Comparative effects of racket sports on physical and cognitive function in older adults: a systematic review and network meta-analysis

Abstract Background Table tennis, badminton and tennis are accessible to older adults but are often treated as one category. We compared their effects across five functional domains in adults aged ≥ 60 years and assessed whether the evidence could distinguish among them. Methods Six databases were searched from inception to December 2025 and updated in August 2026. Randomized and quasi-experimental trials were eligible. Muscular strength, balance and cognitive function were analyzed using random-effects network meta-analysis; aerobic capacity and flexibility, which lacked independent indirect evidence, were analyzed pairwise. Randomized trials formed the primary analysis whereas quasi-experimental studies formed the secondary analysis. Evidence certainty was assessed using GRADE, with each comparison labeled direct, indirect or combined. Results Thirteen trials (14 reports) were included; 10 randomized trials (469 participants) formed the primary analysis. Table tennis was the only sport for which comparisons were informed by more than one trial: estimates favored table tennis over non-exercise control in four of five domains (SMD 0.82–1.42; combined evidence, direct for aerobic capacity) and over active exercise comparators for muscular strength (SMD 0.89, 95% CI 0.28–1.50) and cognitive function (1.16, 0.69–1.64), based on combined evidence. Its network estimates versus non-exercise control for strength, balance and cognition were of low certainty and relatively stable across the estimable sensitivity analyses; most other estimates were of very low certainty. Badminton evidence was sparse, and tennis evidence came from a single trial of 16 men with no non-exercise arm, so every tennis estimate against control was indirect and could not support firm conclusions. No trial directly compared racket sports. The only between-sport estimate excluding the null, table tennis versus badminton for cognitive function (SMD 0.83, 95% CI 0.24–1.43), was indirect, of very low certainty, and not robust across all sensitivity analyses. Conclusions Racket-sport interventions were associated with favorable effects on several functional outcomes in older adults, but evidence was concentrated in table tennis. Current evidence is insufficient to determine whether one racket sport is superior to another; this reflects sparse and imbalanced evidence rather than demonstrated equivalence. Adequately powered head-to-head randomized trials are needed. PROSPERO registration number CRD420251148095 Clinical trial number Not applicable