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Table tennis is an extremely popular sport throughout the world as it requires no expensive equipment, specialized amenities, or physical contact among players, and the pace of play can be adapted to allow participation by players of all skill levels, ages, and abilities. It is an aerobic-dominant sport driven primarily by the phosphagen system because rallies are relatively brief (several seconds) and separated by longer rest periods. Several studies have shown that physical interventions including table tennis can help prevent cognitive decline and dementia. Accordingly, the present paper provides an overview of the basic physical and cognitive demands of table tennis, reviews previous studies reporting improvements in physical and brain health across different non-clinical and clinical populations, and critically evaluates the usefulness of table tennis intervention for the prevention of cognitive decline and dementia. This review suggests that table tennis intervention could be a powerful strategy to prevent cognitive decline and dementia in the elderly.