The acute effects of esports on heart rate variability: a systematic review and meta-analysis

Q: What are the key findings of this study?

Esports gameplay acutely reduced RMSSD by SMD 0.24 and high-frequency HRV by SMD 0.47 compared to resting state, indicating decreased parasympathetic activity.

Q: What is the clinical evidence from this study?

Study design: Systematic Review. Population: Humans of all ages exposed to acute esports gameplay versus resting state (n=489). Intervention: Esports gameplay vs. Resting state (baseline). Primary outcome: Heart rate variability (HRV) parameters during esports gameplay compared with resting state (RMSSD SMD 0.24; 95% CI: 0.10–0.38; P < 0.001; HF SMD 0.47; 95% CI: 0.14–0.81; P = 0.006).

Q: What does this research mean for the field?

Esports significantly decrease heart rate variability (HRV) metrics, specifically RMSSD and high-frequency (HF) components, compared to resting states. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To evaluate the acute physiological effects of competitive esports gameplay on time-domain and frequency-domain indices of heart rate variability compared with resting baseline.

Haitao Lyu; Zhipeng Gu; Yanle Li; Yekui Luo

doi:10.3389/fphys.2026.1762922

March 2, 2026Frontiers in PhysiologyOpen Access

The acute effects of esports on heart rate variability: a systematic review and meta-analysis

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Key result

Esports gameplay acutely reduces HRV vs rest, indicating decreased parasympathetic activity.

RMSSD SMD −0.24; 95% CI: 0.10–0.38; P < 0.001; HF SMD 0.47; 95% CI: 0.14–0.81; P = 0.006
n=489

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Why the study?

The study was conducted to analyze the acute effects of esports on heart rate variability using systematic review and meta-analysis methods.

Does esports gameplay alter heart rate variability compared to a resting state?

Key Points

To evaluate the acute physiological effects of competitive esports gameplay on time-domain and frequency-domain indices of heart rate variability compared with resting baseline.
Systematically searched PubMed, Web of Science, and Scopus through 20 July 2025, identifying 12 eligible studies published between 2017 and 2025 with 489 total participants across seven countries.
Conducted random-effects meta-analyses using Review Manager 5.4 to evaluate time-domain (RMSSD, SDNN, pNN50, NN50) and frequency-domain (HF, LF, LF/HF) metrics during gameplay versus resting states.
Esports gameplay significantly reduced RMSSD (SMD = 0.24; 95% CI: 0.10–0.38; P < 0.001; I2 = 4%) across 10 studies (n = 439) and decreased high-frequency power (SMD = 0.47; 95% CI: 0.14–0.81; P = 0.006; I2 = 72%) compared with resting baseline.
No significant changes occurred for SDNN (SMD = 0.14; 95% CI: −0.08 to 0.35; P = 0.21), pNN50 (SMD = 0.14; 95% CI: −0.12 to 0.41; P = 0.29), or low-frequency power (SMD = 0.04; 95% CI: −0.19 to 0.28; P = 0.71).

Study Design

Type

Systematic Review (n=489)

Structured PICO

Does esports gameplay alter heart rate variability compared to a resting state?

P

Population

12 studies pooling 489 participants (including adults, college students, and esports players)

I

Intervention

Esports gameplay (competitive video gaming across various genres including MOBA, sports, mobile, shooters, and fighting games)

C

Comparator

Resting state (pre-game or seated/supine rest)

O

Outcome

Heart rate variability (HRV) indices including RMSSD, SDNN, pNN50, NN50, HF, LF, LF/HF, and VLFsurrogate

Main Result

Effect estimate: RMSSD SMD 0.24; 95% CI: 0.10–0.38; P < 0.001; HF SMD 0.47; 95% CI: 0.14–0.81; P = 0.006

Esports gameplay significantly decreases vagally mediated heart rate variability parameters (RMSSD and HF), indicating an acute autonomic stress response despite being a sedentary activity.

Limitations

Included studies were predominantly single-group pre-post designs limiting evidence quality
Heterogeneity in HRV measurement protocols and durations
Lack of standardized definition of esports may have excluded some studies
Relatively small total sample size and heterogeneity limit generalizability
Lack of randomization in most included studies
Lack of blinding for participants or providers, potentially introducing performance bias
High heterogeneity in some outcomes (e.g., HF, LF/HF)

Discussion

No takes yet. Share an insight, caveat, or question.

Implication

May inform recovery practices in esports athletes; extends HRV research to sedentary competitive gaming.

Abstract

Purpose The aim of this study was to apply systematic review and meta-analysis methods to analyze the acute effects of esports on heart rate variability (HRV). Methods This study systematically searched the PubMed, Web of Science, and Scopus databases, covering publications up to 20 July 2025. Two reviewers independently screened the literature and extracted data, and the analyses were conducted using Review Manager 5.4. Results The results indicated that, compared with the resting state, the root mean square of successive differences (RMSSD) [SMD = 0.24; 95% CI: 0.10–0.38; P < 0.001] and high-frequency (HF) [SMD = 0.47; 95% CI: 0.14–0.81; P = 0.006] significantly decreased during gameplay. However, no significant differences were observed for standard deviation of normal-to-normal intervals (SDNN), percentage of adjacent normal-to-normal intervals differing by > 50 m (pNN50), low-frequency (LF), or the low to high frequency ratio (LF/HF). Conclusion The study suggests that, although esports is a sedentary activity, it can nevertheless elicit significant autonomic nervous responses. These findings enrich the understanding of the physiological mechanisms of esports and provide empirical support for player health management, training optimization, and psychological regulation strategies.

Cite This Study

Lyu et al. (2026) conducted a systematic review in Humans of all ages exposed to acute esports gameplay versus resting state (n=489). Esports gameplay vs. Resting state (baseline) was evaluated on Heart rate variability (HRV) parameters during esports gameplay compared with resting state (RMSSD SMD 0.24; 95% CI: 0.10–0.38; P < 0.001; HF SMD 0.47; 95% CI: 0.14–0.81; P = 0.006). Esports gameplay acutely reduced RMSSD by SMD 0.24 and high-frequency HRV by SMD 0.47 compared to resting state, indicating decreased parasympathetic activity.

synapsesocial.com/papers/69a91cbed6127c7a504bfa95 https://doi.org/10.3389/fphys.2026.1762922

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The acute effects of esports on heart rate variability: a systematic review and meta-analysis

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Discussion

Implication

Abstract

Cite This Study

The acute effects of esports on heart rate variability: a systematic review and meta-analysis

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Discussion

Implication

Abstract

Cite This Study

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