In recent years, the rapid development of esports has attracted a vast number of spectators and participants, making it one of the most widely discussed competitive activities (Leis et al., 2021). Esports, fundamentally based on video games, refers to competitive video gaming conducted through electronic devices such as mobile phones, computers, and gaming consoles (Hamari and Sjöblom, 2017; Pedraza-Ramirez et al., 2020). Video games can generally be categorized into competitive and non-competitive forms (Leis and Lautenbach, 2020). By definition, the core element of esports is competitive confrontation (Hou et al., 2020). Therefore, only competitive video games can be termed esports. However, up to now, there has been no consensus on which video games should be classified as esports (Karhulahti, 2017). Existing research suggests that non-competitive video games appear to be unrelated to psychophysiological changes (Leis and Lautenbach, 2020). In other words, not all video games elicit comparable psychophysiological stress responses. In terms of the criteria for determining esports, this paper draws on the studies of Pedraza-Ramirez et al. (2020) and Leis and Lautenbach (2020).

Although esports is commonly considered a sedentary activity, professional players face a high-pressure competitive environment that is very similar to that of traditional sport athletes (Hallmann and Giel, 2018; Smith et al., 2019). While esports does not demand the same level of physical exertion as traditional sports, the competitive stress inherent in gameplay has been shown to activate the sympathetic nervous system, thereby inducing physiological responses such as increased heart rate and elevated blood pressure (Leis and Lautenbach, 2020; Pedraza-Ramirez et al., 2020). These stressors primarily arise from performance stressors, team stressors, social stressors, organizational stressors, and personal stressors, among which performance-related stress has been the most frequently reported source in existing studies (Leis et al., 2024). Notably, such stressors elicit psychophysiological responses and are frequently associated with adverse effects on athletes’ competitive performance (Foster et al., 2001). In light of the aforementioned multidimensional stressors, it is necessary to conduct a systematic analysis of players’ psychophysiological responses within the esports context. However, to date, the psychophysiological stress responses of players during esports competitions remain insufficiently understood (Leis and Lautenbach, 2020).

In psychophysiological research, physiological measures such as blood pressure, heart rate, and heart rate variability (HRV) are commonly used to evaluate individuals’ psychophysiological responses. However, blood pressure and heart rate are susceptible to various physiological and environmental influences, which imposes certain limitations on their precision in assessing psychophysiological responses and, consequently, constrains their potential as accurate assessment tools (Mygind et al., 2021). In contrast, HRV is a non-invasive, easily measurable, and cost-effective metric. In particular, vagally mediated HRV parameters are highly valuable for assessing autonomic nervous system (ANS) function in relation to gaming-induced stress and performance (Makivić et al., 2013; Welsh et al., 2023). Recent systematic reviews have demonstrated that HRV, as an indicator for evaluating psychological stress, has been validated with a high degree of accuracy (Kim et al., 2018). HRV is commonly defined as the variation in the intervals between consecutive heartbeats (Camm et al., 1996). Its variations can sensitively reflect adaptive changes in an individual’s responses to stress, emotional regulation, and physiological demands. In traditional sports research, HRV indices have been widely applied to evaluate individuals’ stress-coping capacity and emotional regulation. For instance, Carrillo et al. (2011) compared changes in HRV in archers before and during competition to assess ANS regulation. Similarly, HRV has important practical relevance for esports athletes, as it can serve as an objective indicator to identify fatigue levels and to evaluate post-competition recovery status (Selig et al., 2004). Therefore, HRV may serve as an important tool for optimizing esports training programs.

Previous studies have not reached a consensus regarding the effects of esports on HRV. For example, Andre et al. (2020) reported that, compared to pre-game measurements, root mean square of successive differences (RMSSD) did not show significant changes following esports gameplay (p > 0.05). In contrast, Wu et al. (2025) reported a different finding, showing that RMSSD was significantly higher before gameplay than during the game (p < 0.05). Therefore, conducting a systematic review and meta-analysis is particularly warranted. This approach, by aggregating data across multiple studies, can effectively overcome the limitations of individual studies and yield more robust and reliable conclusions.

To our knowledge, no meta-analysis to date has specifically investigated the effects of esports on HRV. The only related study is a systematic review that preliminarily summarized the potential applications of HRV in esports. Specifically, Welsh et al. (2023) reviewed the main applications of HRV within the esports context. However, limitations such as insufficient measurement indices and a lack of consistency have hindered a comprehensive analysis of HRV outcomes. Consequently, the extent to which esports affects different HRV parameters remains unclear.

In this context, the present systematic review and meta-analysis aim to examine quantitatively, based on empirical data, how esports activities influence HRV. Such analysis holds important implications for optimizing player performance, enhancing training efficiency, and informing personalized competitive strategies.

This systematic review followed the principles outlined by the PRISMA guidelines (Moher et al., 2009). This protocol was registered on the PROSPERO (CRD42024587244).

This study included 12 publications in a meta-analysis and systematic review, aiming to examine the differences in HRV before and during esports activities. To our knowledge, this is the first meta-analysis to investigate HRV in the context of esports. Across six separate meta-analyses, we systematically quantified the effects of esports on different HRV parameters, including RMSSD, SDNN, pNN50, HF, LF, and the LF/HF ratio. The results demonstrated that RMSSD and HF were significantly reduced during gameplay compared with resting conditions, suggesting that esports can exert measurable effects on specific HRV indices, with effect sizes ranging from small to moderate. In contrast, no significant differences were observed in SDNN, pNN50, LF, or the LF/HF ratio when compared with rest.

In the analysis of HRV, RMSSD, HF, and pNN50 are key indices for evaluating vagally mediated parasympathetic activity, as they provide precise reflections of vagal tone (Laborde et al., 2017). The results showed a significant decrease in RMSSD and HF during esports, suggesting that autonomic regulation in this context is characterized by a predominance of sympathetic activity accompanied by a suppression of parasympathetic activity (Watanabe et al., 2021; Long et al., 2023). This phenomenon is likely attributable to the high-intensity and high-stress environment inherent in esports. Previous studies have indicated a link between stressors and changes in HRV that reflect reduced vagal tone (Goessl et al., 2017). Under acute stress, blood pressure and heart rate increase, whereas vagal tone and HRV decrease (Hjortskov et al., 2004). Although esports is generally considered a sedentary activity, the high competitiveness and intense environment inherent in esports may induce a certain level of stress, which can potentially peak during competitive matches (Poulus et al., 2022). Players typically need to maintain high levels of attentional focus, rapidly process visual and auditory information, and make decisions within very short time frames. This combination of high cognitive load and emotional tension is often accompanied by physiological stress responses (Machado et al., 2021). This stress response may help explain the observed changes in HRV indices, reflecting altered autonomic regulation during gameplay.

Surprisingly, esports participation did not produce a significant effect on the pNN50. Some studies have reported that parasympathetic indices remain stable or even increase during gameplay or following interventions, suggesting that HRV changes may depend on both environmental factors and individual differences (You et al., 2021; Nicholson et al., 2024). We speculate that these findings may be attributable to physiological differences arising from variations in game type, in-game roles, or levels of physical activity. Moreover, potential confounding factors, such as breathing rate and physical exertion during gameplay, have not been consistently accounted for, which may have introduced bias into the results (Hernando et al., 2018). Given the limited number of studies included to date, further research is warranted.

Notably, esports participation in the present study did not exert a significant effect on LF or the LF/HF ratio. At present, the interpretation of LF and the LF/HF ratio remains controversial in the literature. Some authors consider the LF parameter as an indicator of cardiac sympathetic regulation, whereas others suggest that it reflects a combination of sympathetic and parasympathetic modulation (Marasingha-Arachchige et al., 2022). Furthermore, although the LF/HF ratio is often used as an index of sympathovagal balance, mounting evidence suggests that this metric oversimplifies the complex, nonlinear interactions between sympathetic and parasympathetic activity within the ANS (Billman, 2013). Recent studies have highlighted the controversy surrounding the interpretation of this metric, recommending that the LF/HF ratio be avoided or interpreted with caution (Welsh et al., 2023; Mosley and Laborde, 2024). Accordingly, in light of these considerations, our findings should be interpreted prudently.

In traditional athletes, HRV changes before and during competition are typically influenced by ANS activity. During competition, parasympathetic activity generally decreases, while sympathetic responses are typically enhanced (Aubert et al., 2003). The findings of the present study indicate that esports players exhibit physiological responses under high-pressure conditions that are highly similar to those observed in traditional athletes (Machado et al., 2021). This perspective is consistent with the findings of Banyai et al. (2019), who reported that esports players face challenges in psychological stress and competitive mindset that are comparable to those encountered by traditional athletes. However, it is noteworthy that, although esports players and traditional athletes exhibit similarities in overall ANS responses, differences remain in specific triggering factors. In traditional athletes, ANS responses are also influenced by stressors (Ayuso-Moreno et al., 2020), but these are more closely related to muscular load, physical exertion, and external bodily contact. For example, in professional football matches, HRV—particularly the RMSSD index—has been shown to correlate significantly with both the distance covered and running speed during competition (Malagù et al., 2021). In contrast, although esports players also experience energy expenditure, their ANS responses are primarily influenced by perceived stress and emotional regulation (Machado et al., 2022). This understanding provides insight into the differences between esports and traditional sports.

Heterogeneity analyses indicated that several outcomes in the present study exhibited substantial heterogeneity. Subgroup analyses based on game genre and the duration of HRV analysis during gameplay failed to identify the source of this heterogeneity. However, sensitivity analysis using a leave-one-out approach showed that heterogeneity decreased markedly after exclusion of the study by Wu et al. (2025), suggesting that this study was the primary contributor to the observed heterogeneity. A plausible explanation is that, compared with other studies, most included studies assessed HRV over analysis durations ranging from 5 to 20 min, whereas Wu et al. (2025) recorded HRV metrics over a substantially longer period of approximately 1.5 h.

This study holds several important implications. First, by employing a systematic review and meta-analysis, it synthesizes findings from multiple studies, thereby enhancing the reliability and validity of the conclusions. Second, the findings provide a scientific basis for optimizing the training strategies of esports athletes. Specifically, during periods of intensive training or consecutive competitions, prolonged low levels of HRV may expose players to potential risks such as cognitive fatigue, emotional fluctuations, and increased cardiovascular strain. For esports coaches, monitoring HRV represents a valuable, non-invasive tool to track players’ stress and recovery in real time, enabling more precise adjustments to training loads and competition schedules. Finally, the results suggest that the psychophysiological stress experienced in esports is comparable to that in traditional competitive sports, which may contribute to a more appropriate positioning of esports within the broader sports domain.

Despite yielding several valuable findings, this study has several limitations. First, the use of a single-group pre-post design entails relatively low evidence quality and is more susceptible to confounding factors compared with randomized controlled trials. Second, the heterogeneity in HRV measurement protocols—including differences in recording duration, devices, and analysis methods—contributes to inconsistencies and, to some extent, weakens the overall strength of the meta-analysis evidence. Third, the lack of a standardized definition of esports in the current literature may have resulted in the exclusion of some potentially eligible studies. Finally, the overall sample size included in this study was relatively limited, and certain HRV indicators exhibited substantial heterogeneity, which may constrain the generalizability of the findings.

Future research should prioritize randomized controlled trials or other high-quality experimental designs to minimize the influence of potential confounders. It is also necessary to establish a more consistent and refined conceptualization of esports to ensure comparability across studies. Additionally, larger-scale studies employing similar research designs are warranted to reduce the impact of heterogeneity on outcomes. Longitudinal studies may further provide stronger scientific evidence to inform esports health management and performance optimization.

This study employed a systematic review and meta-analysis to examine the acute effects of esports on HRV, with significant changes observed in RMSSD and HF. These findings indicate that esports exert measurable effects on the ANS. This pattern is comparable to that seen in certain cognitively demanding physical activities, suggesting that, although esports are primarily sedentary, they can elicit pronounced autonomic responses at the physiological level. These results not only advance our understanding of the physiological mechanisms underlying esports but also provide empirical evidence to inform player health management, training optimization, and psychological regulation strategies.