Kevin Guo, University of Toronto Schools, Toronto, Ontario, Canada
Abstract
As the prevalence of Alzheimer’s disease rises in a globally aging population, developing and implementing policies to mitigate its impacts become essential. Table tennis—a racket sport involving two or four players—is a form of physical activity that can serve as an effective intervention method. From a physiological perspective, it is able to induce cognitive function and stall disease-related decline by increasing production of brain-derived neurotrophic factor, cerebral blood flow, and β-amyloid turnover. Furthermore, because table tennis is an open-skill exercise that takes place in a dynamic environment, it can improve executive functions more effectively than traditional closed-skill exercises such as running or swimming. The low risk for traumatic injury, minimal physicality requirements, and minimal cost requirements make table tennis a highly beneficial form of physical activity for aging populations.
Introduction to Alzheimer’s Disease
Alzheimer’s Disease (AD) is a neurodegenerative disorder that induces irreversible damage to the brains of the elderly population. The global incidence of AD is estimated to reach 152.8 million in 2050, as both the incidence and prevalence rates of AD have shown a steady rise in tandem with the globally aging population over the past 30 years, with the highest rates of growth in North Africa and the Middle East (Nichols et al., 2022; Li et al., 2022). The development of AD symptoms can be attributed to neuronal damage and brain inflammation—the hallmarks of which are β-amyloid plaques outside neurons and hyperphosphorylated tau neurofibrillary tangles within neurons (Alzheimer’s Association, 2023; Lau & Brodney, 2007; Querfurth & LaFerla, 2010; Wiśniewski, 2019). β-amyloid plaques damage neurons by disrupting neuron communication at synapses, and tau tangles interfere with the transportation of nutrients required for neuronal function (Alzheimer’s Association, 2023).
The changes in the brain associated with AD first occur in the hippocampus—the region of the brain responsible for memory formation (Lau & Brodney, 2007). Eventually, these changes extend to parts of the brain that manage language, thinking, and bodily function (Alzheimer’s Association, 2023). Accordingly, the first symptoms of AD tend to be short-term memory difficulty and speech impairment; however, later symptoms include movement and swallowing dysfunction, increasing the risk of aspiration and confining affected individuals to their beds as they become increasingly physically disabled (Alzheimer’s Association, 2023; Lau & Brodney, 2007). The cause of death results from the damage done to the brain's control of vital physiological functions (Lau & Brodney, 2007); once diagnosed with AD, an individual has an average life expectancy of 4-6 years to live (Lau & Brodney, 2007).
Benefits of physical activity in neurocognition
Physical activity (PA) is one of 12 modifiable risk factors that may prevent or delay up to 40% of dementia cases (Yamasaki, 2023); as Alzheimer’s is the leading cause of dementia, PA can serve as a means to reduce Alzheimer’s onset in seniors. Since PA is relatively low-cost and accessible, it is a suitable preventative intervention method for memory loss (Yamasaki, 2023).
To begin, PA increases brain-derived neurotrophic factor (BDNF) levels in the brain (Yamasaki, 2023; Erickson et al., 2011). BDNF is a neurotrophin essential for neuronal survival, brain plasticity, and synaptic plasticity, while also potentiating enhanced anterior hippocampal neurogenesis (Yamasaki, 2023; Valenzuela et al., 2020). BDNF expression is positively correlated with cognitive function, while also proportional to the amount of physical exercise of an individual (Wiśniewski, 2019). Furthermore, PA is shown to increase cerebral blood flow — reduction of neurovascular function has been identified to be a major contributor towards AD. Regular aerobic exercise can mitigate vascular decline, which may help to maintain cerebral perfusion and prevent brain atrophy (Yamasaki, 2023).
Moreover, cardiovascular risk factors — such as diabetes and hypertension — can result in cerebral atherosclerosis as well as reduced blood flow (Yamasaki, 2023). PA is highly protective against these risk factors, reducing the risk of neurodegeneration as a result of improved cardiovascular health (Yamasaki, 2023).
Finally, PA levels were found to be inversely correlated with brain β-amyloid levels in adults; accordingly, PA is believed to promote β-amyloid turnover and may contribute to the prevention of cognitive decline (Liang et al., 2010). Using an AD mouse model, Nigam et al. postulate that the aforementioned phenomenon occurs because PA can ameliorate AD symptoms by regulating the proteolysis of the amyloid precursor protein, which is responsible for the formation of β-amyloid plaque. (Nigam et al., 2017; Coulson & Bartlett, 2017).
Specific benefits and importance of table tennis as preventative in Alzheimer’s
Table tennis (TT) is a racket sport in which two or four players face each other across a small rectangular table, separated by a net at its center (Yamasaki, 2022). Players compete by utilizing a small racket to hit a plastic ball over the net to land on the other side of the table. Because there is no heavy equipment to manipulate or physical contact among players, physical requirements for TT are minimal (Yamasaki, 2022). Moreover, since TT primarily relies on the aerobic energy system, it is classified as a moderate-intensity aerobic physical activity (Yamasaki, 2023).
TT is an example of an open-skill exercise (OSE)—OSEs take place in a dynamic environment, where playing conditions are variable and can change at any point in time (Heilmann et al., 2022). Closed-skill exercises (CSEs), which include running and swimming, are performed in predefined conditions that remain the same throughout the exercise course (Heilmann et al., 2022). As such, CSEs are considered to have lower demand on cognitive ability compared to OSEs (Heilmann et al., 2022). This is supported by the theory that OSEs are more behaviourally and biochemically effective than CSEs in preventing AD (Yamasaki, 2023). OSEs were found to induce a higher BDNF release compared to CSEs, and have been classified as superior in improving executive functions (EF), which are involved in the control and regulation of behavior responsible for basic information processing (Hung et al., 2018; Koch & Krenn, 2021).
Finally, studies have shown that blood flow in the cerebellum, pons, and midbrain increases after playing table tennis, and that table tennis players preserve superior mental ability in old age compared with non-players—both of which suggest that TT can prevent or delay AD onset relatively effectively (Mori, 1998; Kawano et al., 1996).
Conclusion/Takeaways/Policies
Alzheimer’s disease is a neurodegenerative disorder resulting in devastating consequences if left untreated. While scientists are yet to find a definite cure for the disease, aerobic physical activity in the form of table tennis offers an effective intervention, inducing a host of beneficial biochemical changes in the brain. Table tennis as a modality easily aligns with the World Health Organization’s physical activity recommendations for dementia prevention in seniors, which aims for roughly 150 minutes of moderate-intensity aerobic activity per week (WHO, 2019). Moreover, table tennis is low-cost and requires minimal physical strength, making it a suitable sport for aging seniors. As cases of Alzheimer’s disease begin to increase along with an aging global population, encouraging public health policies supporting table tennis in the geriatric population can aid in mitigating its detrimental impacts.
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