When a new activity is introduced to the public, members often ask “Is this a sport?” or “Are the participants athletes?” It was likely asked before skateboarding and surfing joined ancient sports such as boxing and equestrian at the 2021 Summer Olympic Games. It is asked in sports like auto racing, with some arguing that the acceleration of the car is supplied by a machine so it cannot be a sport, while others argue that the skill of the driver as an athlete is what makes it a sport. Esports are played on a monitor or screen, while a subset of these activities, known as active video gaming (AVG), require significant physical exertion. Active video gaming can include shooting games, band and dance simulation games, and fitness games.
In the recently published article, “The AOASM Position Statement on General Esports, Active Video Gaming (AVG) and the Role of the Sports Medicine Physician,” we discuss diagnosis and treatment of participants in electronic sports (esports) and AVG.1 In doing so, we create debate concerning the question, “Esports and the esports athlete—simply misnomer terms, or are they the real deal?” Currently, there is no published research surveying whether sports medicine clinicians consider esports real sports or their participants real athletes, so to help us with the question, we reference the Cambridge English Dictionary which defines sport as, “a game, competition or activity needing physical effort and skill that is played or done according to rules, for enjoyment and/or as a job.”
Esports and AVG have a global audience of over 300 million fans and a projected revenue of over $2 billion in 2022.2 In February 2022, Statisa.com reported that there are over 3600 professional esports participants in the United States alone.3 There are professional teams in several major cities in the United States, Canada, Europe, and Australia. Esports have been recognized as a sport by the International Olympic Committee, the National Collegiate Athletic Association, and several secondary school associations in the United States.
There is debate that these participants are not engaged in sport as there is no aerobic training component to these activities. However, as the activities have evolved, many participants in traditional esports and AVG have realized the importance of aerobic conditioning necessary for endurance and training for competition that often takes hours.4 In a study by Pereira, et al,5 looking at the physical activity levels of adult virtual football players in Portugal, 79% performed regular physical exercise. Many AVGs, by their very nature, use exercise and movement to engage the game that may allow for maintenance or improvement of physical fitness status.6 Thus, these participants have met the first part of the definition of sport as listed above in that these participants engage in competition that requires physical effort.
A common misconception is that these participants do not train, but “just sit in front of a screen,” However, like a baseball or softball pitcher who uses biomechanics and the practice of a repetitive motion to complete an action, these participants engage in the same activity where, instead of the ultimate goal being the release of a ball, the ultimate goal of these participants is to execute an action using a controller that is reflected on a screen. Thus, these participants have met the second part of the definition of sport in that they engage in competition that requires a skill.
Finally, these participants have competition rules for games and matches, account status, formation of teams, communication, streaming, and penalties for violation of rules. These rules exist at both the professional and amateur levels. Two such examples of the extensiveness of competition rules for esports may be seen on these referenced websites.7,8 Thus, these participants have met the third part of the definition of a sport as listed above in that they engage in competition according to rules that involves a job or for enjoyment.
It is the authors' opinion the answer to the questions, “are esports and AVG real sports?” and “are these real athletes?” is “YES.” Sports medicine physicians are already seeing this population in clinic and providing coverage for teams at the professional, collegiate, and scholastic levels. Our desire is to have esports and AVG comprehensively discussed within the sports medicine community with the goal to create a framework with which to approach injuries in those who participate in these activities. In one recent study, complaints of neck and back pain (42%), wrist pain (36%), and hand pain (32%) in these athletes were common.9 It is important that new terminology such as “upper crossed syndrome” and “computer vision syndrome” become as common and understood in the sports medicine vernacular as ankle sprain and concussion so that clinicians can easily and effectively treat these athletes not only in the clinical setting but also during competition at both the amateur and professional level in national and international competitions.
If we consider esports and AVG true sports, our specialty will be given the opportunity to formulate sports-specific evaluations, diagnostic and treatment paradigms, as well as plans for future research so we can be the leaders in treating these athletes. It will also allow us to educate physicians in other disciplines and allied health professions to establish diagnostic and treatment plans to assist in the multidisciplinary care of these athletes.
As esports and AVG are only going to grow and expand with increasing participation, we know that sports medicine clinicians have been given the unique opportunity to lead in improving the health, wellness, and performance of this unique 21st century athlete.
1. Franks RR, King D, Bodine W, et al. AOASM position statement on esports, active video gaming, and the role of the sports medicine physician. Clin J Sport Med. 2022;32:e221–e229.
2. Gray A. The Explosive Growth of Esports. World economic forum; 2018. Available at: https://www.weforum.org/agenda/2018/07/the-explosive-growth-of-esports/
. Accessed August 23, 2022.
4. Kari T, Siutila M, Karhulahti V. An extended study on training and physical exercise in esports. In: Dubbels BR, ed. Exploring the Cognitive, Social, Cultural, and Psychological Aspects of Gaming and Simulations. Hershey, PA: IGI Global; 2019:270–292.
5. Pereira AM, Verhagen E, Figueiredo P, et al. Physical activity levels of adult virtual football players. Front Psychol. 2021;12:596434.
6. Bamparopoulos G, Konstantinidis E, Bratsas C, et al. Towards exergaming commons: composing the exergame ontology for publishing open game data. J Biomed Semant. 2016;7:4.
7. ESL Pro League. Available at: https://pro.eslgaming.com/csgo/proleague/rules/
. Accessed January 5, 2022.
8. Available at: https://www.generationesports.com
. Accessed September 15, 2022.
9. DiFrancisco-Donoghue J, Balentine J, Schmidt G, Zwibel H. Managing the health of the eSport athlete: an integrated health management model. BMJ Open Sport Exerc Med. 2019;5:e000467.