Cardiovascular effects in adolescents while they are playing video games: a potential health risk factor?

Heartbeats and high scores: esports triggers cardiovascular and autonomic stress response

Introduction

Gaming is often labeled as sedentary behavior. However, competitive gaming, also known as esports, involves significant cognitive demands and may induce stress. This study aims to investigate whether the psychophysical demands during esports elicit a physiological stress response.

Methods

Fourteen FIFA 21 and thirteen League of Legends players (23.3 ± 2.8 years) were recruited for the study. Heart rate (HR), root mean square of successive differences between normal heartbeats (RMSSD), peripheral and central blood pressure (BP), pulse wave velocity (PWV), and energy expenditure (EE) were assessed during supine rest, seated rest, and competitive FIFA or League of Legends matches.

Results

No significant group × condition interactions were observed for any of the outcomes. However, there were significant increases in mean HR (p < 0.001, η p 2  = 0.383), RMSSD (p = 0.019, η p 2  = 0.226), peripheral systolic BP (p < 0.001, η p 2  = 0.588), peripheral diastolic BP (p = 0.005, η p 2  = 0.272), central systolic BP (p = 0.005; η p 2  = 0.369), central diastolic BP (p = 0.016, η p 2  = 0.313), PWV (p = 0.004, η p 2  = 0.333), and EE (p < 0.001, η p 2  = 0.721) during both games compared to the seated rest condition.

Conclusion

Despite the sedentary nature of esports, the psychophysical demands appear to elicit physiological responses. Interestingly, no significant differences were found between the different game genres.

The prevalence of high blood pressure and its determinants among Tunisian adolescents

Hypertension can originate in childhood and remain undetected unless special screening is performed. The burden of hypertension in adolescents in Tunisia is unknown. The aim of this study was to investigate the prevalence of blood pressure (BP) within the hypertension range and its association with other risk factors among Tunisian adolescents. A cross-sectional study that included 1385 secondary school students in Sousse, Tunisia, was performed during 2017-2018. A two-stage cluster sampling strategy was used to obtain a representative sample of the study population. BP within the hypertension range (HBP)was classified following the European guideline recommendations for measuring BP in children and adolescents. Anthropometric indices were measured using a standard protocol. A structured questionnaire collected information about sociodemographic characteristics, lifestyle, mental health status, and addictions. Adjusted logistic regression models were used to assess hypertension-related risk factors. Our study included 39.5% boys and 60.5% girls. The mean age of our population was 17 ± 1.5 years. The prevalence of HBP was 15.4% (13.1-18.0%), and it was significantly higher in boys (22.8%) than in girls (10.6%, p value < 0.001). In the multivariate logistic regression model, overweight [OR = 1.72(1.18-2.51)] and obesity [OR = 3.73(2.55-5.41)] were independent risk factors for HBPrange, (p value < 0.001), whereas female sex [OR = 0.41(0.29-0.56), p value < 0.001] and depression [OR = 0.67(0.51-0.88), p value = 0.008] were independent protective factors. Among Tunisian secondary school adolescents, the prevalence of HBP was high and associated with excess body weight. A comprehensive strategy for the prevention of hypertension and its risk factors among youth is urgently needed.

Large Estimate Variations in Assessed Energy Expenditure and Physical Activity Levels during Active Virtual Reality Gaming: A Short Report

The purpose of the study was to compare methods for estimating energy expenditure (EE) and physical activity (PA) intensity during a 30 min session of active virtual reality (VR) gaming. Eight individuals (age = 25.4 ± 2.0 yrs) participated, with a maximal oxygen consumption (VO2max) of 41.3 ± 5.7 mL∙kg−1∙min−1. All tests were conducted over two days. An incremental test to determine the VO2max when running was performed on day 1, while 30 min of active VR gaming was performed on day 2. The instruments used for EE estimations and PA measurements were indirect calorimetry, a heart rate (HR) monitor, and waist- and wrist-worn accelerometer. Compared to indirect calorimetry, waist-worn accelerometers underestimated EE (mean difference: −157.3 ± 55.9 kcal, p < 0.01) and PA levels. HR-based equations overestimated EE (mean difference: 114.8 ± 39.0 kcal, p < 0.01 and mean difference: 141.0 ± 81.6 kcal, p < 0.01). The wrist-worn accelerometer was the most accurate in estimating EE (mean difference: 23.9 ± 45.4 kcal, p = 0.95). The large variations in EE have implications for population-based surveillance of PA levels and for clinical studies using active VR gaming.

The Role of Avoidance Coping and Escape Motives in Problematic Online Gaming: A Systematic Literature Review

Over the past two decades, research into Internet Gaming Disorder (IGD) has markedly increased due to worldwide spread of online videogames. The reasons and motivations for playing greatly contribute to its popularity. Escapism and avoidance coping strategies have been studied extensively and conceptualized as motives to play. A growing research base has demonstrated a strong association between these motives to play and negative gaming outcomes. Consequently, the aim of the present systematic review was to provide a comprehensive overview of the role of avoidance coping and escape motives in problematic online gaming. A systematic literature search was carried out using academic databases and a total of 26 empirical studies met the inclusion criteria. The results show that escapism and avoidance coping represent both a predictor of IGD and play a mediating role between many psychological factors (e.g., self-esteem, loneliness, self-concept, anxiety) and problematic online gaming. However, the review also highlights the paucity of longitudinal studies that hinder the determination of the causal direction of these associations. Despite this limitation, the evidence has important implication for developing more effective prevention programs and clinical interventions.

The physiological and biochemical effects of gaming: A review

BACKGROUND

Recreational, seated video gaming (gaming) has become a favorite pastime of children, adolescents, and adults (gamers) in developed countries. Some engage in gaming behavior for more than 6 h daily, which can subsequently lead to less time spent being physically active. Gaming can potentially have a serious impact on the physiology and biochemistry of gamers and can influence both short-term and long-term health. The aim of this review was to provide an overview of what is known about how gaming affects physiological and biochemical parameters in the human body and how studies have previously been designed and to discuss how studies can be designed moving forward.

METHODS

The literature search included material from three scientific databases (PubMed, EMBASE, and Web of Science) using a two-block search strategy. To be included in this review, studies had to investigate a biochemical or physiological aspect of sedentary, video game-related activities. Studies that investigated neurological, psychologic or musculoskeletal outcomes along with physiological or biochemical outcomes in gaming were eligible for inclusion. Studies regarding psychiatric conditions were excluded as this subject was outside the scope of this review. Additionally, non-English language articles were excluded.

RESULTS

A total of 5417 articles were screened, 138 studies from the literature search and 4 studies from reference lists were selected for further evaluation. The studies were evaluated based on their abstracts or full texts, and 51 studies were eventually included in the review. Thirty-seven studies included physiological results, seven studies included biochemical results, and seven studies included both. Several outcomes such as heart rate, blood pressure, blood glucose levels, and cortisol levels, were the subjects of a large number of investigations.

CONCLUSION

This field is heterogenic and does not lend itself to firm conclusions. Tentatively, it seems reasonable to conclude that heart rate variability studies show that gaming increases activity in the sympathetic nervous system. More high-quality studies are required, and the lack of studies using uniform, standardized designs and realistic gaming sessions (i.e., longer than 30 min) limits our current knowledge.

The Relationship between Sense of Coherence, Stress, Body Image Satisfaction and Eating Behavior in Japanese and Austrian Students

Background: Restrained, emotional, and external eating are related to obesity and eating disorders. A salutogenic model has confirmed sense of coherence (SOC) as a health resource that moderates stress and helps limit the occurrence of overweightness and eating disorders. This study aimed to examine the relationship between SOC, social support, stress, body image satisfaction (BIS) and eating behaviors in different cultural environments. Methods: A total of 371 Austrian (161 men, 210 women) and 398 Japanese (226 men, 172 women) university students participated. The SOC-13 scale, Multidimensional Scale of Perceived Social Support, Dutch Eating Behavior Questionnaire, BMI-Based Silhouette Matching Test and an analogue single-stress item were used as measurements. Results: SOC negatively affected all three types of eating in Austrian students (men: β = −0.227 to −0.215; women: β = −0.262 to −0.214). In Japanese students, SOC negatively affected external eating in both sexes (men: β = −0.150; women: β = −0.198) and emotional eating (β = −0.187) in men. BIS indicated that the desire to become slim predicted restrained eating, women’s emotional eating, and men’s and Austrian women’s external eating. Stress was only predictive of emotional eating in Japanese men. Conclusions: This study found that SOC, BIS and stress might be valuable factors regulating eating behavior in a cultural context. However, the relationship between SOC, BIS, stress and eating behavior differs between cultures.

Virtual Reality Gaming Elevates Heart Rate but Not Energy Expenditure Compared to Conventional Exercise in Adult Males

Virtual reality using head-mounted displays (HMD) could provide enhanced physical load during active gaming (AG) compared to traditional displays. We aimed to compare the physical load elicited by conventional exercise and AG with an HMD. We measured energy expenditure (EE) and heart rate (HR) in nine healthy men (age: 27 ± 5 years) performing three testing components in a randomised order: walking at 6 km/h (W6), AG, and AG with an additional constraint (AG^W; wrist-worn weights). Although we found that HR was not significantly different between W6 and the two modes of AG, actual energy expenditure was consistently lower in AG and AG^W compared to W6. We observed that playing AG with wrist-worn weights could be used as a means of increasing energy expenditure only at maximum game level, but ineffective otherwise. Our findings indicate that AG in an HMD may not provide a sufficient stimulus to meet recommended physical activity levels despite increased psychophysiological load. The differential outcomes of measures of HR and EE indicates that HR should not be used as an indicator of EE in AG. Yet, adding a simple constraint (wrist-worn weights) proved to be a simple and effective measure to increase EE during AG.

Disordered gambling: the evolving concept of behavioral addiction

The reclassification of gambling disorder within the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) addictions category marks an important step for addiction science. The similarities between gambling disorder and the substance use disorders have been well documented. As gambling is unlikely to exert actively damaging effects on the brain, the cognitive sequelae of gambling disorder may provide insights into addictive vulnerabilities; this idea is critically evaluated in light of recent structural imaging data. The second part of the review analyzes a fundamental question of how a behavior can become addictive in the absence of exogenous drug stimulation. The relative potency of drug and nondrug rewards is considered, alongside evidence that cognitive distortions in the processing of chance (for example, the illusion of control and the gambler's fallacy) may constitute an important added ingredient in gambling. Further understanding of these mechanisms at neural and behavioral levels will be critical for the classification of future behavioral addictions, and I consider the current research data for obesity and binge eating, compulsive shopping, and internet gaming disorder.

Frequent video-game playing in young males is associated with central adiposity and high-sugar, low-fibre dietary consumption

PURPOSE

Video-game playing is associated with an increased obesity risk. The association of video-game playing with body composition, physical activity and eating behaviour was investigated.

METHODS

A total of 45 young males (age range 18-27 years, BMI range 18.5-35.1 kg/m(2)) were recruited. Measurements of body composition and blood pressure were performed. The EPIC-FFQ questionnaire was used to assess dietary intake. A questionnaire battery was administered to assess physical activity, eating behaviour, sleep quality and frequency of video-game playing (hours/week). Subjects were categorised into frequent (>7 h/week) and non-frequent (≤7 h/week) players.

RESULTS

Frequent video-game players had greater waist circumference and fat mass. Video-game playing was significantly associated with high added sugar and low fibre consumption. A higher level of dietary restraint was observed in non-frequent video-game users.

CONCLUSIONS

These preliminary results identify frequent video-game playing as an important lifestyle behaviour which may have important implications for understanding obesity risk in young male adults.

Video game playing time and cardiometabolic risk in adolescents: the AFINOS study

BACKGROUND AND OBJECTIVE

We aimed to examine the association of video games playing time with cardiometabolic risk biomarkers in adolescents.

SUBJECTS AND METHODS

This study comprised 181 adolescents (88 girls), aged 13- to 17 years old. Moderate-to-vigorous physical activity (MVPA) was measured by accelerometry, and video game playing time in computer and console was self-reported. Waist circumference, systolic blood pressure (BP) and diastolic BP, mean arterial pressure, HDL-cholesterol, LDL-cholesterol, total cholesterol, triglycerides, glucose, insulin, and apolipoproteins A-1 and B-100 were measured.

RESULTS

Computer games use was not significantly associated with any biomarker (P>0.1) but the time spent using console games was positively associated with diastolic BP, mean arterial pressure, triglycerides, and a clustered cardiometabolic risk score. These results were independent of age, sex, pubertal stage, MVPA, and WC.

CONCLUSION

These results support some evidence regarding a plausible unfavorable role of playing (console) video games on cardiometabolic health in adolescence.

Role of video games in improving health-related outcomes: a systematic review

CONTEXT

Video games represent a multibillion-dollar industry in the U.S. Although video gaming has been associated with many negative health consequences, it also may be useful for therapeutic purposes. The goal of this study was to determine whether video games may be useful in improving health outcomes.

EVIDENCE ACQUISITION

Literature searches were performed in February 2010 in six databases: the Center on Media and Child Health Database of Research, MEDLINE, CINAHL, PsycINFO, EMBASE, and the Cochrane Central Register of Controlled Trials. Reference lists were hand-searched to identify additional studies. Only RCTs that tested the effect of video games on a positive, clinically relevant health consequence were included. Study selection criteria were strictly defined and applied by two researchers working independently. Study background information (e.g., location, funding source); sample data (e.g., number of study participants, demographics); intervention and control details; outcomes data; and quality measures were abstracted independently by two researchers.

EVIDENCE SYNTHESIS

Of 1452 articles retrieved using the current search strategy, 38 met all criteria for inclusion. Eligible studies used video games to provide physical therapy, psychological therapy, improved disease self-management, health education, distraction from discomfort, increased physical activity, and skills training for clinicians. Among the 38 studies, a total of 195 health outcomes were examined. Video games improved 69% of psychological therapy outcomes, 59% of physical therapy outcomes, 50% of physical activity outcomes, 46% of clinician skills outcomes, 42% of health education outcomes, 42% of pain distraction outcomes, and 37% of disease self-management outcomes. Study quality was generally poor; for example, two thirds (66%) of studies had follow-up periods of <12 weeks, and only 11% of studies blinded researchers.

CONCLUSIONS

There is potential promise for video games to improve health outcomes, particularly in the areas of psychological therapy and physical therapy. RCTs with appropriate rigor will help build evidence in this emerging area.

Do motion controllers make action video games less sedentary? A randomized experiment

Sports- and fitness-themed video games using motion controllers have been found to produce physical activity. It is possible that motion controllers may also enhance energy expenditure when applied to more sedentary games such as action games. Young adults (N = 100) were randomized to play three games using either motion-based or traditional controllers. No main effect was found for controller or game pair (P > .12). An interaction was found such that in one pair, motion control (mean [SD] 0.96 [0.20] kcal · kg(-1) · hr(-1)) produced 0.10 kcal · kg(-1) · hr(-1) (95% confidence interval 0.03 to 0.17) greater energy expenditure than traditional control (0.86 [0.17] kcal · kg(-1) · hr(-1), P = .048). All games were sedentary. As currently implemented, motion control is unlikely to produce moderate intensity physical activity in action games. However, some games produce small but significant increases in energy expenditure, which may benefit health by decreasing sedentary behavior.

Primary hypertension and special aspects of hypertension in older children and adolescents

The prevalence of hypertension has increased at an accelerated rate in older children and adolescents. This has raised great concern about premature development of cardiovascular disease, which has major long-term health and financial implications. While obesity and sedentary habits largely explain this phenomenon, there are other social and cultural influences that may unmask genetic susceptibility to hypertension in the pediatric population. While it is essential to exclude numerous causes of secondary hypertension in every child, these disorders are not discussed in this review. Rather, the aim of this review is to familiarize pediatricians with casual and ambulatory blood pressure measurement, epidemiology, pathophysiology, and management of several common conditions that play a role in the development of hypertension in children and adolescents. Besides primary hypertension and obesity-related hypertension, emphasis is given to epidemiology, measurement of blood pressure, including ambulatory blood pressure monitoring, hypertension associated with drug use, teenage pregnancy, and video and computer games. Lastly, because pediatricians are increasingly confronted with special issues concerning the management of the hypertensive athlete, this topic is also addressed.