Comparing Competitive and Recreational Table Tennis Training: Impacts on Quality of life in Older Adults - A Randomized Controlled Trial

Oam To-aj; Apithai Bumrungpanictarworn; Felix Liauw

doi:10.12688/f1000research.160396.2

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Research Article

Revised

Comparing Competitive and Recreational Table Tennis Training: Impacts on Quality of life in Older Adults - A Randomized Controlled Trial

[version 2; peer review: 2 approved]

Oam To-aj¹, Apithai Bumrungpanictarworn ¹, Felix Liauw²

PUBLISHED 25 Jun 2025

Author details Author details

¹ Faculty of Social Sciences and Humanities, Mahidol University, Nakhon Pathom, Thailand
² Department of Health Science, Macquarie University, Sydney, Australia

Oam To-aj
Roles: Conceptualization, Formal Analysis, Software, Supervision, Validation, Writing – Review & Editing

Apithai Bumrungpanictarworn
Roles: Conceptualization, Formal Analysis, Investigation, Methodology, Project Administration, Supervision, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing

Felix Liauw
Roles: Investigation

OPEN PEER REVIEW

REVIEWER STATUS

Abstract

Background

Owing to its combination of speed, tactics, and accuracy, table tennis is becoming a sport exercise that is suitable for older adults. Casual play is fun and relaxing, and more serious table tennis might further develop skills through focused practice.

Methods

A randomized controlled trial (RCT) aimed to determine how the practice of competition compared to leisure playing affects the Quality of life (QoL) of people aged 40-70. Selecting subjects at random, one group of subjects undertook a structured competitive regimen, whereas the other group was given time to play recreationally without any structured competition. QoL was measured before and after the intervention using the WHOQOL-BREF, which measures physical, psychological, social, and environmental domains. Data were analyzed using paired and independent t-test.

Results

The group that received structured competition reported a marked improvement in their QoL indicators, especially in physical health (p < 0.001), psychological health (p < 0.001), and social relationships (p = 0.001), when compared to the control group, which showed few improvements. No significant differences were observed in the environmental domains in either group.

Conclusions

Regular competitive table tennis practice improves physical condition, emotions, and social relationships, which leads to a higher QoL in older adults. Thus, these results emphasize the utility of competitive sports in the maintenance of active and healthy aging.

Registration

Thai Clinical Trial Registry (TCTR) ID TCTR20250105001, registered on December 28, 2024

Keywords

Table Tennis, Competitive training, Recreation sport, Quality of life, Older adults

Corresponding author: Apithai Bumrungpanictarworn

Competing interests: No competing interests were disclosed.

Grant information: This research project has been funded by Mahidol University. Fundamental Fund: fiscal year 2023 by National Science Research and Innovation Fund (NSRF)
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Copyright: © 2025 To-aj O et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

How to cite: To-aj O, Bumrungpanictarworn A and Liauw F. Comparing Competitive and Recreational Table Tennis Training: Impacts on Quality of life in Older Adults - A Randomized Controlled Trial [version 2; peer review: 2 approved]. F1000Research 2025, 14:89 (https://doi.org/10.12688/f1000research.160396.2) First published: 15 Jan 2025, 14:89 (https://doi.org/10.12688/f1000research.160396.1) Latest published: 25 Jun 2025, 14:89 (https://doi.org/10.12688/f1000research.160396.2)

Revised Amendments from Version 1

In this revised manuscript, we have carefully addressed all reviewer comments and made numerous adjustments to clarify, broaden, and strengthen the manuscript’s overall rigor. The objectives statement has been trimmed to present the research aim more precisely. Older citations have been either replaced or supplemented with literature published between 2020 and 2023, especially studies on the mental and social benefits of physical activity in older adults (e.g., Lee et al., 2023; Jonkman et al., 2022; Fanning et al., 2020). These additions fortify the theoretical rationale and ensure the paper aligns with contemporary scholarship.

The conclusion now adopts a more measured tone, indicating that while the findings point to possible gains from competitive training, important caveats must still be considered. The limitations paragraph has similarly been expanded to clearly acknowledge the uneven age distribution between groups, the brief duration of the intervention, and the baseline disparity in quality-of-life scores.Effect-size statistics (Cohen’s d) have been computed and reported in the results section so that readers can better gauge the intervention’s practical significance. Additionally, an unintended sentence previously included in the Methods section has been removed to ensure clarity and maintain the manuscript’s academic tone. Figures, tables, the author list, and the underlying dataset remain unchanged. The new text simply sharpens clarity, corrects minor points of scientific detail, and courteously addresses reviewers’ comments.

See the authors' detailed response to the review by Hadeel Halaweh
See the authors' detailed response to the review by Sairag Saadprai

Introduction

Aging is a natural process that is frequently linked with challenges in the physical, cognitive, and social domains, resulting in a decline in the overall quality of life (QoL) (Huntula et al., 2022; Saxon et al., 2021). With the rapidly increasing number of elderly individuals worldwide, the need to maintain a healthy life has become a serious issue (Lunenfeld & Stratton, 2013). Physical activity is widely recognized as an effective intervention to mitigate the effects of aging, particularly by addressing physical decline and enhancing overall well-being (Fanning et al., 2020). Research has shown that exercise has a stronger ability to ameliorate biological alterations associated with aging, such as excessive inflammation, and arguably working towards restoration of overall health and improvement of aging (Huntula et al., 2022). It is important to create an environment that can improve these aspects in older adults to enhance their overall life and reduce depressive symptoms (Lee et al., 2023).

Moderate to vigorous physical activity and vigorous exercise have several advantages, especially in enhancing health and reducing the impact of aging (Taylor et al., 2004). Physical activity is beneficial for enhancing physical health, psychological well-being, and social participation (Jonkman et al., 2022). Nevertheless, research on the effect of different types of exercise on the well-being of older adults is still a very relevant field of study (Sun et al., 2013). In particular, recreational sports are becoming interesting through the promotion of movement and exercise, thinking, and other socializing aspects (Berg et al., 2015).

Table tennis is a sport that requires quickness in deciding, coordination, and agility, is an effective exercise among the older adult since it is low impact, can be modified if possible for both the seriousness and fun of the game (He et al., 2022). While recreational table tennis is often played for fun, competition and its related training requires a more serious approach which utilizes designed practices that can be beneficial too (Naderi et al., 2018; Shields & Bredemeier, 2009). In addition, sport for recreation can simply engage in various physical activities, in contrast with sport for competition that requires setting aims, exercising self control, and putting more efforts, these goals enable building stronger character components such as endurance, concentration, kind of success, and may improve overall QoL (Locke & Latham, 1985; McCormick et al., 2019).

As for physical activity interventions that have already been researched, they mainly involved generic exercise forms such as walking, yoga, and strength training, as they focus on engaging the core to enhance mobility and independence of older adults so that they can carry out their daily tasks more easily (Abdin et al., 2019; Foster & Armstrong, 2018; Saadprai et al., 2021). Although these activities have shown positive results, they might not provide the same multifaceted engagement as competitive sports do (Foster & Armstrong, 2018). In addition, the differences in the benefits enjoyed by recreation and competitive sports participants remain uninvestigated. Whereas recreational play might focus more on pleasure and relaxation, competitive training provides a particular context that gives individuals the desire to reach specific results (Dixon et al., 2020). This framework might further enhance QoL by instilling a sense of direction, order, and achievement.

This study attempts to fill this gap by examining the impact of engaging in competitive table tennis training along with recreation on the QoL of older adults. In this randomized controlled trial (RCT), participants in the experimental group underwent a structured training program led by expert coaches, focusing on competitive skills and strategies. On the other hand, the control group practiced unorganized leisure table tennis activities. In this instance, we will compare the outcomes of the QoL measurements of the two groups and attempt to determine whether the competitive training approach is more advantageous than the recreational approach for improving QoL.

Objectives

To evaluate the impact of competitive table tennis training on QoL by comparing pre and post intervention changes within the experimental group and between experimental and control groups.

Methods

Registration: Thai Clinical Trial Registry (TCTR) ID TCTR20250105001, registered on December 28, 2024, <https://www.thaiclinicaltrials.org/show/TCTR20250105001>.

Study design

This study was a randomized controlled trial (RCT) with two groups: a structured competitive table tennis training group and a recreational play group, with the aim of assessing the impact of competitive training on the quality of life of seniors aged 40 and above. QoL assessments should be conducted at the beginning of the intervention and after 30 days of intervention.

Participants and setting

The study was conducted at the TTAT Academy in Bangkok, Thailand, and data were collected from the participants in the 1st of August to 30th of August 2024. The participants were recruited from local community centers and table tennis clubs in Bangkok and were aged between 40 and 70 years. The trial was randomized and included 31 participants in total, of which 16 were placed in the experimental group and 15 were placed in the control group. From the recruited 31 participants, 18 were male and 13 were female, which included 10 males and 6 females in the experimental group and 8 males and 7 females in the control group.

In this study, the age group of 40–70 years was selected because of competition protocols that define any person over 40 years of age as an older adult. Such classification and categorization have been adopted in international competitions governed by the International Table Tennis Federation (International Table Tennis Federation, n.d.); hence, this age group is immensely useful in determining the impact of competitive table tennis training on QoL.

This study was approved by the university board and university ethics committee, and all participants provided informed consent prior to the study. Mostly physical ability and knowledge of table tennis was a requirement for participation. However, participants were excluded from the study if they had prior professional experience with table tennis, severe cognitive or physical disabilities, or any medical conditions that limited their recreational activities.

Randomization and allocation

Participants were assigned to either the experimental or control group using simple randomization, conducted by the principal investigator. During this process, participants were assigned to a group based on a random draw. Thus, each participant had an equal probability of being allocated to either group. Informed consent was obtained first and baseline assessments were performed. Only then were participants told which intervention group they belonged to, in order to retain concealment of allocation. This method minimized selection bias and hindered the randomization process.

Experimental group

For a period of 30 days, the participants in the experimental group were subjected to competitive table tennis training through allocated sessions on a daily basis. The time frame was fixed from 10 am to 12 pm and from 3 pm to 5 pm as two training sessions for each day. Each session was structured using a fifteen minute warm up timeline that contained aerobic exercises and dynamic stretches to prepare the body for rigorous training and reduce the risk of injuries. This was followed by a thirty minute instructional course that focused on crucial table tennis skills to be developed, such as forehand and backhand strokes, spins, and footwork.

After that, a fifteen minute hydration and rest break was incorporated into the routine and then moved on to a muscle-building course in order to strengthen their strategies such as offense, defense, positioning, and general gameplay for 30 min. Then a fifteen minute physical conditioning program was added to strengthen their speed, endurance, and agility. The last final fifteen minutes of this training session combined muscle relaxation with static stretching and also allowed the participants to reflect and reinforce on the main points of the day’s training. To conclude the program, the final two days simulated professional competitive matches with teams and singles to give a taste of real tournaments to the participants.

To reduce fatigue and exhaustion, the experimental group engaged in a structured program that included warm-ups, hydration breaks, and cooldown sessions to limit the physical strain. Training intensity was progressively modified according to the participants’ endurance level, and coaches closely monitored exertion levels, giving additional rest as necessary. Participants were asked to communicate any discomforts encountered, which were addressed on an individual basis.

Control group

The control group participants performed recreational table tennis with the same duration and frequency of hours played in the experimental group. No feedback or structured coaching was offered to the players. These sessions focused on social interaction and enjoyment rather than a professional setting.

The participants in the control group played recreational table tennis at their preferred intensity, while a facilitator supervised them to note any indications of fatigue. They were encouraged to take breaks for rest and refreshments to promote health throughout the sessions.

Procedure

1. Recruitment and Consent: Sports clubs and local community centers were used as recruiting grounds for participants with active announcements. Before participants were enrolled into the study, consent was obtained from all enrolled participants.
2. Baseline Assessment: The WHOQOL-BREF questionnaire was given to the participants as an assessment measuring QoL before the interventions began to take place.
3. Intervention Implementation: There were descriptions and control protocols stating exactly what the participants were required to do and the interventions set in place.
4. Post-Intervention Assessment: The participants completed the intervention period of 30 days after which the WHOQOL-BREF questionnaire is filled out to assess.

Outcome measures

The primary outcome was the change in QoL assessed using the WHOQOL-BREF questionnaire, a standardized tool developed and validated by the World Health Organization (WHO). This study employed the Thai version of WHOQOL-BREF, ensuring linguistic and cultural appropriateness for Thai participants. The questionnaire can be accessed from the WHO website at https://www.who.int/tools/whoqol/whoqol-bref. This standardized tool for evaluating QOL encompasses four aspects: physical, psychological, social, and environmental. Each domain is scored on a scale of 1 to 5, with higher scores reflecting better QoL (World Health Organization, n.d.). The total QoL score is the sum cost of the four domains, resulting in a total score of 130–26 and described as poor QoL, 26–60; moderate QoL, 61–95; and good QoL, 96–130.

Physical health

This domain examined mobility, daily activity, sleep, and levels of discomfort. The maximum score was 35, while less than 16 was classified as poor, 17–26 as moderate, and above 27 as good.

Psychological health

This domain assesses the better self, including self-esteem, concentration, positive and negative affect, and emotional health. The maximum score was 30, while less than 14 was classified as poor, 15–22 as moderate, and 23 and above as good.

Social relationships

This domain assessed family relationships, social interactions, and satisfaction with social interactions. The maximum score was 15, while less than 7 was classified as poor, 8–11 as moderate, and above 12 as good.

Environmental factors

Previous work has defined QoL as perceived safety and security, availability of resources, economic conditions, and environmental conditions. The maximum score was 40, where a score lower than 18 was considered poor, 19–29 is moderate, and above 30 was good.

The reliability already shown throughout the years renders the WHOQOL-BREF credible for the assessment of QoL across diverse populations. This accounts for its selection in this study.

Data collection and analysis

The data that were collected used two intervals: the first one at baseline, which was done before the intervention, and the second one after the intervention day, which was day 30. It would then be uploaded to an electronic database and then analyzed by the help of the IBM SPSS Statistics Vol 22 software. Descriptive statistics were used to summarize baseline characteristics, with categorical variables recorded as frequency and percentage and continuous variables as mean and standard deviation.

The paired t-test determined within-group changes occurring in QoL scores of the samples in the two periods of pre-intervention and post-intervention in the experimental and control group participants across four domains: physical health, psychological health, social relationships, and environmental factors. Independent t-tests were also necessary to compare the mean post-interventional QoL scores between the experimental and control groups.

Chi-squared test analysis was performed to assess the QoL – poor, moderate, or good levels of each group pre-intervention and post-intervention in both groups. The means and their 95% confidence intervals (CIs) were also determined regarding the differences between pre-intervention and post-intervention to assess whether there were any statistically significant differences. The standard for a statistically significant difference was set at p < 0.05.

Ethical approval was obtained from the Committee for Research Ethics (Social Sciences), Faculty of Social Sciences and Humanities, Mahidol University, under approval number 2023/205.3011, date of approval on November 30, 2023. The Committee for Research Ethics (Social Sciences) strictly adheres to international guidelines for human subject protection, including the Declaration of Helsinki, the Belmont Report, and the CIOMS guidelines. Written informed consent was obtained from all participants who were provided with detailed information about the study’s purpose and procedures. They were assured that their data would be strictly used for research purposes and publications. Participants retained the right to withdraw from the study at any time, without any consequences. However, all participants completed the study without any withdrawal.

Clinical trial registration

This study was registered with Thai Clinical Trials Registry (TCTR) on December 28, 2024 (TCTR20250105001). Retrospective registration occurred because the research team prioritized completing the study within the project timeline and there was a shift in the study location, which required some modifications. As a result, registration cannot be completed in time. However, this has now been completed to ensure transparency and compliance with international standards.

Result

Participants’ demographic and baseline characteristics

The study comprised 31 participants, with 16 and of experimental and control participants, respectively ( Figure 1). The age of the participants ranged with mean being 56.65 and standard deviation being 7.97 however, specifically the experimental group was significantly younger in comparison with the mean age of being 53.31 (SD = 7.67) while the control group possessed an average of mean age of 60.20 (SD = 6.85) with p value of 0.024. (t(29) = 2.40, p = 0.024, Cohen’s d = 0.91), indicating a large effect size.

The study included more male participants (58.06%), with the majority being ten males (62.5%) in the experimental group and eight males (53.3%) in the control group. There were no significant differences other than the mean age of the participants in terms of baseline characteristics between the experimental and control groups. There was an age gap of 6.9 years between the two groups, where the control participants averaged older ( Table 1).

Figure 1. Study flow diagram.

Table 1. Participants’ demographic.

Characteristic	Total (n = 31)	Experimental Group (n = 16)	Control Group (n = 15)	p-value
Sex (n (%))
Male	18 (58.1%)	10 (62.5%)	8 (53.3%)	0.621
Female	13 (41.9%)	6 (37.5%)	7 (46.7%)
Age (Mean (SD))	56.65 (7.97)	53.31 (7.67)	60.20 (6.85)	0.024*

The QoL baseline scores of the groups differed from those of the experimental group, outperforming the control group with an overall QoL of 95.38 (SD = 6.75) in comparison with 88.40 (SD = 5.75), p = 0.045) (t(29) = 2.12, p = 0.045, Cohen’s d = 1.09), suggesting a large effect size for baseline QoL differences. Such significant differences were noted in the physical health and social relationship domains but otherwise followed suit with no major differences witnessed (see Table 2).

Table 2. Baseline characteristics.

Baseline QoL (Mean (SD))	Total (n = 31)	Experimental Group (n = 16)	Control Group (n = 15)	p-value
Overall QoL	91.89 (6.25)	95.38 (6.75)	88.40 (5.75)	0.045*
Physical Health	27.63 (3.01)	27.63 (3.01)	25.07 (2.46)	0.045*
Psychological Health	23.94 (2.08)	23.94 (2.08)	23.27 (2.58)	0.501
Social Relationships	11.81 (1.05)	11.81 (1.05)	10.13 (0.92)	0.028*
Environmental Factors	32.00 (3.61)	32.00 (3.61)	29.93 (3.41)	0.067

Primary outcomes

Statistical analysis revealed that the experimental group showed a pronounced enhancement in the overall concentration. The rating was improved from 95.38 (SD = 6.75) at the start to 101.13 (SD = 7.99) at the end of the procedure with p value being lower than 0.001 (t(29) = 4.67, p < 0.001, Cohen’s d = 1.69), which represents a very large effect size. In contrast, the control group did not show any improvement, with averages improving from 88.40 (SD = 5.75) to 89.53 (SD = 5.51)( Table 3).

Table 3. Changes in QoL scores after the intervention.

Domain	Pre-Test (Mean (SD))	Pre-Test (Mean (SD))	Post-Test (Mean (SD))	Post-Test (Mean (SD))	p-value (Pre vs. Post)
Domain	Experimental	Control	Experimental	Control
Overall QoL	95.38 (6.75)	88.40 (5.75)	101.13 (7.99)	89.53 (5.51)	< 0.001***
Physical Health	27.63 (3.01)	25.07 (2.46)	30.25 (2.70)	25.73 (2.05)	< 0.001***
Psychological Health	23.94 (2.08)	23.27 (2.58)	25.63 (2.60)	23.60 (2.26)	< 0.001***
Social Relationships	11.81 (1.05)	10.13 (0.92)	13.25 (1.00)	10.27 (0.96)	0.001**
Environmental Factors	32.00 (3.61)	29.93 (3.41)	32.00 (3.61)	29.93 (3.41)	> 0.05

Physical health

Statistical data indicated that the participants in the experimental group showed considerable improvement in the overall physical health, increasing from 27.63 (SD = 3.01) to 30.25 (SD = 2.70), which had a p-value of < 0.001. In contrast, the control group also did not report a drastic change, with results improving from 25.07 (SD = 2.46) and new ratings of 25.73 (SD = 2.05) with p-value of 0.134. This difference was statistically significant (t(29) = 5.22, p < 0.001, Cohen’s d = 1.89), also indicating a very large effect size.

Psychological health

In contrast with the control group that experienced a moderate non-significant upturn from an average of 23.27 (SD = 2.58) to 23.60 (SD = 2.26), p value being 0.096, the experimental group showed a statistically significant improvement from 23.94 (SD = 2.08) to 25.63 (SD = 2.60) with a p-value of lower than 0.001. This between-group difference was statistically significant (t(29) = 2.31, p = 0.029, Cohen’s d = 0.83), representing a moderate to large effect size.

Social relationships

The results showed that there was a notable improvement for the experimental group, raising their scores from 11.81 (SD = 1.05) to 13.25 (SD = 1.00) with a p value of 0.001. The control group only saw a minimal improvement from 10.13 (SD = 0.92) to 10.27 (SD = 0.96) with a p-value of 0.164. The difference was statistically significant (t(29) = 8.46, p < 0.001, Cohen’s d = 3.04), suggesting a very large effect size.

Environmental factors

None of the groups showed any major differences in this regard. The experimental group remained constant with a score of 32.00 (SD = 3.61) and the control group at 29.93 (SD = 3.41), with a p-value of 0.113. Although a moderate effect size was reported (Cohen’s d = 0.59), this result should be interpreted with caution due to the non-significant finding and the small sample size which may undermine the credibility of this effect.

Between-group comparisons

As seen in Table 3, the report shows that there were major differences in the experimental and control groups’ QoL and in three of the specific areas that were assessed. The mean scores for the participants in the experimental group were comparatively higher than those for the control group (101.13 vs. 89.53, p < 0.001). The results in the above item regarding physical health showed that the experimental group scored higher than the control group (30.25 vs 25.73, p < 0.001). As in the experimental group, where the scores were also higher in psychological health (25.63 vs 23.60, p = 0.029) and social relationships (13.25 vs 10.27, p = 0.001). However, the two groups did not show any major differences in Environmental Factors (p > 0.05).

Proportion of QoL levels

In the experimental group, the proportion of participants with a ‘good’ QoL (96–130) increased from 37.50% at baseline to 68.75% post-intervention. On the contrary, the control group did not have any considerable differences with only 6.67% being able to attain ‘good’ QoL at both periods. Most importantly, the experimental group was able to achieve ‘good’ QoL with regards to the social relationships domain, with 100% able to achieve the results in contrast to 13.33% of the control group post-intervention Table 4.

Table 4. Proportion of QoL Levels (Pre-Test and Post-Test).

QoL Level	Pre-Test % (Experimental)	Pre-Test % (Control)	Post-Test % (Experimental)	Post-Test % (Control)
Poor (26–60)	0	0	0	0
Moderate (61–95)	62.5	93.33	31.25	93.33
Good (96–130)	37.5	6.67	68.75	6.67

Summary of effect sizes

The findings showed that the participants who underwent structured competitive table tennis training achieved large and statistically significant changes in their overall QoL, physical health, psychological health, and social relationships. The large effect sizes calculated indicate that the intervention was very effective, especially in social relationships (Cohen’s d = 3.04) and in physical health (Cohen’s d = 1.89). Although a moderate effect size was showed in the environmental domain (Cohen’s d = 0.59), the result is non-statistically significant and thus should be interpreted with caution due to sample size constraints.

Discussion

This study aimed to investigate the effects of a structured table tennis intervention on QoL. After careful observation of the intervention, it was established that the psychological and physical health of the older adults in the experimental group significantly improved. No significant changes were observed in the control group. According to data from existing studies, sports participation and its life quality benefits for older adults have persisted (Acree et al., 2006). In contrast to ordinary exercises, sports competitions, such as table tennis, add a different dimension to mental and social activities, such as well-structured training, rigorous thought processes, and precise interactions (Bar-Eli et al., 2011).

Most importantly, the considerable improvement in physical health scores for the experimental group highlights the role of table tennis in meeting physical requirements and providing cardiovascular benefits. According to prior research, competing in organized sports helps enhance physical health parameters by ameliorating cardiovascular function and the development of muscle structure (Schmidt et al., 2015). These benefits are in agreement with previous observations, indicating the scope of table tennis as a tool for enhancing physical health in general (Mahesh et al., 2013; Naderi et al., 2018). Additionally, the competitive aspect of the training protocol may have provided additional benefits, since all the subjects were raised with the goal of improving their skill and physical performance, which made the process more interesting.

Such psychological effects observed in the present study are consistent with the results of other studies, which suggest that participating in competitive sports enhances emotional well-being, minimizes depression, and increases self-confidence (Andersen et al., 2019). Similarly, research has shown that older adults with lower physical activity levels tend to exhibit higher depressive symptoms, whereas those who engage in regular exercise experience better psychological resilience and reduced mental distress (Halaweh et al., 2024). The impacts may be associated with the competitive nature of sports, which tends to have set objectives, builds a sense of achievement, and promotes sustained participation. The changes noticed in the experimental group also underline the importance of organized sports in the maintenance of mental health, confirming that specific sports-related programs aimed at the older adults are likely to enhance their psychological well-being.

The results of this study support the claims of Sánchez-Santos et al. (2024) that there is an enhancement of social networks for older adults engaging in sporting events. Similar to the results of this study, the role of competitive sports in creating social interaction, particularly with other competitive sports participants. The findings from this study suggest that organized training provided the participants with opportunities to socialize, which in turn enhanced social interactions, thereby improving their QoL.

It is worth noting that the established changes in the environmental factors in both groups were not statistically significant. This finding may represent the overshadowing of short-term intervention approaches on wider environmental aspects, such as resource availability or security perceptions. Further studies are needed to consider ways of combining physical activity strategies with intervention strategies to address these issues.

It needs to be clarified whether there is a distinction between competitive training and leisure physical activity. Protocols were set for training, which would aid the subjects in training at the level of a competitive table tennis player. Additionally, it stressed the need for increased concentration, self-control, and resolution to practice at an intense level of competition, which is very different from recreation table tennis. These variations may explain the remarkable alterations that occurred in the physical and psychological domains of the experimental group.

Conclusion

This research indicates that regular, competitive table-tennis training can raise older adults health-related QoL, especially in physical, psychological, and social dimensions. Compared with casual play, a planned, goal-driven practice schedule seems to deliver stronger benefits and leads to better health outcomes. The results therefore support including competitive sports in active-aging programs that seek not only to boost fitness but also to enhance emotional and social well-being. Larger studies involving more varied and diverse groups are needed, however, to verify and generalize these advantages.

Strengths and limitations

The strongest aspect of the study is its randomized controlled design which reduces bias and augments the credibility of the results. Moreover, the employment of the validated instrument WHOQOL-BREF for the assessment of QoL adds value as it can be compared to other studies of the issue.

Despite its strengths, the study had some limitation. First, the study’s smaller sample size could be an issue regarding generalizability. Second, the experimental group, although randomized, was considerably younger than the control group (p = 0.024), which is likely to impact physical performance and QoL. Although the multi-level training program was designed to cater for different fitness levels and within group differences were stressed to try and control this issue, future research might use stratified randomization to achieve better age balance.

Third, overall QoL, physical health, and social relationships baseline QoL scores were markedly different between the groups. Even though true intervention effects were assessed with within-group analyses, future work may revise their analytic strategy to include these issue. Finally, the results may have been more pronounced had the intervention period not been so short (30 days). Future studies should increase the follow period to see the lasting effects and impact of structured competitive training on QoL.

Implications and future directions

Therefore, this analysis provides scope for utilizing table tennis as a tool to improve QoL among older adults in an enjoyable manner. It is recommended that similar approaches are adopted in the community health domain as they would be cost-effective and convenient for the promotion of health in this demographic. Future studies should incorporate individuals with chronic illnesses or disabilities into the interventions to investigate the impact of table tennis across larger populations. Furthermore, there is a lack of understanding regarding the long-term effects of such interventions on health and QoL in older adults; therefore, these requirements need to be fulfilled.

Ethics and consent

This research received ethical approval from the Office of the Committee for Research Ethics (Social Sciences), Faculty of Social Sciences and Humanities, Mahidol University, under approval number 2023/205.3011. The Committee for Research Ethics (Social Sciences) strictly adheres to international guidelines for human subject protection, including the Declaration of Helsinki, the Belmont Report, and the CIOMS guidelines. This study was registered in the Thai Clinical Trials Registry (TCTR) on December 28, 2024 (TCTR20250105001). Retrospective registration occurred because the research team prioritized completing the study within the project timeline and there was a shift in the study location, which required some modifications. As a result, registration cannot be completed in time. However, this has now been completed to ensure transparency and compliance with international standards. Written informed consent was obtained from all participants who were provided with detailed information about the study’s purpose and procedures. They were assured that their data would be strictly used for research purposes and publications. Participants retained the right to withdraw from the study at any time, without any consequences. However, all participants completed the study without any withdrawal.

Data availability statement

Underlying data

Figshare: Quality of Life Score for Experimental and Control Group (Pre and Post), https://doi.org/10.6084/m9.figshare.28079462.v2 (To-aj et al., 2024).

The project contains the following underlying data:

• Experimental and Control Group QoL Score

Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0).

Reporting guidelines

Figshare: CONSORT Checklist and Study Flow Diagram - Comparing Competitive and Recreational Table Tennis Training: Impacts on Quality of life in Older Adults - A Randomized Controlled Trial, DOI: https://doi.org/10.6084/m9.figshare.28152722.v2 (To-aj et al., 2025).

The project has the following reporting guidelines:

• CONSORT Checklist Competitive Table Tennis
• CONSORT-Flow chart

Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0).

References

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Version 2

VERSION 2 PUBLISHED 15 Jan 2025

Author details Author details

¹ Faculty of Social Sciences and Humanities, Mahidol University, Nakhon Pathom, Thailand
² Department of Health Science, Macquarie University, Sydney, Australia

Oam To-aj
Roles: Conceptualization, Formal Analysis, Software, Supervision, Validation, Writing – Review & Editing

Felix Liauw
Roles: Investigation

Competing interests

No competing interests were disclosed.

Grant information

This research project has been funded by Mahidol University. Fundamental Fund: fiscal year 2023 by National Science Research and Innovation Fund (NSRF)
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Article Versions (2)

version 2

Revised

Published: 25 Jun 2025, 14:89

https://doi.org/10.12688/f1000research.160396.2

version 1

Published: 15 Jan 2025, 14:89

https://doi.org/10.12688/f1000research.160396.1

© 2025 To-aj O et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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To-aj O, Bumrungpanictarworn A and Liauw F. Comparing Competitive and Recreational Table Tennis Training: Impacts on Quality of life in Older Adults - A Randomized Controlled Trial [version 2; peer review: 2 approved]. F1000Research 2025, 14:89 (https://doi.org/10.12688/f1000research.160396.2)

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Version 2

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Reviewer Report 28 Jun 2025

Sairag Saadprai, Department of Sports Science and Sports Development, Faculty of Allied Health Sciences, Thammasat university, Bangkok, Thailand

Approved

https://doi.org/10.5256/f1000research.183926.r394765

I have no ... Continue reading

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Reviewer Report 27 Jun 2025

Hadeel Halaweh, Al-Quds University, Jerusalem, Palestinian Territory

Approved

https://doi.org/10.5256/f1000research.183926.r394764

Thank you for considering my ... Continue reading

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Version 1

VERSION 1

PUBLISHED 15 Jan 2025

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Reviewer Report 17 Jun 2025

Sairag Saadprai, Department of Sports Science and Sports Development, Faculty of Allied Health Sciences, Thammasat university, Bangkok, Thailand

Approved

https://doi.org/10.5256/f1000research.176288.r377811

This manuscript presents a clearly written and timely investigation into the effects of competitive versus recreational table tennis training on quality of life in older adults, using an appropriate randomized controlled trial design. It addressed a relevant problem, applied suitable methodology, and the results were supported by sound statistical analysis and presented in a clear manner.

There are a few areas that require minor but necessary revisions before the manuscript can be considered ready for indexing. These include updating selected references, optionally reporting effect size metrics, clarifying the tone in the conclusions, and removing a sentence that appears to have been included in error.
Overall, this is a valuable and well-executed study that contributes meaningfully to the field of physical activity and aging. I recommend the article for approval with reservations.

I would like to offer the following suggestions to enhance clarity and completeness as follow:

1. Literature Update

Some of the cited references are dated. The authors are encouraged to include more recent literature (preferably from the past five years) to further support the study’s rationale especially regarding the mental and social health benefits of structured physical activity in older adults.

2. Effect Size Reporting

While the statistical analyses are appropriate and well-applied, the manuscript would benefit from reporting effect size measures to help readers better understand the magnitude of differences between groups.

3. Language and Tone in the Conclusions

The authors may consider slightly softening the tone of the conclusions and clearly acknowledging the study’s limitations (e.g., age imbalance between groups and short intervention duration) to maintain a balanced and cautious interpretation of the results.

4. Unintended Sentence in the Methods Section

The following sentence appears to have been included by mistake, as it uses first-person voice, which is generally discouraged in academic writing. It should be removed for consistency with the overall tone of the manuscript: “I would like to know how the study was approved by the appropriate bodies, as obtaining such approvals can sometimes be challenging.”

Is the work clearly and accurately presented and does it cite the current literature?

Partly
Is the study design appropriate and is the work technically sound?

Yes
Are sufficient details of methods and analysis provided to allow replication by others?

Partly
If applicable, is the statistical analysis and its interpretation appropriate?

Yes
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

Partly

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: My area of research is Sport Science.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

CITE

Report a concern

Author Response 11 Sep 2025

Apithai Bumrungpanictarworn, Faculty of Social Sciences and Humanities, Mahidol University, Nakhon Pathom, Thailand

11 Sep 2025

Author Response

We genuinely thank the reviewer for the thoughtful comments and the positive recommendation that accompanied them. Each suggestion has been carefully considered, and we list the principal changes below:

... Continue reading We genuinely thank the reviewer for the thoughtful comments and the positive recommendation that accompanied them. Each suggestion has been carefully considered, and we list the principal changes below:

1.Literature Update: Several references were refreshed with studies published between 2020 and 2023 (Lee et al., 2023; Jonkman et al., 2022; Fanning et al., 2020) so that the theoretical framework now rests on the latest evidence.

2.Effect Size Reporting: Cohen's d has been included throughout the Results section so that readers can grasp how large the observed group differences really are.

3.Conclusion Tone: The Conclusion now strikes a more measured note, and the discussion of limits clearly acknowledges the age imbalance, the brief duration of the intervention, and the baseline inconsistencies.

4.Unintended Sentence: A first-person phrase in the Methods section has been deleted in order to preserve an impersonal scholarly tone.

We once again thank the reviewer for the care shown in reading the paper; the manuscript is unquestionably stronger as a result.

Best regards,

Apithai Bumrungpanictarworn
We genuinely thank the reviewer for the thoughtful comments and the positive recommendation that accompanied them. Each suggestion has been carefully considered, and we list the principal changes below:

1.Literature Update: Several references were refreshed with studies published between 2020 and 2023 (Lee et al., 2023; Jonkman et al., 2022; Fanning et al., 2020) so that the theoretical framework now rests on the latest evidence.

2.Effect Size Reporting: Cohen's d has been included throughout the Results section so that readers can grasp how large the observed group differences really are.

3.Conclusion Tone: The Conclusion now strikes a more measured note, and the discussion of limits clearly acknowledges the age imbalance, the brief duration of the intervention, and the baseline inconsistencies.

4.Unintended Sentence: A first-person phrase in the Methods section has been deleted in order to preserve an impersonal scholarly tone.

We once again thank the reviewer for the care shown in reading the paper; the manuscript is unquestionably stronger as a result.

Best regards,

Apithai Bumrungpanictarworn
Competing Interests: No competing interests were disclosed. Close
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COMMENTS ON THIS REPORT

Author Response 11 Sep 2025

Apithai Bumrungpanictarworn, Faculty of Social Sciences and Humanities, Mahidol University, Nakhon Pathom, Thailand

11 Sep 2025

Author Response

We genuinely thank the reviewer for the thoughtful comments and the positive recommendation that accompanied them. Each suggestion has been carefully considered, and we list the principal changes below:

... Continue reading We genuinely thank the reviewer for the thoughtful comments and the positive recommendation that accompanied them. Each suggestion has been carefully considered, and we list the principal changes below:

1.Literature Update: Several references were refreshed with studies published between 2020 and 2023 (Lee et al., 2023; Jonkman et al., 2022; Fanning et al., 2020) so that the theoretical framework now rests on the latest evidence.

2.Effect Size Reporting: Cohen's d has been included throughout the Results section so that readers can grasp how large the observed group differences really are.

3.Conclusion Tone: The Conclusion now strikes a more measured note, and the discussion of limits clearly acknowledges the age imbalance, the brief duration of the intervention, and the baseline inconsistencies.

4.Unintended Sentence: A first-person phrase in the Methods section has been deleted in order to preserve an impersonal scholarly tone.

We once again thank the reviewer for the care shown in reading the paper; the manuscript is unquestionably stronger as a result.

Best regards,

Apithai Bumrungpanictarworn
We genuinely thank the reviewer for the thoughtful comments and the positive recommendation that accompanied them. Each suggestion has been carefully considered, and we list the principal changes below:

1.Literature Update: Several references were refreshed with studies published between 2020 and 2023 (Lee et al., 2023; Jonkman et al., 2022; Fanning et al., 2020) so that the theoretical framework now rests on the latest evidence.

2.Effect Size Reporting: Cohen's d has been included throughout the Results section so that readers can grasp how large the observed group differences really are.

3.Conclusion Tone: The Conclusion now strikes a more measured note, and the discussion of limits clearly acknowledges the age imbalance, the brief duration of the intervention, and the baseline inconsistencies.

4.Unintended Sentence: A first-person phrase in the Methods section has been deleted in order to preserve an impersonal scholarly tone.

We once again thank the reviewer for the care shown in reading the paper; the manuscript is unquestionably stronger as a result.

Best regards,

Apithai Bumrungpanictarworn
Competing Interests: No competing interests were disclosed. Close
Report a concern

Views

Reviewer Report 17 Feb 2025

Hadeel Halaweh, Al-Quds University, Jerusalem, Palestinian Territory

Approved with Reservations

https://doi.org/10.5256/f1000research.176288.r363782

Thank you for the opportunity to review this manuscript entitled “Comparing Competitive and Recreational Table Tennis Training: Impacts on Quality of life in Older Adults - A Randomized Controlled Trial”.
Introduction:

Generally well-written section.

Generally well-written section.
I noticed an overlap among the three listed objectives and suggest revising them into a single, consolidated objective.

Methods:

Please clarify who conducted the randomization.
Which language was used for the WHOQOL-BREF questionnaire? Was it a validated version? If so, please provide a reference.
The training sessions were scheduled from 10 AM to 12 PM and 3 PM to 5 PM each day. Please clarify whether each participant attended a total of four hours of training daily for 30 days. Additionally, how did you address the risk of exhaustion and fatigue, considering the participants' age range of 40–70 years?
In the data collection section, There is a sentence that has to be deleted “I would like to know how the study was approved by the appropriate bodies, as obtaining such approvals can sometimes be challenging”. Please verify.
I would prefer it if you have a separate title for ethical considerations.

Results:

A major concern in this study is the significant age difference between the experimental and control groups, with the experimental group being younger (p = 0.024). This discrepancy may compromise the internal validity of the results, as age itself can be an independent factor influencing QoL, with younger individuals potentially exhibiting better physical performance.
As shown in Table 2, there were significant differences between the groups in overall QoL, physical health, and social relationships. This raises concerns about the internal validity of the study, particularly regarding the impact of the independent variable (structured training) on QoL domains.
Please calculate the effect size.

Is the work clearly and accurately presented and does it cite the current literature?

Partly
Is the study design appropriate and is the work technically sound?

Partly
Are sufficient details of methods and analysis provided to allow replication by others?

Partly
If applicable, is the statistical analysis and its interpretation appropriate?

Partly
Are all the source data underlying the results available to ensure full reproducibility?

Partly
Are the conclusions drawn adequately supported by the results?

Partly

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Quality of life, gerontology, physical activity.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

CITE

Report a concern

Author Response 10 Sep 2025

Apithai Bumrungpanictarworn, Faculty of Social Sciences and Humanities, Mahidol University, Nakhon Pathom, Thailand

10 Sep 2025

Author Response
Thank you for the review of this manuscript. We sincerely appreciate the time and effort you have taken to review our manuscript. Your thoughtful feedback and constructive suggestions have been ... Continue reading
Thank you for the review of this manuscript. We sincerely appreciate the time and effort you have taken to review our manuscript. Your thoughtful feedback and constructive suggestions have been invaluable in strengthening the quality and clarity of our study. We are grateful for your insights, which have helped refine our methodology, interpretation of results, and overall presentation.

We have carefully addressed each of your comments and made the necessary revisions accordingly. Below, we provide a detailed response to each point, outlining the modifications made in the manuscript. We hope that our revisions align with your expectations and further enhance the rigor of this study. Here are our reply comments:

Introduction:

Generally well-written section.

Reply comment: Thank you

I noticed an overlap among the three listed objectives and suggest revising them into a single, consolidated objective.

Reply comment: We have revised them into a single, consolidated objective to enhance clarity and precision. The updated objective now reflects the core aim of the study more concisely while maintaining the intended scope of the research.
Methods:

Please clarify who conducted the randomization.

Reply comment: We have explicitly stated that the randomization was conducted by the principal investigator using a simple randomization method. This revision ensures clarity regarding the allocation process and maintains the integrity of unbiased participant assignment.

Which language was used for the WHOQOL-BREF questionnaire? Was it a validated version? If so, please provide a reference.

Reply comment: We have now specified that the WHOQOL-BREF questionnaire used in this study was the officially validated Thai version, ensuring linguistic and cultural appropriateness. Additionally, we have provided a reference to the WHO website where the validated version can be accessed.

The training sessions were scheduled from 10 AM to 12 PM and 3 PM to 5 PM each day. Please clarify whether each participant attended a total of four hours of training daily for 30 days. Additionally, how did you address the risk of exhaustion and fatigue, considering the participants' age range of 40–70 years?

Reply comment: We acknowledge your concern regarding the total training hours and fatigue management for participants aged 40–70 years. We have now explicitly stated that each participant attended a total of four hours of training daily for 30 days. Additionally, we have elaborated on the fatigue management strategies implemented, including structured hydration breaks, progressive intensity adjustments, and coach monitoring to ensure participant safety. This clarification highlights the measures taken to minimize exhaustion and optimize training efficacy.

In the data collection section, There is a sentence that has to be deleted “I would like to know how the study was approved by the appropriate bodies, as obtaining such approvals can sometimes be challenging”. Please verify.

Reply comment: Thank you for identifying the unintended sentence in the data collection section. We have now removed the sentence, ensuring that the manuscript remains clear and professionally structured.

I would prefer it if you have a separate title for ethical considerations.

Reply comment: We sincerely apologize for any confusion regarding the ethical approval process. We would like to clarify that this study is part of a larger research project with multiple objectives. Due to this structure, the ethical approval was obtained for the overarching research project as a whole rather than as an independent study. As a result, ethical considerations for this specific study were included within the broader project’s ethics approval.
Although ethical approval was not obtained separately for this particular study, we strictly adhered to all ethical guidelines, participant protection protocols, and the requirements set forth by the approving ethics committee. We appreciate your suggestion and your attention to this matter, and we regret any lack of clarity in our initial submission.
Results:

A major concern in this study is the significant age difference between the experimental and control groups, with the experimental group being younger (p = 0.024). This discrepancy may compromise the internal validity of the results, as age itself can be an independent factor influencing QoL, with younger individuals potentially exhibiting better physical performance.

Reply comment: We appreciate your insightful comment regarding the age difference between the experimental and control groups (p = 0.024). We acknowledge that age can independently influence QoL, particularly in relation to physical performance. This difference arose from the simple randomization process, which did not include age stratification. While this may introduce some variability, the randomization ensured unbiased group assignment.
To address potential age-related confounding effects, the structured training program was designed with adjustable intensity to accommodate participants of varying physical abilities. Coaches closely monitored participants and made modifications as needed to ensure both safety and engagement. Additionally, within-group analyses were conducted to evaluate changes in QoL over time, helping to isolate the impact of structured training from age-related factors.
We recognize this as a limitation of the study and have revised the Study Limitations section to reflect this consideration. We sincerely appreciate your valuable input in strengthening our discussion on this matter.

As shown in Table 2, there were significant differences between the groups in overall QoL, physical health, and social relationships. This raises concerns about the internal validity of the study, particularly regarding the impact of the independent variable (structured training) on QoL domains.

Reply comment: Thank you for highlighting the baseline differences in overall QoL, physical health, and social relationships between the groups. We acknowledge that these differences could raise concerns about internal validity, as higher initial QoL scores in the experimental group might suggest an inherent advantage before the intervention.
To address this concern, we utilized multiple analytical approaches. First, we conducted both within-group and between-group comparisons to evaluate the impact of the intervention comprehensively. The within-group analysis assessed changes relative to each participant’s baseline, ensuring that improvements in the experimental group were attributable to structured training rather than pre-existing differences. The between-group comparisons further demonstrated that post-intervention QoL scores remained significantly higher in the experimental group, reinforcing the effectiveness of the intervention.
While baseline differences existed, the purpose of the study was to evaluate whether structured training could significantly enhance QoL compared to recreational play. The control group, which did not receive structured training, served as a reference point to assess whether improvements were driven by the intervention itself rather than natural variation.
We appreciate this valuable observation and have revised the Study Limitations section accordingly to reflect these considerations.

Please calculate the effect size.

Reply comment: We have now calculated and reported effect sizes for all key comparisons in the study. Specifically, we have incorporated Cohen’s d as the effect size measure for between-group differences, as it is appropriate for comparing two independent groups in a randomized controlled trial.
Effect sizes have been integrated into the Results section, where we report the statistical significance of our findings. The summary of effect sizes has also been provided at the end of the Results section to ensure clarity and facilitate interpretation. Below are the key effect sizes:

Overall QoL: Cohen’s d = 1.69 (very large effect size)

Physical Health: Cohen’s d = 1.89 (very large effect size)

Psychological Health: Cohen’s d = 0.83 (moderate to large effect size)

Social Relationships: Cohen’s d = 3.04 (very large effect size)

Environmental Factors: Cohen’s d = 0.59 (moderate effect size, not statistically significant)

These effect sizes provide additional insight into the magnitude of the intervention’s impact. We have ensured that all effect sizes are reported alongside their corresponding statistical results (t-tests and p-values) for completeness.

Once again, we truly appreciate your dedication to improving our work and your contribution to this research.

Best regards,

Apithai Bumrungpanictarworn
Thank you for the review of this manuscript. We sincerely appreciate the time and effort you have taken to review our manuscript. Your thoughtful feedback and constructive suggestions have been invaluable in strengthening the quality and clarity of our study. We are grateful for your insights, which have helped refine our methodology, interpretation of results, and overall presentation.

We have carefully addressed each of your comments and made the necessary revisions accordingly. Below, we provide a detailed response to each point, outlining the modifications made in the manuscript. We hope that our revisions align with your expectations and further enhance the rigor of this study. Here are our reply comments:

Introduction:

Generally well-written section.

Reply comment: Thank you

I noticed an overlap among the three listed objectives and suggest revising them into a single, consolidated objective.

Reply comment: We have revised them into a single, consolidated objective to enhance clarity and precision. The updated objective now reflects the core aim of the study more concisely while maintaining the intended scope of the research.
Methods:

Please clarify who conducted the randomization.

Reply comment: We have explicitly stated that the randomization was conducted by the principal investigator using a simple randomization method. This revision ensures clarity regarding the allocation process and maintains the integrity of unbiased participant assignment.

Which language was used for the WHOQOL-BREF questionnaire? Was it a validated version? If so, please provide a reference.

Reply comment: We have now specified that the WHOQOL-BREF questionnaire used in this study was the officially validated Thai version, ensuring linguistic and cultural appropriateness. Additionally, we have provided a reference to the WHO website where the validated version can be accessed.

The training sessions were scheduled from 10 AM to 12 PM and 3 PM to 5 PM each day. Please clarify whether each participant attended a total of four hours of training daily for 30 days. Additionally, how did you address the risk of exhaustion and fatigue, considering the participants' age range of 40–70 years?

Reply comment: We acknowledge your concern regarding the total training hours and fatigue management for participants aged 40–70 years. We have now explicitly stated that each participant attended a total of four hours of training daily for 30 days. Additionally, we have elaborated on the fatigue management strategies implemented, including structured hydration breaks, progressive intensity adjustments, and coach monitoring to ensure participant safety. This clarification highlights the measures taken to minimize exhaustion and optimize training efficacy.

In the data collection section, There is a sentence that has to be deleted “I would like to know how the study was approved by the appropriate bodies, as obtaining such approvals can sometimes be challenging”. Please verify.

Reply comment: Thank you for identifying the unintended sentence in the data collection section. We have now removed the sentence, ensuring that the manuscript remains clear and professionally structured.

I would prefer it if you have a separate title for ethical considerations.

Reply comment: We sincerely apologize for any confusion regarding the ethical approval process. We would like to clarify that this study is part of a larger research project with multiple objectives. Due to this structure, the ethical approval was obtained for the overarching research project as a whole rather than as an independent study. As a result, ethical considerations for this specific study were included within the broader project’s ethics approval.
Although ethical approval was not obtained separately for this particular study, we strictly adhered to all ethical guidelines, participant protection protocols, and the requirements set forth by the approving ethics committee. We appreciate your suggestion and your attention to this matter, and we regret any lack of clarity in our initial submission.
Results:

A major concern in this study is the significant age difference between the experimental and control groups, with the experimental group being younger (p = 0.024). This discrepancy may compromise the internal validity of the results, as age itself can be an independent factor influencing QoL, with younger individuals potentially exhibiting better physical performance.

Reply comment: We appreciate your insightful comment regarding the age difference between the experimental and control groups (p = 0.024). We acknowledge that age can independently influence QoL, particularly in relation to physical performance. This difference arose from the simple randomization process, which did not include age stratification. While this may introduce some variability, the randomization ensured unbiased group assignment.
To address potential age-related confounding effects, the structured training program was designed with adjustable intensity to accommodate participants of varying physical abilities. Coaches closely monitored participants and made modifications as needed to ensure both safety and engagement. Additionally, within-group analyses were conducted to evaluate changes in QoL over time, helping to isolate the impact of structured training from age-related factors.
We recognize this as a limitation of the study and have revised the Study Limitations section to reflect this consideration. We sincerely appreciate your valuable input in strengthening our discussion on this matter.

As shown in Table 2, there were significant differences between the groups in overall QoL, physical health, and social relationships. This raises concerns about the internal validity of the study, particularly regarding the impact of the independent variable (structured training) on QoL domains.

Reply comment: Thank you for highlighting the baseline differences in overall QoL, physical health, and social relationships between the groups. We acknowledge that these differences could raise concerns about internal validity, as higher initial QoL scores in the experimental group might suggest an inherent advantage before the intervention.
To address this concern, we utilized multiple analytical approaches. First, we conducted both within-group and between-group comparisons to evaluate the impact of the intervention comprehensively. The within-group analysis assessed changes relative to each participant’s baseline, ensuring that improvements in the experimental group were attributable to structured training rather than pre-existing differences. The between-group comparisons further demonstrated that post-intervention QoL scores remained significantly higher in the experimental group, reinforcing the effectiveness of the intervention.
While baseline differences existed, the purpose of the study was to evaluate whether structured training could significantly enhance QoL compared to recreational play. The control group, which did not receive structured training, served as a reference point to assess whether improvements were driven by the intervention itself rather than natural variation.
We appreciate this valuable observation and have revised the Study Limitations section accordingly to reflect these considerations.

Please calculate the effect size.

Reply comment: We have now calculated and reported effect sizes for all key comparisons in the study. Specifically, we have incorporated Cohen’s d as the effect size measure for between-group differences, as it is appropriate for comparing two independent groups in a randomized controlled trial.
Effect sizes have been integrated into the Results section, where we report the statistical significance of our findings. The summary of effect sizes has also been provided at the end of the Results section to ensure clarity and facilitate interpretation. Below are the key effect sizes:

Overall QoL: Cohen’s d = 1.69 (very large effect size)

Physical Health: Cohen’s d = 1.89 (very large effect size)

Psychological Health: Cohen’s d = 0.83 (moderate to large effect size)

Social Relationships: Cohen’s d = 3.04 (very large effect size)

Environmental Factors: Cohen’s d = 0.59 (moderate effect size, not statistically significant)

These effect sizes provide additional insight into the magnitude of the intervention’s impact. We have ensured that all effect sizes are reported alongside their corresponding statistical results (t-tests and p-values) for completeness.

Once again, we truly appreciate your dedication to improving our work and your contribution to this research.

Best regards,

Apithai Bumrungpanictarworn
Competing Interests: No competing interests were disclosed. Close
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COMMENTS ON THIS REPORT

Author Response 10 Sep 2025

Apithai Bumrungpanictarworn, Faculty of Social Sciences and Humanities, Mahidol University, Nakhon Pathom, Thailand

10 Sep 2025

Author Response
Thank you for the review of this manuscript. We sincerely appreciate the time and effort you have taken to review our manuscript. Your thoughtful feedback and constructive suggestions have been ... Continue reading
Thank you for the review of this manuscript. We sincerely appreciate the time and effort you have taken to review our manuscript. Your thoughtful feedback and constructive suggestions have been invaluable in strengthening the quality and clarity of our study. We are grateful for your insights, which have helped refine our methodology, interpretation of results, and overall presentation.

We have carefully addressed each of your comments and made the necessary revisions accordingly. Below, we provide a detailed response to each point, outlining the modifications made in the manuscript. We hope that our revisions align with your expectations and further enhance the rigor of this study. Here are our reply comments:

Introduction:

Generally well-written section.

Reply comment: Thank you

I noticed an overlap among the three listed objectives and suggest revising them into a single, consolidated objective.

Reply comment: We have revised them into a single, consolidated objective to enhance clarity and precision. The updated objective now reflects the core aim of the study more concisely while maintaining the intended scope of the research.
Methods:

Please clarify who conducted the randomization.

Reply comment: We have explicitly stated that the randomization was conducted by the principal investigator using a simple randomization method. This revision ensures clarity regarding the allocation process and maintains the integrity of unbiased participant assignment.

Which language was used for the WHOQOL-BREF questionnaire? Was it a validated version? If so, please provide a reference.

Reply comment: We have now specified that the WHOQOL-BREF questionnaire used in this study was the officially validated Thai version, ensuring linguistic and cultural appropriateness. Additionally, we have provided a reference to the WHO website where the validated version can be accessed.

The training sessions were scheduled from 10 AM to 12 PM and 3 PM to 5 PM each day. Please clarify whether each participant attended a total of four hours of training daily for 30 days. Additionally, how did you address the risk of exhaustion and fatigue, considering the participants' age range of 40–70 years?

Reply comment: We acknowledge your concern regarding the total training hours and fatigue management for participants aged 40–70 years. We have now explicitly stated that each participant attended a total of four hours of training daily for 30 days. Additionally, we have elaborated on the fatigue management strategies implemented, including structured hydration breaks, progressive intensity adjustments, and coach monitoring to ensure participant safety. This clarification highlights the measures taken to minimize exhaustion and optimize training efficacy.

In the data collection section, There is a sentence that has to be deleted “I would like to know how the study was approved by the appropriate bodies, as obtaining such approvals can sometimes be challenging”. Please verify.

Reply comment: Thank you for identifying the unintended sentence in the data collection section. We have now removed the sentence, ensuring that the manuscript remains clear and professionally structured.

I would prefer it if you have a separate title for ethical considerations.

Reply comment: We sincerely apologize for any confusion regarding the ethical approval process. We would like to clarify that this study is part of a larger research project with multiple objectives. Due to this structure, the ethical approval was obtained for the overarching research project as a whole rather than as an independent study. As a result, ethical considerations for this specific study were included within the broader project’s ethics approval.
Although ethical approval was not obtained separately for this particular study, we strictly adhered to all ethical guidelines, participant protection protocols, and the requirements set forth by the approving ethics committee. We appreciate your suggestion and your attention to this matter, and we regret any lack of clarity in our initial submission.
Results:

A major concern in this study is the significant age difference between the experimental and control groups, with the experimental group being younger (p = 0.024). This discrepancy may compromise the internal validity of the results, as age itself can be an independent factor influencing QoL, with younger individuals potentially exhibiting better physical performance.

Reply comment: We appreciate your insightful comment regarding the age difference between the experimental and control groups (p = 0.024). We acknowledge that age can independently influence QoL, particularly in relation to physical performance. This difference arose from the simple randomization process, which did not include age stratification. While this may introduce some variability, the randomization ensured unbiased group assignment.
To address potential age-related confounding effects, the structured training program was designed with adjustable intensity to accommodate participants of varying physical abilities. Coaches closely monitored participants and made modifications as needed to ensure both safety and engagement. Additionally, within-group analyses were conducted to evaluate changes in QoL over time, helping to isolate the impact of structured training from age-related factors.
We recognize this as a limitation of the study and have revised the Study Limitations section to reflect this consideration. We sincerely appreciate your valuable input in strengthening our discussion on this matter.

As shown in Table 2, there were significant differences between the groups in overall QoL, physical health, and social relationships. This raises concerns about the internal validity of the study, particularly regarding the impact of the independent variable (structured training) on QoL domains.

Reply comment: Thank you for highlighting the baseline differences in overall QoL, physical health, and social relationships between the groups. We acknowledge that these differences could raise concerns about internal validity, as higher initial QoL scores in the experimental group might suggest an inherent advantage before the intervention.
To address this concern, we utilized multiple analytical approaches. First, we conducted both within-group and between-group comparisons to evaluate the impact of the intervention comprehensively. The within-group analysis assessed changes relative to each participant’s baseline, ensuring that improvements in the experimental group were attributable to structured training rather than pre-existing differences. The between-group comparisons further demonstrated that post-intervention QoL scores remained significantly higher in the experimental group, reinforcing the effectiveness of the intervention.
While baseline differences existed, the purpose of the study was to evaluate whether structured training could significantly enhance QoL compared to recreational play. The control group, which did not receive structured training, served as a reference point to assess whether improvements were driven by the intervention itself rather than natural variation.
We appreciate this valuable observation and have revised the Study Limitations section accordingly to reflect these considerations.

Please calculate the effect size.

Reply comment: We have now calculated and reported effect sizes for all key comparisons in the study. Specifically, we have incorporated Cohen’s d as the effect size measure for between-group differences, as it is appropriate for comparing two independent groups in a randomized controlled trial.
Effect sizes have been integrated into the Results section, where we report the statistical significance of our findings. The summary of effect sizes has also been provided at the end of the Results section to ensure clarity and facilitate interpretation. Below are the key effect sizes:

Overall QoL: Cohen’s d = 1.69 (very large effect size)

Physical Health: Cohen’s d = 1.89 (very large effect size)

Psychological Health: Cohen’s d = 0.83 (moderate to large effect size)

Social Relationships: Cohen’s d = 3.04 (very large effect size)

Environmental Factors: Cohen’s d = 0.59 (moderate effect size, not statistically significant)

These effect sizes provide additional insight into the magnitude of the intervention’s impact. We have ensured that all effect sizes are reported alongside their corresponding statistical results (t-tests and p-values) for completeness.

Once again, we truly appreciate your dedication to improving our work and your contribution to this research.

Best regards,

Apithai Bumrungpanictarworn
Thank you for the review of this manuscript. We sincerely appreciate the time and effort you have taken to review our manuscript. Your thoughtful feedback and constructive suggestions have been invaluable in strengthening the quality and clarity of our study. We are grateful for your insights, which have helped refine our methodology, interpretation of results, and overall presentation.

We have carefully addressed each of your comments and made the necessary revisions accordingly. Below, we provide a detailed response to each point, outlining the modifications made in the manuscript. We hope that our revisions align with your expectations and further enhance the rigor of this study. Here are our reply comments:

Introduction:

Generally well-written section.

Reply comment: Thank you

I noticed an overlap among the three listed objectives and suggest revising them into a single, consolidated objective.

Reply comment: We have revised them into a single, consolidated objective to enhance clarity and precision. The updated objective now reflects the core aim of the study more concisely while maintaining the intended scope of the research.
Methods:

Please clarify who conducted the randomization.

Reply comment: We have explicitly stated that the randomization was conducted by the principal investigator using a simple randomization method. This revision ensures clarity regarding the allocation process and maintains the integrity of unbiased participant assignment.

Which language was used for the WHOQOL-BREF questionnaire? Was it a validated version? If so, please provide a reference.

Reply comment: We have now specified that the WHOQOL-BREF questionnaire used in this study was the officially validated Thai version, ensuring linguistic and cultural appropriateness. Additionally, we have provided a reference to the WHO website where the validated version can be accessed.

The training sessions were scheduled from 10 AM to 12 PM and 3 PM to 5 PM each day. Please clarify whether each participant attended a total of four hours of training daily for 30 days. Additionally, how did you address the risk of exhaustion and fatigue, considering the participants' age range of 40–70 years?

Reply comment: We acknowledge your concern regarding the total training hours and fatigue management for participants aged 40–70 years. We have now explicitly stated that each participant attended a total of four hours of training daily for 30 days. Additionally, we have elaborated on the fatigue management strategies implemented, including structured hydration breaks, progressive intensity adjustments, and coach monitoring to ensure participant safety. This clarification highlights the measures taken to minimize exhaustion and optimize training efficacy.

In the data collection section, There is a sentence that has to be deleted “I would like to know how the study was approved by the appropriate bodies, as obtaining such approvals can sometimes be challenging”. Please verify.

Reply comment: Thank you for identifying the unintended sentence in the data collection section. We have now removed the sentence, ensuring that the manuscript remains clear and professionally structured.

I would prefer it if you have a separate title for ethical considerations.

Reply comment: We sincerely apologize for any confusion regarding the ethical approval process. We would like to clarify that this study is part of a larger research project with multiple objectives. Due to this structure, the ethical approval was obtained for the overarching research project as a whole rather than as an independent study. As a result, ethical considerations for this specific study were included within the broader project’s ethics approval.
Although ethical approval was not obtained separately for this particular study, we strictly adhered to all ethical guidelines, participant protection protocols, and the requirements set forth by the approving ethics committee. We appreciate your suggestion and your attention to this matter, and we regret any lack of clarity in our initial submission.
Results:

A major concern in this study is the significant age difference between the experimental and control groups, with the experimental group being younger (p = 0.024). This discrepancy may compromise the internal validity of the results, as age itself can be an independent factor influencing QoL, with younger individuals potentially exhibiting better physical performance.

Reply comment: We appreciate your insightful comment regarding the age difference between the experimental and control groups (p = 0.024). We acknowledge that age can independently influence QoL, particularly in relation to physical performance. This difference arose from the simple randomization process, which did not include age stratification. While this may introduce some variability, the randomization ensured unbiased group assignment.
To address potential age-related confounding effects, the structured training program was designed with adjustable intensity to accommodate participants of varying physical abilities. Coaches closely monitored participants and made modifications as needed to ensure both safety and engagement. Additionally, within-group analyses were conducted to evaluate changes in QoL over time, helping to isolate the impact of structured training from age-related factors.
We recognize this as a limitation of the study and have revised the Study Limitations section to reflect this consideration. We sincerely appreciate your valuable input in strengthening our discussion on this matter.

As shown in Table 2, there were significant differences between the groups in overall QoL, physical health, and social relationships. This raises concerns about the internal validity of the study, particularly regarding the impact of the independent variable (structured training) on QoL domains.

Reply comment: Thank you for highlighting the baseline differences in overall QoL, physical health, and social relationships between the groups. We acknowledge that these differences could raise concerns about internal validity, as higher initial QoL scores in the experimental group might suggest an inherent advantage before the intervention.
To address this concern, we utilized multiple analytical approaches. First, we conducted both within-group and between-group comparisons to evaluate the impact of the intervention comprehensively. The within-group analysis assessed changes relative to each participant’s baseline, ensuring that improvements in the experimental group were attributable to structured training rather than pre-existing differences. The between-group comparisons further demonstrated that post-intervention QoL scores remained significantly higher in the experimental group, reinforcing the effectiveness of the intervention.
While baseline differences existed, the purpose of the study was to evaluate whether structured training could significantly enhance QoL compared to recreational play. The control group, which did not receive structured training, served as a reference point to assess whether improvements were driven by the intervention itself rather than natural variation.
We appreciate this valuable observation and have revised the Study Limitations section accordingly to reflect these considerations.

Please calculate the effect size.

Reply comment: We have now calculated and reported effect sizes for all key comparisons in the study. Specifically, we have incorporated Cohen’s d as the effect size measure for between-group differences, as it is appropriate for comparing two independent groups in a randomized controlled trial.
Effect sizes have been integrated into the Results section, where we report the statistical significance of our findings. The summary of effect sizes has also been provided at the end of the Results section to ensure clarity and facilitate interpretation. Below are the key effect sizes:

Overall QoL: Cohen’s d = 1.69 (very large effect size)

Physical Health: Cohen’s d = 1.89 (very large effect size)

Psychological Health: Cohen’s d = 0.83 (moderate to large effect size)

Social Relationships: Cohen’s d = 3.04 (very large effect size)

Environmental Factors: Cohen’s d = 0.59 (moderate effect size, not statistically significant)

These effect sizes provide additional insight into the magnitude of the intervention’s impact. We have ensured that all effect sizes are reported alongside their corresponding statistical results (t-tests and p-values) for completeness.

Once again, we truly appreciate your dedication to improving our work and your contribution to this research.

Best regards,

Apithai Bumrungpanictarworn
Competing Interests: No competing interests were disclosed. Close
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Version 2

VERSION 2 PUBLISHED 15 Jan 2025

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Version 2 (revision) 25 Jun 25	read	read
Version 1 15 Jan 25	read	read

Hadeel Halaweh, Al-Quds University, Jerusalem, Palestinian Territory
Sairag Saadprai, Thammasat university, Bangkok, Thailand

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4 Views

28 Jun 2025 | for Version 2

Sairag Saadprai, Department of Sports Science and Sports Development, Faculty of Allied Health Sciences, Thammasat university, Bangkok, Thailand

4 Views Cite this report Responses(0)

Approved

I have no further comments to make.

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

My area of research is Sport Science.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

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8 Views

27 Jun 2025 | for Version 2

Hadeel Halaweh, Al-Quds University, Jerusalem, Palestinian Territory

8 Views Cite this report Responses(0)

Approved

Thank you for considering my comments.
My decision is approved

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Quality of life, gerontology, physical activity.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

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Reviewer Report

16 Views

17 Jun 2025 | for Version 1

Sairag Saadprai, Department of Sports Science and Sports Development, Faculty of Allied Health Sciences, Thammasat university, Bangkok, Thailand

16 Views Cite this report Responses(1)

Approved

Is the work clearly and accurately presented and does it cite the current literature?

Partly
Is the study design appropriate and is the work technically sound?

Yes
Are sufficient details of methods and analysis provided to allow replication by others?

Partly
If applicable, is the statistical analysis and its interpretation appropriate?

Yes
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

Partly

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

My area of research is Sport Science.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

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Responses (1)

Author Response

11 Sep 2025

Apithai Bumrungpanictarworn, Faculty of Social Sciences and Humanities, Mahidol University, Nakhon Pathom, Thailand

We genuinely thank the reviewer for the thoughtful comments and the positive recommendation that accompanied them. Each suggestion has been carefully considered, and we list the principal changes below:

1.Literature Update: Several references were refreshed with studies published between 2020 and 2023 (Lee et al., 2023; Jonkman et al., 2022; Fanning et al., 2020) so that the theoretical framework now rests on the latest evidence.

2.Effect Size Reporting: Cohen's d has been included throughout the Results section so that readers can grasp how large the observed group differences really are.

3.Conclusion Tone: The Conclusion now strikes a more measured note, and the discussion of limits clearly acknowledges the age imbalance, the brief duration of the intervention, and the baseline inconsistencies.

4.Unintended Sentence: A first-person phrase in the Methods section has been deleted in order to preserve an impersonal scholarly tone.

We once again thank the reviewer for the care shown in reading the paper; the manuscript is unquestionably stronger as a result.

Best regards,

Apithai Bumrungpanictarworn

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Competing Interests

No competing interests were disclosed.

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Reviewer Report

31 Views

17 Feb 2025 | for Version 1

Hadeel Halaweh, Al-Quds University, Jerusalem, Palestinian Territory

31 Views Cite this report Responses(1)

Approved With Reservations

Generally well-written section.
I noticed an overlap among the three listed objectives and suggest revising them into a single, consolidated objective.

Methods:

Please clarify who conducted the randomization.
Which language was used for the WHOQOL-BREF questionnaire? Was it a validated version? If so, please provide a reference.
The training sessions were scheduled from 10 AM to 12 PM and 3 PM to 5 PM each day. Please clarify whether each participant attended a total of four hours of training daily for 30 days. Additionally, how did you address the risk of exhaustion and fatigue, considering the participants' age range of 40–70 years?
In the data collection section, There is a sentence that has to be deleted “I would like to know how the study was approved by the appropriate bodies, as obtaining such approvals can sometimes be challenging”. Please verify.
I would prefer it if you have a separate title for ethical considerations.

Results:

A major concern in this study is the significant age difference between the experimental and control groups, with the experimental group being younger (p = 0.024). This discrepancy may compromise the internal validity of the results, as age itself can be an independent factor influencing QoL, with younger individuals potentially exhibiting better physical performance.
As shown in Table 2, there were significant differences between the groups in overall QoL, physical health, and social relationships. This raises concerns about the internal validity of the study, particularly regarding the impact of the independent variable (structured training) on QoL domains.
Please calculate the effect size.

Is the work clearly and accurately presented and does it cite the current literature?

Partly
Is the study design appropriate and is the work technically sound?

Partly
Are sufficient details of methods and analysis provided to allow replication by others?

Partly
If applicable, is the statistical analysis and its interpretation appropriate?

Partly
Are all the source data underlying the results available to ensure full reproducibility?

Partly
Are the conclusions drawn adequately supported by the results?

Partly

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Quality of life, gerontology, physical activity.

Respond to this report

Responses (1)

Author Response

10 Sep 2025

Apithai Bumrungpanictarworn, Faculty of Social Sciences and Humanities, Mahidol University, Nakhon Pathom, Thailand

Thank you for the review of this manuscript. We sincerely appreciate the time and effort you have taken to review our manuscript. Your thoughtful feedback and constructive suggestions have been invaluable in strengthening the quality and clarity of our study. We are grateful for your insights, which have helped refine our methodology, interpretation of results, and overall presentation.

We have carefully addressed each of your comments and made the necessary revisions accordingly. Below, we provide a detailed response to each point, outlining the modifications made in the manuscript. We hope that our revisions align with your expectations and further enhance the rigor of this study. Here are our reply comments:

Introduction:

Generally well-written section.

Reply comment: Thank you

I noticed an overlap among the three listed objectives and suggest revising them into a single, consolidated objective.

Reply comment: We have revised them into a single, consolidated objective to enhance clarity and precision. The updated objective now reflects the core aim of the study more concisely while maintaining the intended scope of the research.
Methods:

Please clarify who conducted the randomization.

Reply comment: We have explicitly stated that the randomization was conducted by the principal investigator using a simple randomization method. This revision ensures clarity regarding the allocation process and maintains the integrity of unbiased participant assignment.

Which language was used for the WHOQOL-BREF questionnaire? Was it a validated version? If so, please provide a reference.

Reply comment: We have now specified that the WHOQOL-BREF questionnaire used in this study was the officially validated Thai version, ensuring linguistic and cultural appropriateness. Additionally, we have provided a reference to the WHO website where the validated version can be accessed.

The training sessions were scheduled from 10 AM to 12 PM and 3 PM to 5 PM each day. Please clarify whether each participant attended a total of four hours of training daily for 30 days. Additionally, how did you address the risk of exhaustion and fatigue, considering the participants' age range of 40–70 years?

Reply comment: We acknowledge your concern regarding the total training hours and fatigue management for participants aged 40–70 years. We have now explicitly stated that each participant attended a total of four hours of training daily for 30 days. Additionally, we have elaborated on the fatigue management strategies implemented, including structured hydration breaks, progressive intensity adjustments, and coach monitoring to ensure participant safety. This clarification highlights the measures taken to minimize exhaustion and optimize training efficacy.

In the data collection section, There is a sentence that has to be deleted “I would like to know how the study was approved by the appropriate bodies, as obtaining such approvals can sometimes be challenging”. Please verify.

Reply comment: Thank you for identifying the unintended sentence in the data collection section. We have now removed the sentence, ensuring that the manuscript remains clear and professionally structured.

I would prefer it if you have a separate title for ethical considerations.

Reply comment: We sincerely apologize for any confusion regarding the ethical approval process. We would like to clarify that this study is part of a larger research project with multiple objectives. Due to this structure, the ethical approval was obtained for the overarching research project as a whole rather than as an independent study. As a result, ethical considerations for this specific study were included within the broader project’s ethics approval.
Although ethical approval was not obtained separately for this particular study, we strictly adhered to all ethical guidelines, participant protection protocols, and the requirements set forth by the approving ethics committee. We appreciate your suggestion and your attention to this matter, and we regret any lack of clarity in our initial submission.
Results:

A major concern in this study is the significant age difference between the experimental and control groups, with the experimental group being younger (p = 0.024). This discrepancy may compromise the internal validity of the results, as age itself can be an independent factor influencing QoL, with younger individuals potentially exhibiting better physical performance.

Reply comment: We appreciate your insightful comment regarding the age difference between the experimental and control groups (p = 0.024). We acknowledge that age can independently influence QoL, particularly in relation to physical performance. This difference arose from the simple randomization process, which did not include age stratification. While this may introduce some variability, the randomization ensured unbiased group assignment.
To address potential age-related confounding effects, the structured training program was designed with adjustable intensity to accommodate participants of varying physical abilities. Coaches closely monitored participants and made modifications as needed to ensure both safety and engagement. Additionally, within-group analyses were conducted to evaluate changes in QoL over time, helping to isolate the impact of structured training from age-related factors.
We recognize this as a limitation of the study and have revised the Study Limitations section to reflect this consideration. We sincerely appreciate your valuable input in strengthening our discussion on this matter.

As shown in Table 2, there were significant differences between the groups in overall QoL, physical health, and social relationships. This raises concerns about the internal validity of the study, particularly regarding the impact of the independent variable (structured training) on QoL domains.

Reply comment: Thank you for highlighting the baseline differences in overall QoL, physical health, and social relationships between the groups. We acknowledge that these differences could raise concerns about internal validity, as higher initial QoL scores in the experimental group might suggest an inherent advantage before the intervention.
To address this concern, we utilized multiple analytical approaches. First, we conducted both within-group and between-group comparisons to evaluate the impact of the intervention comprehensively. The within-group analysis assessed changes relative to each participant’s baseline, ensuring that improvements in the experimental group were attributable to structured training rather than pre-existing differences. The between-group comparisons further demonstrated that post-intervention QoL scores remained significantly higher in the experimental group, reinforcing the effectiveness of the intervention.
While baseline differences existed, the purpose of the study was to evaluate whether structured training could significantly enhance QoL compared to recreational play. The control group, which did not receive structured training, served as a reference point to assess whether improvements were driven by the intervention itself rather than natural variation.
We appreciate this valuable observation and have revised the Study Limitations section accordingly to reflect these considerations.

Please calculate the effect size.

Reply comment: We have now calculated and reported effect sizes for all key comparisons in the study. Specifically, we have incorporated Cohen’s d as the effect size measure for between-group differences, as it is appropriate for comparing two independent groups in a randomized controlled trial.
Effect sizes have been integrated into the Results section, where we report the statistical significance of our findings. The summary of effect sizes has also been provided at the end of the Results section to ensure clarity and facilitate interpretation. Below are the key effect sizes:

Overall QoL: Cohen’s d = 1.69 (very large effect size)
Physical Health: Cohen’s d = 1.89 (very large effect size)
Psychological Health: Cohen’s d = 0.83 (moderate to large effect size)
Social Relationships: Cohen’s d = 3.04 (very large effect size)
Environmental Factors: Cohen’s d = 0.59 (moderate effect size, not statistically significant)

These effect sizes provide additional insight into the magnitude of the intervention’s impact. We have ensured that all effect sizes are reported alongside their corresponding statistical results (t-tests and p-values) for completeness.

Once again, we truly appreciate your dedication to improving our work and your contribution to this research.

Best regards,

Apithai Bumrungpanictarworn

View more View less

Competing Interests

No competing interests were disclosed.

Alongside their report, reviewers assign a status to the article:

Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested

Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.

Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions

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Comparing Competitive and Recreational Table Tennis Training: Impacts on Quality of life in Older Adults - A Randomized Controlled Trial

Abstract

Background

Methods

Results

Conclusions

Registration

Keywords

Revised Amendments from Version 1

Introduction

Objectives

Methods

Study design

Participants and setting

Randomization and allocation

Experimental group

Control group

Procedure

Outcome measures

Physical health

Psychological health

Social relationships

Environmental factors

Data collection and analysis

Clinical trial registration

Result

Participants’ demographic and baseline characteristics

Figure 1. Study flow diagram.

Table 1. Participants’ demographic.

Table 2. Baseline characteristics.

Primary outcomes

Table 3. Changes in QoL scores after the intervention.

Physical health

Psychological health

Social relationships

Environmental factors

Between-group comparisons

Proportion of QoL levels

Table 4. Proportion of QoL Levels (Pre-Test and Post-Test).

Summary of effect sizes

Discussion

Conclusion

Strengths and limitations

Implications and future directions

Ethics and consent

Data availability statement

Underlying data

Reporting guidelines

References

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