Big Wave Surfers Take NOTE!


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Considerable attention has been afforded to “Waterman” style training, involving underwater breath-holding activity, in popular surfing media down through the years (1-10). Indeed, a number of prominent big wave riders have employed such methods as preparation for the dreaded “two-wave”, or worse, hold-down (1-3,5,6,8-10). Discussion usually centers on “pushing limits”, “stamina”, and “mental preparation” in order to “relax” and regulate respiratory response. Occasionally, introduction of basic underlying physiological principles are given perfunctory treatment. Others features venture further to advocate hypoxic-conditioning exercise regimens (1,2,4,5,8) or openly reference free-diving techniques (1-3,5-10). Yet unfortunately, too often the inherent dangers associated with practicing underwater breath-holding, even in seemingly supervised environments, receive cursory consideration.


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A case series newly published in the Center for Disease Control & Prevention‘s Morbidity and Mortality Weekly Report (MMWR) importantly highlights a group of voluntary, dangerous behaviours that contributed to a number of unintentional drownings in NY State, USA between 1988 and 2011 (11). The focus is not on final outcome, rather on modifiable behavioural risk factors. Fifty percent (50%; n=8) of cases involved known advanced-expert swimmers. Furthermore, all but one of the incidents at 15 regulated facilities occurred with a lifeguard on duty and involved a lifeguard rescue attempt. Dangerous Underwater Breath-Holding Behaviours (DUBBs) can and do lead to drowning in otherwise healthy individuals. Improved supervision, regulation, and public education can prevent the incidence of this type of drowning.

Interested? … then find out more at Conference 2015! Dr. Paddy Morgan will lecture on The Physiological effects of breath-holding training on the Surfer Athlete at the 4th Annual Surfing Medicine Conference, 29 Sept – 02 Oct 2015, Pays Basque, South West France.

The 3rd Annual Conference in Surfing Medicine in Sligo and Mullaghmore, Ireland.Dr. Morgan is a Consultant Anaesthetist and Critical Care Specialist in Bristol, UK and with the Great Western Air Ambulance. Prior to entering medicine, Paddy was a surf lifeguard instructor and has moved onto be Secretary to the International Lifesaving Federation (ILS) Medical Advisory Committee, Honorary Medical Advisor to Surf Lifesaving GB and sits on the Royal National Lifeboat Institute (RNLI) Medical & Survival Advisory Committee. Current research activities include cold water immersion and drowning with the Extreme Environment Laboratory at the University of Portsmouth.

The European Association of Surfing Doctors (EASD) “Keeping the Surfer Healthy and Safe”.

Note: The physiology of breath-holding and pathophysiology of drowning have been described in the scientific literature. A number of reputable resources are listed below for further reading (12-17).


1. Transworld Surf. ask-the-expert-how-do-big-wave-riders-hold-their-breath-so-long-during-monster-hold-downs. June 2007.

2. Surfline. how-to-hold-your-breath-and-stay-calm-in-big-surf. March 2010.

3. Surfer Magazine. how-to-hold-your-breath-longer. December 2010.

4. Surfing Waves. how-to-survive-hold-downs. July 2011.

5. Surfer Magazine. how-to-hold-your-breath-longer. September 2011.

6. Surfing Magazine. surprise-apnea-for-surfers. November 2012.

7. The Inertia. the-seal-within-learning-to-hold-my-breath. December 2012.

8. RedBull Surfing. does-hypoxia-training-work. April 2014.

9. The Inertia. watermans-survival-extended-be-prepared-for-the-worst. May 2014.

10. The Inertia. 5-reasons-you-should-take-waterman-survival-now. October 2014.

11. Boyd C, Levy A, McProud T, Huang L, Raneses E, Olson C. Fatal and Nonfatal ‪Drowning Outcomes Related to Dangerous Underwater Breath-Holding Behaviors (DUBBs), New York State 1988-2011. MMWR Morb Mortal Wkly Rep. 2015 May 22;64(19):518-21.

12. Barlow H, MacIntosh F. Shallow water black-out. Royal Naval Physiological Laboratory Report R.N.P. 44/125 UPS 48(a).

13. Lanphier E. Breath-hold and ascent blackout. Presented at: The Physiology of Breath-Hold Diving, Undersea and Hyperbaric Medical Society Workshop. Buffalo, NY, USA; October 28–29, 1985. Pg 32-43.

14. Dickinson P, Morgan P. Shallow-Water Blackout: The Production of an ILSF Position Statement. Presented at: The World Conference on Drowning Prevention. Danang, Vietnam, May 10-13, 2011.

15. International Life Saving Federation (ILSF). MPS-16 Shallow water black-out. Leuven, Belgium: ILSF; 2011. Available at

16. Pendergast D, Lundgren C. The underwater environment: cardiopulmonary, thermal, and energetic demands. J Appl Physiol (1985). 2009 Jan;106(1):276-83.

17. Szpilman D, Bierens J, Handley A, Orlowski J. Drowning. N Engl J Med. 2012 May 31;366(22):2102-10.

Additional Open Access Resources:

Young Men’s Christian Association (YMCA). Aquatics safety and risk education: unsafe breath holding practices. Chicago, IL, USA: YMCA; 2011.

Pollock N. Loss of consciousness in breath-holding swimmers. Tustin, CA, USA: National Drowning Prevention Alliance (NDPA); 2014.

Pollock N. Responses to Questions/Statements Regarding Blackout Events. Tustin, CA, USA: NDPA; 2014.

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