Introduction
Video games are electronically based forms of entertainment, played on television, computers and other electronic platforms, with the key element being human interaction with the electronic platform invoking visual feedback. It is a prevalent pastime activity, today, with a growth rate of 10.7% in the year 2018.1 In the USA alone, it was found that 162 million people own video gaming consoles; 70% of those being adults.2 Worldwide, almost 3 billion people engage in video gaming, with China, France, Germany, Japan and the USA making up the countries with the highest concentration of gamers and most revenue spent.3 Competitive gaming, known as eSports, is a billion dollar enterprise with a growth rate of 14% each year and has an estimated fan base of 454 million fans across the world.4 A study conducted across several countries including the USA and UK, found that the mobile phone was the most popular device to game on, followed by the computer (laptop or desktop) and gaming consoles (Xbox, Playstation, etc), with the least popular being the Tablet.5
Non-active video gaming and active video gaming are two different forms of gamification. Active video games can be defined as ‘video games that require physical activity to play’ and non-active video games are defined as ‘video games that are played sedentary’.6 In addition, non-active gaming, a sedentary behaviour (any waking behaviour characterised by an energy expenditure ≤1.5 metabolic equivalents, while in a sitting, reclining or lying posture) as compared with active video gaming, has negative health implications including weight gain, and an increase in the amount of snacking of sugary foods.6 7 Furthermore, the study associates active video gaming with a higher total energy expenditure. Non-active video gaming as a sedentary behaviour increases the risk of developing metabolic syndrome, a disease defined as ‘central obesity (waist circumference) plus any two of the following four risk factors: raised blood pressure (systolic ≥130 or diastolic ≥85), raised triglycerides (≥150 mg/dL), reduced high density lipoprotein (HDL) cholesterol (<40 mg/dL in males and <50 mg/dL in females) and raised fasting plasma glucose (≥100 mg/dL)’.8 Metabolic syndrome and the associated risk factors increase the risk of myocardial infarction, coronary artery disease and type 2 diabetes.9 It is desirable to be more physically active than sedentary, with physical activity diminishing the risks of chronic diseases, such as non-insulin resistant diabetes and early-onset disability or disability later in life.10
Weight and obesity
Physical activity and exercise promote energy expenditure (burning of calories), and helps control an individual’s appetite by preventing overeating, making it a well-documented means of maintaining or losing weight.11 In modern society, physical activity is no longer as prevalent, given the increase in sedentary behaviour (ie, such as seated video gaming), leading to higher rates of overweight and obesity.12 These behaviours are of concern and on the rise, especially due to the COVID-19 pandemic, physical distancing measures and varied lockdown levels in each country. Overweight and, more specifically, obesity is a limiting factor in being able to perform physical activities. This is a major challenge only exacerbated by increased sedentary habits such as seated video gaming.13
Sedentary behaviour
It is a well-established fact that sedentary behaviour is increasing in prevalence. In previous eras, physical activity was more of a necessity than it is currently.11 12 Previously, people walked longer distances to access public transport, and physical labour was more demanding as they did not have the technological advancements that are present in modern society. More specifically the development of smartphones, televisions and video gaming consoles have resulted in reduced active recreational activities and hobbies, replacing them with more sedentary or seated hobbies, thereby contributing to the increase in sedentary behaviour, physical inactivity and non-communicable diseases (NCDs) in modern society. Cancer is an NCD (not contagious) that has the second highest mortality rate worldwide, second to heart disease.14 Growing evidence suggests a link between the formation of various cancers, and sedentary behaviour. These cancers include colorectal ovarian, endometrial and lung cancer. Seated activities such as non-active video gaming to be statistically associated with the prevalence of colon and rectal cancers. The importance of exercise, specifically aerobic training in preventing colon and rectal cancers is further highlighted.15
Measuring sedentary behaviour
The relationship between physical activity (‘any bodily movement produced by skeletal muscles that requires energy expenditure’14) and sedentary behaviour per week is of paramount importance. The American College of Sports Medicine (ACSM) recommends that adults should engage in at least 30 min of moderate intensity activity 5 days/week (150 min) or 20 min of vigorous intensity activity, three times per week (60 min) in order to help maintain adequate health. Included, is recommendations for strength or resistance training, which should be done two times per week.16 NCDs are found to be a significant cause of death in developed and low-income and middle-income countries.17 These NCDs can include cardiovascular diseases, cancers, diabetes and lung diseases all of which occur from poor lifestyle choices including unhealthy eating, inadequate exercise and smoking coupled with increased sedentary activities. Increasing physical activity levels to the standards of the ACSM guidelines can lead to a reduction in deaths caused by NCDs.
In order to measure the relationship between sedentary behaviour and physical activity, one can make use of the International Physical Activity Questionnaire (I-PAQ), which has been approved and used in 12 different countries to document and compare physical activity levels and behaviours. More specific to our study, one can measure the sedentary activity of non-active video gaming with the use of questions from the I-PAQ. The I-PAQ measures the amount of moderate and vigorous activity an individual engages in on a weekly basis.18 The I-PAQ is also practical (especially in situations where extensive research is required), low cost and easy to administer.10
Association of sedentary behaviour with mental health
Increased sedentary behaviour and reduced physical activity levels are associated with substandard mental health. However, it is unknown if all sedentary activities have this association. Furthermore, a study highlighted an association between low physical activity levels and increased rates of depression (based on a trial over a 2-week period), and that an increase of sedentary behaviour by 32 min/day impacted mental health and overall mood.19 Regarding treatment, for serious mental health disorders, such as major depression, schizophrenia and bipolar disorder, interventions involving reducing sedentary behaviour and increasing physical activity levels have been deemed to be effective. A study conducted in Australia involving the use of accredited exercise physiologists implementing exercise programmes for patients suffering mental disorders, found that exercise programmes and sedentary behaviour reduction interventions to be effective treatment modalities of mental disorders, further finding methodical physical activity to reduce feelings of depression and anxiety, as well as improving sleep patterns.20
Musculoskeletal health
Sedentary behaviour is also associated with musculoskeletal pain.21 Additionally, there is also a link with sedentary behaviour and poor musculoskeletal health. Specifically, prolonged sedentary behaviour and physical inactivity, which relates to muscle strength training and this increases the risk of developing sarcopenia (the loss of overall musculature and strength), osteoporosis (decrease in bone density) and osteoarthritis (joint degeneration).22 Modern society and the nature of the corporate world has led to lengthened amounts of time being spent seated at a desk working. This is coupled with an increase in sedentary hobbies such as seated video gaming. More time is spent being sedentary, causing weight gain and the development of certain NCDs. The increase in weight gain causes an increase in joint and muscle strain on the body, therefore increasing the prevalence of lower back pain. Lower back pain can be prevented or managed through exercise; however, the reality is that most people lead stressful lives that demotivate them to exercise. Not to mention the lack of time being a contributing factor of people not partaking in exercise.23 These pose challenges in modern society. Finding the time for regular exercise can greatly diminish the risks of developing poor musculoskeletal health and help alleviate pain and discomfort related to prolonged seated activities. A 2019 review of current physical activity recommendations shows that exercise can diminish musculoskeletal pains in the shoulders, neck and back and can also help manage chronic lower back pain. A more sedentary lifestyle can increase the risk of developing chronic pain resulting in muscle atrophy, and fatigue as well as joint stiffness and immobility, all of which can be treated through exercise therapy.24
Study rationale
In modern society, there is an ever-increasing prevalence of sedentary behaviour (coupled with additional screen time), which leads to reduced physical activity and an increase in poor musculoskeletal health, especially during the COVID-19 pandemic. This paints a concerning picture for the future world we live in where more people may become sedentary, and subsequently, unhealthy.21
Previous studies regarding video gameplay, and its contribution to sedentary behaviour have solely focused on adolescents and the youth, but have neglected to include adults, who make up the greater proportion of video gamers. This limited research provides a challenge in us understanding whether or not seated video gameplay does actually contribute to sedentary behaviour. On the other hand, musculoskeletal health and more specifically poor musculoskeletal health, have been associated with sedentary behaviour. Most studies have focused on musculoskeletal health within the workplace. There currently exists limited data on recreational sedentary hobbies such as video gaming which could potentially pose a risk in one developing poor musculoskeletal health.
Therefore, the primary aim of this research was to determine the physical activity levels of non-active video gamers, and to determine how much other time was spent with sedentary behaviours, both in recreational and occupational domains. The secondary aim of this study was to establish whether or not seated video gameplay, a sedentary hobby, contributed to increased prevalence of physical inactivity, and poor musculoskeletal health among adult South African video gamers. In order to do this, it was necessary to investigate the lifestyles, gaming habits and musculoskeletal health of this population.
