# Exercise as it relates to Disease/Table Tennis as a physiological intervention for elderly males

This page is a critique of the journal article: Naderi, A et al (2021) 'Six-month table tennis training improves body composition, bone health and physical performance in untrained older men; a randomized controlled trial'. Science & Sports. 36(1) pp 72.e1-72.e9.

## What is the background to this research?

It has become well documented that physical activity is a useful tool in promoting healthy aging and creating positive lifestyle among all demographics. However, issue of the older population not meeting physical activity guidelines has become a growing concern.
Exercise training in older people has been associated with health benefits such as decreases in resting and submaximal exercise heart rate, systolic and diastolic blood pressure and increased stroke volume. There is also evidence that physical activity being conducted within this population group acts as a primary and secondary prevention of several chronic diseases such as diabetes and osteoporosis.
Table tennis has also been effectively used as an intervention for physical activity previously and has delivered positive results in improving health and well-being through physical activity, social relations and learning.
It appears the study in which this page is critiquing, has found a gap in the literature as no study was found in regards to using Table Tennis as a physiological intervention for the older population. This trial has been created as a potential intervention for this area of research and looked to better improve the physical health and performance of the participants over a 6-month period.

## Where is the research from?

This article and study was created by a number of researchers from around the world. The study was conducted at Shahwood University in Iran, however the study was researched and analysed by others in varying countries. They are based in the following locations:
* A Naderi: Shahrood University of Technology, Shahrood, Semnan, Iran
* S Goli: Shahrood University of Medical Sciences, Shahrood, Semnan, Iran
* R.J Shephard: University of Toronto, Toronto, Ontario, Canada
* H Degens: Manchester Metropolitan University, UK
This study was approved by the Institutional Review Board of Shahrood University of Medical Sciences and the trial was registered with the Iran Registry of Clinical Trials. Each researcher has conducted multiple studies in the field of Health Science, which makes a strong influence on the validity of this study.

## What kind of research was this?

This study was a randomised controlled trial which contained 40 males aged above the age of 65. They were randomly split evenly into two groups (Control and Experimental). The experimental group were the ones who participated in the 6-month intervention.
The purpose of this trial was to assess how the training intervention affected factors that are known to be negatively deteriorated within this population group. The main areas that were assessed were: bone health, muscle and fat mass, and physical performance.
This study is appropriate for this study as it effectively determines the effects of the intervention within the desired population group through comparing the control and experimental groups of individuals. However the main limitation of this method is the inability to generalise the data to this population group as relatively healthy individuals were selected for this study, as participants needed to be fit and healthy enough to participate in the program.

## What did the research involve?

The trial began with the group of 40 males being split into two groups, with them all being measured in a variety of scales at the beginning of the study as well as at the end of the 6-month period. Only the experimental group however participated in the Table Tennis intervention.
The following measurements were taken pre and post intervention:
* Self-Reported Dietary Intake
* International Physical Activity Questionnaire (IPAQ)
* Maximal heart rate and cardiovascular fitness
* Body Mass Index
* Blood Pressure
* Body Composition
* Short Physical Performance Battery
The Table Tennis intervention consisted of three to five 1.5-hour sessions every week for the 6-month period. The instructor who was not involved with the research of the study recorded attendance as well as any circumstances which resulted in participants being forced to withdraw from the study. At the end of the trial, the control and experimental groups were assessed in the measurements above and the results were compared.
This methodology is a satisfactory approach in conducting this trial as it provides a range of measures that can be compared after the study is completed, as well as providing the researchers with the ability to specifically determine what systems are benefited from this study. Some of the limitations however is that the dietary intake measurements and IPAQ is self-reported which can create a bias in some of the answers provided.

## What were the basic results?

The following tables below outlines the effectiveness of the training program within the experimental group in comparison to the control individuals. The numbers calculated were the average of each of the groups:
Health Variable Results :
| | Control | Control | Experimental | Experimental |
| | Pre | Post | Pre | Post |
| Body Mass Index | 26.9 | 27.0 | 27.1 | 25.9 |
| Systolic BP (mmHg) | 137 | 136 | 138 | 131 |
| Diastolic BP (mmHg) | 88.9 | 88.7 | 89.1 | 85.3 |
| Total Lean Mass (kg) | 80.07 | 79.82 | 81.36 | 83.91 |
| Total Fat Mass (kg) | 40.63 | 40.69 | 39.88 | 34.19 |
| Total Bone Mineral Density (g·cm1) | 6.26 | 6.21 | 6.23 | 6.52 |
The Health Variable Results within the Experimental group post-intervention shows:
* A decrease in BMI, Blood Pressure and Fat Mass
* An Increase in Lean Mass and Bone Mineral Density
Physical Performance Results (s) :
| | Control | Control | Experimental | Experimental |
| | Pre | Post | Pre | Post |
| SPPB | 10.5 | 10.3 | 10.2 | 11.5 |
| 4-metre Walk | 3.46 | 3.41 | 3.42 | 3.15 |
| 5-Chair Stands | 11.0 | 11.0 | 11.0 | 10.6 |
| 400-metre Walk | 286.0 | 286.0 | 284.0 | 268.0 |
| One-Leg Stand | 45.6 | 46.1 | 46.5 | 52.9 |
The Physical Performance Results within the Experimental group post-intervention shows:
* An improvement in the 5-Chair Stands as well as the 4-metre and 400-metre walk
* An improved time and score in sustaining a One-Leg Stand and the SPPB

## What conclusions can we take from this research?

The findings from this research demonstrate how positively effective a physical activity program is on this demographic of individuals. Through an improvement in results within all of the measurements taken in the experimental group as well as a similar or worsening result in the control group, this study is evidence on how important it is for the older population to partake in physical activity to improve their health and lifestyle. Other research enforce these findings as it has been found that moderate physical activity does correlate to an longer life expectancy and is important in the body maintenance in older individuals.

## Practical advice

Physical Activity and Table Tennis is a great way for older individuals to stay active and pick up a sport and has a range of benefits for participants. However, it is important to get cleared by your local GP or physician before taking part in these activities. If this does not occur their may be additional risks associated and they may outweigh the benefits of participating in these programs.
Individuals from this population should also consult the advice and supervision of coaches and physios who may be more aware of your limitations and will prevent any risk of potential injury.

## Further information/resources

* Benefits in playing Table Tennis for Older Adults
* Health Benefits for Playing Table Tennis
* Physical Activity Guidelines for Older Adults
* Table Tennis Senior Social Group in ACT

## References

* 1 2 Naderi A, Goli S, Shephard R, Degens H (2021). Six-month table tennis training improves body composition, bone health and physical performance in untrained older men; a randomized controlled trial. Science & Sports. 36(1):72.e1-72.e9.
* ↑ Moreno-Agostino D, Daskalopoulou C, Yu-Tzu W, Koukounari A, Haro J, Tyrovolas S, Panagiotakos D, Prince M, Prina M. (2020). The impact of physical activity on healthy ageing trajectories: evidence from eight cohort studies. International Journal of Behavioral Nutrition and Physical Activity. 17:92.
* ↑ Langhammer B, Bergland A, Rydwik E. (2018). The Importance of Physical Activity Exercise among Older People. Biomed Res Int. 2018: 7856823.
* ↑ Warburton D, Nicol C, Bredin S. (2006). Health benefits of physical activity: the evidence. CMAJ. 174(6): 801-809.
* ↑ Herrting K, Holmquist M, Parker J. (2020). Ping pong for health: the meaning of space in a sport based health intervention at the workplace. International Journal of Qualitative Studies on Health and Well-being. 15(1):1689602.
* ↑ Reimers C, Knapp G, Reimers A. (2012). Does physical activity increase life expectancy? A review of the literature. J Aging Res. 2012: 243958.