Pickleball for Life? How Different Exercises Reduce the Risk of Dying

Jake Remaly

August 26, 2022

Pick up a racquet. You may live longer.

Older adults who participate in physical activity are less likely to die than ones who don't, and new research shows that some types of exercise may be especially beneficial.

Racquet sports, for example, are associated with the lowest risk of dying from cardiovascular disease, according to a study published this week in JAMA Network Open. People who play tennis, squash, or racquetball were roughly 25% less likely to die of cardiovascular ailments than those who don't participate in regular recreational physical activities.

In comparison, golf was associated with a 9% reduction and walking with an 11% reduction in risk for cardiovascular mortality.

Meanwhile, running or jogging was associated with the lowest odds of dying from cancer, with a 19% reduction in risk of death from that cause. For cyclists, the reduction in risk for cancer mortality was 6%.

The researchers, from the National Institutes of Health (NIH), said they don't expect people to pick an activity based on their findings, however.

"All types of activity were associated with lower mortality risk; therefore, finding an activity that older, inactive individuals enjoy (and so may sustain) is likely of a greater benefit than choosing a particular activity based on the differences between risk estimates," they report.

Seven Healthy Habits

To examine how various leisure time physical activities are associated with mortality risk, Eleanor L. Watts, DPhil, MPH, a researcher with the National Cancer Institute in Rockville, Maryland, and colleagues analyzed data from more than 272,000 participants in a survey of adults ages 59-82 years conducted by NIH and AARP.

The researchers assessed how seven types of exercise correlated with risk of death from cancer, cardiovascular disease, or any cause during an average of 12 years of follow-up. They adjusted their estimates to account for participant characteristics and behaviors such as age, sex, race and ethnicity, education, smoking, health conditions, and sedentary time.

Every kind of exercise they looked at seemed to reduce all-cause mortality — by 16% for racquet sports, 15% for running, and 9% for walking.

Golf and "other" types of aerobic exercise (like aerobics class or using exercise machines) were tied to 7% reductions in risk. For swimming, the risk reduction was 5%. For cycling, it was 3%, according to the researchers.

Racquet sports had the fewest participants (4% of the study population), while walking was the most common form of physical activity (78%). Other aerobic exercises (30%), cycling (25%), golf (14%), swimming (10%), and running (7%) followed.


The Physical Activity Guidelines for Americans recommend that adults get 2.5 to 5 hours of moderate-intensity aerobic physical activity, or 1.25 to 2.5 hours of vigorous aerobic activity, each week.

Study participants who exceeded the recommended amount had greater reductions in mortality risk, albeit with diminishing returns at the highest levels of activity, according to the researchers. Those who participated in brief periods of recreational activities had a lower risk of death than those who did not exercise, but to a lesser extent.

Protection linked to running and racquet sports may relate to the particular demands of those sports, the researchers speculate.

"These activities both require synchronized action from many muscles for correct form, and racquet sports also require hand-eye coordination and intermittent bursts of very high intensity, which may additionally improve physical functioning," they write.

The study relied on participant recall of their participation in physical activity during the past year. The researchers lacked information about exercise earlier in life and during the follow-up period. In addition, the population "was predominantly White, older, and with high socioeconomic status; therefore, risk estimates might not be generalizable to other populations," they acknowledge.

"They are showing what we know, which is that these higher-intensity sports render greater gains in health benefits," said Carole B. Lewis, DPT, PhD, a geriatric rehabilitation specialist who has studied exercise as medicine for older women. "Racquet sports and running are much better than walking or golf, but any exercise is better than no exercise."

"People who are not as fit don't run or play racquet sports, so you may just be measuring that," Lewis added.

Clinicians should embrace exercise as part of their domain and encourage their patients to get off the couch as an essential part of staying healthy — and alive, Lewis said.

She echoed a message that she heard neurologist Majid Fotuhi, MD, PhD, share during a talk: "We do a disservice to our patients by telling them that exercise is good for you. We should be saying you need exercise like cancer patients need chemotherapy."

The study was supported by the NIH. The authors and Lewis have reported no relevant financial relationships.

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