Table tennis exercises: a warm-up, footwork and strength training, injuries, and the evidence for older players

Short rallies, quick feet

Rallies last about 3.5 seconds with 8 to 20 seconds between them. The Compendium of Physical Activities gives table tennis 4.0 metabolic equivalents (METs), moderate activity.

Sources 1, 2

Injuries are uncommon

At international events, 10.0 injuries per 1,000 playing hours; in young national-level players, 1.2 per 1,000 hours, mostly from overuse.

Sources 3, 4

Shoulders, backs, knees and hips

Shoulder pain in elite players went with a loss of inward shoulder rotation, 40% of young players' injuries were growth-related, and 11 of 19 professionals had hip pain.

Sources 5, 4, 6

Thinking skills in older men

In a 6-month trial, playing three times a week sped up task switching in sedentary men aged 60 to 80, as cycling or brisk walking did.

Source 7

Parkinson's: small, encouraging studies

Three small studies without comparison groups reported better movement scores and few problems. It isn't a treatment, but it's a sociable way to be active.

Sources 8, 9, 10

No trial shows it prevents dementia

A 2026 review of 17 studies of table tennis for health called the evidence promising but preliminary.

Source 11

Short bursts, low overall demandEmerging evidence

Rallies average about 3.5 seconds with 8 to 20 seconds of rest, and the energy demand of matches is relatively low. Each rally is a short, explosive burst, and aerobic fitness helps you recover between them and between matches. A review of racket sports found the lowest heart rates (about 104 beats a minute) and lactate in table tennis, mostly in studies of elite men.

Sources 1, 12, 13

How hard it isStrong evidence

The Compendium gives table tennis 4.0 METs, moderate activity. On the UK National Health Service's (NHS) talk test, moderate activity means you can talk but not sing; competitive play is harder in bursts.

Sources 2, 14

The main movementsEmerging evidence

A crouched ready position with bent knees, small side-steps and crossover steps, short lunges, fast trunk rotation for topspin, and wrist and forearm work, reacting to a ball 40 mm across and weighing 2.7 g. Researchers think the bent knees and twisting trunk put turning loads through the knees.

Sources 15, 16, 17

Where the load fallsEmerging evidence

The sites the studies point to:

• The playing shoulder: players lose inward rotation on that side.
• The lower back: 14.7% of young players' injuries, and the ready position rounds the spine.
• The knees: 30.5% of young players' injuries, many of them growth-related.
• The hips, in professionals.
• The wrist, elbow and feet.

Sources 18, 5, 4, 16, 6, 19

What to train (our reading)

Quick, low footwork side to side and in and out, leg strength for a low stance, trunk rotation, shoulder control and reaction speed.

How often players get hurtEmerging evidence

The numbers, by group:

• International competition (Olympic, Youth Olympic, Asian and national games): 31 injuries in 873 players (3.6%), or 10.0 per 1,000 playing hours, and 64% of injuries didn't stop the player training or competing.
• 139 young national-level players over 17 years: 1.2 injuries per 1,000 hours, 82.6% of them overuse.
• 150 Taiwanese university players: 76 had had an injury in the past 6 months.
• 83 top Slovenian players: table tennis players had fewer injuries than tennis or badminton players.
• US emergency departments: table tennis was 4.2% of racket and paddle sport visits.

Sources 3, 4, 20, 21, 22

ShouldersEmerging evidence

In 20 league players, the playing shoulder had about 15 to 16° less inward rotation than the other, and in 46 elite players, shoulder pain went with a large side-to-side loss (6.86 times the odds). Shoulder tendon problems were 11.6% of young players' injuries. Our shoulder pain, shoulder impingement and rotator cuff guides cover these.

Sources 18, 5, 4

Lower backEmerging evidence

The lumbar spine was 14.7% of young players' injuries, and long-term low back pain 8.4%. In 22 female players, the ready position rounded the spine and made the pelvis and spine less symmetrical, which the authors suggest may explain the back pain the players reported. Our back pain and upper back pain guides cover it.

Sources 4, 16

Knees, and growing painsEmerging evidence

Knees were 30.5% of young players' injuries, most of them Osgood-Schlatter disease (15.8%) or Sinding-Larsen-Johansson syndrome (9.5%), and Sever's disease at the heel was another 13.7%. In 22 ex-elite players in their 50s, 78.3% had signs of knee arthritis on X-ray against 36.3% of men who hadn't played, an association. Our Osgood-Schlatter, Sinding-Larsen-Johansson, Sever's disease and knee arthritis guides cover these.

Sources 4, 17

HipsEmerging evidence

11 of 19 French professional players had hip pain, 8 with hip impingement, and 5 needed surgery, after which all returned to the sport. Hip impingement was 6.3% of young players' injuries. Our hip impingement guide covers it.

Sources 6, 4

Wrists, elbows and anklesEmerging evidence

Across 42 studies, tendon irritation (tenosynovitis) was among the commonest types of injury, and the legs were the most affected region. Our wrist pain, tennis elbow and ankle sprain guides cover these.

Source 19

Falls in older playersEmerging evidence

Falls were the commonest cause of racket-sport injuries in US emergency departments, at 36.5%. Table tennis involves little running, but balance still matters.

Source 22

No prevention trialMixed evidence

Reviews of 42 table tennis injury studies and of international competition found no trial of a warm-up or prevention programme.

Sources 19, 3

ShouldersEmerging evidence

A side-to-side loss of inward rotation went with shoulder pain in elite players. Our shoulder guides start with the cross-body stretch and keep the sleeper stretch for a clear loss on one side; the shoulder programmes with trial support come from handball, as our tennis and padel page explains.

Source 5

Young playersEmerging evidence

40% of young players' injuries were growth-related, and 83% came from overuse. Our children's guide and growth plate guides cover training load and when to rest.

Source 4

Older players and fallsStrong evidence

Strength and balance training prevents falls in older adults, as our older adults guide explains, and the NHS asks over-65s for strength, balance and flexibility work on at least 2 days a week. Table tennis involves little running, which a 2026 review suggests may make it safer for older players, but it hasn't been tested as falls prevention.

Sources 23, 11

What isn't shownMixed evidence

Measures without evidence in table tennis:

• A warm-up that prevents injuries: untested.
• Eyewear: we found no table tennis eye injury series, and no governing body advises it.

Source 19

Strength and power in juniorsEmerging evidence

In 45 elite male junior players, 8 weeks of weightlifting twice a week, added to normal practice, improved strength, jumps and change of direction more than jump training did, and both beat practice alone. In 24 female junior players aged about 15, 8 weeks of complex training twice a week, pairing back squats with jumps, leg presses with box jumps and lunges with side bounds, raised squat strength by 18.5% (against 3.2%), jump height by 12.3% (against 2.1%) and change-of-direction speed by 7.5% (against 1.1%) compared with regular strength training.

Sources 24, 25

Footwork, balance and reactionsEmerging evidence

In 30 young players, 8 weeks of multidirectional footwork training three times a week improved change of direction more when the balance work was on unstable surfaces. In 40 young male players, 6 weeks of reactive agility training, responding to light signals, sped up choice reactions within the group, though not significantly more than pre-planned drills by the end. A review of 10 studies in young players found training improved speed, strength, endurance, agility and flexibility, and core training helped racket players' balance and agility.

Sources 26, 27, 28, 29

TaperingEmerging evidence

No table tennis study. In other sports, cutting training volume by 41% to 60% for about 2 weeks while keeping intensity worked best. Our reading: keep table sessions sharp and halve gym work in the last week or two before a key event.

Source 30

Fitting it around table tennis (our suggestion)

Built on the junior trials and the NHS guidelines:

• Before play: the 10-minute warm-up on this page.
• Pre-season: 2 strength and footwork sessions a week for 8 weeks, as in the junior trials.
• In season: 1 session a week, plus shadow footwork on practice days.
• Older and social players: our strength and balance workouts on at least 2 days a week, as the NHS advises for over-65s.

Sources 24, 25, 23

Thinking skillsEmerging evidence

In a 6-month randomised trial, 64 sedentary men aged 60 to 80 did table tennis, cycling or brisk walking, or a balance and stretching class, three times a week. Both exercise groups got faster on the harder trials of a task-switching test than the balance and stretching group; the table tennis group also sped up on the simpler trials, while cycling and walking did better on a working memory test.

Source 7

Strength, bone and quality of lifeEmerging evidence

20 older men who played regularly had more muscle strength, bone density and physical performance, and less body fat, than 20 sedentary men of the same age and weight, an association. In a randomised trial in adults aged 40 to 70, structured competitive play improved quality of life more than recreational play.

Sources 31, 32

Open-skill sports and the brainEmerging evidence

Sports where you react to an opponent and a moving ball may help some thinking skills more than steady exercise such as running, but most of the evidence is cross-sectional. A 2026 review of 17 table tennis studies calls the evidence for health promising but preliminary.

Sources 33, 34, 11

DementiaMixed evidence

No trial has shown that table tennis prevents dementia. Being physically and socially active is part of reducing dementia risk, as our dementia guide explains, and table tennis is one way to be both.

Source 11

Getting started

Table Tennis England runs Bat & Chat sessions for the over-50s. Add strength and balance work on at least 2 days a week, as the NHS advises for over-65s; table tennis hasn't been tested as falls prevention.

Sources 35, 23

Three small studiesEmerging evidence

None had a comparison group, so the changes can't be put down to table tennis alone:

• 12 people, one 6-hour session a week for 6 months: movement and daily-living scores improved in the 9 analysed; one person fell and one had backache.
• 9 people, two 2-hour sessions a week for 10 weeks: the change in a balance test wasn't significant, mood and activity levels improved, and no problems were reported.
• 30 people, two 2-hour sessions a week for 12 weeks: movement scores, balance, the timed up and go test and the 6-minute walk improved in the 26 who finished, with no problems reported.

Sources 8, 9, 10

How it fits (our reading)

Our Parkinson's guide finds most kinds of exercise help, and the best is the one you'll keep doing. Table tennis is a sociable option: Table Tennis England is working with Parkinson's UK to help more Parkinson's groups get started.

Source 36

Children with ADHDEmerging evidence

In a crossover trial in 32 children with attention deficit hyperactivity disorder (ADHD), 12 weeks of table tennis improved executive functions, the thinking skills used to plan and control behaviour, and some motor and social measures. A review of 12 studies in children reports benefits for thinking, coordination and behaviour, but calls for more research.

Sources 37, 38

EyesightMixed evidence

A meta-analysis of 9 trials in 531 children and teenagers found better uncorrected eyesight with table tennis, but results varied a lot between studies and the authors call the finding exploratory. It isn't a treatment for short sight.

Source 39

Growing playersEmerging evidence

Growth-related knee and heel pain made up 40% of young competitive players' injuries; our Osgood-Schlatter, Sinding-Larsen-Johansson and Sever's disease guides cover when to rest.

Source 4

Everyone: seven questions

The PAR-Q+ (Physical Activity Readiness Questionnaire for Everyone) asks about a heart condition or high blood pressure, chest pain, dizziness or losing consciousness, other long-term conditions and their medicines, a bone or joint problem that activity could make worse, and being told to exercise only under supervision. If you answer yes to any, check with your GP or a qualified exercise professional first, and delay if you're ill.

Source 40

Heart disease, chest pain or dizziness

Table tennis is moderate, but competitive play has bursts of hard effort. Use the PAR-Q+, see your GP if it flags anything, and start with social play (our suggestion).

Sources 40, 2, 12

Older players, or anyone who has fallen or worries about balance

Falls were the commonest cause of racket-sport emergency visits, and the NHS advises seeing a GP after a fall or if you're worried about your balance. Wear shoes with grip, hold the table during the warm-up, and add our strength and balance workouts (our suggestion).

Sources 41, 22

Parkinson's

Table tennis was safe and practical in small studies, with one fall and one backache among 12 people in one of them. Follow our Parkinson's guide on exercising in your "on" times, freezing and falls, and look for a Parkinson's-friendly group.

Sources 8, 36

Shoulder pain now

Our shoulder guides allow discomfort up to about 5 out of 10 if it settles by your next session, and start with the cross-body stretch.

Source 5

Growing players with knee or heel pain

40% of young players' injuries were growth-related; see our Osgood-Schlatter, Sinding-Larsen-Johansson and Sever's disease guides.

Source 4

After a hip or knee replacement

Our replacement guides suggest doubles or gentle tennis from about 3 to 6 months. Ask your surgical team, and treat table tennis as a lower-impact step (our reading).

Pregnant

The NHS says it's usually fine to keep doing the activities you already do, but advises against sports with a risk of falling or bumping your tummy. Talk to your midwife.

Source 42

Chest pain: call 999

The NHS says to call 999 if:

• You get sudden pain or discomfort in your chest that doesn't go away; it can feel like squeezing or pressure, burning or indigestion.
• The pain spreads to your left or right arm, or your neck, jaw, stomach or back.
• You have chest pain and feel sweaty, sick, light-headed or short of breath.

Source 43

Fainting or palpitations

Call 999 if someone faints while exercising, isn't breathing, or can't be woken within a minute. Call 999 or go to A&E (accident and emergency) for palpitations that don't go away or come with chest pain, shortness of breath or fainting.

Sources 44, 45

After a fall

Call 999 if you or someone else has fallen and may have injured the head, back, neck or hip, or can't get up. Get help from NHS 111 if they may be in pain, injured or unwell, and see a GP after a fall or if you're worried about your balance.

Source 41

A shoulder injury

Ask for an urgent GP appointment or contact NHS 111 for sudden or very bad shoulder pain, an arm you can't move, a shoulder that has changed shape or is badly swollen, pins and needles that don't go away, or pain that started after a fall.

Source 46

A knee injury

Get advice from NHS 111 if your knee is very painful, you can't move it or put weight on it, it's badly swollen or has changed shape, or it locks, gives way or painfully clicks.

Source 47

Back pain with numbness: call 999

Call 999 or go to A&E for back pain with pain, tingling, weakness or numbness in both legs, loss of feeling around your genitals or bottom, changes in your bladder or bowels, or chest pain.

Source 48

"Table tennis isn't real exercise"Strong evidence

It's moderate activity at 4.0 METs, it counts towards the NHS's 150 minutes a week, and competitive play includes bursts of hard effort.

Sources 2, 14, 12

"Table tennis prevents dementia"Mixed evidence

No trial has shown it. In healthy older men, it sped up task switching over 6 months, as cycling and walking did, and most of the evidence on sports like it is cross-sectional.

Sources 7, 11, 33

"Table tennis treats Parkinson's"Emerging evidence

Three small studies without comparison groups reported better movement scores. It's an enjoyable part of the exercise mix, not a treatment.

Sources 8, 9, 10

"You can't get injured playing table tennis"Emerging evidence

Injury rates are low, but competitive players get shoulder, back, knee and hip problems.

Sources 3, 5, 4, 6

"Table tennis is the best brain sport"Mixed evidence

Sports where you react to an opponent may have an edge for some thinking skills, mostly in cross-sectional studies. No study has shown that one sport is best.

Sources 33, 34

"Table tennis improves your eyesight"Mixed evidence

In children, a meta-analysis found better uncorrected eyesight, but the results varied a lot and the authors call them exploratory. It hasn't been shown in adults, and it isn't a treatment for short sight.

Source 39