Do Health and Wellness Matter in Scholastic Esports?

Written by Haylesh Patel, MSc - Esports Exercise Physiologist for UCI Esports

This is always an interesting question whenever it arises, and people have different perspectives on whether physical health and overall wellness is an integral part to esports performance.  Many people are of the thought that being physically fit or allocating time to physical fitness and health related activities is not needed due to the non-physically demanding nature of gaming.  Also, a common point is that it takes away valuable time from practicing, training and becoming a better competitor in your respective game.  However, on the other side, there are those that swear by their exercise regime and believe that without it, they wouldn’t be the high-level competitor that they are today.  In this post we’ll take a quick peek into this topic to see what it’s all about when it comes to health and wellness in esports.

Preface

Before jumping into a discussion about a topic it is always helpful to have context or a goal of what you want to learn about in a particular area.  Firstly, let me preface this piece by saying I am in no way telling you what to do. I am not your parent, rather I am an enthusiastic scientist and gamer, who is VERY interested in exercise, health and gaming.  I am here to explain what the literature (research) is showing, what the evidence is, provide you with some tools and resources.  I’ll then leave it up to you to make your own decisions on whether you want to adopt some, all or none of the information.  When it comes down to it in the long run, you are all young adults or are going to become one soon.  Therefore, making decisions about your long-term health and wellness will be up to you and determined by what actions you take.  Ultimately, you are responsible for your own health and wellbeing and success.  This is especially true for those of you that aspire of being a professional in whatever industry you choose.  The good habits that you develop now will help you a great deal in the long run.


Now, with that out of the way, let's take a look at where the intersection of health, fitness and gaming meet.  For the most part, this discussion is going to be a high-level overview of the topic.  So, rather than zooming in and being super detailed, we will be floating high above, looking down at the field, seeing how things fit in the big picture.

Is there a problem with gaming? If so, what is the problem?

Everything in life requires balance and the same applies to gaming.  If you were gaming 24/7 and did not eat, sleep, exercise or socialize, you wouldn’t be doing so well, physically and mentally.  I wouldn’t say there is a problem with gaming per say but there is an inherent negative byproduct from participating in gaming, this being sedentary time.  More specifically, too much sedentary time.  The definition of sedentary is when you are not moving around, inactive, seated not standing.

How many hours during the day do you think you are sedentary for?  Let’s do a little calculation in our heads: How many hours are there in the day? 24 hours.  Say you sleep for 8 hours, so subtract that from 24, that leaves you with 16 hours left.  Of those 16 hours, how many are you sitting or sedentary? So, what is your number? 8, 10, 15?

According to a recently published article[1] the average American adult sits for 6.5 hours per day and that this number is substantially higher for teenagers.  When I ask this same question to my collegiate esports athletes the number is substantially higher, ranging from 10-14 total sedentary hours.  But this kind of makes sense in a way, if you are going to commit to playing something at a high level, whether that be a musical instrument, a sport or a video game, you need to practice to become good, build your skill set and then maintain it.  This, however, doesn’t compensate for what is occurring to our body in this sedentary state.

So, what is wrong with sitting? An Australian study published in 2010[2] highlighted that too much sitting is detrimental to human health and wellbeing and may cause negative metabolic effects upon the body.  The study included 8800 people and measured a variety of health variables, their nutrition habits, TV watching duration and physical activity.  What they found was a positive correlation between TV watching time and all-cause mortality.  All-cause mortality is a term used to describe death in relation to some kind of disease or lifestyle factor.  Basically, what the main finding entailed is that those who spend more time watching TV were more likely to die prematurely from some form of disease.  It is important to note that this was a correlation, not a causation.  This is an important distinction, which we will leave for another conversation on another day to dive into.

As of now they haven’t been able to identify what specifically changes in the body that leads to this outcome.  However, there is a discussion about the potential for changes relating to how blood and particles move through our body, specifically our arteries and veins, causing unfavorable changes that affect our heart and other organs in our body.  Research is still investigating an exact mechanism that causes these detrimental effects, however there is thought that sitting causes decreased BF in the lower leg, which decrease shear stress on walls of veins and arteries, increasing development of atherosclerotic plaque, leading to a cascade of changes to blood composition, increasing risk of CVD and other clinical diseases.

If you don’t move around and use your body, then your body adapts to this by making changes to different areas of the body.  Your overall fitness will decrease since you are not stimulating your heart and lungs.  This happens in conjunction with a reduction in muscle mass and strength.  This can also be associated with decreases in bone mineral density due to a reduced stimulus, increasing the risk of breaking bones and osteoporosis later in life.

Now, sitting time is not the only predictor of mortality.  There is a growing body of evidence that shows having a low fitness level is more likely to increase mortality as well.  Here are a few studies that show this association[3][4][5].  Now, many of you may be thinking, c’mon that is just common sense, if you are fitter, you’ll live longer.  Personally, I think that this area of research is super fascinating, but I am going to table this for future discussion in another post.

What does exercise have to do with gaming?

Let's flip the coin and look at it from another side.  There are specifics, other than sitting low cardiovascular fitness that relate to healthy gaming and will influence long term outcomes both personally and professionally. As you probably already know, the time span for the career of a pro gamer is quite short.  The average career of an athlete is 5-10 years, retiring around ~20-25 years old, depending on what game they play.  Physical and mental burnout is also common and overuse injuries occur frequently in both amateur and professional scenes. There are high stakes involved, high stress, lots of travel, no downtime.  I am a firm believer that by taking appropriate steps with physical activity, sleep, nutrition and managing time well, we can avoid the occurrence of burn out, injury and other factors.

Exercise - benefit, risks and increasing performance

Before we talk about the benefits of exercise, we need to talk about what happens when we don’t exercise.  There is a myriad of changes to the body when we do not exercise, here a just a few:

  • ↓ cardiovascular fitness
  • Sarcopenia (decrease in muscle mass)
  • Decrease in bone mineral density
  • Increase fat mass
  • Increase risk of cardiovascular disease, diabetes, stroke and dying prematurely

Benefits of exercise (the opposite of the above points)

  • Improve general health and performance
  • ↓ fatigue
  • ↑ energy

There are many unique adaptations that occur in the body that happen within the heart, lungs, skin, eyes, DNA, brain, bones, muscles.

 

Heart and lungs

Heart is a muscle and just like any other muscle in the body it can become stronger, bigger and more efficient.  A measure of efficiency in the heart is called cardiac output, interaction of heart rate (HR) and stroke volume (SV), which determines the amount of blood that exits the heart.

Another way to look at the efficiency of the heart of looking at resting heart rate.  At rest the heart rate of a regular individual is around 60-100 beats per min (BPM).  An Olympic athlete in contrast has a resting heart rate of around 40-60 BPM.  This is reflective of the adaptation that has occurred in their heart as a result of their physical conditioning.  

In relation to the lungs they also become more efficient at exchanging oxygen and CO2.  Breathing muscles become more efficient, diaphragm and intercostal muscles also change, also the composition of our blood, specifically hemoglobin.

Muscles and bones adapt by increases in muscle mass, mitochondria (powerhouse of the cell) and increased bone mineral density.

There is one area where exercise has an effect which is usually overlooked, or unknown, the brain.  

Image Source: www.waitbutwhy.com

Image Source: www.waitbutwhy.com

There are some amazing changes that occur within the brain during and after exercise, that have a positive effect upon its structure and function. The really interesting thing is that these changes start to happen straight away after one exercise session and the more often you do it, the greater effects occur. 

These include:

  • Improved stress resilience
  • ↓ anxiety, depression
  • ↑ mood
  • ↑ blood flow
  • ↑ Brain plasticity
  • ↑ memory and learning
  • ↑ reaction time (fast reaction time)
  • Spatial learning
  • Improved memory function
  • Better pattern separation
  • Increased executive function

Executive function is a combination of cognitive processes that help us do daily things (attention, planning, reasoning, rational decision making, inhibiting behavior - Avoid saying or doing the wrong thing).  Your hippocampus is where memory gets encoded and other functions, like spatial learning, memory function and pattern separation. 

Here is a great TED talk by Dr. Wendy Suzuki that speaks to some of the wonderful changes that happen to the brain when you exercise: The brain-changing benefits of exercise | Wendy Suzuki

During and after a single exercise session there is an increase in the number of neurochemicals: hormones (like testosterone, oxytocin, cortisol), neurotransmitters (dopamine, serotonin, epinephrine), Neurotrophins (proteins).  These effects last from ~2hours post exercise to 3wks.

Different types of exercises have different effects on changes to the brain and specifically the hippocampus:

  • Endurance exercise: shown to have the biggest increase in hippocampus volume
  • High intensity interval training (HIIT): Increases hippocampus volume but not as big as endurance exercise
  • Strength: smaller increase in hippocampus volume when compared to endurance and HIIT exercise

What effect does exercise have upon gaming performance?

With all that information from above in mind, what effect do you think exercise will have on gaming? Well when you put the information above into the context of gaming there are a few areas of overlap and areas of potential improvement. 

To be successful in most games it is more beneficial to have a fast reaction time, carry out complex decision making on the fly, have a good memory and a good mindset.  So, it seems that in addition to practicing and playing our respective video games we can also give ourselves a boost in performance by doing a little bit of exercise.

How much exercise do I need to do to get the benefits from exercise?  A good place to start is with the recommendations that are set by leading organizations and governing bodies, such as the American College of Sports Medicine (ACSM).  They recommend the following amount of exercise per week: 150 minutes of moderate activity per week + 2 x week of strengthening exercises.  That works out to be around 30 minutes of aerobic exercise on 5 days of the week, with two sessions of strengthening exercises during the week. 

Even if you cannot commit to that level throughout the week, even a short 5-10 minute walk outside will have some benefits to your brain and overall health.  You do not need to go to a gym to exercise, what you really want to do is find some physical activity that you enjoy doing, whether that is sports, walking, hiking, running, dancing etc. And then do that activity more, and often by yourself or in a group with friends.

To wrap this up, there are some negative consequences that are associated with living our daily lives, like being sedentary for too long and have lower overall physical fitness.  However, we can counteract these negative effects by getting out and about, performing a little bit of physical activity. There are additional benefits to our cognition, by performing physical activity or being more active in general that can have a positive effect on our gaming performance.

Editor's Note: For additional resources, please visit NASEF's page on Healthy Gaming and read Haylesh's earlier post, "Healthy Gaming: Stay Fit While Playing Esports"

[1] Yang L, Cao C, Kantor ED, et al. Trends in Sedentary Behavior Among the US Population, 2001-2016. JAMA. 2019;321(16):1587–1597. doi:10.1001/jama.2019.3636

[2] https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.109.894824

[3] Nauman, Javaid et al. Prediction of Cardiovascular Mortality by Estimated Cardiorespiratory Fitness Independent of Traditional Risk Factors: The HUNT Study. Mayo Clinic Proceedings , Volume 92 , Issue 2 , 218 – 227

[4] Blair SN, Kampert JB, Kohl HW, et al. Influences of Cardiorespiratory Fitness and Other Precursors on Cardiovascular Disease and All-Cause Mortality in Men and Women. JAMA. 1996;276(3):205–210. doi:10.1001/jama.1996.03540030039029

[5] Francisco B. Ortega, Duck-chul Lee, Xuemei Sui, Laura D. Kubzansky, Jonatan R. Ruiz, Meghan Baruth, Manuel J. Castillo, Steven N. Blair,Psychological Well-Being, Cardiorespiratory Fitness, and Long-Term Survival, American Journal of Preventive Medicine, Volume 39, Issue 5, 2010, Pages 440-448, ISSN 0749-3797