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

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.