Effects of table tennis multi-ball training

on dynamic posture control

Yaodong Gu1 , Changxiao Yu1 , Shirui Shao1 and Julien S. Baker2
1
Faculty of Sports Science, Ningbo University, Ningbo, China
2
School of Science and Sport, University of the West of Scotland, Hamilton, United Kingdom

ABSTRACT
Background. Prior to the 2017 table tennis season, each participant performed the
anterior, posteromedial, and posterolateral the star excursion balance test (SEBT) reach
distances in a randomized order. The aim of this study was to assess the effects of table
tennis multi-ball training and dynamic balance on performance measures of the SEBT
for the male and female.
Methods. The limb lengths of the 12 table tennis athletes were measured bilaterally
in the study. Besides warm-up end, the data of this study were recorded at a regular
interval at approximately 16 min for the entire multi-ball training session, and they
were defined as Phase I, Phase II, Phase II, respectively. The Borg rating of perceived
exertion (RPE) scale was used to document the degree of physical strain.
Results. Reaching distances showed a decrease with training progression in all direc-
tions. Compared with the male table tennis athletes, the females showed poorer dynamic
posture control, particularly when the free limb was considered with the right-leg stance
toward posterolateral and posteromedial directions in phase I.
Discussion. This study suggests that during table tennis multi-ball training the male
should have a regulatory protocol to compensate the deficit observed in phase II, but
the females should be given the protocol in phase I.

Subjects Bioengineering, Kinesiology

Keywords Center of pressure, Star excursion balance test, Reach distance, Borg rating of
Submitted 24 October 2018 perceived exertion, Musculoskeletal
Accepted 11 December 2018
Published 16 January 2019
Corresponding author INTRODUCTION
Yaodong Gu,
guyaodong@hotmail.com Table tennis is one of the most popular sports in the world. According to a report by the
Academic editor International Sports Federation, the population of table tennis participants has reached
Justin Keogh over 300 million worldwide (Zhang, 2017). Playing table tennis is regarded as a pro-health
Additional Information and sporting pastime, which is generally accepted by more and more people who engage
Declarations can be found on
in physical activity (Biernat, Buchholtz & Krzepota, 2018). As a rational movement, the
page 14
characteristics of table tennis play, which involve complex spatial movements of the body
DOI 10.7717/peerj.6262
that include, acceleration, deceleration, direction change, moving quickly and balance all
Copyright help players generate optimum stroke production (Girard & Millet, 2009). Table tennis
2019 Gu et al.
coaches have observed the importance of conditioning and have been proactive in helping
Distributed under table tennis players achieve a better competitive condition. To be successful in the sport,
Creative Commons CC-BY 4.0
table tennis players are usually asked to perform high intensity training in the preseason
OPEN ACCESS as part of their physiological preparation. In addition, technical practice is essential for

How to cite this article Gu Y, Yu C, Shao S, Baker JS. 2019. Effects of table tennis multi-ball training on dynamic posture control. PeerJ
6:e6262 http://doi.org/10.7717/peerj.6262
 table tennis players in training sessions, especially during the preseason phase. In order to
develop the so-called dynamic stereotype, the table tennis player should try to improve the
skills involved when stroking the ball that is in a fixed position or with tactical variations. As
a common training method for technical practice, multi-ball training requires the players
to repeatedly stroke and return the balls with a combination of feasible footwork (Zhang,
2017), which is generally applied in training sections.
To our knowledge, dynamic balance and fatigue are related (Gioftsidou et al., 2011),
and the greater body control for individuals would possess a lower risk of injuries during
dynamic movements (Kollock et al., 2018; Knapik et al., 2015). The star excursion balance
test (SEBT) is a reliable, valid and easy method to measure lower-limb function in
sports and clinical practice (Munro & Herrington, 2010; Hertel, Miller & Denegar, 2000;
Kinzey & Armstrong, 1998; Gribble & Hertel, 2003; Bouillon & Baker, 2011). The intra class
correlation coefficient values of the SEBT have ranged from 0.67 to 0.96, with high intra
rater reliability values of 0.81 to 0.93 (Hertel, Miller & Denegar, 2000; Kinzey & Armstrong,
1998). Therefore, the SEBT has wide practical application in assessing the ability to maintain
balance in a single-leg stance in exercise testing, rehabilitation and training (Winter, Patla
& Frank, 1990; Robinson & Gribble, 2008). For example, the test has not only been used
previously to predict lower limb injury in high school soccer (Bressel et al., 2007; Filipa
et al., 2010; Rasool & George, 2007) and basketball (Bressel et al., 2007; Plisky et al., 2006),
but also used for convalescent patients with chronic ankle instability (Olmsted et al., 2002;
Gribble et al., 2004; Hertel et al., 2006; Hubbard et al., 2007; Isles et al., 2004) and anterior
cruciate ligament injuries (Herrington et al., 2009). In addition, it has been applied to
evaluate the effects of patellar taping on lower-limb kinematics and dynamic postural
control (Aminaka & Gribble, 2008). As a closed-kinetic chain exercise, the SEBT mimics
the single-leg squat exercise while attempting maximal reach with the opposite leg, which
requires better neuromuscular control, flexibility, balance and strength for the stance leg
(Olmsted et al., 2002). Indeed, the SEBT was not only used as a method of assessment, but
also as an approach used to improve the performance of movement skills in an athletic
population (Munro & Herrington, 2010; Filipa et al., 2010). In addition, a previous study
showed that males have larger reach distance when compared with females (Gribble, Hertel
& Piegaro, 2003). However, there was no significant gender differences observed when
the reach distances were normalized (Gribble et al., 2009). In addition, Day and colleagues
(2004) corroborated that the rating of perceived exertion (RPE) is a reliable method to
quantify exercise intensities during high-intensity, moderate-intensity and low-intensity
resistance training. Faulkner, Parfitt & Eston (2008) found a relationship between the RPE
scales and the exercise time during competitive running races. Borg (1982) showed that
the scale values, range from 6 to 20 can be used to denote heart rates and cardiovascular
responses to exercise (60–200 beats min−1 ). RPE cooperating with SEBT measures the
effect of table tennis multi-ball training on dynamic posture control from subjectivity to
objectivity for this study.
Dynamic postural-control tasks require contributions from the kinetic chain to generate
a greater coordinated movement pattern (Winter, Patla & Frank, 1990; Gribble et al., 2009).
As a source of energy, the lower limb can transfer energy upwards to the upper limb through

Gu et al. (2019), PeerJ, DOI 10.7717/peerj.6262 2/19

 the kinetic chain (Elliott, 2006; Qian et al., 2016). Previous studies reported that lower limb
drive was the origin of the kinetic chain, which not only impacts on the quality of skills
and tactics used in table tennis (Qian et al., 2016; Fu et al., 2016), but also in lawn tennis
(Elliott, 2006; Girard, Micallef & Millet, 2005). These studies showed that power lower-limb
drive has an important relationship with optimizing energy transfer in the kinetic chain,
which influence the lower-limb flexibility and tactical application. In order to hit back
balls from different directions, table tennis players need to be able to adjust their body
into a apposite position that facilitates ball return. Moreover, as a multiple-set sport, table
tennis players should be able to distribute their energy demand in a way that facilitates
continuous strokes and good movement patterns during competition and training. Due
to the onset of fatigue, there is a negative relationship between sport performance and
playing time (Yaggie & Armstrong, 2004; Pau, Ibba & Attene, 2014). It is well known that
the movement of the center of pressure (COP) is a practical parameter used to assess
lower extremity performance. Yu et al. (2018) analyzed the trends of load transmission
on the foot between squat and standing serves in female table tennis athletes, according
to the investigations of COP trajectory. They found squat serve needs higher lower-limb
drive compared with standing serve during a short serve. In fact, potential mechanisms
that limit performance have been reported, as being related to increasing muscle-spindle
discharge that influence the feedback to the central nervous system and then decrease
postural control (Gribble et al., 2009; Rozzi et al., 2000; Khin-Myo-Hla, Sakane & Hayashi,
1999). However, to date no study has looked at multi-ball training associated with SEBT
and examined what percentage change reflects the degree of exercise intensity that would
impact on the performance of table tennis preparation preseason. In addition, there is no
study that report the effects of neuromuscular fatigue on the performance of the dynamic
postural-control task during table tennis multi-ball training. The aims of the current study
are firstly, to identify any relationship between multi-ball training and dynamic postural
control in table tennis players; secondly, to provide a guide to formulate feasible pacing
strategy for table tennis coaches and players. The research hypotheses of the study were
that (1) the normalized reach distance would show decrease when both of the groups
perform the SEBT with continuous multi-ball training, and the significant decrease in
reach distance would occur later in the male table tennis players compared with the female
players, (2) compared with warm-up end, the reach distance for both the dominant and
non-dominant leg in the male and female would show different conditions with the training
continuing and (3) as training continues, the COP motion (medial-lateral direction, length-
X; anterior-posterior direction, length-Y) would show significant changes compared with
warm-up end.

METHODS
Participants
Twelve experts (6 males: age 21.6 ± 1.42 years, weight 73.75 ± 3.24 kg, height 1.78 ± 0.04 m,
training experience 14.2 ± 1.46 years; 6 females: age 21.6 ± 1.53 years, weight 63.72 ± 5.4 kg,
height 1.65 ± 0.05 m, training experience 14.2 ± 1.62 years) from Ningbo University table

Gu et al. (2019), PeerJ, DOI 10.7717/peerj.6262 3/19

 Figure 1 Participants undertook the test procedures consisting of warm-up (W), rest (R), different
training phases (Phase I, Phase II, Phase III) and test (T), and end of test (E).
Full-size DOI: 10.7717/peerj.6262/fig-1

tennis team volunteered to participate in the study. All participants were National Division
I players, they were right-handed and free from any previous lower limb injuries, surgery,
foot diseases and had no previous injury for at least six months. The Ethics Committee
of Ningbo University (RAGH20170819) has approved this study, and written informed
consent was obtained from all individuals prior to participation. No participant received
any payment for this study.
In this study, dominant lower limb was determined according to the ball-kick test (Zakas,
2006). The participants were asked to kick football with arbitrary power and maximal
accuracy through a set of obstacles placed 1 m apart and 10 m from the participants, the
limb used to kick the football was regarded as the dominant limb and the other side was
non-dominant limb.

Procedures
This test was executed at Ningbo University table tennis training gymnasium. The study
was divided into three sessions, as shown in Fig. 1, each session comprised four phases
(warm-up end, Phase I, Phase II, Phase III). The time interval of two sessions for this trial
was over 24 h. The first two sessions consisted of a familiarization session that included an
instructional video, informed-consent the test procedures, introduction on the Borg 6-20
RPE scale and explanation of how to use the scale. At the third session, each participant was
asked to rate his/her perceived exertion based on the RPE scale by answering the question
‘‘How was your workout?’’: the scale is shown in Fig. 2.
Before the trials, each participant was given a standardized warm-up of 20 min in the
experimental environment. Participants were then assigned multi-ball training protocols
in pairs, which included change of direction at impact cooperating topspin, backspin etc.
All data sets from the study were recorded at each phase (each phase lasted approximately

Gu et al. (2019), PeerJ, DOI 10.7717/peerj.6262 4/19

 Figure 2 The RPE scale for the study.
Full-size DOI: 10.7717/peerj.6262/fig-2

16 min) for one entire training session (Malliou et al., 2008). Participants performed the
SEBT in the four different training conditions (warm-up end, Phase I, Phase II, Phase
III), respectively. Participants were asked to single-leg stand in the center of a grid, then
using the free limb to reach in the anterior, posteromedial and posterolateral directions
touching lightly—so as not to aid balance—and then return the starting position. The time
of one entire session was approximately 50 min. The reach distance (with the big toe as
the dependent measure for participants) was recorded when the players could maintain
not less than 30 s in each direction. The test was performed from the left leg support to
the right leg, and both lower limbs were measured under the same conditions respectively.
Each participant performed eight times in each direction. The mean of the top five reach
distances for each participant in the three reach directions were used for further data
analysis (Fig. 3).
At the initial session, to calculate the dependent variable for normalized reach distance,
leg length was measured with the participants in supine position. The participants’ right
and left leg lengths were measured (respectively), from the anterior superior iliac to the
distal end of the medical malleolus with a calibrated tape measure.
The trial was discarded and repeated when: (1) the stance leg lost balance, (2) the heel of
the stance leg lost contact, (3) the support time was less than required, and (4) the reaching
foot could not return the starting position.

Instrumentation
COP was recorded by a Novel Pedar insole plantar pressure measurement system (Novel
GmbH, Munich, Germany) at a frequency of 50 Hz. This equipment has been previously
used in kinetic analysis for table tennis and tennis (Girard et al., 2010; Fu et al., 2016; Qian
et al., 2016). The length of COP motion includes length-X and length-Y, which are routinely
used to assess postural control (Fu et al., 2016). Measuring insoles were placed bilaterally
inside the participants’ shoes (size 38–42 cm), and the data recording was sampled through
Bluetooth technical equipment. This equipment did not influence technical motions, and
was worn in both the training times and the trial processes, respectively.

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 Figure 3 Reaching directions on the SEBT. Note: (A) and (B) show the performance for left- and right-
leg stances, respectively.
Full-size DOI: 10.7717/peerj.6262/fig-3

Statistical analysis
All statistical tests were performed using SPSS version 19.0 software (SPSS Inc., Chicago, IL,
USA) for Windows. Prior to statistical comparisons, an initial Shapiro–Wilks test confirmed
that all data were normally distributed. Descriptive statistics were used to calculate the
means ± standard deviations for all participants. To examine the differences in the reach
distance of dominant and non-dominant limbs during the SEBT for the male or the female,
independent t -tests were carried out, respectively. There were pairwise comparisons in
two different phases for the RPE, reach distance and length of COP (-X and -Y), one-way
repeated-measures analysis of variance (ANOVA) was used to determine differences in
the four training stages. The significance level for all tests was set at p ≤ 0.05. The effect
size was determined based on Cohen’s d which was used to compare the differences in the
average of the two groups. Effect size (ES) is evaluated as trivial (≥ 0.19), small (≥ 0.2 and
≤ 0.49), medium (≥ 0.50 and ≤ 0.79) and large (≥ 0.80), respectively (Cohen, 1992).

RESULTS
RPE
Descriptive characteristics of the participants in the four phases are presented in Table 1.
As expected, significant differences were found in phase I, phase II and phase III compared
with warm-up (Fig. 4).

SEBT
As Fig. 5 shown, there were similar high between left and right legs in reaching distances
when performed the SEBT for the two groups. Based on independent t-tests, the

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 Figure 4 Trend of RPE for the male (A) and female (B) during the multi-ball training in each phase.
Full-size DOI: 10.7717/peerj.6262/fig-4

Table 1 Mean ± standard deviations (mean ± SD), standard error of measurement (SEM), 95% con-
fidence intervals (CI), effect sizes (ES) for the RPE values at warm-up end, phase I, phase II and phase
III.
Phase Gender Mean ± SD SEM CI ES
Warm- Male 9.67 ± 0.82 0.33 (8.81, 10.52) –
up end Female 10.50 ± 1.05 0.43 (9.40, 11.60) –
a
Male 13.83 ± 0.75 0.31 (13.04, 14.62) 0.93
Phase I a
Female 14.83 ± 1.17 0.48 (13.61, 16.06) 0.89
a
Male 16.00 ± 1.10 0.45 (14.85, 17.15) 0.95
b
0.75
Phase II a
Female 17.17 ± 0.75 0.31 (16.38, 17.96) 0.96
b
0.77
a
Male 18.50 ± 1.05 0.43 (17.40, 19.60) 0.97
b
0.93
c
0.75
Phase III a
Female 19.33 ± 0.52 0.21 (18.79, 19.88) 0.98
b
0.92
c
0.86
Notes.
a
Shows a comparison with warm-up end (p ≤ 0.05).
b
Shows a comparison with phase I (p ≤ 0.05).
c
Shows a comparison with phase II (p ≤ 0.05).

reaching distance had no significant differences in the three reach directions of the
each phase between dominant and non-dominant limbs for the male or female (p >
0.05) (Fig. 5). In addition, compared with warm-up, the reach distance of the right leg
for the male participants at phaseII showed significant decrease in the anterior direction
and posteromedial direction (Tables 2, 3). The reach distance of the left leg for the male
participants at the warm-up end showed significantly greater distance in the posterolateral
direction and posteromedial direction than phase II and III, in addition, greater distances

Gu et al. (2019), PeerJ, DOI 10.7717/peerj.6262 7/19

 Figure 5 The comparison of entire trend in the male (A) and female (B)
Full-size DOI: 10.7717/peerj.6262/fig-5

were recorded in the anterior direction compared with the phase III (Tables 2 and 3).
For the female participants, there were no significant changes in the all reach distances
observed for the right leg except the posterolateral direction at phase II and III when
compared with warm-up end (Tables 2 and 4). However, for the reach distance of the left
leg, there were significant differences in all directions except the anterior direction at phase
I when compared with warm-up (Tables 2 and 4).

COP
Figure 6 displays the length of COP in each phase. For all participants, length-X increased
more than warm-up end, but length-Y decreased more compared with warm-up end
following continuous training when performed the SEBT in all directions (p ≤ 0.05). For
the male participants, when the right lower limb reached anterior and posteromedial
directions, length-X of the support leg in phase II was significantly greater, but length-Y
was significantly smaller than warm-up end (p ≤ 0.05). Similarly, compared with warm-up
end, length-X of the right leg was significantly greater in phase II and III when the free
limb reached posteromedial/posterolateral and anterior directions (respectively), but
length-Y was significantly smaller. For female participants, the length-X of the left leg was
significantly greater in phase II than warm-up end when the free limb reached posterolateral
direction, but length-Y was significantly smaller in the same phase. In addition, compared
with warm-up end, length-X of the right leg was significantly greater. The free leg reached
the anterior direction in phase II and it reached the posteromedial/posterolateral direction
in phase I, but length-Y were significantly smaller.

DISCUSSION
To our knowledge, this is the first study that has provided evidence related to the relationship
between dynamic balance and multi-ball training in preseason table tennis. The purpose of
this study was to assess the effects of multi-ball training on dynamic posture control using
the SEBT during table tennis multi-ball training. Based on the findings of the study, the

Gu et al. (2019), PeerJ, DOI 10.7717/peerj.6262 8/19

 Table 2 Distance on the SEBT for each direction (mean ± SD).

Direction/ Warm-up end Phase I Phase II Phase III

Limb/Group
Anterior
Right
Male 66.33 ± 0.59 65.60 ± 0.58 64.81 ± 1.06a 64.00 ± 1.14a,b
Female 67.74 ± 0.78 67.33 ± 0.94 66.95 ± 0.60 66.87 ± 0.98
Left
Male 65.81 ± 1.09 65.11 ± 0.34 64.95 ± 0.84 64.30 ± 0.73a
A,B
Female 71.73 ± 0.71 71.13 ± 0.60 67.20 ± 0.77 66.37 ± 0.79A,B
Posteromedial
Right
Male 85.40 ± 0.87 84.40 ± 0.59 79.13 ± 1.44a,b 78.21 ± 1.02a,b
Female 86.43 ± 1.76 85.43 ± 1.30 85.17 ± 1.01 85.05 ± 1.70
Left
Male 86.77 ± 1.49 85.26 ± 1.12 78.97 ± 2.60a,b 78.91 ± 0.39a,b
Female 87.00 ± 0.47 82.96 ± 0.74A 82.60 ± 0.37A 82.52 ± 0.23A
Posterolateral
Right
Male 75.05 ± 1.09 74.88 ± 0.82 74.42 ± 0.86 74.14 ± 0.87
Female 86.11 ± 0.43 85.63 ± 0.54 82.93 ± 0.79A,B 82.12 ± 1.18A,B
Left
Male 75.44 ± 1.40 74.91 ± 0.77 68.18 ± 1.65a,b 67.49 ± 2.14a,b
Female 90.54 ± 0.32 87.16 ± 1.08A 83.14 ± 0.63A,B 82.78 ± 0.53A,B
Notes.
Mean ± standard deviations are normalised reach distance (reach distance/leg length ×100).
a and A
Significant difference from warm-up end in male and female (p ≤ 0.05), respectively.
b and B
Significant difference from phase I in male and female (p ≤ 0.05), respectively.
c and C
Significant difference from phase II in male and female (p ≤ 0.05), respectively.

results and analysis could help coaches to better regulate the training pace during preseason
preparation. As expected, the results of the study indicated that the significant decrease in
dynamic balance mainly occurred in phase II, but the female participants started to decline
earlier than the males. Additionally, when postural control started to decrease significantly,
length-X of COP motion showed to increase more than that observed at the warm-up end.
The length-Y of COP motion showed significant reductions when the same stages were
compared.
It is well documented that the Borg RPE scale has become a standard method to evaluate
perceived exertion and has been used in exercise science to quantify exercise intensity (Day
et al., 2004; Noble et al., 1983; Noble & Robertson, 1996). In addition, Foster et al. (1996);
Foster (1998); Foster et al. (2001); Foster, Rodriguez-Marroyo & De Koning (2017) studied
the specific stages of exercises in an entire aerobic exercise session using the RPE scale.
They provided evidence that this method can be applied to quantifying the intensity of
exercise during various types of exercise. The results of our study found that there were
apparently different training loads between each phase for both the male and female
participants. This provided useful information for comparative purposes between the male

Gu et al. (2019), PeerJ, DOI 10.7717/peerj.6262 9/19

Gu et al. (2019), PeerJ, DOI 10.7717/peerj.6262

Table 3 Standard error of measurement (SEM), 95% confidence intervals (CI), effect sizes (ES) for trials of males in each direction.

Anterior Posteromedial Posterolateral

Right Left Right Left Right Left
Warm-up SEM 0.24 0.44 0.36 0.61 0.45 0.57
end CI (65.72, 66.94) (64.67, 66.95) (84.49, 86.32) (85.21, 88.34) (73.90, 76.20) (73.97, 76.90)
SEM 0.24 0.38 0.24 0.45 0.34 0.31
Phase I CI (64.98, 66.21) (64.12, 66.09) (83.79, 85.02) (84.10, 86.43) (74.02, 75.74) (74.11, 75.72)
a a a a a a
ES(95% CL) 0.53 0.40 0.56 0.50 0.09 0.23
SEM 0.43 0.34 0.59 1.06 0.35 0.67
Phase II CI (63.70, 65.92) (64.07, 65.82) (77.61, 80.64) (76.23, 81.70) (73.51, 75.33) (66.45, 69.90)
a
ES(95% CL) 0.66 b 0.42 a
0.40 b 0.12 a
0.93 b 0.92 a
0.88 b 0.84 a
0.31 b 0.26 a
0.92 b 0.93
SEM 0.47 0.30 0.41 0.16 0.35 0.87
Phase III CI (62.80, 65.20) (63.54, 65.06) (77.15, 79.26) (78.50, 79.32) (73.23, 75.05) (65.25, 69.73)
a
ES(95% CL) 0.79 b 0.66 c 0.35 a
0.63 b 0.58 c 0.38 a
0.97 b 0.97 c 0.35 a
0.96 b 0.97 c 0.02 a
0.42 b 0.40 c 0.16 a
0.91 b 0.92 c 0.18
Notes.
All values are normalised reach distance (reach distance/leg length ×100).
a
Shows a comparison with warm-up end (p ≤ 0.05).
b
Shows a comparison with phase I (p ≤ 0.05).
c
Shows a comparison with phase II (p ≤ 0.05).
10/19
Gu et al. (2019), PeerJ, DOI 10.7717/peerj.6262

Table 4 Standard error of measurement (SEM), 95% confidence intervals (CI), effect sizes (ES) for trials of females in each direction.

Anterior Posteromedial Posterolateral

Right Left Right Left Right Left
Warm-up SEM 0.32 0.29 0.72 0.20 0.18 0.13
end CI (66.92, 68.57) (70.99, 72.47) (84.58, 88.28) (86.51, 87.50) (85.66, 86.56) (90.20, 90.88)
SEM 0.38 0.24 0.53 0.30 0.22 0.44
Phase I CI (66.34, 68.31) (70.51, 71.75) (84.07, 86.79) (82.18, 83.73) (85.07, 86.19) (86.03, 88.30)
a a a a a a
ES(95% CL) 0.23 0.42 0.31 0.96 0.44 0.90
SEM 0.24 0.31 0.41 0.15 0.32 0.26
Phase II CI (66.32, 67.57) (66.40, 68.01) (84.12, 86.22) (82.21, 82.99) (82.10, 83.76) (82.47, 83.80)
a
ES(95% CL) 0.49 b 0.23 a
0.95 b 0.94 a
0.40 b 0.11 a
0.98 b 0.29 a
0.93 b 0.89 a
0.99 b 0.92
SEM 0.40 0.32 0.70 0.95 0.48 0.22
Phase III CI (65.84, 67.89) (65.54, 67.20) (83.26, 86.84) (82.28, 82.76) (80.88, 83.35) (82.22, 83.33)
a
ES(95% CL) 0.44 b 0.23 c 0.05 a
0.96 b 0.96 c 0.47 a
0.37 b 0.12 c 0.04 a
0.99 b 0.37 c 0.13 a
0.91 b 0.89 c 0.37 a
0.99 b 0.93 c 0.30
Notes.
All values are normalised reach distance (reach distance/leg length ×100).
a
Shows a comparison with warm-up end (p ≤ 0.05).
b
Shows a comparison with phase I (p ≤ 0.05).
c
Shows a comparison with phase II (p ≤ 0.05).
11/19
 Figure 6 The length of COP motion in each phase. Note: ‘‘.’’ means significant difference began to show in COP length-X or -Y compared with
warm-up end. For male, (A), (B), (C) and (D) show the length of COP motion (X- or Y- axis) at left and right leg support, respectively. For female,
(E), (F), (G) and (H) show the length of COP motion (X- or Y- axis) at left and right leg support, respectively.
Full-size DOI: 10.7717/peerj.6262/fig-6

and female participants. Considering the characteristics of table tennis multi-ball training,
this finding may be related to the training time observed and the duration of the activity
may be contributing to the fatigue profiles recorded. However, because we only used one
method it may be speculative to try and explain the relationship between dynamic balance
and training time. Therefore, further work is needed to examine in detail any relationship
observed.
Plisky et al. (2006) have indicated that potential risk factors for injury may result in
the opposite limb if a reduced reach distance in the free limb is observed when using the
measurement method employed in the SEBT. Previous studies have indicated that the
reduced work of skeletal muscle is associated with muscle fatigue, which was believed to
be a potential cause of increased injury rates for athletes during unexpected perturbations
(Hassanlouei et al., 2012). Additionally, in racket sport players, there is a potential source of
muscle asymmetry between two legs, which could largely affect the pattern of movement and
perhaps induce sport injuries (Ye, Sun & Fekete, 2018; Lam et al., 2018; Ireland et al., 2013;
Sanchis-Moysi et al., 2010). The less adept lower limb for balance, the greater the inability
to provide an optimally stable base for the neuromuscular system to maintain a constant
tension. This could promote absorption of increased load and contribute to the instability
recorded (Fang, 2018; Plisky et al., 2006; Hewett, Myer & Ford, 2001; Weaver et al., 1999).
In addition, Earl & Hertel (2001) showed that the support leg muscles could be activated
to a different extent during the SEBT, which could be contributing to postural sway under
during continuous table tennis multi-ball training. Exercise-induced fatigue would result
in failure to produce maximal force and reduce flexibility, which could influence motor
performance. Previous studies have corroborated that fatigue-induced impairments could
badly impact on joint proprioception and neuromuscular control (Hassanlouei et al., 2012;
Voight et al., 1996; Ribeiro et al., 2008; Miura et al., 2004). Boden et al. (2000) reported that

Gu et al. (2019), PeerJ, DOI 10.7717/peerj.6262 12/19

 these findings constantly occurred at the end stages of athletic competition. Additionally,
the motions of sudden deceleration, landing and pivoting maneuvers throughout the entire
table tennis multi-ball training regime would exacerbate the risk of sport injury. In order to
try and quantify the influence of postural control on a participant performance, Caron et al.
(2000) measured the displacement of the COP. The findings from our study in relation to
COP displacement indicated that the reach distance in nearly all directions was beginning
to show a sharp decline trend in phase II. At the same time, in order to maintain posture
balance, the length-X of the COP showed increases, but its length-Y showed a decrease
when compared with the warm-up end. The results indicated that dynamic balance was
significantly decreased with table tennis multi-ball training. When we consider the step
features in table tennis, that include suddenly stopping and pivoting, which place repeated
rotational shear and loading forces on each joint of the lower limbs during table tennis
multi-ball training, it may be useful to compare the actions with tennis players. Tennis
players are at risk of increasing overuse and acute injuries including ligament sprains,
chronic muscle strain, hamstring strains, stress fractures, ankle sprains, shin splints, knee
contusions and growth plate injuries (Murphy, Connolly & Beynnon, 2003; Kibler & Safran,
2005; Hutchinson et al., 1995). According to the report of Kondrič et al. (2011), they found
that the most frequent injuries in racket sports is muscle tissues from training and/or
competition processes, and there is a high percentage of injuries in lower-limb joints (ankle
and foot in particular; 23.69% in total). They also indicated that due to the characteristics
of abrupt blocking movements in playing table tennis, the percentage of hip injuries exists
5.76%. In relation to these findings since table tennis players exhibited a apparent decline
in dynamic balance in phase II, a sport injury prevention program may be beneficial.
As a method of neuromuscular training, the SEBT can be incorporated into a pre-
participation physical examination for athletes to improve identified specific deficits in the
preseason phase of competition (Plisky et al., 2006). Paterno et al. (2004) and Holm et al.
(2004), reported that a period of 6–7 weeks of balance training would help athletes rapidly
improve postural stability. Based on the finding of this study, these methods should be
incorporated into preseason training and preparation phases. Future work would include
training monitoring being dominated by emerging new technologies that would consist
of real-time monitoring of the internal and external forces during training and recovery
(Foster, Rodriguez-Marroyo & De Koning, 2017). Therefore, the RPE and the SEBT may be
merged to formulate exciting training monitoring design via new and exciting technologies.
Some limitations to this study should be noted. Firstly, the data were based on one
table tennis season using one university table tennis team. Although all participants were
granted with National DivisionI status, it may limit the external validity at some degree.
Further, the study did not collate lower-limb strength and flexibility data. There is another
potential limitation is that we did not have electromyographic data to analyze the internal
mechanism of inducing decrease in dynamic balance from the standpoint of neuromuscular
system. In addition, future studies should consider research during competition to assess
the relationship between dynamic balance, strength and time duration.

Gu et al. (2019), PeerJ, DOI 10.7717/peerj.6262 13/19

 CONCLUSIONS
This study examined the relationship between dynamic posture control and the time of
table tennis multi-ball training preseason. The study’s prospective design allowed the
requirements of each trainee to reduce the risk of injury during table tennis multi-ball
training. Further, the findings of this study may assist the coaches and the certified
athletic trainees to understand the effects of table tennis multi-ball training on dynamic
posture control. The findings may also be useful in determining musculoskeletal deficits
in performance. Finally, the findings may also help in the design and implementation of
specific rehabilitative programs when the postural control descends significantly.

ADDITIONAL INFORMATION AND DECLARATIONS

Funding
This study was supported by the Zhejiang Social Science Program ‘Zhi Jiang youth project’
(16ZJQN021YB), the National Natural Science Foundation of China (81772423), the K. C.
Wong Magna Fund of Ningbo University, and the National Social Science Foundation of
China (16BTY085). The funders had no role in study design, data collection and analysis,
decision to publish, or preparation of the manuscript.

Grant Disclosures
The following grant information was disclosed by the authors:
Zhi Jiang youth project: 16ZJQN021YB.
National Natural Science Foundation of China: 81772423.
Ningbo University.
National Social Science Foundation of China: 16BTY085.

Competing Interests
The authors declare there are no competing interests.

Author Contributions
• Yaodong Gu conceived and designed the experiments, analyzed the data, contributed
reagents/materials/analysis tools, prepared figures and/or tables, authored or reviewed
drafts of the paper, approved the final draft.
• Changxiao Yu conceived and designed the experiments, performed the experiments,
analyzed the data, contributed reagents/materials/analysis tools, prepared figures and/or
tables, approved the final draft.
• Shirui Shao conceived and designed the experiments, performed the experiments,
contributed reagents/materials/analysis tools, prepared figures and/or tables.
• Julien S. Baker prepared figures and/or tables, authored or reviewed drafts of the paper.

Human Ethics
The following information was supplied relating to ethical approvals (i.e., approving body
and any reference numbers):
The Ethics Committee of Ningbo University (RAGH20170819) approved this study.

Gu et al. (2019), PeerJ, DOI 10.7717/peerj.6262 14/19

 Data Availability
The following information was supplied regarding data availability:
The raw data are provided in the Supplemental Files.

Supplemental Information
Supplemental information for this article can be found online at http://dx.doi.org/10.7717/
peerj.6262#supplemental-information.

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