Pickleball: How to play safe, get fit, and have more fun

The Harvard Medical School Special Report on Pickleball outlines the sport's rise in popularity, health benefits, and best practices for playing safely. Pickleball, a hybrid of tennis, ping-pong, and badminton, has surged in popularity and is one of the fastest-growing sports in the United States, particularly since 2020. It appeals to players of all ages due to its accessibility, social nature, and low-impact gameplay. Pickleball started as a family activity but quickly turned into a global competitive phenomenon with increasing media coverage and professional leagues.

Pickleball has many physical and mental health benefits including the ability to improve cardiovascular health, agility, strength, and bone density while reducing stress and promoting social connections. Compared to other racquet sports, pickleball offers a moderate workout suitable for older adults and those seeking joint-friendly activities. Its social aspects help combat loneliness and provide a sense of purpose, making it particularly beneficial for retirees.

To ensure safety and longevity in playing pickleball, this report provides recommendations for warm-ups, protective gear, proper equipment, and injury prevention. It warns of common injuries like ankle sprains and muscle strains and offers tips on recovery. Additionally, it includes training exercises to build strength and flexibility, helping players enhance their game and reduce injury risks. Ultimately, the report positions pickleball as a fun, inclusive sport that supports physical fitness and community bonding.

Prepared by the editors of the Harvard Health Publishing in consultation with Michael Philip O'Leary, M.D., Senior Surgeon at Brigham and Women's Hospital, Professor of Surgery at Harvard Medical School, and Founding Director, Men’s Health Center, Brigham and Women’s Hospital. 45 pages. (2024)

Pickleball vs. tennis: A fitness comparison

Pickleball is often described as a less intense version of tennis, but both sports offer a workout that’s challenging enough to condition your heart, build muscle and bone strength, and bolster your balance and coordination skills. While tennis is typically more intense, that’s not always the case, and pickleball players often spend longer on the court.

In a head-to-head comparison, the Apple Heart and Movement Study (AHMS) tracked pickleball and tennis workouts for about two and a half years. AHMS is a collaboration with Harvard’s Brigham and Women’s Hospital, the American Heart Association, and Apple that tracks and analyzes the physical activity and heart health of more than 200,000 Apple watch wearers. Because the study requires participants to already have an Apple watch, they are not representative of the general population. For instance, there are fewer women, people of color, and people over the age of 65 in the study. While not universal, the findings offer some unique comparisons between the sports.

During the study, 250,000 individual workouts were analyzed:

• 94,596 pickleball workouts by 4,794 players
• 162,089 tennis workouts by 7,770 players

Only people who played at least one game each month during the 32-month study were included. While more people played tennis overall, the number of people playing pickleball steadily increased each month. During the last two months of the study, the number of people playing pickleball each month surpassed the number playing tennis.

Despite individual tennis matches lasting significantly longer than a game of pickleball—about an hour compared to 15 minutes, respectively—pickleball players tended to be on the court about 10% longer each time they played. The lower intensity of pickleball may enable participants to play for longer durations.

The researchers found the average peak heart rate during a tennis workout to be nine beats faster on average—152 beats per minute (bpm) compared to 143 bpm for pickleball. Tennis players also spent slightly more time playing at a vigorous intensity.

In addition, participants in the study had the option of completing a depression screening questionnaire. When pickleball and tennis players were compared to other Apple watch exercisers who completed the same questionnaire, pickleball players appeared to have the lowest risk of feeling depressed. On average, their scores were 60% below the threshold suggestive of a depressed mood, while tennis players were 51% below that cutoff, and general exercisers 47% below it.

Bottom line: both sports offer a variety of physical and mental health benefits, so feel free to choose either—or both!

• Pickleball: The hot “new” sport
  • What is pickleball?
  • How did pickleball get its start?
• Benefits of pickleball
  • Physical health benefits
  • Mind and mood benefits
• Stay safe while you play
  • How to reduce your risk of injury
  • Types of pickleball injuries
• Must-have gear
  • Paddles
  • Balls
  • Court shoes 
  • Protective eyewear
  • Optional equipment
• How to play pickleball
  • Must-know lingo
  • The pickleball court
  • Gameplay and rules
  • Etiquette
• Your pickleball training program
• Get Ready Workouts
  • Basic Strength Workout
  • Daily Stretch
• Game Day Workouts 
  • Pre-Game Warmup
  • Post-Game Stretch
• Power Play Workouts
  • Upper-Body Workout
  • Core Workout
  • Lower-Body Workout
• Resources

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