Due to long periods of sedentary behavior, and unhealthy diets gamers and esports players are at risk for numerous chronic diseases and all-cause mortality. Health research has started addressing the public health implications of the esports phenomenon, drawing a bleak picture of this megatrend. However, instead of just highlighting adverse public health implications of this trend, it is recommended to become involved in this phenomenon and positively influence it. Esports has an enormous potential for physical activity and health-promoting efforts, provides a context for broadly disseminating interventions, and offers new ways of gaining access to an often-neglected population. This paper presents: the potential of the esports phenomenon to promote physical activity, health, and well-being in gamers and esports players; the strategic and preventive solutions to ameliorate esports possible adverse health impacts; and the utilization of esports technology (streams, media platforms, exergames, etc.) as an innovative health promotion tool, especially reaching gamers and esports players with attractive and interactive interventions. This is to encourage systematic scientific research so that evidence-based guidelines and intervention strategies involving regular physical activity, healthy diet, and sleep hygiene for esports will be developed. The goal is to promote public health approaches that move toward a better integration of esports and gaming.
Physical inactivity, sedentary behavior (SB), and unhealthy diets are major causes of non-communicable diseases and premature death (Lee et al., 2012; Wilmot et al., 2012). As esports—serious competitive video gaming—has been associated with these unhealthy behaviors, esports developments are often regarded as questionable, especially from a public health perspective (Borggrefe, 2019; Yin et al., 2020). Researchers started addressing the public health implications of the esports phenomenon, drawing a bleak picture of this megatrend (Wattanapisit et al., 2020). Commonly identified adverse health outcomes related to esports and gaming include increased stress (Smith et al., 2019), sleep disturbances (Peracchia and Curcio, 2018), obesity (DiFrancisco-Donoghue et al., 2020), and behavioral problems (Yin et al., 2020). Relatedly, gaming time is linked to sedentary behavior (Rudolf et al., 2020) which also is associated with a higher risk for non-communicable diseases (Bailey et al., 2019). Additionally, esport participants are at risk for problematic Internet use (Argyriou et al., 2017). However, instead of just illustrating the adverse side effects and public health implications, it seems more advisable to understand this phenomenon and leverage the opportunities it offers. Just by its sheer dimension, esports has enormous potential as a setting to promote physical activity (PA) and health. It is important to improve our understanding of how to promote PA, health, and well-being and identify strategic and preventive solutions to address possible adverse health impacts in the esports community.
This paper presents some unique opportunities the esports phenomenon offers to influence PA and health in the esports community. It further tries to encourage systematic scientific research to develop evidence-based guidelines and intervention strategies for health promotion. This is intended to promote public health approaches that move toward a better integration of an ever-growing population of esports players, gamers, and audience.
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Esports players and gamers are stereotypically portrayed as young, male, socially inept, isolated “couch potatoes” (Williams, 2003). However, modern video games are not isolating activities that come at the expense of social interaction. Especially multiplayer online games are vibrant community sites (Steinkuehler and Williams, 2006). Research on gamer populations suggests that modern gamers are not isolated teenage males (Yee, 2006; Hedlund, 2021), and that video games are no longer child's play. The average gamer is older than 30 years (Hedlund, 2021). Millennials make up a large portion of the gaming community. Besides playing games with the primary intention of pure enjoyment and entertainment, people from all continents and all walks of life practice or watch esports. Also, the gender composition is changing to an increasing number of highly competitive female esports players (McLean and Griffiths, 2013; Hedlund, 2021).
An esports viewer is usually a video gamer that often wants to learn something about a particular game and the esports audience is mainly made up of millennials (Hamilton et al., 2014; Nilsen, 2019; Xiao, 2020). About 71% of millennials watch gaming content, consuming almost 6 h of gaming content each week (Nilsen, 2019). It is evident that esports is no longer a niche but has arrived in society's mainstream. By reaching the esport community, we potentially gain access to a significant and continuously growing part of our society.
PA is considered a vital component of a healthy lifestyle as seen in guidelines of different professional societies (Piercy et al., 2018). Adults should do at least 150–300 min of moderate-intensity aerobic PA; or at least 75–150 min of vigorous-intensity aerobic PA; or an equivalent combination of moderate- and vigorous-intensity activity throughout the week (World Health Organisation, 2020). Despite the benefits of regular PA (Lee et al., 2012), around one-fourth of the world's population do not meet the WHO guidelines (Guthold et al., 2018). Technological advances, societal influences, changes in transportation, and environment have shaped our daily life, decreasing PA, and increasing SB. A growing body of evidence has linked SB to several adverse health outcomes, including obesity, metabolic syndrome, and cardiovascular disease (Katzmarzyk et al., 2009; Marker et al., 2019). Media use is often implicated for causing physical inactivity and increasing SB (Duncan et al., 2012; Hingle and Kunkel, 2012).
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Esports players are often referred to as sedentary athletes as gaming requires prolonged sedentary activity. Esports players of different performance levels accumulate more than 3.5 h of gaming per day (Rudolf et al., 2020), while competitive elite esport players reach ~5.3 h per day (Kari and Karhulahti, 2016). Leading up to competitions, collegiate esports athletes reported to practice between 5.5 and 10 h daily (DiFrancisco-Donoghue et al., 2019).
Current data on esports players' PA show inconsistent results; according to an international online survey conducted by Trotter et al. (2020), 80.3% of esports players do not meet the WHO's PA recommendations. Thus, the prevalence of physical inactivity in esports players seems higher than in the general population (Guthold et al., 2018). Contrary, a study by Rudolf et al. (2020) determined that two-thirds of the esport players in Germany achieve the WHO's PA recommendations. This is in line with DiFrancisco-Donoghue et al. (2019), who reported that only about 40% of collegiate esport players from the USA and Canada did not participate in regular PA.
Gaming is typically associated with a higher body mass index (BMI) and, as the length of video gaming sessions is positively associated with BMI (Ballard et al., 2009), esports players may display a higher BMI compared to the general population. According to Trotter et al. (2020), esports players were more likely to be of normal weight, however, they were also more likely to be morbidly obese than the global population. In the study by Rudolf et al. (2020), 51% of the esports players were classified as normal weight. DiFrancisco-Donoghue et al. (2020) found no difference between collegiate esports players and age- matched controls in BMI. Esports players, however, had significantly higher total body fat percentage and significantly lower total lean mass.
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Currently, it is difficult to draw conclusions on the PA and health status of esports players. Most available data is cross-sectional and only based on online surveys, not allowing to establish causality. To date, large-scale accelerometer-based and longitudinal cohort studies are missing. Furthermore, many studies are methodologically flawed as they do not control for potential confounding factors like gender, age, game type, and performance level. Pereira et al. (2019) show that increasing competitiveness affects PA engagement in esports players. Players with a higher in-game rank are more likely to be physically active (Trotter et al., 2020). In a study on high-performance esports athletes, PA levels were three times higher than the WHO guidelines (Kari and Karhulahti, 2016).
Furthermore, studies did not compare the gamers to age matched controls when classifying their sample. A recent study compared accelerometer count in esports players to non-esports players, showed that collegiate esports players were significantly less active (DiFrancisco-Donoghue et al., 2020). Also Rudolf et al. (2020) stated PA status in their study was lower in esports players vs. age matched controls. Due to these methodological deficiencies, the health and PA status of esports players and gamers may be worse than the literature portrays. Regardless, the sedentary nature of gaming puts gamers at a higher health risk. To compensate for this higher risk all efforts should be undertaken to decrease SB and increase PA levels in this population. The esports ecosystem provides promising opportunities.
In the context of PA and health promotion, technology is often perceived as a double-edged sword. On the one hand, it contributes to the increase in SB by expanding screen based entertainment services (video games, applications, television shows), and automating operations increasing occupational sitting time (Clark and Sugiyama, 2015). On the other hand, the widespread use of fitness trackers, smartphone applications, and wearable technologies offers innovative solutions (nudging, ambulatory assessment, tracking) to promote healthy behavior changes, motivate the user to increase PA, and foster consumer empowerment (Spanakis et al., 2016; Wortley et al., 2017). Technology potentially overcomes many barriers associated with traditional face-to-face PA programs.
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Currently, it is difficult to draw conclusions on the PA and health status of esports players. Most available data is cross-sectional and only based on online surveys, not allowing to establish causality. To date, large-scale accelerometer-based and longitudinal cohort studies are missing. Furthermore, many studies are methodologically flawed as they do not control for potential confounding factors like gender, age, game type, and performance level. Pereira et al. (2019) show that increasing competitiveness affects PA engagement in esports players. Players with a higher in-game rank are more likely to be physically active (Trotter et al., 2020). In a study on high-performance esports athletes, PA levels were three times higher than the WHO guidelines (Kari and Karhulahti, 2016).
Furthermore, studies did not compare the gamers to age matched controls when classifying their sample. A recent study compared accelerometer count in esports players to non-esports players, showed that collegiate esports players were significantly less active (DiFrancisco-Donoghue et al., 2020). Also Rudolf et al. (2020) stated PA status in their study was lower in esports players vs. age matched controls. Due to these methodological deficiencies, the health and PA status of esports players and gamers may be worse than the literature portrays. Regardless, the sedentary nature of gaming puts gamers at a higher health risk. To compensate for this higher risk all efforts should be undertaken to decrease SB and increase PA levels in this population. The esports ecosystem provides promising opportunities.
In the context of PA and health promotion, technology is often perceived as a double-edged sword. On the one hand, it contributes to the increase in SB by expanding screen based entertainment services (video games, applications, television shows), and automating operations increasing occupational sitting time (Clark and Sugiyama, 2015). On the other hand, the widespread use of fitness trackers, smartphone applications, and wearable technologies offers innovative solutions (nudging, ambulatory assessment, tracking) to promote healthy behavior changes, motivate the user to increase PA, and foster consumer empowerment (Spanakis et al., 2016; Wortley et al., 2017). Technology potentially overcomes many barriers associated with traditional face-to-face PA programs.
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