Table Tennis Plus Resistance Training Cuts Arterial Stiffness 27% in Heart Disease Patients

Coronary heart disease kills more than 380,000 Americans each year. It remains the single leading cause of death worldwide. Standard cardiac rehabilitation programs focus on moderate-intensity aerobic exercise and resistance training, and decades of research confirm they work. A 2023 Cochrane meta-analysis published in the European Heart Journal, analyzing data from thousands of coronary heart disease patients, found that exercise-based cardiac rehabilitation reduces cardiovascular mortality and hospital admissions while improving quality of life and functional capacity.

But what if adding something as simple as table tennis could make cardiac rehab substantially more effective? A new randomized controlled trial published in the Annals of Thoracic Medicine in 2025 suggests exactly that.

The Study

Researchers Guochang Liu from Huanghe Science and Technology College and Xiaoyun Zhu from Hubei University of Science and Technology recruited 70 patients with confirmed coronary heart disease between 2019 and 2021. All participants were aged 50 to 75 and had NYHA cardiac function classification of Grade III or lower, meaning their heart conditions were stable enough for exercise.

The patients were randomly divided into two equal groups of 35. Both groups performed moderate-to-high-intensity resistance training for 30 minutes daily, targeting back muscles, knee flexion and extension, seated abdominal work, and upper limbs. This was standard cardiac rehab resistance work.

The difference was that the test group also played table tennis three times per week. Their table tennis protocol included small steps, parallel steps, forward and backward footwork, and racket swings. They also performed multiball training, where a coach feeds balls rapidly for one group every five minutes, completing five groups per session. This created intermittent high-intensity cardiovascular stimulation.

The intervention lasted four months.

Arterial Stiffness: A 27% Reduction

Arterial stiffness is one of the strongest independent predictors of cardiovascular events. Stiff arteries force the heart to work harder, raise blood pressure, and reduce blood flow to vital organs. Two key measures of arterial stiffness are brachial-ankle pulse wave velocity (baPWV) and carotid-femoral pulse wave velocity (cfPWV). Higher numbers mean stiffer arteries.

After four months, the table tennis group had dramatically lower arterial stiffness than the resistance-only group:

• baPWV: 10.65 m/s in the table tennis group versus 14.65 m/s in the resistance-only group. That is a 27% reduction (p < 0.05).
• cfPWV: 7.95 m/s versus 11.65 m/s. That is a 32% reduction (p < 0.05).
• Ankle-brachial index (ABI): 1.10 versus 1.07, indicating improved peripheral blood flow (p < 0.05).

Patients who started with the highest baseline arterial stiffness saw the greatest improvements, with a correlation coefficient of r = 0.559 (p < 0.001). In other words, the worse your arteries when you start, the more table tennis helps.

Walking 70 Meters Further in Six Minutes

The six-minute walk test is a gold-standard measure of functional exercise capacity in cardiac patients. It directly reflects how far someone can walk in daily life before fatigue or breathlessness stops them.

After four months, the table tennis group walked an average of 489 meters in six minutes, compared to 419 meters for the resistance-only group. That is a 70-meter advantage, or roughly 17% further.

The clinical threshold for meaningful improvement in cardiac rehab is generally accepted as reaching 450 meters within six minutes. The table tennis group achieved a 76% completion rate against this benchmark, while the resistance-only group managed only 44%.

Seventy-six percent versus forty-four percent. Adding table tennis nearly doubled the number of patients who reached the functional walking threshold.

Cardiopulmonary Gains

Beyond walking distance, the study measured detailed cardiopulmonary function. The table tennis group showed significantly greater improvement across nearly every metric:

• Anaerobic threshold: 17.29 ml/min/kg versus 13.95 ml/min/kg in the resistance-only group. A higher anaerobic threshold means the body can sustain effort longer before switching to inefficient anaerobic metabolism.
• Peak oxygen uptake (VO2 peak), left ventricular ejection fraction (LVEF), and max workload all improved significantly more in the table tennis group (p < 0.05).
• Pulmonary function measures including FEV1, forced vital capacity, and maximum voluntary ventilation all favored the table tennis group.

The resistance-only group showed limited improvement on several of these metrics, with some internal pre-versus-post comparisons failing to reach statistical significance.

Blood Lipid Improvements

Coronary heart disease is driven in part by dyslipidemia: high total cholesterol, high triglycerides, high LDL cholesterol, and low HDL cholesterol. The table tennis group showed significantly greater improvements across the lipid panel:

• Total cholesterol, triglycerides, and LDL cholesterol all decreased significantly more in the table tennis group (p < 0.05).
• HDL cholesterol (the protective “good” cholesterol) increased to 1.12 mmol/L in the table tennis group compared to 0.99 mmol/L in the resistance-only group, where the improvement was not even statistically significant from baseline.

This is notable because raising HDL cholesterol through exercise alone has proven difficult in many studies. The combination of table tennis and resistance training achieved what resistance training alone could not.

Psychological and Lifestyle Benefits

Heart disease takes a heavy psychological toll. Anxiety, depression, and poor coping skills are common among cardiac patients and are themselves independent risk factors for worse outcomes.

The study measured psychological state using validated scales for anxiety, depression, and coping ability. After four months, the table tennis group scored significantly higher on all three measures:

• Coping ability: 6.86 versus 4.97 (p < 0.005). This was the largest psychological difference between groups.
• Anxiety: 7.15 versus 6.02 (p < 0.05).
• Depression: 7.03 versus 5.89 (p < 0.05).

Sleep quality and dietary habits also improved more in the table tennis group (sleep: 7.31 vs 6.32; diet: 7.01 vs 6.01, both p < 0.05).

These psychological and lifestyle improvements matter because they affect long-term adherence to rehabilitation programs. A patient who sleeps better, eats better, and feels more capable of coping with their condition is far more likely to stick with exercise long-term.

Why Table Tennis Works for Cardiac Rehab

The authors attribute the superior results to the unique physiological demands of table tennis. Unlike steady-state aerobic exercise such as walking or cycling, table tennis involves rapid bursts of movement, direction changes, and varying intensity levels. This intermittent, high-intensity interval-like stimulus appears to be particularly effective for cardiovascular conditioning.

A 2024 narrative review by González-Devesa and colleagues published in the journal Children, which examined the scientific evidence on table tennis across multiple populations, identified the sport’s unique combination of aerobic demand, motor coordination, cognitive engagement, and adaptability as key factors in its health benefits. The review noted that table tennis can be easily modified in intensity to suit different fitness levels, making it appropriate even for clinical populations.

In the context of cardiac rehabilitation, the multiball training protocol used in this study deserves particular attention. By feeding balls at varying speeds and placements for sustained intervals, coaches created an intermittent cardiovascular challenge that mimics the high-intensity interval training (HIIT) protocols that have shown superior results in cardiac rehab research. But unlike a stationary bike or treadmill, table tennis provides this stimulus in a social, engaging, game-like context that patients actually enjoy.

The Bigger Picture

The Cochrane meta-analysis by Dibben and colleagues in the European Heart Journal (2023), which pooled data from 85 randomized controlled trials involving over 13,000 coronary heart disease patients, established that exercise-based cardiac rehabilitation reduces cardiovascular mortality, decreases hospital admissions, and improves health-related quality of life. Their findings support the general principle that structured exercise helps heart disease patients.

What the Liu and Zhu study adds is a specific, practical protocol that outperforms standard resistance training alone. Table tennis is inexpensive, requires minimal space, and can be played indoors year-round. It is also inherently social, which addresses the isolation that many cardiac patients experience.

What This Means for You

If you or someone you know is living with coronary heart disease, this study offers encouraging evidence that adding table tennis to a standard exercise program can produce meaningful improvements in cardiovascular health, functional capacity, and quality of life. The key findings:

• Arterial stiffness dropped 27-32% compared to resistance training alone after four months.
• Walking capacity improved by 70 meters, with 76% of patients reaching the clinical walking threshold versus 44% in the control group.
• HDL cholesterol increased significantly, an improvement that resistance training alone failed to achieve.
• Psychological well-being, sleep, and dietary habits all improved more with the addition of table tennis.

As always, anyone with heart disease should consult their cardiologist before starting a new exercise program. But for patients who have been cleared for moderate exercise, table tennis offers a uniquely engaging, low-barrier, and now evidence-backed addition to cardiac rehabilitation.

A paddle may be the most enjoyable prescription your heart ever receives.