Introduction
Hundreds of millions of players are engaged daily in virtual and competitive electronic gaming—eSport.1 Whether it is playing these games or just being a fan, eSports enthusiasts have proliferated throughout the world. According to Newzoo, a market tracking company, 427 million people will be watching eSports by 2019 and will reach a global audience of 1.1 billion by 2021.1 Player earnings from sponsorships and prizes exceed $1.5 billion.2 In recent months, competitive gaming (eSport) has received a large amount of social media and public attention. Ninety per cent of children in the USA play electronic video games on a regular basis.3 The IOC on 28 October 2017 in Lausanne, Switzerland, has accepted that eSport is a sporting activity.4 Viewership is so high for certain games (such as League of Legends) that it has bypassed the Major League World series.5 6 These competitions are aired on YouTube or on streaming sites. The most widely known is ‘Twitch.com’ which accounts for >40% of eSport streaming volume. Twitch was purchased by Amazon in 2014 for $970 million.
Colleges, universities, and high schools are adding eSport teams at a rapid pace. It is appealing for a school because it attracts a different type of student than the prototypical athlete image. In South Korea, universities classify eSport competitors as traditional athletes.7 In the US, over 50 colleges have varsity eSport teams under the National Association of Collegiate eSports (NACE).8 Twenty-two colleges in the US currently offer scholarships for gaming. High schools across the United States have launched a competitive varsity season in the fall of 2018.9 Undergraduate programme have been created and offered in the industry of eSport. The NCAA is currently investigating eSport as a recognised sport. In 2018, the National Basketball Association developed NBA’s 2K League. This consists of a group of 17 franchises affiliated with NBA teams that play electronic basketball. This league gets aired on ESPN’s sport channel and has drafts similar to professional basketball.
There is, however, little known about the physical and mental health demands and injury management of eSport players. This new sport requires the support of health professionals who understand social or addictive behaviours, changes in academic or work performance, and chronic eSport participatory injuries such as wrist or hand problems, eye strain and postural assessments.
Our aim was to report the common health issues that occur in competitive gaming and outline a healthcare model for institutions to help create protocols to prevent and treat common health concerns in eSport athletes.
A changing role for coaches and healthcare practitioners in sports medicine and rehabilitation
eSport has received much controversy from critics as a traditional sport due to its lack of physicality. Regardless of this debate, the eSport team are the ‘new athletes’ on campus and they should be held to the same standards of other athletes. These teams have uniforms, coaches; they practice together and compete regularly. However, they do not have the sport administration behind them of traditional sports teams. When we think of an eSport player, we do not typically think of a physician’s clearance to participate in a sedentary activity with little chance of injury. Quite contrary to that belief, these athletes suffer health concerns and chronic overuse injuries.10 It is common for professional eSport athletes to suffer career-ending injuries. The most common injury is wrist and hand injuries.10 Alarmingly, in 2013 pro StarCraft 2 Player Geoff ‘Incontrol’ Robinson suffered from a blood clot in his knee. This clot is also called a deep vein thrombosis (DVT) which is common when individuals sit for long periods of time.10 11 If ignored, DVT can travel to the lungs and cause a pulmonary embolism which is life threatening.11 The common concerns and injuries that are seen in eSport athletes are not the typical injuries seen in traditional student athletes and many health professionals and trainers may not know what type of injuries to look for.
eSport athletes at a collegiate level have talents that exceed the skills of the average recreational virtual gaming players. The manual dexterity that is needed to perform the actions required to compete has a direct impact on the athlete’s performance.12 These games require thinking skills and reaction times faster than their competitor.12 Whereas novice players average approximately 50 action moves per minute, higher level athletes make 10 moves per second or 500–600 action moves per minute.13
In order to succeed at gaming on a competitive level, athletes are required to play for many hours a day. College and school teams can practice together for 3–4 hours a day, with many of them going home to continue practising their game. In many cases, they practice in a less than ideal environment with improper posture, lighting and time awareness.
eSport requires players to have their eyes fixed on a computer screen with excessive exposure to light-emitting diodes (LEDs). LEDs are used to provide illumination in computers, smartphones, tablets and televisions. LEDs have a broad spectrum of light. They appear white, but these LEDs have a peak emission in the blue light range of (400–490 nm).14 Recent research has demonstrated that excessive exposure to this blue-light spectrum can create retinal and photoreceptor damage.14 15 Excessive exposure can also impact the natural circadian rhythm.14 15 Melatonin is a hormone synthesised in our bodies. It is an important marker of the natural circadian clock. Typically, melatonin is lowest during awake hours during the day and then rises at night before sleep. Excessive exposure to LED lights, seen in computer screens, can alter melatonin levels.16 Players often need to take breaks to refocus their eyes.
There are very little data on lifestyle habits and common complaints from eSport players.
This paper presents results of a survey that characterise lifestyle habits of collegiate eSport players and a proposed healthcare model for eSport athletes.