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.
Systematic Review (n=489)
Does esports gameplay alter heart rate variability compared to a resting state?
Esports gameplay significantly decreases vagally mediated heart rate variability parameters (RMSSD and HF), indicating an acute autonomic stress response despite being a sedentary activity.
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
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.
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.