Literature Review

Health benefits of tennis

Article· Literature Review (PDF Available)inBritish Journal of Sports Medicine 41(11):760-8 · December 2007with 1,241 Reads 
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DOI: 10.1136/bjsm.2006.034967 · Source: PubMed
Cite this publication
Abstract
The aim of the study was to explore the role of tennis in the promotion of health and prevention of disease. The focus was on risk factors and diseases related to a sedentary lifestyle, including low fitness levels, obesity, hyperlipidaemia, hypertension, diabetes mellitus, cardiovascular disease, and osteoporosis. A literature search was undertaken to retrieve relevant articles. Structured computer searches of PubMed, Embase, and CINAHL were undertaken, along with hand searching of key journals and reference lists to locate relevant studies published up to March 2007. These had to be cohort studies (of either cross sectional or longitudinal design), case-control studies, or experimental studies. Twenty four studies were identified that dealt with physical fitness of tennis players, including 17 on intensity of play and 16 on maximum oxygen uptake; 17 investigated the relation between tennis and (risk factors for) cardiovascular disease; and 22 examined the effect of tennis on bone health. People who choose to play tennis appear to have significant health benefits, including improved aerobic fitness, a lower body fat percentage, a more favourable lipid profile, reduced risk for developing cardiovascular disease, and improved bone health.
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REVIEW
Health benefits of tennis
Babette M Pluim, J Bart Staal, Bonita L Marks, Stuart Miller, Dave Miley
...................................................................................................................................
Br J Sports Med 2007;41:760–768. doi: 10.1136/bjsm.2006.034967
The aim of the study was to explore the role of tennis in the
promotion of health and prevention of disease. The focus was
on risk factors and diseases related to a sedentary lifestyle,
including low fitness levels, obesity, hyperlipidaemia,
hypertension, diabetes mellitus, cardiovascular disease, and
osteoporosis. A literature search was undertaken to retrieve
relevant articles. Structured computer searches of PubMed,
Embase, and CINAHL were undertaken, along with hand
searching of key journals and reference lists to locate relevant
studies published up to March 2007. These had to be cohort
studies (of either cross sectional or longitudinal design), case–
control studies, or experimental studies. Twenty four studies
were identified that dealt with physical fitness of tennis players,
including 17 on intensity of play and 16 on maximum oxygen
uptake; 17 investigated the relation between tennis and (risk
factors for) cardiovascular disease; and 22 examined the effect
of tennis on bone health. People who choose to play tennis
appear to have significant health benefits, including improved
aerobic fitness, a lower body fat percentage, a more favourable
lipid profile, reduced risk for developing cardiovascular
disease, and improved bone health.
.............................................................................
See end of article for
authors’ affiliations
........................
Correspondence to:
Babette M Pluim, KNLTB,
Displayweg 4, 3821 BT
Amersfoort, The
Netherlands; bpluim@euro
net.nl
Accepted 30 April 2007
Published Online First
15 May 2007
........................
T
he health benefits of exercise are well estab-
lished. Research has shown that regular
moderate physical activity has a beneficial
effect on health
1
and is associated with a decreased
risk of diabetes
2–4
and cardiovascular disease.
5–8
Regular exercise has a beneficial effect on cardio-
vascular risk factors through many mechanisms. It
improves the plasma lipid profile,
910
reduces body
weight,
11
lowers blood pressure,
912
increases insu-
lin sensitivity,
13 14
and improves lung function,
15
cardiac function
16 17
and cardiorespiratory fit-
ness.
16 17
In addition, exercise has a positive effect
on bone health.
18
Recommended exercise duration and intensity
have changed over time. In the early 1990s, exercise
recommendations exhorted vigorous intensity exer-
cise (for example, jogging) for at least 20 minutes
continuously, three days a week, in order to reap the
benefits.
19 20
More recent recommendations prescribe
the accumulation of at least 30 minutes of moderate
intensity physical activity, almost daily, relative to
the physical fitness of the individual (for example,
brisk walking, cycling, or swimming).
21 22
The
requirement of continuous exercise has been
dropped, because the benefits derived from the
accumulation of shorter sessions have been shown
to be equivalent to those of longer sessions as long as
the total amount of energy expended is similar.
6
The recommended type of exercise has also
received attention. Jogging, cycling, and swim-
ming are well known to have significant health
benefits, but not everyone participates in these
sports. Tennis is one of the most popular sports
throughout the world and is played by millions of
people. Furthermore, a large majority of the people
who play tennis maintain the sport throughout
life. Tennis would therefore be an ideal sport to
improve physical activity levels of the general
population.
Although many studies have been published on
the health benefits of exercise in general, it is still
unclear whether there is a direct relation between
improved health and playing tennis. For that
reason, we undertook a systematic review to
explore the health benefits of tennis in the
prevention of several risk factors and major
diseases that have been related to a sedentary
lifestyle—that is, low fitness levels, obesity, hyper-
tension, hyperlipidaemia, diabetes mellitus, cardi-
ovascular disease, and osteoporosis.
METHODS
A literature search was undertaken to retrieve
potentially relevant articles. The following electro-
nic databases were explored: PubMed (from 1966
up to March 2007), Embase (from 1989 up to
March 2007), and Cumulative Index to Nursing
and Allied Health Literature (CINAHL) (from 1982
up to March 2007). A priori defined search terms
(Medical subject heading (Mesh) and text words)
used in this search were: ‘‘physical fitness’’,
‘‘aerobic fitness’’, ‘‘cardiovascular decondition-
ing’’, ‘‘cardiovascular disease’’, ‘‘heart disease’’,
‘‘cardiac function’’, ‘‘diabetes mellitus’’, ‘‘hyperli-
pidemia’’, ‘‘lipid profile’’, ‘‘hypercholesterolemia’’,
‘‘cholesterol level’’, ‘‘hypertension’’, ‘‘blood pres-
sure’’, ‘‘obesity’’, ‘‘body mass index’’, ‘‘BMI’’,
‘‘osteoporosis’’, and ‘‘bone health’’. Each term
was combined with ‘‘tennis’’. Hand searching of
key journals and citation tracking of the retrieved
articles was also done to identify additional
relevant articles.
To be included in this review, studies had to
meet the following criteria:
N
they had to be cohort studies (of either cross
sectional or longitudinal design), case–control
studies, or experimental studies published in
English or German;
N
they had to contain data on the relation
between playing tennis and physical fitness,
cardiovascular disease, obesity, hypertension,
Abbreviations: BMC, bone mineral content; BMD, bone
mineral density; CINAHL, Cumulative Index to Nursing and
Allied Health Literature
760
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hyperlipidaemia, diabetes mellitus, and osteoporosis, or
between playing tennis and the occurrence of health benefits
in patients who suffer from these diseases.
The most important results of the identified studies were
summarised and categorised according to the aforementioned
categories. Studies on the prevention or treatment of sports
injuries and literature reviews were excluded.
RESULTS
Our results in the PubMed, Embase, and CINAHL databases
resulted in, respectively, 191, 179, and 382 potentially relevant
papers. Papers were included when the content was felt to be
appropriate by two independent reviewers. In case of disagree-
ment, further discussion was undertaken to achieve consensus.
Twenty four studies (25 articles) were identified that contained
data on physical fitness of tennis players.
23–47
Seventeen studies
(18 articles) provided information on intensity of play,
23–40
and 16
studies contained data on maximum oxygen uptake of tennis
players.
26313435394147
Seventeen studies
45 47–62
were found that
investigated the relation between tennis and risk factors for
cardiovascular disease and included eight cross sectional studies
on cardiac size or function,
54–61
four cross sectional studies on
obesity,
45 47 50 51
two cross sectional studies
47 49
and one long-
itudinal study
48
on hyperlipidaemia, two cross sectional studies on
hypertension,
47 52
one longitudinal study on diabetes,
53
and one
longitudinal study on cardiovascular morbidity and mortality.
62
Twenty two studies (two longitudinal
63 64
and 20 cross sectional
65–
85
) were retrieved that examined the effect of tennis on bone
health.
Physical fitness levels
Exercise intensity
In 17 studies the intensity of match play was examined using
heart rate recordings
23–39
or maximum oxygen uptake (V
˙
O
2
max),
or both
23 26 27 39 40
during play (table 1). Mean (SD) heart rate
during singles play ranged from 141 (16) to 182 (12) beats/
minute, equating to 70–90% of maximum heart rate. Mean
oxygen consumption during play ranged from 23.1 (3.1) to 40.3
(5.7) ml.kg
21
.min
21
, reflecting 50% to 80% of V
˙
O
2
max. Mean
lactate levels during play were generally 2 to 3 mmol.l
21
; however,
one investigator reported levels as high as 6 mmol.l
21
.
28
The
results of these studies indicate that singles tennis play can be
categorised as vigorous intensity exercise (.6Mets).
Aerobic capacity
One longitudinal and 15 cross sectional studies on the V
˙
O
2
max
of tennis players were identified (table 2).
26–31 34 35 39 41–47
The
mean V
˙
O
2
max ranged from 35.5 (5.8) to 65.9
(6.3) ml.kg
21
.min
21
, depending on age, sex, and training level,
indicating that these tennis players had high fitness levels
compared with the norm for normally active controls of the
same age and sex.
86 87
In the one longitudinal study,
46
38 sedentary, middle aged
volunteers were randomly assigned into one of four groups:
bicycling (9), tennis (10), jogging (9), and control (10). Each
group exercised three times a week for 30 minutes per session
for 20 weeks. Tennis produced modest increases in endurance
capacity (5.7%), compared with cycling (14.8%) and jogging
(13.3%). The control group did not change. However, it should
be taken into account that the duration of each training session
was only 30–50% of a typical time for playing tennis.
Cardiovascular risk factors
Obesity
Vodak et al
45
found below average body fat in 25 male (age 42
(6) years) and 25 female (age 39 (3) years) tennis players, with
mean values of 16.3% and 20.3% for men and women.
Schneider and Greenberg (n = 7248; 18–34 year old
Americans),
50
showed that runners/joggers/fast walkers and
tennis players were less likely to be obese, smoke, consume
large quantities of alcohol, or drive without seat belts than
those who participate in team sports and an aggregate of other
sports.
Further evidence of an association between below average
body fat and tennis was provided by Swank et al,
47
who found
that elite male veteran tennis players had significantly less fat
than an age matched active control group (p(0.05). Both the
younger veterans (aged 40 to 59) and the older veterans (over
60) were on average 3% leaner than the non-tennis-playing
moderately active controls (17–20.5% v 21–25%, respectively).
Finally, LaForest et al
51
studied recreational tennis players
who had played twice a week for the previous ten years. Mean
body fat percentage of the tennis players (aged 23 to 69 years)
was significantly lower than the body fat of the age matched
controls (20.4% v 23.9%, p,0.05).
Hyperlipidaemia
In a cross sectional study by Vodak et al,
49
fasting plasma lipid
and lipoprotein concentrations of 25 male and 25 female tennis
players (mean age 42 years, nine years playing history) were
compared with a sedentary group matched for age, sex, and
education. Mean plasma high density lipoprotein (HDL)
cholesterol was significantly higher in tennis players than in
sedentary subjects (men, 1.39 (0.30) v 1.17 (0.31) mmol.l
21
(p,0.001); women, 1.72 (0.22) v 1.56 (0.29) mmol.l
21
(p = 0.02)). The increased plasma HDL cholesterol concentra-
tions were independent of other factors known to alter these
lipid concentrations. Very low density lipoprotein subfractions
(VLDL-C) and triglycerides were also significantly lower in the
tennis players; however, total cholesterol (TC) and low density
lipoprotein (LDL) cholesterol concentrations were similar to the
controls.
Ferrauti et al
48
investigated the short term effects of tennis
training on lipid metabolism. They studied the effects of a six
week running–intensive tennis training programme in 22
veteran players (11 men and 11 women aged 43 to 47 years)
and compared these with 16 control subjects who continued
their usual (tennis) habits. They found slight increases in HDL
2
cholesterol as well as small decreases in HDL
3
cholesterol, LDL
cholesterol, and triglycerides. Despite the overall positive
improvement of the lipid profile, the changes were not
significantly different from the control group, possibly because
of the limited number of subjects and the relatively short
duration of the study.
Finally, Swank et al
47
studied 28 elite senior male tennis
players (aged 40 to 60+ years) who had participated in tennis
for an average of 21 years, and 18 moderately active age
matched controls. There were no significant differences
between tennis players and the control group for total
cholesterol, LDL cholesterol, HDL cholesterol, total cholesterol/
HDL cholesterol ratio and triglycerides. However, the tennis
players in the 40 to 59 year old age group had an average HDL
cholesterol of 0.21 mmol greater than an age matched control
group. Furthermore, tennis players in the 60+ year old age
group had an average HDL cholesterol 0.06 mmol greater than
their age matched control group.
Hypertension
Blood pressure was studied in 21 middle aged male tennis
players (age 50 (7) years), using a portable ambulatory blood
pressure recorder.
52
Mean resting systolic blood pressure was
137 (19) mm Hg and diastolic blood pressure was 88 (13)
mm Hg, suggestive of pre-hypertension (blood pressure
between 120/80 and 139/89 mm Hg).
88
Mean systolic blood
pressure during play was 168 (19) mm Hg, with a peak systolic
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Table 1 Intensity of match play
Reference*
Standard of
player ITN Sex n Age (years)
Mean HR during
play (beats/min)
HR
max
exercise
test (beats/min) % HR max
Lactate
(mmol.l
21
) Surface
V
˙
O
2
mean during
play (ml.kg
21
.min
21
)
V
˙
O
2
max exercise test
(ml.kg
21
.min
21
)
Juniors
Girard et al
23
Club 6 M 7 15 (2) 182 (12) 201 (9) 90 (5) 2.36 (0.47) Clay 40.3 (5.7) 50.3 (3.9)
M 7 15 (2) 173 (17) 201 (9) 86 (6) 3.08 (1.12) Hard court 35.9 (7.5) 50.3 (3.9)
Weber
24
Competitive 4 M/F 18 12.6 (1.2) 172 (6) nr nr 1.41 (0.63) Carpet nr nr
18–35 years
Fernandez et al
40
International 1–2 M 6 3.79 (2.03) Clay 26.6 (3.3) 58.2 (2.2)
Novas et al
25
State, national 3 F 6 18.3 (2.5) 146 (20) Hard court
Smekal et al
26
Top league 3–4 M 20 26 (4) 151 (19) 193 (9) 78 2.07 (0.88) Clay 29.1 (5.6) 57.3 (5.1)
Bernardi et al
27
Intermediate 4–5 M 7 28.1 (3) 147 (9) 194 (5) 76 nr Clay 33 (3) 65 (6)
Christmass et al
28
State 3 M 7 24 (2) nr 190 (3) 86 (1) 5.86 (1.33) Hard court nr 53.4 (1.8)
Christmass et al
29
State 3 M 8 23 (1) 155 180 (3) 86 Hard court nr 54.3 (1.9)
Reilly et al
30
Top club 4 M 8 23.4 (3.1) 146 (19) 191 (11) 76 nr Wood nr 53.2 (7.3)
Bergeron et al
31
University 4 M 10 20.3 (2.5) 145 (13) 196 (6) 74 2.3 (1.2) Clay nr 58.5 (9.4)
Therminarias et al
32,33
Intermediate 4–5 F 9 21.2 (1.9) 157 (3) 190 (3) 82 1.76 (0.3) Clay nr nr
Weber
24
Competitive 4 M/F 18 23.8 (3.6) 148 (10) nr nr 2.11 (0.77) Carpet nr nr
Recreational 6–7 M/F 33 25.3 (2.5) 147 (11) nr nr 2.43 (1.28) Carpet nr nr
Beginners 9 M/F 16 25.8 (3.0) 135 (19) nr nr 1.92 (0.56) Carpet nr nr
Morgans et al
34
Intermediate to
advanced
2–4 M 17 31.4 (7.3) 154 (17) 188 (11) 82 nr Hard court nr 46.4 (6.2)
Eliott et al
35
College 4 M 8 20.3 (1.3) 153 (3) 192 (11) 79 nr Hard court nr 65.9 (6.3)
Docherty
36
Low to high 4–9 M 42 25 (5) 150 (10) nr 70 nr Hard court nr nr
Kindermann et al
37
Well trained 4–5 M 12 32.2 (8.5) 146 (20) nr nr 2.0 (0.5) Unknown nr nr
Seliger et al
38
Top level 3 M 16 24.7 (3.7) 143 nr nr nr Indoor court 27.3 nr
35 years and over
Ferrauti et al
39
National 2–3 M 6 47 (5.4) 142.5 (12.7) nr nr 1.24 (0.37) Clay 25.6 (2.8) 47.5 (4.3)
National 2–3 F 6 47.2 (6.6) 141.5 (18.9) nr nr 1.67 (0.49) Clay 23.1 (3.1) 41.4 (6.0)
Therminarias
32, 33
Intermediate 4–5 F 10 46.5 (1.3) 156 (4) 175 (2) 89 1.79 (0.29) Clay nr nr
Weber
24
Competitive 4 M/F 12 50.4 (4.9) 154 (15) nr nr 2.82 (0.92) Carpet nr nr
Recreational 6–7 M/F 18 54.3 (6.1) 141 (16) nr nr 2.67 (0.96) Carpet nr nr
Values are mean (SD).
*First author and reference number.
F, female; HR, heart rate; HR
max
, maximum heart rate; ITN, international tennis number; M, male; n, number of subjects; nr, not reported.
762 Pluim, Staal, Marks, et al
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pressure of 198 (30) mm Hg. Mean diastolic blood pressure
during play decreased to 82 (16) mm Hg.
Swank et al
47
studied 28 elite senior male tennis players (21
years of tennis play) and 18 moderately active age matched
controls and found no significant difference between groups in
either systolic or diastolic blood pressure values (40 to 59 years:
systolic blood pressure (SBP) = 121 (10) v 124 (14) mm Hg,
diastolic blood pressure (DBP) = 78 (10) v 79 (10) mm Hg; 60+
years: SBP = 136 (10) v 135 (14), DBP = 82 (7) v 81 (7)
mm Hg).
Diabetes mellitus
Nessler
53
undertook a longitudinal study of 12 patients (seven
men, mean age 62 (4) years and five women, mean age 60 (4)
years) with type II diabetes at the Sports University of Cologne.
The untrained beginners played tennis twice a week with a
modified ball for six weeks; training sessions lasted 90 minutes.
No significant changes occurred in baseline glucose levels,
HbA1c concentration, triglyceride levels, LDL, HDL, and total
cholesterol levels, or free fatty acids. There were small but
significant increases in plasma insulin (10.3 (3.8) v 13.9 (5.7)
mE/ml, p = 0.026) and c-peptide production (3.5 (1.0) v 4.7 (1.4
nmol.l
21
), p = 0.001). The mean glucose concentration (mean
of 12 participants measured before and after 12 training
sessions) fell from 188.0 (72.7) mg/dl before to 156.7 (52.2)
mg/dl after 90 minutes of training (p = 0.001).
Cardiovascular disease
Heart size
Eight studies examined the cardiac dimensions of elite tennis
players.
54–61
Increased heart size and increased performance
capacity were noted regardless of sex.
54 55 59–61
Systolic and
diastolic function were within normal limits.
56 57 61
Morbidity and mortality
Houston et al
62
studied 1019 male students between 1948 and
1964. After a standard physical examination, the students were
asked to rate their ability in tennis, golf, football, baseball, and
basketball during medical school and earlier. The researchers
assessed the participants’ physical activities an average of 22
and 40 years later. Tennis was the only sport in which a greater
ability during medical school was associated with a lower risk
of cardiovascular disease. After adjustment for confounding
variables, the relative risk of developing cardiovascular disease
was 0.56 (95% confidence interval (CI), 0.35 to 0.89) in the high
ability group and 0.67 (0.47 to 0.96) in the low ability group,
compared with the no ability group. A primary factor for this
beneficial health profile may be that tennis was the sport
played most often through mid-life. Half the tennis players
were still participating in the sport in mid-life, compared with
only a quarter of those who reported playing golf and none who
reported playing baseball, basketball, or football.
Osteoporosis
Twenty two studies (23 articles)
63–85
were identified that
examined the effects of tennis play on bone health. Generally,
the bone mineral content (BMC) and bone density (BMD) were
shown to be consistently greater in the dominant (playing) arm
than in the non-dominant arm. Also, BMC and BMD were
greater in the hip and lumbar spine regions of tennis players
than in controls, and exercise induced bone gain was greater in
young than in old starters. Table 3 provides more specific
information on the effect of tennis on bone health.
DISCUSSION
The general findings of this review indicate that those who
choose to play tennis appear to have positive health benefits.
Specifically, lower body fat percentages, more favourable lipid
profiles, and enhanced aerobic fitness contributed to an overall
improved risk profile for cardiovascular morbidity.
Furthermore, numerous studies have identified better bone
health not only in tennis players with lifelong tennis participa-
tion histories, but also in those who take on the sport in mid-
adulthood.
A limitation of this review is the small number of studies
with a longitudinal design. For example, of the 17 studies
Table 2 Maximum oxygen uptake of tennis players of various levels of play
Reference* Level of play, country ITN Sex n
Age
(years)
V
˙
O
2
max
(ml.kg
21
.min
21
)
Juniors
Buti et al
41
State squad, Australia 3 M 8 11.7 56.3 (6.5)
F 8 11.7 52.6 (8.2)
Carlson et al
42
Elite junior, Australia 2–3 M 6 16.8 60.3 (6.4)
F 6 14.6 52.3 (7.5)
Powers, et al
43
High school, USA 4–5 F 10 15.8 (0.4) 48 (2.1)
18–35 years
Smekal et al
26
Top league, Austria 3–4 M 20 26 (4) 57.3 (5.1)
Bernardi et al
27
Intermediate, Italy 4–5 M 7 28.1 (3) 65 (6)
Christmass et al
28
State level, Australia 3 M 7 24 (2) 53.4 (1.8)
Kraemer et al
44
College, Div I and III, USA 3–5 F 38 20 (2) 47.6 (4.4)
Christmass et al
29
State level, Australia 3 M 8 23 (1) 54.3 (1.9)
Reilly et al
30
Top club, UK 4 M 8 23.4 (3.1) 53.2 (7.3)
Bergeron et al
31
University, Div I, USA 3–4 M 10 20.3 (2.5) 58.5 (9.4)
Morgans et al
34
Intermediate to advanced, USA M 17 31.4 (7.3) 46.4 (6.2)
Elliott et al
35
College level, Australia 3–4 M 8 20.3 (1.3) 65.9 (6.3)
Wilmore et al
46
Beginners, USA 9–10 M 9 29 (6.6) 44.4 (7.5)
35 years and over
Ferrauti et al
39
Nationally ranked, Germany 2–3 M 6 47 (5.4) 47.5 (4.3)
F 6 47.2 (6.6) 41.4 (6.0)
Vodak et al
45
Recreational, USA 6–8 M 25 39 (3) 50.2 (5.7)
6–8 F 25 42 (6) 44.2 (5.4)
Swank et al
47
Elite, USA 3–4 M 13 40–59 48.7 (11.7)
4–5 M 15 .60 35.3 (5.8)
Values are mean (SD).
*First author and reference number.
F, female; ITN, international tennis number; M, male; n, number of subjects; V
˙
O
2
max, maximum oxygen consumption.
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Table 3 Characteristics and results of included studies on the effect of playing tennis on indicators of bone health
Reference* Design Study population Method Main results
Ducher et al
85
XS 28 young (22 boys, 6 girls, 11.6
(1.4) y) and 47 adult tennis players
(23 M, 24 F, 22.3 (2.7) y), and 70
age matched controls (12 children
(12.2 (1.6) y) and 58 adults (23.3
(3.2) y))
DXA At the ultradistal radius, asymmetry in BMC in young and adult tennis
players was 16.35% and 13.8%, respectively (p, 0.0001). At the mid- and
third-distal radius, asymmetry was much greater in adults than in children
(p,0.0001) for BMC (mid-distal radius, +6.6% v +15.6%; third-distal radius
+6.9% v +13.3%).
Ducher et al
82
XS 52 tennis players (24.2 (5.8) y),
16.2 (6.1) y of practice
DXA Lean tissue mass, bone area, BMC, and BMD of the dominant forearm were
significantly (p,0.0001) greater. Bone area and BMC correlated with grip
strength on both sides (r = 0.81–0.84, p,0.0001).
Ducher et al
83
XS 20 regional level tennis players (10 M;
10 F, mean age 23.1 (4.7) years,
with 14.3 (3.4) years of playing)
DXA Significant side-to-side differences (p,0.0001) were found in muscle
volume (+9.7%), grip strength (+13.3%), BMC (+13.5%), total bone volume
(+10.3%), and subcortical volume (+20.6%), but not in cortical volume
(+2.6%, NS). The asymmetry in total bone volume explained 75% of the
variance in BMC asymmetry (p,0.0001). Volumetric BMD was slightly
higher on the dominant side (+3.3%, p,0.05). Grip strength and muscle
volume correlated with all bone variables (except volumetric BMD) on both
sides (r = 0.48–0.86, p,0.05–0.0001) but the asymmetries in muscle
indices did not correlate with those in bone indices.
Ducher et al
84
XS 57 regional level tennis players (33 M,
24 F). All had been practising tennis
for at least 5 years
DXA At the ultradistal radius, the side-to-side difference in BMD was larger than
in bone area (8.4 (5.2)% and 4.9 (4.0)%, respectively, p,0.01). In he
cortical sites, the asymmetry was lower (p,0.01) in BMD than in bone area
(mid-distal radius: 4.0 (4.3)% v 11.7 (6.8)%; third-distal radius: 5.0 (4.8)% v
8.4 (6.2)%).
Sanchis-Moysi
et al
66
XS 10 F postmenopausal tennis
players (60 (5) y) and 12
postmenopausal controls (63 (7) y).
Tennis players started at 31 (9) y and
had been playing for 27 (7) y, at least
3h/wk
DXA Tennis players showed 8% greater BMC and 7% greater osseous area in the
dominant arm than in the non-dominant arm (p,0.05). There was a
positive correlation between duration of tennis participation and inter-arm
asymmetry in BMC (r = 0.81, p,0.01) and bone area (r = 0.78, p,0.01).
Sanchis Moysi
et al
65
XS 17 M tennis players (55 (2) y),
9 F tennis players (61 (1) y), 15 M
(56 (3) y) and 20 F (62 (2) y) control
subjects. Mean tennis participation
was 27 (7) y, 3 h/wk
DXA Male tennis players had a 16% higher BMC and 10% BMD in legs than
controls (p,0.05). 10–30% greater BMC and BMD were observed in the
hip region and lumbar spine (L2–L4) of tennis players v controls (p,0.05).
Kontulainen
et al
80
XS 36 young F Finnish tennis/squash
players (22 (8) y, mean starting age
11 (2) y), and 28 older F players
(39 (11) y, mean starting age 26 (8) y),
and 27 controls (29 (10) y)
pQCT, DXA The side-to-side differences in the young starters bone mineral content,
cortical area, total cross sectional area of bone, and cortical wall thickness
were 8–22% higher than those of controls and 8–14% higher than those of
old starters.
Nara-Ashizawa
et al
68
XS 92 middle aged F tennis players
(46 (5) y) who initiated training after
bone had matured (mean starting
age 36 (3) y)
pQCT Endocortical area (0.278 (0.094) v 0.300 (0.106) cm
2
), periosteal area
(1.007 (0.14) v 1.061 (0.15) cm
2
), BMC (0.141 (0.017) v 0.147
(0.017) g), moment of inertia (1598 (413) v 1744 (460) mm
4
), section
modulus (219 (41) v 233 (44) mm
3
), and SSI (352 (66) v 376 (71) mm
3
)of
dominant midradius were greater (p,0.01) than in the non-dominant
radius. BMD of trabecular bone (0.383 (0.060) v 0.363 (0.070) g/cm
3
,
p,0.05) and whole bone (0.756 (0.115) v 0.656 (0.120) g/cm
3
,p,0.01)
at the dominant distal radius were greater than in the non-dominant radius.
Kontulainen
et al
64
PCS; 5-y
follow up
36 young F Finnish tennis/squash
players (22 (8) y, mean starting age
11 (2) y), and 28 older female
players (39 (11) y, mean starting age
26 (8) y), and 27 controls (29 (10) y).
Young starters reduced training from
4.7 (2.7) to 1.4 (1.3) times/wk; old
starters from 4.0 (1.4) to 2.0 (1.4)
times/wk
DXA Bone gain was 1.3–2.2 times greater in favour of young starters: The
difference in BMC of humeral shaft in dominant v non-dominant arm was 22
(8.4)% in young starters v 10 (3.8)% in old starters at follow up.
Haapasalo
et al
67
XS 12 M former Finnish national level
tennis players (30 (5) y) and 12 age,
height, and weight matched controls
pQCT Among the players significant side-to-side differences (p,0.05) in favour of
the dominant arm were found in BMC, total area, cortical area, and bone
strength index at the proximal humerus, humeral shaft, distal humerus,
radial shaft, and distal radius. Increased bone strength was mainly due to
increased bone size and not to a change in volumetric bone density.
Kontulainen
et al
63
PCS; 4-y
follow up
13 M former competitive tennis players
(26 (5) y) who started their career at a
mean age of 11 y and 13 controls
(26 (6) y). The players had all retired
from top tennis before (mean 2.3
(0.6) y) follow up
DXA Relative side-to-side BMC differences were significantly (p,0.001) larger in
players than in controls at all measured sites in both 1992 and 1996 for
proximal humerus (1992: 18.5% v 1.4%; 1996: 18.4% v 0.5%), humeral
shaft (1992: 25.2% v 4.7%; 1996: 25.9% v 4.5%), radial shaft (1992:
13.9% v 1.8%; 1996: 14.2% v 2.1%), and distal radius (1992: 13.2% v
2.0%; 1996: 13.2% v 2.3%).
Ashizawa
et al
69
XS Forearms of 16 competitive tennis
players (10 F) and 12 healthy controls
(7 F) aged 18–24 y were scanned at
mid and distal site of the radius
pQCT Players had an increase in total BMC (13.3%, p,0.001), periosteal bone
area (15.2%, p,0.001), cortical BMC (12.6%, p,0.001), and cortical
bone area (13.5%, p,0.01) in the playing arm v the non-playing arm. In
controls, side-to-side differences in these variables were not significant.
In the distal radius, total BMC (13.8%, p,0.01), periosteal bone area
(6.8%, p,0.05), total BMD (6.8, p,0.01), trabecular bone area (6.8%,
p,0.05), and trabecular BMD (5.8%, p,0.05) of the playing arm were
greater than in the non-playing arm. In controls, significant side-to-side
differences were not found in any measured variables.
764 Pluim, Staal, Marks, et al
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examining tennis and cardiovascular risk factors, only two had
a longitudinal design (six week follow up). Similarly, of the 22
studies on bone health, only two had a longitudinal design. But
to their credit, follow up was much longer (four and five years).
A second limitation, that of selection bias, may also have
occurred in the studies reviewed, given that those who are
healthy may be more inclined to play tennis (and continue
lifelong participation) in comparison with others who may have
health problems and deem tennis inappropriate for them. The
type of person who is able to and does play tennis may self
select for more positive health outcomes, as playing tennis is
generally associated with a higher socioeconomic status.
89
Furthermore, most of the studies included failed to adjust
appropriately for confounding variables when studying the
relation between tennis and health indices.
Despite these limitations, there remains an indication of
positive health benefits associated with regular tennis partici-
pation. This conclusion concurs with those of other well
designed studies investigating the general impact of exercise
on various health indices.
Reference* Design Study population Method Main results
Haapasalo
et al
70
XS 91 7–17 y F tennis players and 58
healthy F controls. In each Tanner
stage, differences in BMD in playing
and non-playing arms and lumber
spine were compared between the
players and controls
DXA In players, BMD inter-arm differences were significant (p,0.05 to ,0.001)
in all Tanner stages, with mean differences ranging from 1.6% to 15.7%.
Mean arm differences between players and controls did not become obvious
until Tanner stage III (mean age 12.6 y). In the lumbar spine differences
were not found until Tanner stage IV (mean age 13.5 y, 0.97 (0.13) v 0.89
(0.09) g/cm
2
,p,0.05) and Tanner stage V (mean age 15.5 y, 1.08
(0.105) v 0.96 (0.134) g/cm
2
,p,0.05).
Calbet
et al
71
XS 9 M professional tennis players
(26 (6) y) and 17 non-active M
subjects (24 (3) y)
DXA Total mass (4977 (908) v 4220 (632) g, lean mass (3772 (500) v 3246
(421) g, p,0.001, and BMC (229 (43.5) v 194 (33) g) were greater in the
dominant arm of tennis players than in controls (all p, 0.05). BMD was
increased in tennis players v controls in the lumbar spine (1.25 (0.29) v 1.09
(0.12) g/cm
2
, p = 0.09) and in the trochanteric region (0.94 (0.11) v 0.80
(0.07) g/cm
2
,p,0.001).
Haapasalo
et al
72
XS 17 young competitive M tennis
players (25 (5) y), 30 young F
players (19 (3) y), 20 older F players
(43 (5) y), 16 M controls (25 (5) y),
25 young F controls (21 (3) y), and
16 older F (39 (6) y). Starting age,
M 10 (3) y, young F 9 (2) y, older
F 29 (6) y
DXA There were significant side-to-side humeral length differences in young M
players (+1.4%), young F controls (+1.1%), and older F players (+0.7%).
Relative side-to-side differences in BMC (range +7.6 to +25.2%), BMD
(range +5.8% to +22.5%), cortical wall thickness (range +6.9% to +45.2%),
cross sectional moment of inertia (range +7.8% to +26.4%), and section
modulus (range +3.0% to +21.7%) were significantly larger in players than
in controls at the proximal, mid, and distal part of the humerus. Relative
side-to-side differences were significantly larger in young (range +11.7% to
+45.2%) than in older players (range +3.0% to + 12.4%).
Etherington
et al
73
XS 16 former tennis players (aged
40–65 y), 67 former middle and
long distance runners and 585 age
matched controls
DXA Tennis players had greater BMD than runners (lumbar spine 12% (95% CI,
5.7 to 18.2), p = 0.0004, femoral neck 6.5% (–0.2 to 13.2), p = 0.066).
Athletes had greater BMD than controls (lumbar spine 8.7% (5.4 to 12.0),
p,0.001 and femoral neck 12.1% (9.0 to 15.3), p,0001). BMD of tennis
players’ forearms were greater than their non-dominant forearms.
Tsuji et al
74
XS 10 M college wrestlers (20 (1) y),
16 female college basketball players
(20 (1) y), and 12 F college tennis
players (21 (1) y)
DXA A significant and positive relation was found between mid-radial (0.48
(0.07) g/cm
2
) BMD and grip strength (31.2 (4.1) kg) in the dominant
forearm of tennis players (r = 0.43, p,0.05). There was a significant
difference between mid-radial BMD in the dominant (range 0.63–0.87 g/
cm
2
) and non-dominant arm (range 0.52–0.57 g/cm
2
,p,0.05).
Kannus et al
75
XS 105 F Finnish national level tennis/
squash players (28 (11) y) and 50
controls (27 (9) y). Players were divided
into starting groups according to the
biological age (y before or after
menarche) at which their playing
careers began
DXA The players had a larger (p,0.001) side-to-side difference in BMC for
proximal humerus (1.42 (1.33) v 0.41 (1.08) g), humeral shaft (2.77 (2.20)
v 0.57 (1.68) g), radial shaft (0.32 (0.47) v 0.12 (0.40) g), and distal
radius (0.32 (0.38) v 0.11 (0.28) g). Differences were two to four times
greater in players who started before or at menarche than 15 years after
menarche.
Kannus et al
76
XS 20 top level M Finnish tennis players
(25 (5) y), and 20 controls (26 (5) y)
DXA Relative side-to-side differences in BMD and BMC were significantly
increased in players v controls for humeral shaft (BMD 0.29 (0.09) v 0.03
(0.10) g/cm
2
, BMC 6.41 (0.28) v 1.06 (0.33) g, p,0.001), and proximal
humerus (BMD 0.12 (0.08) v 0.01 (0.10) g/cm
2
, BMC 2.38 (1.8) v 0.28
(1.7) g, p,0.001).
Krahl
et al
77, 78
XS 20 highly ranked professional tennis
players (12 M, 8 F, 20.1 (4.5) y), and
12 controls (7 M, 5 F, 23.1 (4.7) y)
x ray Relative side-to-side differences were significantly increased in tennis
players v controls for ulnar diameter (2.1 v 0.02 mm, p,0.01), ulnar length
(8 v 0.17 mm, p,0.01), second metacarpal diameter (0.9 v 0.0 mm,
p,0.01), and second metacarpal length (2.7 v 0 mm, p,0.01).
Jacobson
et al
79
XS 11 college tennis players, 23
swimmers, and 86 older athletic F
aged 23 to 75 y and age matched
non-athletic controls.
Single
and dual
photon
densitrometry
Lumbar spine density was increased in tennis players v swimmers and
controls (1.51 (37) v 1.39 (27) and 1.36 (49) g/cm
2
,p,0.02). Metatarsal
density was increased in tennis players v swimmers and controls (626 (26) v
565 (14) and 512 (13) g/cm
2
,p,0.001). BMC of dominant arm of tennis
players 16% higher than in non-dominant arm; in controls (3% (p,0.001).
Differences between controls and athletic women were highest in oldest age
groups.
Huddleston
81
XS 35 active M tennis players were
studied during the 1978 USTA’s 70-,
75-, and 80-y age group clay court
championship (21 aged 70–74 y,
9 aged 75–79 y, 5 aged 80–84 y
Transmission
scanning with
a low energy
x-ray beam
Bone mass of the radius of the playing arm (mean, 1.37 g/cm) was greater
than that of the non-playing arm (mean, 1.23 g/cm) in all but one person.
The quantity of BM present in the playing arms of the tennis population was
greater than that of the dominant arm on non-athletes.
*First author and year of publication.
BMC, bone mineral content; BMD, bone mineral density; CI, confidence interval; DXA, dual energy x ray absorptiometry; F, female; M, male; PCS, prospective cohort
study; pQTC, peripheral quantitative computer tomography; wk, week; XS, cross sectional study; y, years.
Table 3 Continued
Health benefits of tennis 765
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The lower body fat percentage of tennis players compared
with less active controls is an important finding because obesity
has become a ‘‘global epidemic’’, with more than one billion
adults overweight (body mass index (BMI) .25) and at least
300 million of them clinically obese (BMI .30).
90
This review shows that tennis is associated with increased
plasma HDL cholesterol.
47–49
Even though more than 200 risk
factors for coronary heart disease have now been identified, the
single most powerful predictor is hyperlipidaemia.
91
It is also a
significant one—more than half the cases of heart disease are
attributable to lipid abnormalities. The higher HDL cholesterol
concentrations associated with a lower risk of cardiovascular
disease implies that playing tennis may be at reduced risk of
cardiovascular events.
92
The results of the study by Vodak et al
49
indicate that blood
pressure response during tennis play is comparable to the
response to an acute bout of moderate intensity dynamic
exercise.
93
Unfortunately, no longitudinal studies on the long
term effect of tennis on blood pressure were identified and
further studies are warranted.
Studies retrieved in this review unanimously showed that
tennis was related to healthier bone structure in both sexes and
across the age spectrum.
63 65–85
The association depended on the
duration of tennis participation and training frequency, being
stronger in young starters than in old starters, but was
maintained despite decreased tennis participation. This was
most clearly present in load bearing bones such as the humerus
of the dominant arm, lumbar spine, and femoral neck. These
findings support the exercise recommendations described in
the American College of Sports Medicine (ACSM) position
stand on ‘‘Physical activity and bone health’’, which recom-
mends 20 to 40 minutes of weight bearing endurance activities,
such as tennis, at least three times a week to augment bone
mineral accretion in children and adolescents, and 30 to
60 minutes of these activities at least three times a week to
preserve bone health during adulthood.
94
Playing tennis on a regular basis (two to three times a week),
either singles or doubles, meets the exercise recommendations
of the ACSM and American Heart Association (AHA).
20–22
Reported mean heart rates during singles tennis ranged from
70% to 90% of maximum heart rate, and mean oxygen
consumption ranged from 50% to 80% of V
˙
O
2
max. Moderate
intensity activities are those done at a relative intensity of 40%
to 60% of V
˙
O
2
max (60–75% of maximum heart rate), whereas
vigorous intensity activities are those done at a relative
intensity of .60% of V
˙
O
2
max (.75% maximum heart rate).
Thus exercise intensity during singles tennis play is high
enough to categorise it as a moderate to vigorous intensity
sport. This is supported by the findings that tennis players
display an above average maximal oxygen uptake compared
with normally active populations of the same age and sex.
86 87
In doubles play, heart rate and V
˙
O
2
tend to be lower than
during singles play. However, it is not the absolute intensity of
the exercise that is relevant, but rather the intensity relative to
the physical capacity of the individual. This means that, while
singles play may be necessary to result in health benefits for the
younger player, doubles play may be sufficient for the middle
aged or senior tennis player, because their maximum heart rate
and V
˙
O
2
max are decreased. Doubles play is therefore particu-
larly suitable for these categories. This has the added benefit
that it increases the chance that those who play tennis are likely
to maintain the sport when they grow older. Hence, the positive
effects are maintained. In order for exercise to exert a positive
effect, one has to embrace lifelong exercise patterns. The
positive effects of sustained physical activity were demon-
strated by Houston et al,
62
who found that the association of
high ability in tennis during college and a reduced risk of
cardiovascular disease in later life was at least partly mediated
through continued participation in tennis.
CONCLUSIONS AND RECOMMENDATIONS
A positive association has been shown between regular tennis
participation and positive health benefits, including improved
aerobic fitness, a leaner body, a more favourable lipid profile,
improved bone health, and a reduced risk of cardiovascular
morbidity and mortality. Exercise intensity during tennis play
meets the exercise recommendations of the ACSM and AHA,
and playing tennis regularly will contribute to improved fitness
levels. In addition, long term tennis play leads to increased
bone mineral density and bone mineral content of the playing
arm, lumbar spine, and legs. However, further longitudinal
studies with appropriate adjustment for confounding variables
and self selection are warranted, to determine whether the
positive association between a leaner body, a more favourable
lipid profile, and a reduced risk of cardiovascular morbidity and
mortality and tennis is an indication of the health benefits of
tennis, or the effect of self selection and a healthier lifestyle of
tennis players.
Authors’ affiliations
.......................
Babette M Pluim, Royal Netherlands Lawn Tennis Association (KNLTB),
Amersfoort, The Netherlands
J Bart Staal, Department of Epidemiology and Caphri Research Institute,
Maastricht University, Maastricht, The Netherlands
Bonita L Marks, Department of Exercise and Sport Science, University of
North Carolina at Chapel Hill, Chapel Hill, NC, USA
Stuart Miller, Dave Miley, International Tennis Federation, London, UK
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N
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doi: 10.1136/bjsm.2006.034967
2007
2007 41: 760-768 originally published online May 15,Br J Sports Med
Babette M Pluim, J Bart Staal, Bonita L Marks, et al.
Health benefits of tennis
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  • ... Based on her research Klára Kovács states that the validity of the development model and Coleman's social capital theory for leisure-time athletes has been clearly demonstrated, primarily due to the personality development and social character of sports. The results that sport has a positive effect on learning outcomes are consistent with the earlier results of Hartman (2008), Castelli et al. (2007), Miller et al. (2007. According to Trudeu and Sephard (2008), sporting in leisure time or as an extracurricular program enhances school attachment, gives confidence, and plays an important role in learning success. ...
    ... The general findings of similar research indicate that those who choose to practice tennis as a recreational leisure activity experienced positive benefits on their physical fitness and implicitly on their health. Lower body fat percentages, more favorable lipid profiles and improved aerobic capacity contributed to a generally smaller risk of cardiovascular morbidity (Pluim, Bonita, Marks, Miller, Miley, 2007). The same authors also outlined the results of numerous studies which identified better bone health, not only for tennis players which took part in tennis activities over the course of their lives, but also for those who started to practice tennis in adulthood. ...
  • ... Based on her research Klára Kovács states that the validity of the development model and Coleman's social capital theory for leisure-time athletes has been clearly demonstrated, primarily due to the personality development and social character of sports. The results that sport has a positive effect on learning outcomes are consistent with the earlier results of Hartman (2008), Castelli et al. (2007), Miller et al. (2007. According to Trudeu and Sephard (2008), sporting in leisure time or as an extracurricular program enhances school attachment, gives confidence, and plays an important role in learning success. ...
    ... The general findings of similar research indicate that those who choose to practice tennis as a recreational leisure activity experienced positive benefits on their physical fitness and implicitly on their health. Lower body fat percentages, more favorable lipid profiles and improved aerobic capacity contributed to a generally smaller risk of cardiovascular morbidity (Pluim, Bonita, Marks, Miller, Miley, 2007). The same authors also outlined the results of numerous studies which identified better bone health, not only for tennis players which took part in tennis activities over the course of their lives, but also for those who started to practice tennis in adulthood. ...
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    Study success is usually closely related to the popularity of certain subjects and the sport activities. The purpose of our study is to highlight the connection between the participation of students in out-of-school sports activities and their success in school on the basis of the analysis of the 10th-year student questionnaires of the 2016 OKM database. In our research we examine the correlation between sport activities and gender using cross tables. For forming student groups we used cluster analysis, for analysing the factors of participation in extracurricular sport classes we used logistic regression analysis, and for analysing the factors influencing grade point average we used linear regression analysis. As for out-of-school extra and private lessons, according to our results sports activities seem to be the most popular with students. Concerning gender and school grade average, boys and students with a better school grade average take part in sports activities unlike girls and students with lower school grade average. Regression results have shown that boys, those living in the city, the more financially well-off, the highly educated and the labour-marketed parents, those attending grammar school, and pupils in church-based institutions attend extra-curricular sports classes. There is also a strong correlation between the average education and non-school sports, as students with a higher average grade are involved in separate sports classes. Keywords: success in school, out-of-school sports activities, national competence survey
  • ... Further studies, amplify the statements in Dr. Groppel's articles. Pluim et al (2007) showed that recreational players playing an hour of tennis, with similar level players, covered an average distance of 3.17 kilometres and had an average heart rate while playing of 149 beats per minute. ...
  • ... For all these reasons, our research follows the guidelines set by previous studies, substituting the physical activities included in them for tennis, a sport that both involves heart healthy exercise and has an appropriate intensity to achieve health benefits (Plaza, Villar, Mata, Pérez, Maiquez, Casasnovas, Banegas, Tomás, Rodríguez and Gil, 2000;American College of Sport Medicine, 2006;Boraita, 2008). The tennis program we have designed for this population group aims to achieve not only health benefits in the patient, that have been previously supported by literature references such as Marks (2006), Pluim et al (2007) andFernández et al (2009), but also an improvement in their technical skills that will further lead to the mastering of this sport, enhancing their access to exercise in an autonomous, healthy and sustainable manner. Conversely to other programs currently recommended in Spain, our program assures that patients will be able to resume the training program in normal conditions after our intervention, guaranteeing an appropriate and autonomous execution of the exercises. ...
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    At present, slightly healthy ways of life (sedentary lifestyle, unhealthy food, stress, etc.) prevail in our society. Concurrently, rates of cardiovascular diseases causes alarm since they constitute the first cause of death in developed countries. Considering this social problem, we have conducted a study that aims to define the effects of a cardiac rehabilitation training program, based on the practice of tennis, in patients with acute coronary syndrome. Our objective was to determine the technical level achieved after the training program and to specify if improvements were made regarding accuracy comparing the pre-test and the post-test. The sample consisted of a group of six patients, of average age 53.57 ± 4.68. Systematic observation was used as an assessment tool. The shot technique and accuracy achieved were filmed and subsequently analysed with the help of observational grids previously validated. The statistical analysis of the results showed significant differences (p =.001 and p =.005) in both shot technique and shot accuracy after the training program.
  • ... similares como el tenis, ofrece beneficios como una disminución de la frecuencia cardíaca (FC) en reposo, mejora la función metabólica, mantiene la masa ósea y disminuye el tiempo de reacción (8). Además, con un buen estilo de vida, encontramos un perfil lipídico más favorable y un menor riesgo de morbilidad y mortalidad cardiovascular (9,10). ...
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    El objetivo de este estudio es analizar la percepción del nivel de calidad de vida y determinar el perfil de estado de ánimo de las mujeres deportistas que practican pádel y compararlo con los resultados obtenidos por las mujeres sedentarias. Las participantes del estudio fueron 60 mujeres extremeñas (Edad media = 40,43 ± 5,73 años), divididas en dos grupos, distinguiendo entre mujeres deportistas que practican pádel y mujeres sedentarias. Se utilizó el Cuestionario Internacional de Actividad Física para dividir a las participantes en dos grupos (deportistas y sedentarias) y posteriormente se aplicó cuestionario del Perfil de Estado de Ánimo y el test EuroQol-5D para conocer la percepción de calidad de vida. Los resultados de este trabajo mostraron valores significativamente más elevados en el todas las dimensiones del estado de ánimo en las mujeres deportistas. Sin embargo, no parece que la práctica de pádel influya significativamente en las dimensiones de calidad de vida excepción de la medida en la escala visual analógica, que es superior en las mujeres practicantes de pádel.
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    RESUMEN Continuando con el artículo que elaboramos en el pasado número de la revista, donde indicábamos los beneficios de la práctica del tenis para la salud, presentamos el presente artículo en el que avanzamos los resultados de una investigación que se llevó a cabo con jugadores de tenis veteranos en España y aportamos una serie de orientaciones para la práctica de este deporte en edades avanzadas. Este estudio se llevó a cabo gracias a una beca de la Federación Internacional de Tenis y se desarrolló en el Real Club de Tenis Barcelona (1899), agradeciendo desde estas líneas a la directiva del club, a sus técnicos y fundamentalmente a los jugadores objeto del estudio que se prestaron a llevar a cabo el mismo. La clínica FIATC colaboró en el trabajo, de igual forma, con la realización de las pruebas de esfuerzo de todos los jugadores. El objetivo de este estudio fue analizar si las diferencias en el nivel de juego influyen en el patrón de actividad y en las demandas fisiológicas de jugadores veteranos de nivel recreativo y avanzado durante la práctica de una hora jugando un partido de tenis. En el estudio participaron 10 jugadores de nivel avanzado y 10 recreativo que realizaron 4 sesiones. La primera para determinar el nivel de juego (ITN Test), la segunda donde se hizo una prueba incremental en laboratorio, en la tercera se realizó un partido de una hora y en la cuarta, media hora con un analizador de gases portátil durante un partido simulado. El consumo de oxígeno (VO 2) y la frecuencia cardiaca (FC) se registró mediante analizadores portátiles. Además, el gasto energético fue evaluado de forma indirecta.
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    La salud de la población va a depender de la predisposición genética de la misma y de los riesgos ambientales (ej., fumar, el sedentarismo). Así, el proceso de envejecimiento de las personas se verá agravado por el descenso de la actividad física y de la salud en general. El español medio actual vive cerca del doble del que vivía hace sólo 100 años y en el año 2001, aproximadamente, uno de cada ocho habitantes tenía más de 65 años de edad. Además algunos estudios parecen indicar que España será uno de los países con un mayor índice de habitantes mayores en su población en varias décadas. Este "envejecimiento" de la población de todos los países industrializados alrededor del mundo y en concreto de España, ha conducido a un dramático incremento en los costes del cuidado de la salud. De hecho, cada vez es más habitual comprobar que las personas mayores practican actividad física, enmarcadas en los diferentes programas y actividades destinados a ese colectivo, en ocasiones, para dar continuidad a la actividad deportiva que han realizado a lo largo de su vida y, en otros casos, para iniciarles en una actividad física que anteriormente no habían realizado. En nuestro caso, no es extraño observar a jugadores de tenis de más de 65 años de edad compitiendo en torneos de tenis, incluso a nivel mundial. Por lo general, los medios de comunicación y organizaciones profesionales de tenis exponen los beneficios que puede tener el tenis sobre la salud de una forma empírica, y a través de deducciones lógicas, sin basarse en investigaciones científicas. Los beneficios de la práctica de ejercicio físico sobre la salud están bien establecidos, y la investigación al respecto muestra que la actividad física de nivel moderado tiene un efecto beneficioso sobre la salud,[1] y que existe un descenso asociado en la morbilidad cardiovascular,[2,3] diabetes[4,5] y mortalidad general[6,7]. El ejercicio practicado de forma regular tiene un efecto beneficioso sobre los factores de riesgo cardiovascular a través de varios mecanismos. Se mejora el perfil lipoprotéico, [8] se reduce el peso corporal,[9] disminuye la tensión arterial,[10,11] se incrementa la sensibilidad a la insulina,[12,13] y se mejora la función cardiaca y el estado de forma cardiorrespiratorio.[14,15] Junto a esta mejora de los factores de riesgo cardiovascular se ha visto que el ejercicio tiene efectos sobre mecanismos independientes (ej., factores endoteliales), y que de esta forma, dentro de los grupos de enfermos (ej., diabéticos, hipertensos), la supervivencia es mayor en aquellas personas que tienen mejor condición física. Además, el ejercicio tiene una serie de efectos beneficiosos sobre la salud ósea,[16] y reduce el riesgo de diversos tipos de cáncer.[17,18] Finalmente, la actividad física afecta de manera positiva el bienestar psicosocial del individuo que lo practica.[19,20]
  • Article
    This study estimated upper and lower limb bone mineral content (BMC) and bone area (BA) in 48 children tennis players (24 boys, 24 girls) aged 7–13 years. The sample comprised four age groups (8.2 ± 0.44, 9.5 ± 0.13, 10.5 ± 0.33, 12.2 ± 0.58). BMC and BA were measured via DXA, and sexual maturity by the Tanner scale, then used as a binary: prepubertal vs peripubertal. Total training time (TTT) included all playing years. Arms were asymmetric and legs symmetric. Boys were more asymmetric than girls in BMC (18% vs 13%) and BA (11% vs 8%). Pre-pubertal children were less asymmetric than peri-pubertal in BMC (14% vs 18%) and in BA (9.4% vs 10%). Bone growth changed with age and TTT markedly better in the dominant arm. The linear combination of TTT, sex, and maturity binary extracted 59% of BMC asymmetry and only 21% of BA asymmetry. For both bone parameters the sex effect was significant only for the pre-pubertal children. Training time constitutes the best predictor of bone asymmetry compared to age, sex, and maturity; when adequate, playing arm bone hypertrophy may be detectable at the age of 7–8 years. These results have health and performance implications.
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    Full-text available
    Background The prevalence of musculoskeletal (MSK) conditions is increasing, and although current guidelines for physical activity attempt to combat this, many fail to achieve the recommended targets. The present study sought to investigate whether regular tennis participation is more effective at enhancing MSK function than meeting the current international physical activity guidelines. Hypothesis Tennis players will display significantly enhanced MSK function when compared with age-matched healthy active nonplayers. Study Design Cross-sectional study. Level of Evidence Level 3. Methods Ninety participants (age range, 18-65 years) took part in this study; there were 43 tennis players (18 men, 25 women) and 47 nonplayers (26 men, 21 women). MSK function was assessed by cluster analysis of 3 factors: (1) electromyographic fatigability of prime movers during handgrip, knee extension, and knee flexion; (2) isometric strength in the aforementioned movements; and (3) body composition measured by bioelectrical impedance analysis. Maximal oxygen uptake was also assessed to characterize cardiorespiratory fitness. Results Tennis players displayed significantly greater upper body MSK function than nonplayers when cluster scores of body fat percentage, handgrip strength, and flexor carpi radialis fatigue were compared by analysis of covariance, using age as a covariate (tennis players, 0.33 ± 1.93 vs nonplayers, −0.26 ± 1.66; P < 0.05). Similarly, tennis players also demonstrated greater lower extremity function in a cluster of body fat percentage, knee extension strength, and rectus femoris fatigue (tennis players, 0.17 ± 1.76 vs nonplayers, −0.16 ± 1.70; P < 0.05). Conclusion The present study offers support for improved MSK functionality in tennis players when compared with age-matched healthy active nonplayers. This may be due to the hybrid high-intensity interval training nature of tennis. Clinical Relevance The findings suggest tennis is an excellent activity mode to promote MSK health and should therefore be more frequently recommended as a viable alternative to existing physical activity guidelines.
  • Chapter
    Tennis is an intermittent sport characterized by repeated high-intensity efforts during a variable period of time. Aiming to be competitive and successful, tennis players need a mixture of speed, agility, and power combined with high aerobic fitness. Plyometrics are training techniques used by athletes in all types of sports to increase strength and explosiveness. The objectivity of the performance measure varies through measures such as: time, checklists, or established criteria. Makey Makey is an invention kit for everyone, is an electronic invention tool and toy that allows users to connect everyday objects to computer programs. The aim of this study was twofold. Firstly the purpose of this study was to examine the effects of a 8-week plyometric training program on tennis specific agility. Secondly, this study was directed towards examining objectivity evaluation among three different evaluators/coaches and highlight the need to use new technologies in order to evaluate performance on agility objectively. 24 male amateur tennis players participated in this study. Subjects separated randomly in two groups, the first group underwent an intervention of a 8 week plyometric program. In order to examine agility we used two tennis specific agility test. 3 independent coaches were used in order to measure participants score on each test. When we use the mean scores of coaches we show that the experimental group showed significant improvement on doth test. We also examined the differences and the correlations among coach’s test in order to estimate the objectivity. Our findings highlight the need of mew technologies in order to improve objectivity in laboratory and field measurements. Here we suggest the use, and the development of suitable software for the Makey Makey device.
Literature Review
  • Article
    In brief: The heart rates of 17 male tennis players (aged 18 to 44, mean 31.4 ± 7.3 years) were monitored during singles and doubles competition. The purposes were to compare average heart rate intensities of players during singles and doubles competition, and to document the amount of time spent in continuous activity. In a one-hour singles match, subjects reached an average of 61% of their maximal heart rate reserve (MHRR), whereas in doubles competition they averaged only 33%. The authors concluded that singles competition in tennis meets the MHRR intensity criteria established by the American College of Sports Medicine for developing and maintaining cardiorespiratory fitness. However, doubles competition does not meet those criteria and should not be considered as an exercise regimen for developing fitness.
  • Article
    Full-text available
    In brief: Eight male and eight female elite prepubescent tennis players were tested to determine their anthropometric and physiological profiles. No significant differences between girls and boys were found for height weight, bone widths, girth measures, VO2 max, maximum aerobic performance, lactacid anaerobic capacity, alactacid anaerobic power, flexibility, muscular endurance, and grip strength in preferred and nonpreferred hands. The girls had a significantly higher level of fat as measured by sum of skinfold thicknesses. Both boys and girls had a significantly higher grip strength in preferred than nonpreferred hands.
  • Article
    Objective: To encourage increased participation in physical activity among Americans of all ages by issuing a public health recommendation on the types and amounts of physical activity needed for health promotion and disease prevention. Participants: A planning committee of five scientists was established by the Centers for Disease Control and Prevention and the American College of Sports Medicine to organize a workshop. This committee selected 15 other workshop discussants on the basis of their research expertise in issues related to the health implications of physical activity. Several relevant professional or scientific organizations and federal agencies also were represented. Evidence: The panel of experts reviewed the pertinent physiological, epidemiologic, and clinical evidence, including primary research articles and recent review articles. Consensus process: Major issues related to physical activity and health were outlined, and selected members of the expert panel drafted sections of the paper from this outline. A draft manuscript was prepared by the planning committee and circulated to the full panel in advance of the 2-day workshop. During the workshop, each section of the manuscript was reviewed by the expert panel. Primary attention was given to achieving group consensus concerning the recommended types and amounts of physical activity. A concise "public health message" was developed to express the recommendations of the panel. During the ensuing months, the consensus statement was further reviewed and revised and was formally endorsed by both the Centers for Disease Control and Prevention and the American College of Sports Medicine. Conclusion: Every US adult should accumulate 30 minutes or more of moderate-intensity physical activity on most, preferably all, days of the week.
  • Article
    [Two of the authors respond:] We agree with Herbert Nehrlich that there are many situations in which physicians would benefit from the assistance of health and fitness professionals. It is essential that such advice be sought from professionals who have received formal training and attained national accreditation. In North America1 these would be professionals certified by the Canadian Society for Exercise Physiology or the American College of Sports Medicine. Together, physicians and health and fitness professionals will be able to provide information that is based on sound physiological principles and a clear knowledge of the absolute and relative contraindications to exercise for a variety of populations. Giuseppe Lippi and associates correctly point out that vigorous exercise may lead to supplemental health gains in sedentary community-dwelling individuals. There is growing evidence to suggest that certain groups may benefit greatly from high-intensity exercise training. We1 have advocated high-intensity exercise training for sedentary individuals2 and patients with cardiovascular disease3 and chronic heart failure.4 However, we are careful to acknowledge that adherence to this form of exercise may be poor and the risk of musculoskeletal injury higher. Therefore, we must weigh carefully the potential advantages and disadvantages of vigorous exercise for each individual client. As pointed out by Ediriweera Desapriya and colleagues, discussion of the barriers to exercise and innovative means to deliver inclusive and culturally appropriate physical activity interventions is of great importance. Furthermore, more effective lifestyle interventions are required to address the global crisis of physical inactivity. We have worked diligently to address the barriers to physical activity and have taken a transdisciplinary approach to the creation of novel exercise interventions. More work is required to “develop and deliver” inclusive interventions for all, but we believe that our work1,5 is a step in the right direction. As Rajesh Chauhan and associates point out, the determinants of health are multifactorial and physical activity is not the sole factor influencing health status. However, physical inactivity is an independent predictor of the risk for many chronic diseases and premature mortality. In fact, the risk for chronic disease and premature mortality in North America appears to be about 20% to 50% greater among those with a physically inactive lifestyle.5 Furthermore, physical activity appears to be protective in the presence of other known risk factors for chronic disease. Therefore, there is compelling evidence to support the independent health benefits of physical activity.
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    Purpose: This study aimed at examining the inuence of different playing surfaces on in-shoe loading patterns in each foot (back and front) separately during the rst serve in tennis. Methods: Ten competitive tennis players completed randomly ve rst (ie, at) serves on two different playing surfaces: clay vs GreenSet. Maximum and mean force, peak and mean pressure, mean area, contact area and relative load were recorded by Pedar insoles divided into 9 areas for analysis. Results: Mean pressure was signicantly lower (123 ± 30 vs 98 ± 26 kPa; −18.5%; P < .05) on clay than on GreenSet when examining the entire back foot. GreenSet induced higher mean pressures under the medial forefoot, lateral forefoot and hallux of the back foot (+9.9%, +3.5% and +15.9%, respectively; both P < .01) in conjunction with a trend toward higher maximal forces in the back hallux (+15.1%, P = .08). Peak pressures recorded under the central and lateral forefoot (+21.8% and +25.1%; P < .05) of the front foot but also the mean area values measured on the back medial and lateral midfoot were higher (P < .05) on clay. No signicant interaction between foot region and playing surface on relative load was found. Conclusions: It is suggested that in-shoe loading parameters characterizing the rst serve in tennis are adjusted according to the ground type surface. A lesser asymmetry in peak (P < .01) and mean (P < .001) pressures between the two feet was found on clay, suggesting a greater need for stability on this surface.
  • Article
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    Osteoporosis is a serious health problem that diminishes quality of life and levies a financial burden on those who fear and experience bone fractures. Physical activity as a way to prevent osteoporosis is based on evidence that it can regulate bone maintenance and stimulate bone formation including the accumulation of mineral, in addition to strengthening muscles, improving balance, and thus reducing the overall risk of falls and fractures. Currently, our understanding of how to use exercise effectively in the prevention of osteoporosis is incomplete. It is uncertain whether exercise will help accumulate more overall peak bone mass during childhood, adolescence and young adulthood. Also, the consistent effectiveness of exercise to increase bone mass, or at least arrest the loss of bone mass after menopause, is also in question. Within this framework, section 1 introduces mechanical characteristics of bones to assist the reader in understanding their responses to physical activity. Section 2 reviews hormonal, nutritional and mechanical factors necessary for the growth of bones in length, width and mineral content that produce peak bone mass in the course of childhood and adolescence using a large sample of healthy Caucasian girls and female adolescents for reference. Effectiveness of exercise is evaluated throughout using absolute changes in bone with the underlying assumption that useful exercise should produce changes that approximate or exceed the absolute magnitude of bone parameters in a healthy reference population. Physical activity increases growth in width and mineral content of bones in girls and adolescent females, particularly when it is initiated before puberty, carried out in volumes and at intensities seen in athletes, and accompanied by adequate caloric and calcium intakes. Similar increases are seen in young women following the termination of statural growth in response to athletic training, but not to more limited levels of physical activity characteristic of longitudinal training studies. After 9–12 months of regular exercise, young adult women often show very small benefits to bone health, possibly because of large subject attrition rates, inadequate exercise intensity, duration or frequency, or because at this stage of life accumulation of bone mass may be at its natural peak. The important influence of hormones as well as dietary and specific nutrient abundance on bone growth and health are emphasised, and premature bone loss associated with dietary restriction and estradiol withdrawal in exercise-induced amenorrhoea is described. In section 3, the same assessment is applied to the effects of physical activity in postmenopausal women. Studies of postmenopausal women are presented from the perspective of limitations of the capacity of the skeleton to adapt to mechanical stress of exercise due to altered hormonal status and inadequate intake of specific nutrients. After menopause, effectiveness of exercise to increase bone mineral depends heavily on adequate availability of dietary calcium. Relatively infrequent evidence that physical activity prevents bone loss or increases bone mineral after menopause may be a consequence of inadequate calcium availability or low intensity of exercise in training studies. Several studies with postmenopausal women show modest increases in bone mineral toward the norm seen in a healthy population in response to high-intensity training. Physical activities continue to stimulate increases in bone diameter throughout the lifespan. These exercise-stimulated increases in bone diameter diminish the risk of fractures by mechanically counteracting the thinning of bones and increases in bone porosity. Seven principles of bone adaptation to mechanical stress are reviewed in section 4 to suggest how exercise by human subjects could be made more effective. They posit that exercise should: (i) be dynamic, not static; (ii) exceed a threshold intensity; (iii) exceed a threshold strain frequency; (iv) be relatively brief but intermittent; (v) impose an unusual loading pattern on the bones; (vi) be supported by unlimited nutrient energy; and (vii) include adequate calcium and cholecalciferol (vitamin D3) availability.