Ping-Pong Serves Up Improved Motor Symptoms in Parkinson's

Pauline Anderson

February 28, 2020

Dr Shinsuke Fujioka

Playing table tennis, also known as ping-pong, appears to improve motor symptoms in patients with Parkinson's disease (PD), new research suggests.

The results of a small pilot study show that table ping-pong is a safe and effective rehabilitative intervention for patients with PD that can be easily introduced, study investigator Shinsuke Fujioka, MD, Department of Neurology, Fukuoka University, Japan, told Medscape Medical News.

He emphasized that any rehabilitation for patients with PD could be beneficial, especially during the early stages of their illness. "The most important thing is that patients have fun when doing rehabilitation."

The findings will be presented at the American Academy of Neurology (AAN) 2020 Annual Meeting in April.

All Exercise Beneficial

The idea of studying ping-pong as a therapy for patients with PD originated when Fujioka heard about a patient who used a cane but no longer needed it after taking up the exercise as a weekly rehabilitation therapy.

"It's apparent that the exercise can improve motor function of PD. However, to date, the effects of the sport have not been well investigated for this patient population, so our study aimed to disclose the effects that table tennis can bring to patients with PD," said Fujioka.

The study included 12 patients with PD — 10 women and two men. Mean age at disease onset was 67 years, and mean disease duration was 7 years.

Mean stage on the Hoehn & Yahr scale, which assesses severity of PD symptoms, was three, so most patients had balance problems.

Study participants played ping-pong at once-weekly 5-hour sessions that included rest breaks whenever they felt it was necessary.

Researchers assessed participants using the Unified Parkinson's Disease Rating Scale (UPDRS) part I-IV. Parts II and III assess motor function whereas parts I and IV evaluate nonmotor function and motor complications, respectively.

The main motor symptoms of PD include bradykinesia and muscle rigidity, tremor, and postural instability.

Researchers also assessed participants using the Montreal Cognitive Assessment (MoCA), Frontal Assessment Battery (FAB), Self-Rating Depression Scale (SDS), and Apathy scale.

Results showed that UPDRS part II significantly improved at 3 and 6 months (both P<.001), as did UPDRS part III (P=.002 at 3 months; P<.001 at 6 months).

Fujioka speculated, "twisting axial muscles when hitting a ping-pong ball may be the most efficacious for patients, especially for bradykinesia and balance problems."

Significant Improvement

Such findings may not be that surprising. Fujioka pointed to other rehabilitation therapies such as tai chi or tango that may also improve PD motor symptoms.

For UPDRS part II, subscores of speech, saliva and drooling, dressing, handwriting, doing hobbies and other activities, getting out of bed, a car, or a deep chair, and walking and balance, significantly improved.

In addition, for UPDRS part III, subscores of facial expression, rigidity, postural stability, posture, bradykinesia, and kinetic tremor of the hands also significantly improved.

As for nonmotor symptoms such as mood, anxiety, depression, and apathy assessed in UPDRS part I, scores did not significantly change, which was also the case for part IV.

However, Fujioka pointed out that patient scores didn't worsen. "Given the nature of disease, not worsening of nonmotor features can potentially be a good effect of the sport." MoCA, FAB, SDS, and Apathy scale scores also did not change.

Fujioka noted that all participants enjoyed the table tennis rehabilitation, and "gradually smiled more during the study period." All continued the table tennis rehabilitation after the 6-month program.

Fujioka noted that although patients with PD often have difficulty moving in a front-to-back direction, they can move relatively easily in a lateral direction.

"In that sense, table tennis is suitable for them," he said.  However, he added, court tennis, handball, and badminton may not be suitable for most patients with PD.

One patient suffered a fall and another backache. Fujioka cautioned that more frequent ping-pong playing might increase the risk of adverse events.

He also suggests patients with PD have their bone density checked before starting regular rehabilitation exercise as they are at increased risk for osteoporosis.

The investigators are currently organizing a prospective, multicenter randomized study to compare the effectiveness of table tennis with conventional rehabilitation and the Lee Silverman Voice Treatment, which is designed to increase vocal intensity in patients with PD.

Fun, Engaging

Commenting on the findings for Medscape Medical News, Cynthia Comella, MD, professor emeritus, Neurological Sciences, Rush University Medical Center, New Philadelphia, Ohio, said p​ing-pong is a "fun and engaging" exercise for patients with PD.

Comella noted prior studies have shown many types of exercise are beneficial for patients with PD "provided that they continue" with it.

In that regard, these new results are "promising", she said. "It may be that this type of community generating, fun exercise would lead to a continuation of the exercise after a study is completed."

A controlled trial that includes a post-study follow-up to evaluate compliance and continued benefit is needed, she said.

Purchase of equipment, including tables, rackets, and balls, was possible through funds donated by Hisako Kobayashi-Levin, which provides Murakami Karindoh Hospital with an annual fund to improve the quality of their rehabilitation program.

The authors have reported no relevant financial relationships.

American Academy of Neurology (AAN) 2020 Annual Meeting. Abstract #485. To be presented in April 2020.

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