Does Playing Pickleball Benefit the Heart and Soul of Seniors?

Can you achieve cardio exercise goals by playing this highly entertaining and social sport?

The skeptical cardiologist has become an unbridled pickleball enthusiast in the last year.

Since my teens, I’ve had a fondness for all activities that involve whacking a moving ball with a racquet-type instrument, ranging from ping-pong to badminton to racquetball.

Tennis was my focus for 40 or so years until a  persistent pesky tennis elbow and knee pain convinced me to hang up my racquet

Like millions of seniors, however, I have discovered that pickleball (Pball) scratches my itch for a competitive and social sport that does not overly tax my aging body.

Lately, I’ve been pondering the cardiovascular and overall risks and benefits of the sport, ruminating on questions such as:

Does playing Pball count as moderate or vigorous exercise when calculating one’s success at achieving the 150 minutes of moderate to vigorous physical activity per week goal I tell my patients to aim for?

Does regular Pball play help improve one’s overall cardio fitness, e.g. will it increase MVO2?

Is Pball safe for cardiac patients?

Pball and cardiovascular fitness

I played 3 games of doubles at the YMCA (of EGYM fame) next door to me this morning and recorded some relevant parameters using my Apple Watch.

I played without a break for 55 minutes and took around 2500 steps. My average heart rate was 108 BPM which is 72% of my predicted maximal heart rate (PMHR), a range considered typical for vigorous intensity exercise.

My numbers are very similar to HRs found in a study from 2022 that collected data on HR in 22 singles and 31 doubles Pball players (62.1 ± 9.7 years of age) using Garmin Fenix 5 watches and ActiGraph GT3X+ accelerometers. 

The average HR during singles was  111.6 (70% PMHR) and for doubles players it was 111.5  (71% PMHR). 

Over 70% of singles and doubles playing time was categorized in moderate to vigorous heart rate zones whereas 80.5% of singles time and 50.4% of doubles time were moderate based on Freedson accelerometer cut-points.

Steps per hour were higher in singles versus doubles (3,322 ± 493 vs. 2,791 ± 359), p < .001. 

The authors concluded that “Singles and doubles pickleball are moderate- to vigorous-intensity activities that can contribute substantially toward older adults meeting physical activity guidelines.”

Based on this analysis, playing Pball for three times a week for 60 minutes does indeed satisfy the recommended requirements for weekly MVPA minutes.

Pball Risks: Injuries and Cardiac Events

I'm interested in how many of you have picked up the pickleball paddle and what your experience with the sport has been. Has it enhanced your cardiovascular fitness? Have you run into any cardiac issues related the sport?

I have several patients who regularly go into atrial fibrillation when playing pickleball. They manage to keep playing, generally, at a lower level of exertion, and typically the atrial fibrillation resolved within a few hours.

Pickleball injuries have skyrocketed apparently in the senior population.

A recent article provides a narrative review of "an exercise craze among seniors" which summarizes injuries in this table

Is it possible that frequent injuries sustained from Pball playing result in seniors losing rather than gaining cardiovascular fitness over time?

After lunging deeply for a shot in a Pball game a few months ago, I experienced a severe exacerbation of my chondromalacia patellae knee pain which limited stair climbing and Pball playing for weeks. Fortunately, activities that did not require deep knee bending (like cycling, running and elliptical workouts) I could continue and I was able to maintain my max MVO2.

A common treatment for the aches, strains, and pains experienced playing pickleball is to take a non-steroidal inflammatory drug like ibuprofen.

NSAIDs are known to raise blood pressure and increase the risk of heart attack and if used frequently could counter the beneficial cardiovascular effects from Pball.

Pickleball: Can You Feel the Eudaimonia?

The narrative review I mentioned earlier introduces a term I was unfamiliar with: Eudaimonia*:

 Pickleball may be considered a eudaemonic pursuit, that is, an activity that brings happiness, contributes to a sense of overall fulfillment, and allows participants opportunities for obvious self-improvement. Eudaemonic efforts are not purely hedonistic or pleasurable but revolve around finding happiness in a personally meaningful context. In other words, eudaemonic pursuits are not just about having a good time, they are about building a better life. It has been postulated that seniors pursuing sports activities, such as pickleball, may be acting to contribute to their own eudaemonic sense of well-being.

The authors give three reasons for Pball popularity among previously sedentary seniors:

Unlike solo gym routines or online exercise classes, pickleball is an inherently social game that involves face-to-face interactions with other people. People play pickleball with each other. Seniors in large numbers are playing pickleball, so there is less awkwardness for older individuals to play the game. The nature of the game is such that both old and young can not only play the game, but they can play fairly against each other. The age gap virtually evaporates. Furthermore, pickleball provides older players the opportunity to get to know and interact with younger people, something society does not always facilitate. The strong social aspect of pickleball is missing in other exercise regimens. This idea of getting out and interacting with real people playing a game has an innate and strong appeal that should not be dismissed when designing other exercise interventions.

Second, unlike golf or tennis, pickleball has a short learning curve and is inexpensive to play. Novices can generally gain skills sufficient to play passably well in a very short time, although the sport does offer more competitive players the chance to fine-tune their skills over time. Thus, players get the satisfaction of playing reasonably well in a short time. For seniors, this means not being outclassed right from the start in more competitive sports such as tennis, soccer, or marathon running. Furthermore, the skills that can be honed over time with pickleball are accessible to seniors. Among marathon runners, for example, there is an age barrier because all things being equal, a 60-year-old cannot compete fairly against a 20-year-old, no matter how much the older person trains. That barrier is not present in pickleball or it is at least not a brick wall.

Third, pickleball players enjoy their workout. Pickleball players do not even consider their time on the court to be exercise or a fitness routine. They are not working out, they are playing. It is a time they look forward to and a time they enjoy. It is exercise, but it is exercise disguised as fun. Many other fitness regimens emphasize work, effort, sweat, and discipline. Pickleball, from its silly name to the funny-looking modified courts, is more fun than exercise.

I think they have hit the nail on the head.

Pball provides sedentary or active seniors with an aerobic exercise that feels like an entertaining and social activity and that is pretty awesome.

I'm still pondering the questions I outlined at the top of this post but for now I recommend pickleball to the vast majority of my patients.

Let me know your thoughts.

Dinkingly Yours,

-ACP