Effects of table tennis on vision in children and adolescents: a multilevel dose-response meta-analysis

To evaluate the effects of table tennis exercise on uncorrected visual acuity-related outcomes in children and adolescents and to assess the dose-effect relationship within a dose-response framework.

In accordance with PRISMA guidelines and PROSPERO registration, we searched PubMed, Web of Science, PsycINFO, Cochrane Library, and CNKI for studies published through February 11, 2026. Eligible studies were randomized controlled trials (RCTs) in Chinese or English involving children or adolescents, comparing table tennis exercise with care, no intervention, or non-table tennis controls, and reporting visual outcomes assessed with visual acuity tools. We excluded non-original, non-experimental, preclinical, and review studies; meta-analyses; conference abstracts; gray literature; duplicate publications; unavailable full texts; and consultation interventions. A three-level random-effects model (REML) was used to pool effect sizes (Hedges' g), and analyses of heterogeneity, publication bias, sensitivity, subgroup effects, and dose-response relationships were conducted using cubic splines.

This study included nine RCTs, comprising 32 effect sizes from 531 participants. After outlier removal, 31 effect sizes were retained for analysis. Five studies had a risk of bias. After removing one outlier, table tennis improved vision (SMD = 0.91, 95% CI: 0.42-1.41, p < 0.001), despite heterogeneity (I² = 85.5%). No evidence of publication bias was detected. Subgroup analyses indicated effects for twice-weekly training (SMD = 1.91) and for adolescents (SMD = 1.46). Dose-response analysis showed a pattern, with results observed at approximately 2 sessions per week, 40 min per session, over approximately 15 weeks. The model estimated an optimal total dose of 19.8-22.8 h, corresponding to an SMD of approximately 0.86. This finding should be regarded as exploratory evidence and interpreted with caution.

Table tennis exercise may improve uncorrected visual acuity-related outcomes in children and adolescents, but the certainty of the evidence remains low because of high heterogeneity and risk-of-bias concerns. Dose-response evidence suggests that low-to-moderate doses may be most effective, offering valuable guidance for school-based programs. Due to limited reporting of exercise intensity and adherence in the included studies, the "21.3-h" optimal dose proposed here is an exploratory clinical reference, not an absolute standard.

The unique identifier is CRD420261334889, which corresponds to the International Prospective Register of Systematic Reviews (PROSPERO). The publicly accessible URL is: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD420261334889.