Discussion
This study was conducted virtually due to the lockdown regulations imposed globally from the COVID-19 pandemic during July through December 2020, comparing a 6 min active break, a 6 min passive break and no break on competitive FPS player performance and executive function. It is the first to demonstrate that an active break improves executive function compared with a passive (ie, rest) break while not impacting game performance. Interestingly, the continuous play (no break) performed superior to the resting break. Hence, a resting break may be a detriment to esports players.
The complexity and fast-paced demands of FPS gameplay place a significant demand on attention, cognition, working memory and executive function.1 2 In gaming, on a neural basis, elite esports players demonstrate enhanced cognitive control and attention.2 23 These cognitive demands elicit a sympathetic nervous system response presented by heart rate variability, heart rate fluctuations, respiratory rate increases, ventilation changes and blood pressure changes.3 11 This type of demand may lead to mental fatigue, cognitive decline and, possibly, poor performance over time.
This project studied FPS gamers ranked at a highly competitive level. FPS games require rapid speed and reaction time, fine motor hand–eye coordination and demand high amounts of executive function and simultaneous actions.3 FPS gameplay also facilitates HR variability, HR fluctuations and increased cortisol levels.1 3 11 Finally, 2 hours of continuous esports gameplay have resulted in less accuracy and more impulsivity.11 Given the cognitive demands required for high-level esports and the multiple hours of being seated, it is of interest to players and health professionals to incorporate practical ways to improve on performance while also improving health. To date, there are no studies that have comprehensively evaluated the physiological parameters in gamers. Therefore, the mechanisms described below of the underlying effects of prolonged sitting are based on previous studies in other populations and have been well established.
Cerebral blood flow and prolonged sitting
The middle cerebral artery (MCA) accounts for 70%–80% of the brain’s perfusion. In healthy individuals who were not gamers, uninterrupted sitting for 4 hours caused a significant decrease in MCA blood flow velocity to 1.4–3.2 cm/s.10 This may not seem relevant, but this decline has been correlated to decreased focus and fatigue. Simply taking a 2 min light walking break every 30 min prevented these declines and improved cerebral autoregulation.10 Moreover, Wennberg et al found that 3 min of light walking, following 30 min of being seated, reduced fatigue and improved cognition in overweight adults.13 Although we were unable to collect biological variables in this study, we demonstrated an improvement in decision-making and impulsivity following a 6 min light walking break at the 60 min marker.
Endothelial function and prolonged sitting
Thrombolytic events are concern in gamers despite age or activity level.5 7 The underpinning mechanism resulting in DVTs is endothelial function changes and blood flow, resulting from bouts of prolonged sitting. Following 1 hour of sitting, there is a significant reduction in superficial femoral artery flow-mediated dilation and a decrease in popliteal flow-mediated dilation that can last up to 3 hours or more.24 Furthermore, endothelial changes and blood volume changes create an environment that can create blood pooling and more dangerous DVTs or PE. However, these blunted and vascular impairments caused by prolonged sitting were reversed with very light short bouts of activity.25
Exercise intensity
De Las Heras et al exercised gamers using HIIT for 15 min at an RPE of 15.17 (0.34), which translates to working ‘hard’ or ‘heavy’.26 The average RPE for participants in the walking condition in this study was 10.5 (2.8), which translates to ‘light’ intensity effort. Interestingly, the RPE for gaming was higher than the RPE for the walking break. The average perceived intensity level of gameplay was 13.5 (1.2), which is ‘somewhat hard’, further demonstrating the perceived demands of gaming.18 This study demonstrated improvement in cognitive abilities with as little as 6 min of light movement. Additionally, 73.9% of participants perceived that the active walking break positively helped their gaming performance. Based on the results of the IPAQ, there was no relationship between physical activity level and preference for a walking break.
Limitations
There are several limitations to this study. To collect data during the lockdowns of a pandemic, compromises had to be made. Collecting valid objective biometric data proved to be difficult and not feasible. Therefore, the walking effort was determined using the Borg RPE scale. Although this scale is validated, self-report bias may exist. The nature of the online data collection may have impacted how subjects conducted the tests without being in a testing environment. However, this is more reflective of a typical gaming environment than conducting the tests in a lab, which may have increased external validity. Results indicated no study intervention arm significantly impacted player win/loss rate or KDR. Still, other extraneous factors may also impact this (eg, quality of opponent or teammate gameplay, varying maps across games etc). Although there were no executive function changes seen between genders, the physiological changes from prolonged gaming while improving executive function could not be tested in this cohort.