Exercise is the only established disease-modifying intervention in Parkinson's disease (PD), and continued exploration of innovative and engaging exercise modalities may further enhance outcomes for individuals living with PD. Table tennis (TT) is a cognitively engaging, task-specific activity integrating visuospatial processing, anticipatory motor planning, and dynamic postural control.
Objective
To examine the feasibility, including attendance, retention, and safety, and effects of a 12 week TT-based program, NeuroPongTM, on motor and non-motor symptoms in individuals with PD.
Methods
In this single-arm pilot study, 30 participants were enrolled and 26 completed 12 weeks of twice-weekly, 2-h TT sessions. The primary outcome was the Movement Disorders Society-Unified Parkinson's Disease Rating Scale Part III (MDS-UPDRS III). Secondary outcomes included the Berg Balance Scale (BBS), Timed Up and Go (TUG), Six-Minute Walk Test (6MWT), Montreal Cognitive Assessment (MoCA) and several patient-reported outcomes. Pre-post comparisons were conducted using paired T-tests.
Results
Improvements were observed in the MDS-UPDRS Part III (mean change −5.73, 95% CI −9.02 to −2.44, p = 0.0014), BBS (mean change +3.08, 95% CI 1.987 to 4.17, p < 0.0001), TUG (mean change −1.04, 95% CI −1.69 to −0.38, p = 0.0032), and 6MWT (mean change 66.77, 95% CI 49.82 to 83.71, p < 0.0001). Self-reported depression decreased (Hospital Anxiety and Depression Scale, HADS-D mean change −1.12, 95% CI −1.97 to −0.26, p = 0.0129). Attendance averaged approximately 90%, and no adverse events were reported. No significant changes were observed in other outcomes.
Conclusions
A 12-week TT-based program, NeuroPong™, was feasible and associated with improvement in motor function, balance, walking endurance and self-reported depression in PD. The multidimensional motor and cognitive demands of table tennis may contribute to these observed benefits. Larger randomized controlled trials are warranted.
BlumL.Korner-BitenskyN. (2008). Usefulness of the Berg Balance Scale in stroke rehabilitation: A systematic review. Physical Therapy, 88(5), 559–566. https://doi.org/10.2522/ptj.20070205
3.
BronsteinA. M.HoodJ. D.GrestyM. A.PanagiC. (1990). Visual control of balance in cerebellar and parkinsonian syndromes. Brain : A Journal of Neurology, 113(Pt 3), 767–779. https://doi.org/10.1093/brain/113.3.767
4.
ChaudhuriK. R.HealyD. G.SchapiraA. H. V. (2006). Non-motor symptoms of Parkinson’s disease: Diagnosis and management. The Lancet Neurology, 5(3), 235–245. https://doi.org/10.1016/S1474-4422(06)70373-8
5.
CombsS. A.DiehlM. D.StaplesW. H.ConnL.DavisK.LewisN.SchanemanK. (2011). Boxing training for patients with Parkinson disease: A case series. Physical Therapy, 91(1), 132–142. https://doi.org/10.2522/ptj.20100142
6.
CugusiL.MancaA.BergaminM.Di BlasioA.MonticoneM.DeriuF.MercuroG. (2019). Aquatic exercise improves motor impairments in people with Parkinson’s disease, with similar or greater benefits than land-based exercise: A systematic review. Journal of Physiotherapy, 65(2), 65–74. https://doi.org/10.1016/j.jphys.2019.02.003
7.
DeciE. L.RyanR. M. (2000). The “what” and “why” of goal pursuits: Human needs and the self-determination of behavior. Psychilogical Inquiry, 11(4), 227–268. https://doi.org/10.1207/S15327965PLI1104_01
8.
DorseyE. R.ShererT.OkunM. S.BloemB. R. (2018). The emerging evidence of the Parkinson pandemic. Journal of Parkinson’s Disease, 8(S1), S3–S8. https://doi.org/10.3233/JPD-181474
9.
DuncanP. W.WeinerD. K.ChandlerJ.StudenskiS. (1990). Functional reach: A new clinical measure of balance. Journal of Gerontology, 45(6), M192–M197. https://doi.org/10.1093/geronj/45.6.M192
10.
EllisT.BoudreauJ. K.DeAngelisT. R.BrownL. E.CavanaughJ. T.EarhartG. M.FordM. P.ForemanK. B.DibbleL. E. (2013). Barriers to exercise in people with Parkinson disease. Physical Therapy, 93(5), 628–636. https://doi.org/10.2522/ptj.20120279
11.
EllisT.de GoedeC. J.FeldmanR. G.WoltersE. C.KwakkelG.WagenaarR. C. (2005). Efficacy of a physical therapy program in patients with Parkinson’s disease: A randomized controlled trial. Archives of Physical Medicine and Rehabilitation, 86(4), 626–632. https://doi.org/10.1016/j.apmr.2004.08.008
12.
GuY.YuC.ShaoS.BakerJ. S. (2019). Effects of table tennis multi-ball training on dynamic posture control. PeerJ, 6, e6262. https://doi.org/10.7717/peerj.6262
13.
HirschM. A.IyerS. S.SanjakM. (2016). Exercise-induced neuroplasticity in human Parkinson’s disease: What is the evidence telling us?Parkinsonism & Related Disorders, 22(Suppl 1), S78–S81. https://doi.org/10.1016/j.parkreldis.2015.09.030
HorváthK.AschermannZ.ÁcsP.DeliG.JanszkyJ.KomolyS.BalázsÉKarádiK.KovácsN. (2015). Minimal clinically important difference on the motor examination part of the Movement Disorder Society–sponsored revision of the Unified Parkinson’s Disease Rating Scale. Parkinsonism & Related Disorders, 21(12), 1421–1426. https://doi.org/10.1016/j.parkreldis.2015.10.006
16.
InoueK.FujiokaS.NagakiK.SuenagaM.KimuraK.YonekuraY.YamaguchiY.KitanoK.ImamuraR.UeharaY.KikuchiH.MatsunagaY.TsuboiY. (2021). Table tennis for patients with Parkinson’s disease: A single-center, prospective pilot study. Clinical Parkinsonism & Related Disorders, 4, 100086. https://doi.org/10.1016/j.prdoa.2020.100086
17.
JohanssonM. E.CameronI. G. M.van der KolkN. M.de VriesN. M.KlimarsE.ToniI.BloemB. R.HelmichR. C. (2022). Aerobic exercise alters brain function and structure in Parkinson’s disease: A randomized controlled trial. Annals of Neurology, 91(2), 203–216. https://doi.org/10.1002/ana.26291
18.
JohnsM. W. (1991). A new method for measuring daytime sleepiness: The Epworth Sleepiness Scale. Sleep, 14(6), 540–545. https://doi.org/10.1093/sleep/14.6.540
19.
LiF.HarmerP.FitzgeraldK.EckstromE.StockR.GalverJ.MaddalozzoG.BatyaS. S. (2012). Tai chi and postural stability in patients with Parkinson’s disease. The New England Journal of Medicine, 366(6), 511–519. https://doi.org/10.1056/NEJMoa1107911
20.
LubomskiM.TanA. H.LimS. Y.HolmesA. J.DavisR. L.SueC. M. (2020). Parkinson’s disease and the gastrointestinal microbiome. Journal of Neurology, 267(9), 2507–2523. https://doi.org/10.1007/s00415-019-09320-1
21.
MelansonE. L.JainS.RobichaudJ. A.PoonC.CorcosD. M. (2018). Effect of high-intensity treadmill exercise on motor symptoms in patients with de novo Parkinson disease: A phase 2 randomized clinical trial. JAMA Neurology, 75(2), 219–226. https://doi.org/10.1001/jamaneurol.2017.3517
22.
MiguelezC.De DeurwaerdèreP.SgambatoV. (2020). Editorial: Non-dopaminergic systems in Parkinson’s disease. Frontiers in Pharmacology, 11, 593822. https://doi.org/10.3389/fphar.2020.593822
23.
MooreA.YeeE.WillisB. W.ProstE. L.GrayA. D.MannJ. B. (2021). A community-based boxing program is associated with improved balance in individuals with Parkinson’s disease. International Journal of Exercise Science, 14(3), 876–884. https://doi.org/10.70252/BNAX9498
24.
MooreC. G.SchenkmanM.KohrtW. M.DelittoA.HallD. A.CorcosD. (2013). Study in Parkinson disease of exercise (SPARX): Translating high-intensity exercise from animals to humans. Contemporary Clinical Trials, 36(1), 90–98. https://doi.org/10.1016/j.cct.2013.06.002
25.
NaderiA.DegensH.RezvaniM. H.ShaabaniF. (2018). A retrospective comparison of physical health in regular recreational table tennis participants and sedentary elderly men. Journal of Musculoskeletal & Neuronal Interactions, 18(2), 200–207.
26.
NasreddineZ. S.PhillipsN. A.BédirianV.CharbonneauS.WhiteheadV.CollinI.CummingsJ. L.ChertkowH. (2005). The Montreal Cognitive Assessment (MoCA): A brief screening tool for mild cognitive impairment. Journal of the American Geriatrics Society, 53(4), 695–699. https://doi.org/10.1111/j.1532-5415.2005.53221.x
27.
OlanowC. W.SternM. B.SethiK. (2009). The scientific and clinical basis for the treatment of Parkinson disease. Neurology, 72(21 Suppl 4), S1–S136. https://doi.org/10.1212/WNL.0b013e3181a1d44c
28.
OlssonK.FranzénE.JohanssonA. (2020). A pilot study of the feasibility and effects of table tennis training in Parkinson disease. Archives of Rehabilitation Research and Clinical Translation, 2(3), 100064. https://doi.org/10.1016/j.arrct.2020.100064
29.
PetoV.JenkinsonC.FitzpatrickR.GreenhallR. (1995). The development and validation of a short measure of functioning and well-being for individuals with Parkinson’s disease. Quality of Life Research, 4(3), 241–248. https://doi.org/10.1007/BF02260863
30.
PetzingerG. M.FisherB. E.McEwenS.BeelerJ. A.WalshJ. P.JakowecM. W. (2013). Exercise-enhanced neuroplasticity targeting motor and cognitive circuitry in Parkinson’s disease. The Lancet. Neurology, 12(7), 716–726. https://doi.org/10.1016/S1474-4422(13)70123-6
31.
PetzingerG. M.FisherB. E.Van LeeuwenJ. E.VukovicM.AkopianG.MeshulC. K.HolschneiderD. P.NaccaA.WalshJ. P.JakowecM. W. (2010). Enhancing neuroplasticity in the basal ganglia: The role of exercise in Parkinson’s disease. Movement Disorders : Official Journal of the Movement Disorder Society, 25(Suppl 1), S141–S145. https://doi.org/10.1002/mds.22782
32.
PodsiadloD.RichardsonS. (1991). The timed “up & go”: A test of basic functional mobility for frail elderly persons. Journal of the American Geriatrics Society, 39(2), 142–148. https://doi.org/10.1111/j.1532-5415.1991.tb01616.x
33.
PowelL. E.MyersA. M. (1995). The activities-specific balance confidence (ABC) scale. Journal of Gerontology: Series A, Biological Science and Medical Sciences, 50A(1), M28–M34. https://doi.org/10.1093/gerona/50A.1.M28
34.
ReijndersJ. S.EhrtU.WeberW. E.AarslandD.LeentjensA. F. (2008). A systematic review of prevalence studies of depression in Parkinson’s disease. Movement Disorders, 23(2), 183–189. htpps://doi.org/10.1002/mds.21803 https://doi.org/10.1002/mds.21803
35.
SangarapillaiK.NormanB. M.AlmeidaQ. J. (2021). Boxing vs sensory exercise for Parkinson’s disease: A double-blinded randomized controlled trial. Neurorehabilitation and Neural Repair, 35(9), 769–777. https://doi.org/10.1177/15459683211023197
36.
SchapiraA. H. V.ChaudhuriK. R.JennerP. (2017). Non-motor features of Parkinson disease. Nature Reviews Neuroscience, 18(7), 435–450. https://doi.org/10.1038/nrn.2017.62
37.
SchenkmanM.MooreC. G.KohrtW. M.HallD. A.DelittoA.ComellaC. L.JosbenoD. A.ChristiansenC. L.BermanB. D.KlugerB. M.MelansonE. L.JainS.RobichaudJ. A.PoonC.CorcosD. M. (2018). Effect of high-intensity treadmill exercise on motor symptoms in patients with De Novo Parkinson disease: A phase 2 randomized clinical trial. JAMA Neurology, 75(2), 219–226. https://doi.org/10.1001/jamaneurol.2017.3517
38.
ShuH. F.YangT.YuS. X.HuangH. D.JiangL. L.GuJ. W.KuangY. Q. (2014). Aerobic exercise for Parkinson’s disease: A systematic review and meta-analysis of randomized controlled trials. PLOS ONE, 9(7), e100503. https://doi.org/10.1371/journal.pone.0100503
39.
SteffenT.SeneyM. (2008). Test-retest reliability and minimal detectable change on balance and ambulation tests, the 36-item short-form health survey, and the unified Parkinson disease rating scale in people with parkinsonism. Physical Therapy, 88(6), 733–746. https://doi.org/10.2522/ptj.20070214
40.
TeixeiraP. J.CarraçaE. V.MarklandD.SilvaM. N.RyanR. M. (2012). Exercise, physical activity, and self-determination theory: A systematic review. The International Journal of Behavioral Nutrition and Physical Activity, 9(1), 78. https://doi.org/10.1186/1479-5868-9-78
41.
UcE. Y.DoerschugK. C.MagnottaV.DawsonJ. D.ThomsenT. R.KlineJ. N.RizzoM.NewmanS. R.MehtaS.GrabowskiT. J.BrussJ.BlanchetteD. R.AndersonS. W.VossM. W.KramerA. F.DarlingW. G. (2014). Phase I/II randomized trial of aerobic exercise in Parkinson disease in a community setting. Neurology, 83(5), 413–425. https://doi.org/10.1212/WNL.0000000000000644
42.
ZhengC.CaoY.LiY.YeZ.JiaX.LiM.YuY.LiuW. (2024). Long-term table tennis training alters dynamic functional connectivity and white matter microstructure in large-scale brain regions. Brain Research, 1838, 148889. https://doi.org/10.1016/j.brainres.2024.148889
43.
ZigmondM. J.SmeyneR. J. (2014). Exercise: Is it neuroprotective and if so, how does it work?Parkinsonism & Related Disorders, 20(Suppl 1), S123–S127. https://doi.org/10.1016/S1353-8020(13)70030-0
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
