The more you play, the better you feel: a dose–response analysis of pickleball and mental wellbeing in U.S. adults

Introduction Participation in sports, including pickleball, has been linked to improved mental health in prior research. However, the potential dose-response relationship between the amount of pickleball played and mental wellbeing has not been examined in the existing literature. We examined if a higher participation level is associated with greater mental wellbeing in pickleball players. In addition, we assessed if the relationship between pickleball participation and mental wellbeing differs by sex, injury history, and age. Methods An online survey including questions regarding participation frequency and duration (over the past 12 months), and mental wellbeing using the WHO-5 Wellbeing Index (higher scores indicating greater wellbeing) was administered to 1,667 pickleball players (mean age: 62.8±12.8 years) across the United States. Descriptive statistics and both unadjusted and adjusted linear regression analyses were conducted, controlling for age, sex, injury history, and participation in other sports. Results Higher pickleball participation frequency, characterized by ≥ 3 times weekly (vs. ≤ 2 times weekly), was significantly associated with higher mental wellbeing scores (b = 3.3, 95% CI: 1.74.9, p < 0.001) and higher participation duration, characterized by > 2 h per session (vs. ≤ 2 h per session), was significantly associated with higher mental wellbeing scores (b = 3.0, 95% CI: 1.54.4, p < 0.001). Sex did not moderate the association between pickleball participation and mental wellbeing. However, players with a recent injury reported substantially lower wellbeing scores compared to those without an injury history. Age moderated the relationship between participation and mental wellbeing with increasing age boosting mental wellbeing. Conclusion This study identified a positive dose-response relationship between pickleball participation and mental wellbeing, with greater frequency and duration of play associated with higher wellbeing scores. The effect was suppressed in players with injury history, but consistent across sexes and strongest among older adults, particularly those aged 6377. These findings support the potential of pickleball as a low-barrier strategy to promote mental health in aging populations.