Video Games and Stress: How Stress Appraisals and Game Content Affect Cardiovascular and Emotion Outcomes

Altered Heart Rate Variability During Mobile Game Playing and Watching Self-Mobile Gaming in Individuals with Problematic Mobile Game Use: Implications for Cardiac Health

Introduction

The surge in mobile gaming, fueled by smartphone and internet accessibility, lacks a comprehensive understanding of physiological changes during gameplay.

Methods

This study, involving 93 participants (average age 21.75 years), categorized them into Problematic Mobile Gaming (PMG) and non-problematic Mobile Gaming (nPMG) groups based on Problematic Mobile Gaming Questionnaire (PMGQ) scores. The PMGQ is a 12-item scale developed in Taiwan to assess symptoms of problematic mobile gaming. The research delved into heart rate variability (HRV) alterations during real-time mobile gaming and self-gaming video viewing.

Results

Results showed that the PMG group significantly presents a lower root mean square of successive differences (RMSSD), and High Frequency (lnHF) than does the nPMG group (F=4.73, p=0.03; F=10.65, p=0.002, respectively) at the baseline. In addition, the PMG group significantly displayed elevated HF and low-frequency to high-frequency (LF/HF) in the mobile-gaming (F=7.59, p=0.007; F=9.31, p=0.003) condition as well as in the watching self-gaming videos (F=9.75, p=0.002; F=9.02, p=0.003) than did the nPMG.

Conclusion

The study suggests targeted interventions to mitigate autonomic arousal, offering a potential avenue to address adverse effects associated with problematic mobile gaming behavior. The PMG group displayed increased craving scores after real-time mobile gaming and watching self-gaming video excerpts, unlike the nPMG group. Elevated LF/HF ratios in frequent gaming cases heightened autonomic arousal, presenting challenges in relaxation after mobile gaming. These findings contribute to a nuanced understanding of the complex interplay between mobile gaming activities, physiological responses, and potential intervention strategies.

Heartbeats and high scores: esports triggers cardiovascular and autonomic stress response

Introduction

Gaming is often labeled as sedentary behavior. However, competitive gaming, also known as esports, involves significant cognitive demands and may induce stress. This study aims to investigate whether the psychophysical demands during esports elicit a physiological stress response.

Methods

Fourteen FIFA 21 and thirteen League of Legends players (23.3 ± 2.8 years) were recruited for the study. Heart rate (HR), root mean square of successive differences between normal heartbeats (RMSSD), peripheral and central blood pressure (BP), pulse wave velocity (PWV), and energy expenditure (EE) were assessed during supine rest, seated rest, and competitive FIFA or League of Legends matches.

Results

No significant group × condition interactions were observed for any of the outcomes. However, there were significant increases in mean HR (p < 0.001, η p 2  = 0.383), RMSSD (p = 0.019, η p 2  = 0.226), peripheral systolic BP (p < 0.001, η p 2  = 0.588), peripheral diastolic BP (p = 0.005, η p 2  = 0.272), central systolic BP (p = 0.005; η p 2  = 0.369), central diastolic BP (p = 0.016, η p 2  = 0.313), PWV (p = 0.004, η p 2  = 0.333), and EE (p < 0.001, η p 2  = 0.721) during both games compared to the seated rest condition.

Conclusion

Despite the sedentary nature of esports, the psychophysical demands appear to elicit physiological responses. Interestingly, no significant differences were found between the different game genres.

Two Sides of the Same Virtual Coin: Investigating Psychosocial Effects of Video Game Play, including Stress Relief Motivations as a Gateway to Problematic Video Game Usage

Video gamers can play to negate the psychological impact of stress, which may become problematic when users over-rely on the stress relief potential of gaming. This study used a repeated measures experimental design to investigate the relationships between stress, video gaming, and problematic video gaming behaviours in a convenience sample of 40 students at a UK university. The results indicated that positive affect increased and negative affect decreased, whilst a biological stress measure (instantaneous pulse rate) also decreased after a short video gaming session (t(36) = 4.82, p < 0.001, d = 0.79). The results also suggested that video gaming can act as a short-term buffer against the physiological impact of stress. Further research should focus on testing individuals who have been tested for gaming disorder, as opposed to the general population. Research could also utilise variations of the methodological framework used in this study to examine the intensity of a stress relief effect under different social situations. The study's findings in relation to published works are also discussed.

Heart Rate Variability during Online Video Game Playing in Habitual Gamers: Effects of Internet Addiction Scale, Ranking Score and Gaming Performance

Previous studies have demonstrated that individuals with internet gaming disorder (IGD) display abnormal autonomic activities at rest and during gameplay. Here, we examined whether and how in-game autonomic activity is modulated by human characteristics and behavioral performance of the player. We measured heart rate variability (HRV) in 42 male university student habitual gamers (HGs) when they played a round of League of Legends game online. Short-term HRV indices measured in early, middle and late phases of the game were compared between the players at high risk of developing IGD and those at low risk, as assessed by the revised Chen Internet addiction scale (CIAS-R). Multiple linear regression (MLR) was used to identify significant predictors of HRV measured over the whole gameplay period (WG), among CIAS-R, ranking score, hours of weekly playing and selected in-game performance parameters. The high-risk players showed a significantly higher low-frequency power/high-frequency power ratio (LF/HF) relative to the low-risk players, regardless of game phase. MLR analysis revealed that LF/HF measured in WG was predicted by, and only by, CIAS-R. The HRV indicators of sympathetic activity were found to be predicted only by the number of slain in WG (NSlain), and the indicators of parasympathetic activity were predicted by both CIAS-R and NSlain. Collectively, the results demonstrated that risk of developing IGD is associated with dysregulated autonomic balance during gameplay, and in-game autonomic activities are modulated by complex interactions among personal attributes and in-game behavioral performance of the player, as well as situational factors embedded in game mechanics.

Assessment of the human response to acute mental stress-An overview and a multimodal study

Numerous vital signs are reported in association with stress response assessment, but their application varies widely. This work provides an overview over methods for stress induction and strain assessment, and presents a multimodal experimental study to identify the most important vital signs for effective assessment of the response to acute mental stress. We induced acute mental stress in 65 healthy participants with the Mannheim Multicomponent Stress Test and acquired self-assessment measures (Likert scale, Self-Assessment Manikin), salivary α-amylase and cortisol concentrations as well as 60 vital signs from biosignals, such as heart rate variability parameters, QT variability parameters, skin conductance level, and breath rate. By means of statistical testing and a self-optimizing logistic regression, we identified the most important biosignal vital signs. Fifteen biosignal vital signs related to ventricular repolarization variability, blood pressure, skin conductance, and respiration showed significant results. The logistic regression converged with QT variability index, left ventricular work index, earlobe pulse arrival time, skin conductance level, rise time and number of skin conductance responses, breath rate, and breath rate variability (F1 = 0.82). Self-assessment measures indicated successful stress induction. α-amylase and cortisol showed effect sizes of -0.78 and 0.55, respectively. In summary, the hypothalamic-pituitary-adrenocortical axis and sympathetic nervous system were successfully activated. Our findings facilitate a coherent and integrative understanding of the assessment of the stress response and help to align applications and future research concerning acute mental stress.

Physiological Signal Analysis and Stress Classification from VR Simulations Using Decision Tree Methods

Stress is induced in response to any mental, physical or emotional change associated with our daily experiences. While short term stress can be quite beneficial, prolonged stress is detrimental to the heart, muscle tissues and immune system. In order to be proactive against these symptoms, it is important to assess the impact of stress due to various activities, which is initially determined through the change in the sympathetic (SNS) and parasympathetic (PNS) nervous systems. After acquiring physiological data wirelessly through captive electrocardiogram (ECG), galvanic skin response (GSR) and respiration (RESP) sensors, 21 time, frequency, nonlinear, GSR and respiration features were manually extracted from 15 subjects ensuing a baseline phase, virtual reality (VR) roller coaster simulation, color Stroop task and VR Bubble Bloom game. This paper presents a comprehensive physiological analysis of stress from an experiment involving a VR video game Bubble Bloom to manage stress levels. A personalized classification and regression tree (CART) model was developed using a novel Gini index algorithm in order to effectively classify binary classes of stress. A novel K-means feature was derived from 11 other features and used as an input in the Decision Tree (DT) algorithm, strong learners Ensemble Gradient Boosting (EGB) and Extreme Gradient Boosting (XGBoost (XGB)) embedded in a pipeline to classify 5 classes of stress. Results obtained indicate that heart rate (HR), approximate entropy (ApEN), low frequency and high frequency ratio (LF/HF), low frequency (LF), standard deviation (SD1), GSR and RESP all reduced and high frequency (HF) increased following the VR Bubble Bloom game phase. The personalized CART model was able to classify binary stress with 87.75% accuracy. It proved to be more effective than other related studies. EGB was able to classify binary stress with 100% accuracy, which outperformed every other related study. XGBoost and DT were able to classify five classes of stress with 72.22% using the novel K-means feature. This feature produced less error and better model performance in comparison to using all the features. Results substantiate that our proposed methods were more effective for stress classification than most related studies.

Neurobiological Link between Stress and Gaming: A Scoping Review

Research on video gaming has been challenged by the way to properly measure individual play experience as a continuum, and current research primarily focuses on persons with gaming disorder based on the diagnostic criteria established in relation to substance use and gambling. To better capture the complexity and dynamic experience of gaming, an understanding of brain functional changes related to gaming is necessary. Based on the proinflammatory hypothesis of addiction, this scoping review was aiming to (1) survey the literature published since 2012 to determine how data pertinent to the measurement of stress response had been reported in video gaming studies and (2) clarify the link between gaming and stress response. Eleven studies were included in this review, and the results suggest that gaming could stimulate a stress-like physiological response, and the direction of this response is influenced by an individual's biological profile, history of gaming, and gaming content. Our findings highlight the need for future investigation of the stress-behaviour correlation in the context of gaming, and this will assist in understanding the biological mechanisms underlying game addiction and inform the potential targets for addiction-related proinflammatory research.

Health Consequences of Intensive E-Gaming: A Systematic Review

The aim of this review is to examine the links among the different factors that determine harmful or even deadly events in professional and semiprofessional intensive Esports players. Cases of serious injuries or even death in young (<35 years old) male professional Esports players are reported every year. Fatalities and injuries in professional Esports players (PEGS) have only affected male players, and these events have mostly been concentrated in Asia. Studies in the literature have reported several causes and mechanisms of injuries. Links between injuries and previous comorbidities have emerged from the extant literature; obesity and/or metabolic disorders, seizures (associated with overstimulation of the eyes), heart malfunctions, high basal and abrupt increases in systolic blood pressure (SBP), prolonged stress, and poor posture have been associated with injuries. Several clinical signs have been identified and the question emerges whether or not self-regulation by Esports associations or public health authorities is necessary.

Large Estimate Variations in Assessed Energy Expenditure and Physical Activity Levels during Active Virtual Reality Gaming: A Short Report

The purpose of the study was to compare methods for estimating energy expenditure (EE) and physical activity (PA) intensity during a 30 min session of active virtual reality (VR) gaming. Eight individuals (age = 25.4 ± 2.0 yrs) participated, with a maximal oxygen consumption (VO2max) of 41.3 ± 5.7 mL∙kg−1∙min−1. All tests were conducted over two days. An incremental test to determine the VO2max when running was performed on day 1, while 30 min of active VR gaming was performed on day 2. The instruments used for EE estimations and PA measurements were indirect calorimetry, a heart rate (HR) monitor, and waist- and wrist-worn accelerometer. Compared to indirect calorimetry, waist-worn accelerometers underestimated EE (mean difference: −157.3 ± 55.9 kcal, p < 0.01) and PA levels. HR-based equations overestimated EE (mean difference: 114.8 ± 39.0 kcal, p < 0.01 and mean difference: 141.0 ± 81.6 kcal, p < 0.01). The wrist-worn accelerometer was the most accurate in estimating EE (mean difference: 23.9 ± 45.4 kcal, p = 0.95). The large variations in EE have implications for population-based surveillance of PA levels and for clinical studies using active VR gaming.

The Association between Video Game Time and Adolescent Mental Health: Evidence from Rural China

As digital devices like computers become more widely available in developing countries, there is a growing need to understand how the time that adolescents spend using these devices for recreational purposes such as playing video games is linked with their mental health outcomes. We measured the amount of time that adolescents in rural China spent playing video games and the association of video game time with their mental health. We collected data from primary and junior high schools in a poor, rural province in northwest China (n = 1603 students) and used the Depression, Anxiety, and Stress Scales (DASS-21) to measure mental health symptoms. The results indicated that the average video game time was about 0.69 h per week. There was a significant association between adolescent video game time and poorer mental health. Each additional hour of playing video games also increased the chance of having moderate or above symptoms. Moreover, boys and non-left-behind children had worse mental health if they played more video games. Our study contributes to literature on the links between recreational screen time and mental health, and it sheds light on an issue addressed by recent government legislation to limit the video game time of minors in China.

A Multi-Analysis of Children and Adolescents' Video Gaming Addiction with the AHP and TOPSIS Methods

The video game market has become increasingly popular among children and adolescents in recent decades. In this research, we investigated the Video Game Addiction Scale (VGAS) for Chinese children and adolescents. We aimed to examine children and adolescents' prioritization on the VGAS criteria and comparative analysis of the trend of video game addiction among them. A cross-sectional paper questionnaire study was conducted on 1400 Chinese students from grade 3 (9 years old) to grade 12 (18 years old). The respondents had to complete the socio-demographic information and the VGAS test. The VGAS characteristic was prepared in 18 criteria, which was the combination of the Video Game Addiction Test (VAT), Gaming Addiction Scale (GAS), and Revised Chinese Internet Addiction (CIAS-R). Eventually, the VGAS criteria prioritization was ranked methodologically through the Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) method for each grade separately. Additionally, the Analytic Hierarchy Process (AHP) weighting technique was utilized to analyze the video game addiction of each grade under the four alternatives, individually. The results indicate that 3rd-grade students with some levels of addiction were the youngest who felt their life would not be fun without video games. Students in 5th grade with some levels of addiction were the youngest students who disclosed that their willingness to play video games is for forgetting their problems or feeling down. Moreover, they played video games more than before, thus, they did not sleep enough. Pupils of grade 6 reported that they played video games more than last semester. In their opinion, it is fair to play video games this much and does not need to reduce playing hours. Not getting enough sleep because of playing video games was seen in 7th graders as their first preference. 10th-grade students were the first to neglect to do their important responsibilities for playing video games. None of the 7th and 12th graders were somehow safe from video game addiction. In conclusion, playing video games can negatively affect studying, sleeplessness, getting far from society, and skipping important responsibilities for school students. Furthermore, the symptoms of video game addiction had seen at younger ages. These data provided insights for decision-makers to target effective measures to prevent children and adolescents' video game addiction.

Arousal/Stress Effects of "Overwatch" eSports Game Competition in Collegiate Gamers

ABSTRACT

Kraemer, WJ, Caldwell, LK, Post, EM, Beeler, MK, Emerson, A, Volek, JS, Maresh, CM, Fogt, JS, Fogt, N, Häkkinen, K, Newton, RU, Lopez, P, Sanchez, BN, and Onate, JA. Arousal/stress effects of "Overwatch" eSports game competition in collegiate gamers. J Strength Cond Res XX(X): 000-000, 2022-To date, no physical response data are available for one of the most popular eSport games, Overwatch. The purpose of this investigation was to describe the stress signaling associated with competitive Overwatch play and to understand how acute hormonal responses may affect performance. Thirty-two male college-aged gamers (age: 21.3 ± 2.7 years; estimated time played per week: 18 ± 15 hours) completed the study. Subjects were randomly assigned to a 6-player team to compete in a tournament-style match. Salivary measures of cortisol and testosterone were collected immediately before (PRE) and after (POST) the first-round game, with the heart rate recorded continuously during the match. The mean characteristics were calculated for each variable and comparisons made by the skill level. Significance was defined as p ≤ 0.05. There were no differences in measures of salivary cortisol. A differential response pattern was observed by the skill level for testosterone. The low skill group displayed a significant increase in testosterone with game play (mean ± SD, testosterone PRE: 418.3 ± 89.5 pmol·L-1, POST: 527.6 ± 132.4 pmol·L-1, p < 0.001), whereas no change was observed in the high skill group. There were no differences in heart rate characteristics between skill groups. Overall, the average heart rate was 107.2 ± 17.8 bpm with an average max heart rate of 133.3 ± 19.1 bpm. This study provides unique physiological evidence that a sedentary Overwatch match modulates endocrine and cardiovascular responses, with the skill level emerging as a potential modulator.

Tracking Cognitive Workload in Gaming with In-Ear [Formula: see text]

The feasibility of using in-ear [Formula: see text] to track cognitive workload induced by gaming is investigated. This is achieved by examining temporal variations in cognitive workload through the game Geometry Dash, with 250 trials across 7 subjects. The relationship between performance and cognitive load in Dark Souls III boss fights is also investigated followed by a comparison of the cognitive workload responses across three different genres of game. A robust decrease in in-ear [Formula: see text] is observed in response to cognitive workload induced by gaming, which is consistent with existing results from memory tasks. The results tentatively suggest that in-ear [Formula: see text] may be able to distinguish cognitive workload alone, whereas heart rate and breathing rate respond similarly to both cognitive workload and stress. This study demonstrates the feasibility of low cost wearable cognitive workload tracking in gaming with in-ear [Formula: see text], with applications to the play testing of games and biofeedback in games of the future.

A Multimodal Approach for Real Time Recognition of Engagement towards Adaptive Serious Games for Health

In this article, an unobtrusive and affordable sensor-based multimodal approach for real time recognition of engagement in serious games (SGs) for health is presented. This approach aims to achieve individualization in SGs that promote self-health management. The feasibility of the proposed approach was investigated by designing and implementing an experimental process focusing on real time recognition of engagement. Twenty-six participants were recruited and engaged in sessions with a SG that promotes food and nutrition literacy. Data were collected during play from a heart rate sensor, a smart chair, and in-game metrics. Perceived engagement, as an approximation to the ground truth, was annotated continuously by participants. An additional group of six participants were recruited for smart chair calibration purposes. The analysis was conducted in two directions, firstly investigating associations between identified sitting postures and perceived engagement, and secondly evaluating the predictive capacity of features extracted from the multitude of sources towards the ground truth. The results demonstrate significant associations and predictive capacity from all investigated sources, with a multimodal feature combination displaying superiority over unimodal features. These results advocate for the feasibility of real time recognition of engagement in adaptive serious games for health by using the presented approach.

Invisible ECG for High Throughput Screening in eSports

eSports is a rapidly growing industry with increasing investment and large-scale international tournaments offering significant prizes. This has led to an increased focus on individual and team performance with factors such as communication, concentration, and team intelligence identified as important to success. Over a similar period of time, personal physiological monitoring technologies have become commonplace with clinical grade assessment available across a range of parameters that have evidenced utility. The use of physiological data to assess concentration is an area of growing interest in eSports. However, body-worn devices, typically used for physiological data collection, may constitute a distraction and/or discomfort for the subjects. To this end, in this work we devise a novel "invisible" sensing approach, exploring new materials, and proposing a proof-of-concept data collection system in the form of a keyboard armrest and mouse. These enable measurements as an extension of the interaction with the computer. In order to evaluate the proposed approach, measurements were performed using our system and a gold standard device, involving 7 healthy subjects. A particularly advantageous characteristic of our setup is the use of conductive nappa leather, as it preserves the standard look and feel of the keyboard and mouse. According to the results obtained, this approach shows 3-15% signal loss, with a mean difference in heart rate between the reference and experimental device of -1.778 ± 4.654 beats per minute (BPM); in terms of ECG waveform morphology, the best cases show a Pearson correlation coefficient above 0.99.

Electroencephalography in Evaluating Mental Workload of Gaming

The feasibility of electroencephalography (EEG) analysis in evaluating mental workload of gaming was studied by carrying out a proof-of-concept type experiment on a set of EEG recordings, with a bespoke tool developed for the purpose. The EEG recordings (20 recordings in total) that were used in the experiment had been acquired by groups of students and staff of Tampere University during n-back gaming sessions, as part of course projects. The ratio of theta and alpha power, calculated over the EEG signal segments that were time-locked to game events, was selected as EEG metrics for mental load evaluation. Also, Phase Locking Value (PLV) was calculated for all pairs of EEG channels to assess the change in phase synchronization with the increasing difficulty level of the game. Wilcoxon rank-sum test was used to compare the metrics between the levels of the game (from 1-back to 4-back). The rank-sum test results revealed that the theta-alpha power ratio calculated from the frontal derivations Fp1 and Fp2 performed as a confident indicator for the evaluation and comparison of mental load. Also, phase locking between EEG derivations was found to become stronger with the increasing difficulty level of the game, especially in the case of channel pairs where the electrodes were located at opposite hemispheres.

Classification of the risk of internet gaming disorder by flow short scale and cardiovascular response

The American Psychiatric Association has identified Internet gaming disorder (IGD) as a potential psychiatric disorder. Questionnaires are the main method to classify high-risk IGD (HIGD) and low-risk IGD (LIGD). However, the results obtained using questionnaires might be affected due to several factors. Flow can measure a person's state of concentration and cardiovascular signals can reflect the autonomic responses of a person. We propose to observe the cardiovascular responses and flow scores from the flow short scale of the HIGD and LIGD groups to assist questionnaires in IGD risk assessment. The preliminary study recruited 18 gamers from colleges. Games with the easy and hard levels were set to arouse desire for playing. The result showed that the flow scores of five HIGD participants were significantly lower compared with that of 13 LIGD participants. The stroke volume (SV) of the LIGD group during baseline (67.06 ± 11.61) was significantly greater that of (p < 0.05) while playing the easy game (64.08 ± 10.37) and playing the hard game (63.70 ± 9.89). For the LIGD group, the cardiac output (CO) during baseline (5.28 ± 0.97) was significantly greater (p < 0.01) than that of recovery (5.03 ± 0.83), and while playing the easy game (5.34 ± 0.98) it was significantly more than that during recovery (p < 0.05). For the HIGD group, a significant difference in the heart rate, SV, and CO was not observed. The changes in cardiovascular responses of the LIGD group are greater than that of the HIGD group. Gamers with LIGD might have a higher susceptibility to the negative effect of playing video games, but gamers with HIGD might not. The finding of this study might help psychologists to estimate the IGD risk.Clinical Relevance- This study investigated the differences in the score of flow short scale, self-assessment manikin, challenge/skill, emotional questionnaire, and the changes in the cardiovascular responses between the HIGD and LIGD groups.

Analysis of Heart Rate Variability in Response to Serious Games in Elderly People

As the proportion of elderly people continues to grow, so does the concern about age-related cognitive decline. Serious games have been developed for cognitive training or treatment, but measuring the activity of the autonomic nervous system (ANS) has not been taken to account. However, cognitive functioning has been known to be heavily influenced by the autonomic nervous system (ANS), and ANS activity can be quantified using heart rate variability (HRV). This paper aims to analyze the physiological response in normal elderly people as they play two types of serious games using HRV features from electrocardiography (ECG). A wearable device designed in-house was used to measure ECG, and the data from this device was pre-processed using digital signal processing techniques. Ten HRV features were extracted, including time-domain, nonlinear, and frequency-domain features. The experiment proceeds as follows: rest for three minutes, play a cognitive aptitude game, rest for another three minutes, followed by two reaction time games. Data from thirty older adults (age: 65.9 ± 7.34; male: 15, female: 15) were analyzed. The statistical results show that there was a significant difference in the HRV between the two types of games. From this, it can be concluded that the type of game has a significant effect on the ANS response. This can be further used in designing games for the elderly, either for training or mood management.

Commercial Off-The-Shelf Video Games for Reducing Stress and Anxiety: Systematic Review

BACKGROUND

Using commercial off-the-shelf video games rather than custom-made computer games could have several advantages for reducing stress and anxiety, including their low cost, advanced graphics, and the possibility to reach millions of individuals worldwide. However, it is important to emphasize that not all commercial video games are equal, and their effects strongly depend on specific characteristics of the games.

OBJECTIVE

The aim of this systematic review was to describe the literature on the use of commercial off-the-shelf video games for diminishing stress and anxiety, examining the research outcomes along with critical variables related to computer game characteristics (ie, genre, platform, time of play).

METHODS

A systematic search of the literature was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. The search databases were PsycINFO, Web of Science, Medline, IEEExplore, and the Cochrane Library. The search string was: [("video game*") OR ("computer game*")] AND [("stress") OR ("anxiety") OR ("relaxation")] AND [("study") OR ("trial") OR ("training")].

RESULTS

A total of 28 studies met the inclusion criteria for the publication period 2006-2021. The findings demonstrate the benefit of commercial off-the-shelf video games for reducing stress in children, adults, and older adults. The majority of the retrieved studies recruited young adults, and fewer studies have involved children, middle-aged adults, and older adults. In addition to exergames and casual video games, other genres of commercial off-the-shelf games helped to reduce stress and anxiety.

CONCLUSIONS

Efficacy in reducing stress and anxiety has been demonstrated not only for exergames and casual video games but also for other genres such as action games, action-adventure games, and augmented reality games. Various gaming platforms, including consoles, PCs, smartphones, mobile consoles, and virtual reality systems, have been used with positive results. Finally, even single and short sessions of play had benefits in reducing stress and anxiety.

TRIAL REGISTRATION

International Platform of Registered Systematic Review and Meta-analysis Protocols INPLASY202130081; https://inplasy.com/?s=INPLASY202130081.

The effects of competitive and interactive play on physiological state in professional esports players

In esports competitions, both motor skills used to manipulate an avatar and psychological skills are important to achieve optimal performance. Previous studies have investigated the role of psychological skill on computer game performance by observing the modulation of physiological state. However, how physiological state is modulated in esports athletes during an esports match is unclear. In this study, we examined two hypotheses to clarify the effects of competitive and interactive play on the physiological state of esports professionals: (1) the sympathetic nervous system of esports players is activated by competitive play and modulated by the game situation, and (2) the autonomic nervous system activities of players in dyads are synchronized positively/negatively by interpersonal interaction.

We measured electrocardiograms (ECGs) in nine professional esports players while they played a fighting video game to investigate changes in physiological state. We compared ECGs collected in the resting state, while playing against a computer, and while playing against other players. We calculated the mean heart rate (HR), temporal pattern of HR, and correlation of temporal HR patterns of the pairs in the player-versus-player condition.

The results showed that mean HR was elevated by the presence of a human opponent compared with a computer opponent, and an increase in mean HR was also observed in specific game situations (beginning of the match, toward the end of a game or match). These results suggest that the sympathetic nervous system in esports players is activated by competitive play and is modulated by the game situation. In addition, the temporal HR patterns in the opponent pairs were synchronized, suggesting that autonomic nervous system activity is synchronized in player dyads via interpersonal interaction during competitive play. Our results provide insight regarding the relationship between physiological state and psychological skill in esports professionals during esports competitions.

Applications of Biological and Physiological Signals in Commercial Video Gaming and Game Research: A Review

Video gaming is now available as a fully immersive experience that creates responsive inputs and outputs concerning the user, and some experimental developers have integrated the use of the voice, brain, or muscles as input controls. The use of physiological signal equipment can provide valuable information regarding the emotion of a player or patient during gameplay. In this article, we discuss five of the most common biosignals that are used in gaming research, and their function and devices that may be used for measurement. We break down those individual signals and present examples of research studies that implement them. We also discuss the usage of biological signals within commercial gaming and conclude with some possible future directions for the use of biological signals in gaming and game research.

Is early life adversity a trigger towards inflammageing?

There are many 'faces' of early life adversity (ELA), such as childhood trauma, institutionalisation, abuse or exposure to environmental toxins. These have been implicated in the onset and severity of a wide range of chronic non-communicable diseases later in life. The later-life disease risk has a well-established immunological component. This raises the question as to whether accelerated immune-ageing mechanistically links early-life adversity to the lifelong health trajectory resulting in either 'poor' or 'healthy' ageing. Here we examine observational and mechanistic studies of ELA and inflammageing, highlighting common and distinct features in these two life stages. Many biological processes appear in common including reduction in telomere length, increased immunosenescence, metabolic distortions and chronic (viral) infections. We propose that ELA shapes the developing immune, endocrine and nervous system in a non-reversible way, creating a distinct phenotype with accelerated immunosenescence and systemic inflammation. We conclude that ELA might act as an accelerator for inflammageing and age-related diseases. Furthermore, we now have the tools and cohorts to be able to dissect the interaction between ELA and later life phenotype. This should, in the near future, allow us to identify the ecological and mechanistic processes that are involved in 'healthy' or accelerated immune-ageing.

Análise da variabilidade da frequência cardíaca em crianças submetidas a jogos eletrônicos

Objetivo: avaliar a função autonômica do coração de crianças sadias em situações de jogos eletrônicos, mediante a análise de Variabilidade da Frequência cardíaca.Métodos: participaram deste estudo 60 crianças sadias, que foram monitoradas por um monitor de frequência cardíaca digital e submetidas ao experimento com o jogo eletrônico. A análise da Variabilidade da Frequência cardíaca foi calculadacom emprego da transformada Wavelet Contínua.Resultados: pode-se observar um aumento na intensidade dos valores de baixa frequência/alta frequência, sugerindo influência das fases do protocolo, de modo que houve uma elevação nos valores da fase de Repouso para a fase de Jogo, mas não foi encontrado um valor significativo. Entre as fases de Repouso (1,52±0,97 ms²) e Recuperação (1,89±1,04 ms²) houve um aumento significativo obtendo um valor de p=0,003. Comparando os valores de baixa frequência/alta frequência entre as fases Jogo 2,37±1,20 ms² e Recuperação 1,89±1,04 ms², verificou-se uma redução significativa da relação (p = 0,016).Conclusão: conclui-se que Jogos eletrônicos podem provocar um aumento da atividade simpática, diminuindo a Variabilidade da Frequência cardíaca das crianças estudadas, sugerindo uma situação estressante.

PASS: A Multimodal Database of Physical Activity and Stress for Mobile Passive Body/ Brain-Computer Interface Research

With the burgeoning of wearable devices and passive body/brain-computer interfaces (B/BCIs), automated stress monitoring in everyday settings has gained significant attention recently, with applications ranging from serious games to clinical monitoring. With mobile users, however, challenges arise due to other overlapping (and potentially confounding) physiological responses (e.g., due to physical activity) that may mask the effects of stress, as well as movement artifacts that can be introduced in the measured signals. For example, the classical increase in heart rate can no longer be attributed solely to stress and could be caused by the activity itself. This makes the development of mobile passive B/BCIs challenging. In this paper, we introduce PASS, a multimodal database of Physical Activity and StresS collected from 48 participants. Participants performed tasks of varying stress levels at three different activity levels and provided quantitative ratings of their perceived stress and fatigue levels. To manipulate stress, two video games (i.e., a calm exploration game and a survival game) were used. Peripheral physical activity (electrocardiography, electrodermal activity, breathing, skin temperature) as well as cerebral activity (electroencephalography) were measured throughout the experiment. A complete description of the experimental protocol is provided and preliminary analyses are performed to investigate the physiological reactions to stress in the presence of physical activity. The PASS database, including raw data and subjective ratings has been made available to the research community at http://musaelab.ca/pass-database/. It is hoped that this database will help advance mobile passive B/BCIs for use in everyday settings.

A brief positive psychological intervention prior to a potentially stressful task facilitates more challenge-like cardiovascular reactivity in high trait anxious individuals

When confronted with stress, anxious individuals tend to evaluate the demands of an upcoming encounter as higher than the available resources, thus, indicating threat evaluations. Conversely, evaluating available resources as higher than the demands signals challenge. Both types of evaluations have been related to specific cardiovascular response patterns with higher cardiac output relative to peripheral resistance indicating challenge and higher peripheral resistance relative to cardiac output signaling threat. The aim of this research was to evaluate whether a brief positive psychological exercise (best possible selves intervention) prior to a potentially stress‐evoking task shifted the cardiovascular profile in trait anxious individuals from a threat to a challenge type. We randomly assigned 74 participants to either a best possible selves or a control exercise prior to performing a sing a song stress task and assessed their level of trait anxiety. Cardiac output (CO) and total peripheral resistance (TPR) were continuously recorded through baseline, preparation, stress task, and recovery, respectively, as well as self‐reported affect. Trait anxiety was related to higher CO in the best possible selves group and lower CO in the control group. While high trait anxious individuals in the control group showed increasing TPR reactivity, they exhibited a nonsignificant change in the best possible selves group. Moreover, in the latter group a stress‐related decrease in positive affect in high trait anxious participants was prevented. Findings suggest that concentrating on strengths and positive assets prior to a potentially stressful encounter could trigger a more adaptive coping in trait anxious individuals.

According to the biopsychosocial model anxious individuals may evaluate motivated performance tasks as threatening, resulting in stronger vascular than cardiac responding. We found that a positive writing exercise (best possible selves‐intervention) prior to a laboratory stress task led to a more challenge‐type response profile (i.e., higher cardiac output relative to peripheral resistance) in trait anxious individuals, suggesting that positive psychological micro‐interventions could foster more adaptive coping.

Instantaneous Respiratory Response of Gamer with High-Risk Internet Gaming Disorder during Game-Film Stimuli by Using Complementary Ensemble Empirical Mode Decomposition

Gamers with Internet gaming disorder (IGD) dynamically regulate their psychophysiological responses during playing; however, analyzing instantaneous psychophysiological responses in these gamers has been limited by a lack of appropriate methods. We propose combining the Complementary Ensemble Empirical Mode Decomposition and Direct Quadrature methods to overcome this limitation. The related effect of abdominal breathing (AB) training (as a relaxing psychology method) on the distribution of instantaneous frequency (IF) was investigated by calculating median (IF_med), kurtosis (IF_kurt) and skewness (IF_skew), and 19 participants with high-risk IGD (HIGD) were found to have increased IF_med [massively multiplayer online role-playing game (MMORPG): 0.36 ± 0.08; first-person shooter game (FPSG): 0.34 ± 0.08] but decreased IF_kurt (MMORPG: 5.98 ± 2.31; FPSG: 6.84 ± 4.61) and IF_skew (MMORPG: 0.40 ± 0.69; FPSG: 0.64 ±1.04) during game-film stimuli compared with baseline and recovery states. After AB training, IF_med of these 19 participants (MMORPG: 0.24 ± 0.11; FPSG: 0.18 ± 0.06) decreased significantly. This study is firstly to observe the IF distribution of respiratory signal in gamers with HIGD; thus, this distribution may be used as a respiratory physiological marker of IGD risk.

Physiological and Cognitive Functions Following a Discrete Session of Competitive Esports Gaming

Competitive organized electronic video gaming, termed “esports,” has become an international industry. The physiological and cognitive health results of prolonged esport practice and competition have not been adequately studied. The current study examined physiological and cognitive changes after a session of esport gameplay for two types of games, first-person shooter and multiplayer online battle arena games. Increases in systolic blood pressure, increases in speed, and decreases in accuracy and inhibitory processes were found for esport gamers overall. For peak heart rate change, first-person shooter games elicited a larger change than did multiplayer online battle arena games. These results have implications for the management of esport player cognitive and physical health as well as for the optimization of performance in competitive esport tournaments.

Wireless Sensors System for Stress Detection by Means of ECG and EDA Acquisition

This paper describes the design of a two channels electrodermal activity (EDA) sensor and two channels electrocardiogram (ECG) sensor. The EDA sensors acquire data on the hands and transmit them to the ECG sensor with wireless WiFi communication for increased wearability. The sensors system acquires two EDA channels to improve the removal of motion artifacts that take place if EDA is measured on individuals who need to move their hands in their activities. The ECG channels are acquired on the chest and the ECG sensor is responsible for aligning the two ECG traces with the received packets from EDA sensors; the ECG sensor sends via WiFi the aligned packets to a laptop for real time plot and data storage. The metrological characterization showed high-level performances in terms of linearity and jitter; the delays introduced by the wireless transmission from EDA to ECG sensor have been proved to be negligible for the present application.