‘It’s a blast’: Pickleball improves cancer survivors’ physical fitness, social well-being
Key takeaways:
- Cancer survivors who took part in a pickleball program had high retention and adherence rates.
- Survivors significantly increased their moderate-to-strenuous physical activity.
Pickleball programs may encourage more cancer survivors to increase their physical activity, according to a pilot study.
A feasibility investigation showed Project Rally — a pickleball program developed and delivered in a partnership between Moffitt Cancer Center and YMCA of the Suncoast — had high interest, retention and adherence rates among survivors. Participants increased their weekly moderate-to-strenuous physical activity by more than 80 minutes.
“Folks were motivated to enroll,” Nathan H. Parker, MPH, PhD, researcher in the department of health outcomes and behavior at Moffitt Cancer Center, told Healio. “They stuck with the program. They enjoyed the program and the group that they became a part of.”
Background
More than 18 million cancer survivors lived in the United States in 2022, and that number is projected to increase to roughly 26 million by 2040, according to study background.
Prior research has shown physical activity can alleviate adverse effects of treatments, while also conferring benefits in physical functioning, psychological stress, cardiorespiratory fitness, body composition and quality of life.
However, between 53% and 83% of survivors do not meet physical activity recommendations, and about a third do not do any physical activity in their leisure time, Parker said.
“Being inactive can lead to more muscle loss and loss of physical function during and following cancer treatments,” he added. “As someone with a cancer diagnosis deals with treatment side effects and their physical and emotional tolls, it can become more difficult to be physically active, to find that starting place and be consistent.”
Parker had long thought about how to get survivors more interested in and enjoying physical activity, and he honed in on pickleball due to elements like social support, friendly competition and accessibility that make it widely appealing.
He found inspiration from his mother.
“Five years ago or so, my mom became a devoted pickleball player, pretty much playing every day,” Parker said. “It’s been a huge boost in many aspects of her health, including physical and emotional wellness and making new friends. The benefits are broad and deep for her. I started thinking about how cool that would be as a program in my work, knowing the benefits of physical activity in cancer survivorship.”
Pickleball has been the fastest growing sport in the U.S. over the past several years, with a 220% growth since 2020.
“We’re in Florida. Pickleball is all the rage,” Parker said.
Methods
Parker and colleagues opened enrollment for the single-arm study to adult survivors of cancer — excluding those who had nonmelanoma skin cancer — and their family members or friends.
They recruited 31 individuals, of whom 28 performed baseline assessments and 23 completed the pickleball program.
In all, 18 were cancer survivors (median age, 61.5 years; range, 47-76; 94.4% women; 77.8% white; 55.6% breast cancer survivors) and five were friends or family of survivors (median age, 58 years; range, 54-76; 100% men; 80% white).
Researchers encouraged participants to attend at least 2 hours of Project Rally pickleball programing per week for 3 to 7 months. Participants received 1 year of YMCA access, a pickleball paddle and a study T-shirt for joining. YMCA personnel led program delivery and contributed to program and study design.
Feasibility and acceptability of Project Rally for cancer survivors served as primary endpoints. Though the pilot study was not designed to detect differences in other outcomes, the researchers also explored changes in social support, physical activity enjoyment, stress, quality of life, physical functioning and functional fitness among participants.
Researchers judged acceptability based on nine questions rated on a scale of 1 to 5 (1 = strongly disagree; 2 = disagree; 3 = neutral; 4 = agree; 5 = strongly agree), and an overall score on all items.
Results
The study had a 90.3% recruitment rate (95.5% among survivors), which exceeded the original target of 50%.
Additionally, it had a retention rate of 82.1% (85.7% among survivors), exceeding researchers’ 75% target.
The adherence rate of 85.2% (87% among survivors) also exceeded expectations (75% target).
The study had an overall acceptability score of 4.5.
Scores ranged from 4.3 to 4.7 for specific questions, including: “I found the pickleball program fun” (4.6); “The pickleball program was worth my time” (4.3); “The intensity of pickleball sessions was appropriate for my ability and needs” (4.6); and “I was able to make progress (in pickleball and/or fitness) over the course of the program” (4.5).
Survivors had a mean increase of weekly moderate-to-strenuous physical activity of 82.2 minutes (standard deviation, 152.2 minutes; P = .045) and strenuous physical activity of 49.7 minutes (standard deviation, 76 minutes; P = .03).
Survivors also reported an increase in perceived social support for physical activity from companions (P = .02).
Survivors significantly improved their performance in physical functioning tests including 30-second chair stands (P = .006) and 30-second arm curls (P = .003), as well.
Parker and colleagues did not observe significant differences for perceived stress, physical activity enjoyment, exercise motivation, health-related quality of life, multidimensional social support or self-reported physical functioning among participants.
However, researchers acknowledged the pilot sample was, on average, already fairly active before enrolling in Project Rally. They noted the small sample size and lack of diversity as additional limitations.
Parker described the pilot study as “a huge success,” and he and his colleagues are eager to capitalize on the feasibility and acceptability of Project Rally to further understand its benefits.
‘Keep it going!’
Participants gave feedback for four categories: aspects that supported participation, perceived benefits, barriers or challenges to participation, and suggestions for improvement.
Investigators reported the following responses:
- “[I liked] playing and socializing with such nice and fun co-participants. We enjoyed each other’s company, supported each other, had fun, and laughed often,” a 69-year-old female survivor said about group cohesion.
- “I learned a new sport that I want to keep playing consistently,” a 59-year-old female survivor said about learning the game and improving.
- “I loved interacting with other participants. Talking, sharing, laughing. The feeling of not being alone going through cancer,” a 56-year-old female survivor said about social support.
- “After a session, I realize that I feel better and have more energy. Attending consistently improved my spirit and gave me something to look forward to. Overall, I feel much better in every facet of life than before I started the program. I loved it!” a 69-year-old female survivor said about improved well-being.
- “I work full time, so at times it was hard to get to the sessions,” a 59-year-old female survivor said about the schedule.
- “Try to make more times available for those who have day jobs,” a 61-year-old male friend or family member said about improving the program.
- “Keep it going!” a 63-year-old female survivor suggested.
‘It’s a blast’
Parker and colleagues aim to conduct a larger investigation into the impact of Project Rally.
“We’ll be able to compare participating in the program to a control condition to see how it’s actually benefiting folks in terms of their fitness and their wellness, both emotionally and physically,” he said.
Researchers could measure intensity, duration and frequency of physical activity for participants compared with those in a control condition.
They also could evaluate cardiorespiratory fitness, muscle strength and function, self-reported physical functioning, and quality of life.
They could examine how participants maintain potential increases in physical activity over time, too.
“We could easily ask participants, ‘Are you still playing?’ and ‘Where are you playing?’ and understand the lasting impact of learning pickleball for 6 months on behavior,” Parker said.
Project Rally could be a lasting program both in Moffitt’s area and potentially around the country, he added. In the YMCA, Parker highlights that he and his Moffitt colleagues have identified a research partner that is highly motivated to and capable of delivering effective programs that benefit their communities, including cancer survivors.
“[Pickleball] really lends itself to this sustained behavior change and Project Rally has a lot of potential to be one of these sustained programs that continues to impact folks and make a difference for them in cancer survivorship,” Parker said. “It’s a blast.”
For more information:
Nathan H. Parker, MPH, PhD, can be reached at nathan.parker@moffitt.org.
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