program is administered by the Pinc and Steel Cancer Rehabilitation Foundation in NZ and Australia.  


The Case For Stand Up Paddling after a cancer diagnosisStand up paddle boarding (SUP) was created in Hawaii in the 1950’s and there are numerous anecdotal reports about its benefits for improving fitness, core strength and balance (1).   Paddle boarders need to balance on a board longer and wider than a surf board. While the standing position is unstable to begin with, it is continuously disturbed by the motion of the board and paddle in the water and the movement of the arms in the air, providing a constant postural challenge (2,3).

It requires a rhythmic alternating paddling action to propel the board through the water

Isometric contractions of the entire trunk, glutes and lower leg musculature are required to counter the rotational forces from the pull phase of each paddling stroke (1,3).

It is suggested that stand up paddle boarding activity may be less strenuous on the body than other water based sports (2). Stand up paddle boarding is low impact, making it suitable for mature individuals after cancer treatment and people suffering from arthritic degenerative changes through the lower limb. The fact that it is performed while standing, decreases the shearing forces on the spine associated with rotational movements encountered in kayaking (7). Another potential benefit of paddle boarding is that it is conducted in bare feet. The intrinsic foot musculature has been found to make a significant contribution to maintaining a stable base of support during dynamic activity (8). High levels of proprioceptive input are relayed to the brain due to the foot having high mechanoreceptor density.

Poor paddling technique however, may involve lumbar flexion and rotation or adopting impingement positions of the shoulder (2,4,5). It is therefore essential that correct instruction is given on paddling technique for individuals affected by cancer. The modules of the PaddleOn Program break down the paddling stroke to help ensure correct technique is attained by each participant.

The Benefits of WaterStand up paddle boarding definitely has the potential to provide both physical and psychological benefits simultaneously.  Studies suggest that simply being around water can increase levels of "feel-good" brain chemicals (like dopamine) and sink levels of cortisol, the stress hormone. Other researchers have also suggests that "ocean therapy" and time spent surfing can play a role in decreasing symptoms of PTSD in veterans (9).  It is suggested that when people hear the crashing of waves or even simply observe the movement of the water, it can put their mind into a calm or meditative state. This has numerous benefits for contributing to lowering depression, lowering stress levels, anxiety, and promotes better mental clarity and sleep patterns (10).  

 "Water makes you happier, healthier, more connected to other people, and better at what you do," Wallace Nichols, Ph.D., author of Blue Mind.

Teaching people to enjoy the benefits of being out on the water, balancing on their boards and connecting with others is all part of the PaddleOn Program. This brings a message of self-empowerment and self-efficacy, which many people crave for at a time when cancer has removed so much control from their lives.

This program gives Physiotherapists working in cancer rehabilitation the chance to ‘walk the talk', get outside their clinics to actively be involved in helping people move more and make lifestyle changes.  It extends their skills from the clinic onto the water and is beneficial for their own health and wellbeing as well.

#cancerrehab #exerciseoncology #paddleboarding

 "My heartfelt thanks to the PaddleOn team for the opportunity to take part in your incredibly uplifting program. Becoming a paddle-boarder through PaddleOn has had a profoundly positive impact on my life. I've really enjoyed learning to paddle in such a supportive environment, and bonding with a group of women with shared challenges has been one of the biggest benefits. I've also appreciated the outstanding instruction from your dedicated team of Physiotherapists. Knowing how important it is to be active after treatment, paddle-boarding has given me an amazing form of low impact exercise in the outdoors, which I love and look forward to each time I go out on the water. PaddleOn has given me the confidence and resilience to achieve things I didn't think I was capable of and inspired me to live life to the fullest. I will continue to spread the word about your amazing programme." Helen Wakefield

Funding Support: Funding participants through the PaddleOn Program requires financial and community support. If you are interested in supporting the program in your region please email: [email protected]

Acknowledgements: Thanks to Victoria Stuart, Karin Horen, StarboardNZ and all the PaddleOn Physiotherapists and SUP instructors for their continued support of the PaddleOn Program.

PINC & STEEL International run cancer rehabilitation certification courses for Physiotherapists/Physical Therapists worldwide: To find out more visit

Author: Lou James (MNZM) PINC & STEEL Founder and Director. Visit for more information about the full range of PINC & STEEL cancer rehab programs.


1.     Ho SR, Smith R, O'Meara D. (2009). Biomechanical analysis of dragon boat paddling: a comparison of elite and sub-elite paddlers. Journal Sports Sci. Jan 1;27(1):37-47

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

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

4.     Michael, J., Reid, S., & Rooney, K. B. (2009).Determinants of Kayak Paddling Performance. Sports Biomechanics. 8(2), 167-179.

5.     Ruess, C., Kristen, K. H., Eckelt, M., Mally, F., Litzenberger, S., & Sabo, A. (2013). Activity of Trunk and Leg Muscles during Stand up Paddle Surfing. Procedia Engineering, 60(0), 57-61.

6.     Stanger, S. (2010). SUP Essentials. Canoe & Kayak.

7.     Bono, C. (2004). Low Back Pain in Athletes. Journal of Bone and Joint Surgery, 86, 382-396.

8.     Rothermel, S. (2004). Effect of active foot positioning on the outcome of a balance training program. Physical Therapy in Sport, 5(2), 98-103.

9.     Rogers CM, Mallinson T, Peppers D. (2014). High-Intensity Sports for Post traumatic Stress Disorder and Depression: Feasibility Study of Ocean Therapy With Veterans. American Journal of Occupational Therapy, July/August 2014, Vol. 68, 395-404.

10.  Wheeler BW, White M et al. (2012). Does living by the coast improve health and wellbeing? Health & Place, Sept, Vol 1:1198-1201