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

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.

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

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.

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.

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).

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).

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.

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.

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.