The role of pickleball doubles training in promoting post-traumatic growth and social support network in lung cancer survivors in a sports town environment
Abstract
Lung cancer is the malignant tumor with the highest morbidity and mortality worldwide, and survivors frequently experience chronic physical symptoms and psychological trauma that persist long after treatment. These challenges substantially impair quality of life and complicate long-term rehabilitation. Among them, 33%–45% of survivors develop clinical-grade anxiety or depression, the incidence of fear of recurrence reaches 62%, and approximately 46% withdraw from their original social networks due to changes in body image and decreased activity tolerance. Addressing both psychological adaptation and social reintegration therefore represents a critical unmet need in lung cancer survivorship care. This study aimed to synthesize and map existing evidence on the role of pickleball doubles training, situated within a sports town environment, in promoting post-traumatic growth (PTG) and strengthening social support networks among lung cancer survivors. A scoping review combined with bibliometric analysis was conducted using literature published between 2010 and 2024 and indexed in the Web of Science Core Collection. The review identified multidisciplinary research spanning oncology, exercise science, psychology, and community health, with increasing scholarly attention in recent years. The synthesized findings suggest that the integration of a health-oriented sports town environment with a low-intensity, highly interactive exercise modality may exert synergistic benefits by supporting psychological growth, fostering interpersonal connection, and facilitating social participation. Although direct empirical evidence specific to pickleball remains limited, the conceptual framework emerging from this review highlights its potential value as a rehabilitation-oriented, socially engaging physical activity. These findings provide a theoretical foundation for future intervention studies and support the development of community-based, psychosocial rehabilitation strategies for lung cancer survivors.
Copyright (c) 2026 Hui Sun, Fengliang Yu, Haixiang Bi, Na Hu
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
1. Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA: A Cancer Journal for Clinicians. 2021; 71(3): 209–249. doi: 10.3322/caac.21660
2. Fox KR, Posluszny DM, DiMartini AF, et al. Predictors of post‐traumatic psychological growth in the late years after lung transplantation. Clinicians Transplant. 2014; 28(4): 384–393. doi: 10.1111/ctr.12301
3. Lafuenti L, Dinapoli L, Mastrilli L, et al. Post-traumatic growth in oncological patients during the COVID-19 pandemic. Health Psychology Report. 2023; 12(2): 142. doi: 10.5114/hpr/169165
4. Tian X, Jin Y, Chen H, T et al. Relationships among social support, coping style, perceived stress, and psychological distress in chinese lung cancer patients. Asia-Pacific Journal of Oncology Nursing .2021; 8(2): 172–179. doi: 10.4103/apjon.apjon_59_20
5. Liu N, Zhang L, Liu Y, et al. Relationship between self-psychological adjustment and post-traumatic growth in patients with lung cancer undergoing chemotherapy: A cross-sectional study. BMJ Open. 2024; 14(5): e081940. doi: 10.1136/bmjopen-2023-081940
6. Liu N, Zhang H, Lixia G, et al. Impact of positive cognitive emotion regulation and sense of coherence in the relationship between family hardiness and post-traumatic growth in patients with lung cancer: A mediation analysis study in two tertiary hospitals of China. BMJ Open. 2025; 15(7): e099195. doi: 10.1136/bmjopen-2025-099195
7. Rothpletz-Puglia P, Smith J, Pavuk C, et al. A theoretical explanation for how a nutrition counseling and medically tailored meal delivery program benefitted participants living with lung cancer. Supportive Care in Cancer. 2024; 32(7): 428. doi: 10.1007/s00520-024-08616-x
8. Hofman A, Zajdel N, Klekowski J, Chabowski M. Improving social support to increase qol in lung cancer patients. Cancer Management and Research. 2021; 13: 2319–2327. doi: 10.2147/CMAR.S278087
9. Chambers A, Damone E, Chen YT, et al. Social support and outcomes in older adults with lung cancer. Journal of Geriatric Oncology. 2022; 13(2): 214–219. doi: 10.1016/j.jgo.2021.09.009
10. Luszczynska A, Pawlowska I, Cieslak R, et al. Social support and quality of life among lung cancer patients: a systematic review. Psychooncology. 2013; 22(10): 2160–2168. doi: 10.1002/pon.3218
11. Walker MS, Zona DM, Fisher EB. Depressive symptoms after lung cancer surgery: Their relation to coping style and social support. Psychooncology. 2006; 15(8): 684–693. doi: 10.1002/pon.997
12. Zhang J, Gan Z. Construction and Application of sports towns characterized by sports event chains. IOP Conference Series: Earth and Environmental Science. 2019; 267(3): 032021. doi: 10.1088/1755-1315/267/3/032021
13. Dubinsky Y. Branding a city as a sports town: A Conceptual model based on ‘Track Town USA.’ Journal of Global Sport Management. 2024; 9(1): 1–17. doi: 10.1080/24704067.2021.2001354
14. Liu S, Qi W. Sports poverty alleviation: concept and model innovation for the development of Chinese sports towns in the new Era. Front Sports Act Living. 2024; 6: 1423767. doi:10.3389/fspor.2024.1423767
15. Deng K. Sports town development strategy driven by the sports industry and multi-industry integration. Mathematical Problems in Engineering. 2022; 2022: 1–17. doi: 10.1155/2022/2484838
16. Casper JM, Kim ACH, Bocarro JN. Perceived constraints to pickleball participation among black older adults. Journal of Aging and Physical Activity. 2024; 32(1): 107–113. doi: 10.1123/japa.2023-0009
17. Boudreaux BD, Schmidt MD. Physical activity characteristics of recreational doubles pickleball. Medicine & Science in Sports & Exercise. 2019; 51(6S): 929–929. doi: 10.1249/01.mss.0000563283.89045.f3
18. Lauxtermann L, Stubbs B. Padel, pickleball and wellbeing: A systematic review. Frontiers in Psychology. 2025; 16: 1614448. doi:10.3389/fpsyg.2025.1614448
19. Wang S, Chen CC, Chu YH, et al. Predicting the sustainability of pickleball competitions as a new sport from the behavioral intention of pickleball players. Sustainability. 2023; 15(7): 6137. doi: 10.3390/su15076137
20. Heo J, Ryu J. Maintaining active lifestyle through pickleball: A qualitative exploration of older pickleball players. The International Journal of Aging and Human Development. 2024; 98(4): 469–483. doi:10.1177/00914150231208012
21. Moore D, Orsega-Smith E, Goodwin S. Motivational differences among older adult pickleball players. Activities, Adaptation & Aging. 2025:1–24. doi: 10.1080/01924788.2025.2486772
22. Schmitz KH, Courneya KS, Matthews C, et al. American college of sports medicine roundtable on exercise guidelines for cancer survivors. Medicine and Science in Sports and Exercise. 2010; 42(7): 1409–1426. doi: 10.1249/MSS.0b013e3181e0c112
23. Mishra SI, Scherer RW, Snyder C, et al. Exercise interventions on health-related quality of life for people with cancer during active treatment. Cochrane Database of Systematic Reviews. 2012(8). doi: 10.1002/14651858.CD008465.pub2
24. Patel AV., Friedenreich CM, Moore SC, et al. American college of sports medicine roundtable report on physical activity, sedentary behavior, and cancer prevention and control. Medicine and Science in Sports and Exercise. 2019; 51(11): 2391–2402. doi: 10.1249/MSS.0000000000002117
25. Stanton AL, Revenson TA, Tennen H. Health Psychology: Psychological adjustment to chronic disease. Annu Rev Psychol. 2007; 58(1): 565–592. doi: 10.1146/annurev.psych.58.110405.085615
26. Knols R, Aaronson NK, Uebelhart D, et al. Physical exercise in cancer patients during and after medical treatment: A systematic review of randomized and controlled clinical trials. Journal of Clinical Oncology. 2005; 23(16): 3830–3842. doi: 10.1200/JCO.2005.02.148
27. Morey MC, Snyder DC, Sloane R, et al. Effects of home-based diet and exercise on functional outcomes among older, overweight long-term cancer survivors. JAMA. 2009; 301(18): 1883. doi: 10.1001/jama.2009.643
28. Mishra SI, Scherer RW, Snyder C, et al. Are exercise programs effective for improving health-related quality of life among cancer survivors? A systematic review and meta-analysis. Oncology Nursing Forum. 2014; 41(6): E326–E342. doi: 10.1188/14.ONF.E326-E342
29. Hayes SC, Newton RU, Spence RR, Galvão DA. The exercise and sports science australia position statement: Exercise medicine in cancer management. Pensar en Movimiento: Revista de Ciencias del Ejercicio y la Salud. 2023; 21(2): 1659–4436. doi: 10.15517/pensarmov.v21i2.57059
30. Avancini A, Sartori G, Gkountakos A, et al. Physical activity and exercise in lung cancer care: Will promises be fulfilled? Oncologist. 2020; 25(3): e555–e569. doi: 10.1634/theoncologist.2019-0463
31. Hayes SC, Spence RR, Galvão DA, Newton RU. Australian association for exercise and sport science position stand: Optimising cancer outcomes through exercise. Journal of Science and Medicine in Sport. 2009; 12(4): 428–434. doi: 10.1016/j.jsams.2009.03.002
32. Denning WM, Zagrodnik J, Smith M, Ruden T. Physical activity differences between walking and playing pickleball doubles. Science Sports. 2022; 37(5–6): 513.e1–513.e4. doi: 10.1016/j.scispo.2021.06.009
33. Smith M, Denning M, Zagrodnik J, Ruden T. A comparison of pickleball and walking. Medicine & Science in Sports & Exercise. 2016; 48: 93–94. doi: 10.1249/01.mss.0000485287.22769.50
34. Webber SC, Anderson S, Biccum L, et al. Physical activity intensity of singles and doubles pickleball in older adults. Journal of Aging and Physical Activity. 2023; 31(3): 365–370. doi: 10.1123/japa.2022-0194
35. Casper JM, Jeon JH. Psychological connection to pickleball: Assessing motives and participation in older adults. Journal of Aging and Physical Activity. 2019; 27(1): 28–33. doi: 10.1123/japa.2017-0381
36. Chen Q, Chou CY, Chen CC, et al. The effect of leisure involvement and leisure satisfaction on the well-being of pickleball players. Sustainability. 2021; 14(1): 152. doi: 10.3390/su14010152
37. Vitale K, Liu S. Pickleball: Review and clinical recommendations for this fast-growing sport. Current Sports Medicine Reports. 2020; 19(10): 406–413. doi: 10.1249/JSR.0000000000000759
38. Cerezuela JL, Lirola MJ, Cangas AJ. Pickleball and mental health in adults: A systematic review. Frontiers in Psychology .2023; 14: 1137047. doi:10.3389/fpsyg.2023.1137047
39. Wray P, Ward CK, Nelson C, et al. Pickleball for inactive mid-life and older adults in rural utah: A feasibility study. International Journal of Environmental Research and Public Health. 2021; 18(16): 8374. doi: 10.3390/ijerph18168374
40. Peng X, Su Y, Huang W, Hu X. Status and factors related to posttraumatic growth in patients with lung cancer. Medicine. 2019; 98(7): e14314. doi: 10.1097/MD.0000000000014314
41. Couderc AL, Bouhnik AD, Rey D, et al. Quality of life in older French long-term lung cancer survivors: VICAN5 national survey. Lung Cancer. 2023; 180: 107197. doi: 10.1016/j.lungcan.2023.107197
42. Zhang Y, Ding Y, Liu C, et al. Relationships among perceived social support, family resilience, and caregiver burden in lung cancer families: A mediating model. Seminars in Oncology Nursing. WB Saunders. 2023; 39(3): 151356. doi: 10.1016/j.soncn.2022.151356
43. Zhao M, Jiang Y, Xu G, Lin X. The mediating effect of hope level between social support and benefit finding in patients with advanced lung cancer. Cancer Nursing. 2025; 48(3): 213–220. doi: 10.1097/NCC.0000000000001295
44. Arksey H, O’Malley L. Scoping studies: Towards a methodological framework. International Journal of Social Research Methodology. 2005; 8(1): 19–32. doi: 10.1080/1364557032000119616
45. Cheville AL, Kollasch J, Vandenberg J, et al. A home-based exercise program to improve function, fatigue, and sleep quality in patients with stage iv lung and colorectal cancer: A randomized controlled trial. Journal of Pain and Symptom Management. 2013; 45(5): 811–821. doi: 10.1016/j.jpainsymman.2012.05.006
46. Jones LW, Hornsby WE, Goetzinger A, et al. Prognostic significance of functional capacity and exercise behavior in patients with metastatic non-small cell lung cancer. Lung Cancer. 2012; 76(2): 248–252. doi: 10.1016/j.lungcan.2011.10.009
47. Cavalheri V, Granger C. Preoperative exercise training for patients with non-small cell lung cancer. Cochrane Database of Systematic Reviews. 2017; 2017(6). doi: 10.1002/14651858.CD012020.pub2
48. Granger CL, McDonald CF, Berney S, et al. Exercise intervention to improve exercise capacity and health related quality of life for patients with Non-small cell lung cancer: A systematic review. Lung Cancer. 2011; 72(2): 139–153. doi: 10.1016/j.lungcan.2011.01.006
49. Arbane G, Tropman D, Jackson D, Garrod R. Evaluation of an early exercise intervention after thoracotomy for non-small cell lung cancer (NSCLC), effects on quality of life, muscle strength and exercise tolerance: Randomised controlled trial. Lung Cancer. 2011; 71(2): 229–234. doi: 10.1016/j.lungcan.2010.04.025
50. Sebio Garcia R, Yáñez Brage MI, Giménez Moolhuyzen E, et al. Functional and postoperative outcomes after preoperative exercise training in patients with lung cancer: A systematic review and meta-analysis. Interactive Cardiovascular and Thoracic Surgery. 2016; 23(3): 486–497. doi: 10.1093/icvts/ivw152
51. Chen HM, Tsai CM, Wu YC, et al.Randomised controlled trial on the effectiveness of home-based walking exercise on anxiety, depression and cancer-related symptoms in patients with lung cancer. British Journal of Cancer. 2015; 112(3): 438–445. doi: 10.1038/bjc.2014.612
52. Peddle-McIntyre CJ, Singh F, Thomas R, et al. Exercise training for advanced lung cancer. Cochrane Database of Systematic Reviews. 2019. doi:10.1002/14651858.CD012685.pub2
53. Hwang CL, Yu CJ, Shih JY, et al. Effects of exercise training on exercise capacity in patients with non-small cell lung cancer receiving targeted therapy. Supportive Care in Cancer. 2012; 20(12): 3169–3177. doi: 10.1007/s00520-012-1452-5
54. Stefanelli F, Meoli I, Cobuccio R, et al. High-intensity training and cardiopulmonary exercise testing in patients with chronic obstructive pulmonary disease and non-small-cell lung cancer undergoing lobectomy. European Journal of Cardio-Thoracic Surgery. 2013; 44(4): e260–e265. doi: 10.1093/ejcts/ezt375
55. Steffens D, Beckenkamp PR, Hancock M, et al. Preoperative exercise halves the postoperative complication rate in patients with lung cancer: A systematic review of the effect of exercise on complications, length of stay and quality of life in patients with cancer. British Journal of Sports Medicine. 2018; 52(5): 344–344. doi: 10.1136/bjsports-2017-098032
56. Quist M, Rørth M, Langer S, et al. Safety and feasibility of a combined exercise intervention for inoperable lung cancer patients undergoing chemotherapy: A pilot study. Lung Cancer. 2012; 75(2): 203–208. doi: 10.1016/j.lungcan.2011.07.006
57. Cavalheri V, Burtin C, Formico VR, et al. Exercise training undertaken by people within 12 months of lung resection for non-small cell lung cancer. Cochrane Database of Systematic Reviews. 2019; 2019(6). doi: 10.1002/14651858.CD009955.pub3
58. Bade BC, Thomas DD, Scott JB, Silvestri GA. Increasing physical activity and exercise in lung cancer: reviewing safety, benefits, and application. Journal of Thoracic Oncology. 2015; 10(6): 861–871. doi: 10.1097/JTO.0000000000000536
59. Rosero ID, Ramírez-Vélez R, Lucia A, et al. Systematic review and meta-analysis of randomized, controlled trials on preoperative physical exercise interventions in patients with non-small-cell lung cancer. Cancers (Basel). 2019; 11(7): 944. doi: 10.3390/cancers11070944
60. Crandall K, Maguire R, Campbell A, Kearney N. Exercise intervention for patients surgically treated for Non-Small Cell Lung Cancer (NSCLC): A systematic review. Surgical Oncology. 2014; 23(1): 17–30. doi: 10.1016/j.suronc.2014.01.001
61. Granger CL, Connolly B, Denehy L, et al. Understanding factors influencing physical activity and exercise in lung cancer: A systematic review. Supportive Care in Cancer. 2017; 25(3): 983–999. doi: 10.1007/s00520-016-3484-8
62. Brocki BC, Andreasen JJ, Langer D, et al. Postoperative inspiratory muscle training in addition to breathing exercises and early mobilization improves oxygenation in high-risk patients after lung cancer surgery: A randomized controlled trial. European Journal of Cardio-Thoracic Surgery. 2016; 49(5): 1483–1491. doi: 10.1093/ejcts/ezv359
63. Messaggi-Sartor M, Marco E, Martínez-Téllez E, et al. Combined aerobic exercise and high-intensity respiratory muscle training in patients surgically treated for non-small cell lung cancer: A pilot randomized clinical trial. European Journal of Physical and Rehabilitation Medicine. 2019; 55(1): 113–122. doi: 10.23736/S1973-9087.18.05156-0
64. Quist M, Adamsen L, Rørth M, et al. The impact of a multidimensional exercise intervention on physical and functional capacity, anxiety, and depression in patients with advanced-stage lung cancer undergoing chemotherapy. Integrative Cancer Therapies. 2015; 14(4): 341–349. doi: 10.1177/1534735415572887
65. Ni HJ, Pudasaini B, Yuan XT, et al. Exercise training for patients pre- and postsurgically treated for non–small cell lung cancer: A systematic review and meta-analysis. Integrative Cancer Therapies. 2017; 16(1): 63–73. doi: 10.1177/1534735416645180
66. Ha D, Mazzone PJ, Ries AL, et al. The utility of exercise testing in patients with lung cancer. Journal of Thoracic Oncology. 2016; 11(9): 1397–1410. doi: 10.1016/j.jtho.2016.04.021
67. Brocki BC, Andreasen J, Nielsen LR, et al. Short and long-term effects of supervised versus unsupervised exercise training on health-related quality of life and functional outcomes following lung cancer surgery – A randomized controlled trial. Lung Cancer. 2014; 83(1): 102–108. doi: 10.1016/j.lungcan.2013.10.015
68. Quist M, Langer SW, Lillelund C, et al. Effects of an exercise intervention for patients with advanced inoperable lung cancer undergoing chemotherapy: A randomized clinical trial. Lung Cancer. 2020; 145: 76–82. doi: 10.1016/j.lungcan.2020.05.003
69. Jones LW, Eves ND, Kraus WE, et al. The lung cancer exercise training study: a randomized trial of aerobic training, resistance training, or both in postsurgical lung cancer patients: rationale and design. BMC Cancer. 2010; 10(1): 155. doi: 10.1186/1471-2407-10-155
70. Granger C, Cavalheri V. Preoperative exercise training for people with non-small cell lung cancer. Cochrane Database of Systematic Reviews. 2022; 2022(9). doi: 10.1002/14651858.CD012020.pub3
71. Cheung DST, Takemura N, Lam TC, et al. Feasibility of aerobic exercise and tai-chi interventions in advanced lung cancer patients: A randomized controlled trial. Integrative Cancer Therapies. 2021; 20: 15347354211033352. doi: 10.1177/15347354211033352
72. Takemura N, Cheung DST, Fong DYT, et al. Effectiveness of aerobic exercise and Tai Chi interventions on sleep quality in patients with advanced lung cancer. JAMA Oncology. 2024; 10(2): 176. doi: 10.1001/jamaoncol.2023.5248
73. Heo J, Ryu J, Yang H, et al. Importance of playing pickleball for older adults’ subjective well-being: A serious leisure perspective. The Journal of Positive Psychology. 2018; 13(1): 67–77. doi: 10.1080/17439760.2017.1374438
74. Ester M, Culos-Reed SN, Abdul-Razzak A, et al. Feasibility of a multimodal exercise, nutrition, and palliative care intervention in advanced lung cancer. BMC Cancer. 2021; 21(1): 159. doi: 10.1186/s12885-021-07872-y
75. Scott JM, Thomas SM, Herndon JE, et al. Effects and tolerability of exercise therapy modality on cardiorespiratory fitness in lung cancer: a randomized controlled trial. Journal of Cachexia, Sarcopenia and Muscle. 2021; 12(6): 1456–1465. doi: 10.1002/jcsm.12828
76. Codima A, das Neves Silva W, de Souza Borges AP, de Castro G. Exercise prescription for symptoms and quality of life improvements in lung cancer patients: a systematic review. Supportive Care in Cancer. 2021; 29(1): 445–457. doi: 10.1007/s00520-020-05499-6
77. Yang M, Liu L, Gan Ce, et al. Effects of home-based exercise on exercise capacity, symptoms, and quality of life in patients with lung cancer: A meta-analysis. European Journal of Oncology Nursing. 2020; 49: 101836. doi: 10.1016/j.ejon.2020.101836
78. Voorn MJJ, Franssen RFW, Hoogeboom TJ, et al. Evidence base for exercise prehabilitation suggests favourable outcomes for patients undergoing surgery for non-small cell lung cancer despite being of low therapeutic quality: A systematic review and meta-analysis. European Journal of Surgical Oncology. 2023; 49(5): 879–894. doi: 10.1016/j.ejso.2023.01.024
