Association Between Esports Participation and Health: A Systematic Review and Meta-analysis

With the growth of the esports industry, concerns about participants' health risks have drawn public and academic attention. However, existing research remains inconsistent and often fails to distinguish esports from general video gaming. This study evaluates health differences between esports participants and non-participants and explores correlations between participation and health outcomes.

A systematic search of seven databases (PubMed, Web of Science, Scopus, SPORTDiscus, MEDLINE, Esports Research Network, and ProQuest) was conducted up to May 13, 2026. Data were synthesized using mean differences (MD) or standardized mean differences (SMD) for group comparisons, and Fisher's Z-transformed correlation coefficients (r) for relationships between esports participation and health outcomes. Subgroup analyses based on professional and non-professional status were also conducted.

Of 5090 identified studies, 53 (n = 86,652) were included, with 36 analyzed in meta-analyses. Initial analyses showed no significant differences between esports participants and non-participants across physical activity, body mass index (BMI) sleep duration, anxiety, depression, stress, and grip strength. However, following sensitivity analysis, esports participants exhibited significantly lower depression levels (SMD -0.13, 95% CI -0.17 to -0.10). Conversely, non-professional esports players demonstrated a significantly higher body fat percentage than non-players (MD 4.57, 95% CI 1.73 to 7.41). Additionally, esports participation was significantly correlated with sedentary behavior (r = 0.17, 95% CI 0.12 to 0.23), BMI (r = 0.09, 95% CI 0.04 to 0.13), and gaming disorder (r = 0.10, 95% CI 0.05 to 0.15).

Although current evidence suggests that esports participants do not generally display worse overall health than non-participants, the association between esports participation and health is multifaceted and requires a nuanced perspective. Furthermore, given the existing heterogeneity and the cross-sectional design of the included studies, alongside a moderate risk of bias, these findings warrant careful interpretation. Future research must prioritize standardized definitions, consistent reporting, objective measures, and longitudinal designs to further validate these associations and investigate causal relationships. Concurrently, the industry should develop stratified, evidence-based guidelines to safeguard the long-term well-being of different types of players. Registration CRD42024622812 (PROSPERO).