Sport is always beneficial to the heart, even if virtual! The case of exergames

reviewed by Martino Pepe

eSports and exergames represent a groundbreaking fusion of technology, entertainment, and health, offering innovative approaches to engaging individuals in physical activity.[1,2] Basically, we can define esports as competitive, organized video gaming events where players or teams compete professionally or recreationally in various digital games, whereas exergames are interactive video games that combine physical activity with gameplay, promoting exercise and fitness through motion-based controls.

These platforms have evolved rapidly, driven by technological advancements and interactive designs that appeal to diverse populations. Accordingly, their potential in cardiovascular prevention and therapeutics is significant, as they can transform how individuals approach exercise and health monitoring. Notably, by integrating gamified experiences, exergames encourage sustained physical activity, also positively influencing cardiovascular metrics such as heart rate, blood pressure, vascular function, and cardiovascular fitness.[1,2] This novel approach bridges the gap between traditional exercise regimens and the modern, tech-savvy lifestyle.

In a timely article by Fung and Pelliccia and recently published in the European Journal of Preventive Cardiology, the authors clearly highlight that exergames have demonstrated significant cardiovascular benefits, promoting physical activity, improving cardiovascular function, and reducing risk factors like hypertension and LDL cholesterol, with energy expenditure comparable to moderate-intensity exercise.[3] Conversely, professional eAthletes face emerging health challenges, including the risk of cardiovascular and metabolic disorders, as well as the occurrence of rare arrhythmic events, highlighting the importance of tailored pre-participation screening and targeted health management strategies appropriate for this unique setting.[4] Looking ahead, esports and exergames hold great potential as tools for global cardiovascular prevention, with the possibility of integration into public health strategies and even influencing Olympic-level sports medicine practices. However, appropriate regimens and tailored solutions are required to maximize their benefits and minimize their risks.

Exergames excel as tools for primary prevention by addressing modifiable cardiovascular risk factors such as obesity, hypertension, and dyslipidaemia. By gamifying physical activity, they make exercise more engaging and accessible, particularly for sedentary individuals.[5] These benefits extend to rehabilitation, where exergames provide structured, home-based programs for patients recovering from cardiac events. Telerehabilitation systems using exergames allow for real-time feedback and progress monitoring, enabling personalized care and improving patient adherence to rehabilitation protocols. Additionally, esports platforms have emerged as valuable avenues for cardiovascular research, with biometric tracking and gamified studies enabling large-scale data collection on behaviour, physiology, and intervention outcomes.

Beyond physical health, exergames contribute to mental and cognitive well-being by reducing stress, enhancing mood, and supporting cognitive function, particularly in aging populations. Technological innovations such as virtual and augmented reality, coupled with artificially intelligence-driven personalization and wearable sensors, are further transforming the exergame landscape.[6]

Despite these advances, challenges remain, including disparities in accessibility, high costs, and the risk of gaming addiction. Addressing these limitations is critical to maximizing the benefits of these platforms. Looking forward, adaptive systems and precision health approaches hold promise for making exergames indispensable tools in personalized cardiovascular care, bridging the gap between entertainment and impactful therapeutic interventions. By combining physical activity with engaging digital platforms, esports and exergames offer clinicians and researchers new opportunities to enhance patient outcomes and promote public health on a large scale.

In conclusion, esports and exergames offer innovative solutions for cardiovascular health, bridging entertainment with preventive and therapeutic exercise strategies. While exergames enhance physical activity and rehabilitation, professional esports athletes face unique cardiovascular risks requiring tailored health monitoring. Future advancements in information technology, wearables, and telerehabilitation can optimize exergame applications, promoting personalized and accessible cardiovascular care.

Table 1. Key features of cardiovascular applications of exergames. 

source: created by Giuseppe Biondi-Zoccai

Acknowledgement: This manuscript was drafted with the assistance of artificial intelligence tools, including ChatGPT 4 (OpenAI, San Francisco, CA, USA), in keeping with established best practices (Biondi-Zoccai G, editor. ChatGPT for Medical Research. Torino: Edizioni Minerva Medica; 2024). The final content, including all conclusions and opinions, has been thoroughly revised, edited, and approved by the authors. The authors take full responsibility for the integrity and accuracy of the work and retain full credit for all intellectual contributions. Compliance with ethical standards and guidelines for the use of artificial intelligence in research has been ensured.

Note: The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.