As colleges embrace esports, will player health fall through the cracks?

Matt Moret: Welcome to Field Study, a podcast about sports and science from the Pittsburgh Post-Gazette. I’m your host, and producer, Matt Moret.

Anyone with a desk job has, at some point, heard about the dangers of sitting all day long. Back injuries, poor circulation, eye strains, sleeping disorders. And that’s just the physical toll. Toss the words “sitting” and “health” into Google and you’ll find countless more.

Now, you may not expect these things to affect athletes. After all, many people associate athletics with strenuous physical activity. In reality, that’s not always the case.

Esports players spend their entire careers sitting down. A lot. But because their sport isn’t defined by high speed impacts, health isn’t a common focus of industry coverage. It’s not even a common focus for the industry itself.

That could have severe consequences for the young people entering a world often associated with unhealthy habits.

For today’s episode, Post-Gazette sports reporter Steve Rotstein took a look at how the world of collegiate esports is handling the issue. Here’s what he learned.

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Steve Rotstein: Picture yourself sitting at the table with your family for Thanksgiving dinner. You have a younger brother or sister who loves playing video games, so much that they want to make a career out of it. So they mention to your parents and relatives that they want to go to college to be a varsity esports player. They even got a scholarship to help pay for it.

How do you think the rest of your family would react? Probably with a lot of shock and skepticism.

The world of esports is a rapidly expanding and ever-changing landscape. And because it’s such a new world, there’s still a ton of research left to do regarding the proper way to train esports athletes and prevent injuries.

Maybe you’re the skeptical one now. Injuries? From playing video games?

They exist, both physically and mentally. And many of the schools investing in building an esports team may not be taking those risks into consideration.

One of the leading experts trying to raise awareness is Dr. Hallie Zwibel, the director of the Center for Esports Medicine at New York Institute of Technology.

Dr. Hallie Zwibel: We speak at medical conferences with other physicians and we work with mostly traditional athletes, so we’re always having those conversations on a daily basis. And to be honest, it’s fun. It’s fun explaining. This is a new field and this is something that needs to be addressed, and there’s a vacuum there that people haven’t been addressing.

And really, if you look at the numbers, which is what we present first, it speaks for itself. It’s a $1.5 billion industry. To put that in perspective, the NHL is a $2.5 billion industry. It has more viewers of some of its championship games than the Super Bowl.

Over 200 colleges now have varsity esports teams. There’s $16 million in scholarships.

Rotstein: Zwibel also serves as the team physician for NYIT’s varsity esports team.

Dr. Zwibel: About a year and a half ago, or two years now, NYIT created a varsity esports team as part of [its] athletic program. So, as the team physician, we have to care for all the athletes. And this was going to be a new bunch of athletes coming into the system, so we wanted to learn about them and first of all find out, “What is esports?” And then next, “How do we care for these players medically? What are the issues that they face?”

Common sense would suggest that you can’t just retrofit the model of a soccer player and prevent ACL tears and concussions to these players. So we went to the medical literature, and we found, really, nothing. We were kind of at a loss for where to go. So we came up with the idea that we could really do the foundational research.

We’re part of a medical school, we have a team that’s multi-disciplinary that has a research background. And we’ve been, since that time, doing that foundational research — presenting, publishing and talking to esports players in the community about what we’ve found.

Rotstein: There may not be any world-altering revelations, at least not yet, but some of the data has shocked them.

Dr. Zwibel: One of the findings from our study was that less than half of players take a standing break every two hours. The average time for exercise is about one to one-and-a-half days per week, about 30 minutes in a weekly period.

So, maintaining their physical health is an issue, and they don’t view it as something that — as spoken by their behaviors — as something that’s important to being successful in gaming. And we’re trying to change that. We’re trying to tell them how being physically fit and having that physical activity under your belt will make you a better player.

Rotstein: Consider how pop culture depicts video game players. It’s often energy drinks, dimly lit rooms and crinkled snack bags.

That stereotype is obviously a bit extreme. Not all gamers completely ignore their wellbeing to score a digital touchdown or headshot. But fitness and nutrition aren’t typically associated with esports culture, at least at the moment.

The universities building esports teams could help change that — if they build standards for the players they’re scooping up at such a young age.

Dr. Zwibel: The governing body for esports is the National Academy of Collegiate Esports, the NACE. And they don’t have as strict of guidelines or recommendations in place in terms of the conditioning you need, in terms of the rules and regulations to be a collegiate, varsity-level player, that you have in the NCAA, which governs traditional sports. So that’s something that I think needs to change and will change the conversation dramatically.

Rotstein: Dr. Zwibel is already immersed in esports medicine, with a particular focus on how it pertains to varsity-level esports athletes. He knows the health risks these players face, both physical and mental.

His concern is that not every school taking the plunge into esports has considered those pitfalls.

Here in Pittsburgh, Point Park University recently announced the formation of its own varsity esports team, beginning in the fall of 2020. VP of Student Affairs and Dean of Students Keith Paylo led the charge to create the program.

Keith Paylo: I think it really hit home last year with the NACE conference, which is the governing body of esports. They had their national conference at Harrisburg University last July, and I knew that by going to that, this is where I was going to get immersed. The whole purpose of it was to gain as much information as I could.

The conference starts off with, “Ladies and gentlemen, thanks for coming here.” The previous year they had under 100 attendees at the conference, and last year they had 500 or more. So everyone was like, “We’ve got to learn about this.”

Everyone was in the same stage that we were — thinking about it. “Should we do this?” And it was all colleges and universities. So over that two-day period, that was just an absolute eye-opening experience for me.

I came back to the university and said, “We need to do this and get ahead of it. Instead of being a follower, let’s be a leader.”

So we went full force starting really last summer of looking into this and looking at where our space is going to be, investigating the games, hiring a coach. So you asked the question, “Where are we?” We are in the final stages of hiring our head coach. We already have a space here on campus under construction. It will be ready for fall of 2020, which will be in a few months. We’re ready for this new class coming in in August of this year. We will determine, once a head coach gets here, because that’s part of the process, of which games, and we have an idea of where we want to land.

Rotstein: Paylo has spent 30 years working in student services at the university level, including the last 17 at Point Park.

WIth nearly two decades of experience working within the infrastructure of the university’s traditional sports programs, Paylo realizes that forming a varsity esports program from scratch calls for a different set of guidelines.

Paylo: We were at the national conference, and they introduced our esports athletes, and you’ll have some folks in the audience who maybe don’t know enough about it, and you’ll hear kind of that kind of grumbling under your breath in a sense of, “You’re calling these people athletes?” And they truly are.

And the process is just like athletes. You’ve got to find them, you’ve got to recruit them, you’ve got to obtain, just like any other sport, if there are lists available — who are the top players? If it’s a basketball player or it’s an “Overwatch” or “League of Legends” player, it’s very similar how you go about the recruitment process. So we’ve housed this in athletics, and we’re going to offer scholarships.

I’m a competitor, my athletic director is a very big competitor, and we’re on the same page that we’re not just doing this to do it. We’re going to go out there and compete at the highest level we can, and we want to be winners. So we’re going to go after those that are out there in the industry and in the high schools. We see more and more not only locally but nationally forming esports teams, so it’s getting easier and easier to find those esports athletes.

It used to be much harder, from my understanding, because it was almost underground. You didn’t know where they were at. The lists didn’t exist. Now it’s getting easier and easier through the organizations such as NACE and through your connections with high schools and even community colleges, it’s becoming very popular. And now you have a base that you can go after, and you do it just like any other sport.

You go, you recruit, you see how good they are, and then you make offers and you try to attract the best team that you can here.

Rotstein: Paylo has made player safety a key part of the school’s esports initiative. How will a university like Point Park ensure that esports competitors are in top physical condition to perform, the same way they would for athletes in traditional sports?

Paylo: In all honesty, there are going to be some similarities, where our esports athletes can run through our normal training area. And then there’s going to be differences.

Yes, we’re going to have to make sure that there are limitations on the amount of screen time that these esports athletes have. That’s a fact. There are different issues and different types of training that they need.

The best programs that you’ll see have a regimen of how these esports athletes eat — again, this is very similar to other sports, but yet different. They’re sitting a lot, so there has to be physical activity.

Rotstein: That covers the physical side of it, but there’s also the mental aspect. There’s widespread debate about the impact of screen time on young people, and diagnosing things like internet gaming disorder or gaming addiction is a complicated process without much of a blueprint.

Paylo: The amount of gaming does try on a person’s mind, and you have to just be sensitive to that. You have to put things in place to make sure that you have the right people and facilities involved and make sure the players know that these resources are there and available for them.

And I’m not saying it’s rampant, but they even warned us in all these, you’ve just got to obviously watch that, depending on the games that they’re playing and so on, and the amount of time. But we’ll make sure that those requirements are in place. So yeah, there are similarities in the training — you know, we’re not going to be seeing as many twisted ankles or things like that, and for our baseball team you won’t hear about Tommy John or a shoulder maybe.

But at the same time, we’re going to make sure our trainers — and we know that as time goes by, we’re going to have to adjust somewhat differently to esports than we would maybe a traditional sport as it grows of what those needs are. And we’re going to rely upon the coach and again just the atmosphere of what the esports players are doing.

Rotstein: Like Paylo, Dr. Zwibel emphasized the importance of focusing on esports athletes’ mental health just as much as their physical well-being. But when it comes to making sure competitors are in top physical shape, there aren’t many tried-and-true methods for training and preparation.

Dr. Zwibel: No one has shown that there's a specific way of play or practice or preparation in esports that will make you a better competitor in that moment. That's in stark opposition to other sports, where sports science has shown you how you should be training. You should not be practicing a certain move the day before a game. You should be doing more and more cardio earlier in the week and things like that.

There is no standard out there, except for the anecdotal standard of, “Oh, this player does that, so I’m going to mimic that behavior.” There has to be more than just gameplay.

If you imagine for traditional sports, if soccer players only practiced — not by going to the weight room, not by doing drills, but strictly by scrimmaging each other — it would be a very different sport.

Individuals have learned over time that drills and fitness will make you a better player on the field. Not just strictly engaging in the activity of the competition.

Esports doesn’t have that yet. So I think by showing — and I truly believe this, although we don’t have the research to support it yet — by showing that you can incorporate these fitness activities and other exercises into your preparation, it will make you a better player. I think that will speak a lot.

And from the mental health side of things, I think that will go a long way, instead of something that might seem abstract or something that is hard to tackle directly. I think by viewing it as, you’re making yourself a better player, you’ll organically get a lot of individuals trying to emulate these behaviors that are healthy.

Rotstein: Outside of college, professional esports athletes are often on their own when it comes to staying in top physical and mental shape. Michael “D3liveranc3” Pinter is a professional “Madden NFL” player for the Pittsburgh Knights, a local professional esports team affiliated with the Pittsburgh Steelers.

Michael “D3liveranc3” Pinter: Obviously as a video gamer, do you need to be in tip-top shape physically and going to the gym? No. However, for me, I feel like the physical really translates into the mental for me.

For example, when I had to go through the surgery with a labral repair, I couldn't run. I couldn't go to the gym. It wasn’t until like five or six weeks after recovery that I was allowed to at least go and start doing leg presses and hamstring curls and at least the leg machines.

So I’m sitting around, I’m putting on some extra weight, I’m feeling like, “Man, I can’t do anything.” I’m sitting around like a bum. You really kind of feel yourself go down mentally. So that’s when I say the physical component, as soon as I was able to start running and going to the gym — so to answer your question, yes, one of the main things I do, I still go to the gym on a daily basis, run sprints, whatever I can.

The better you feel about yourself physically, I feel like that’s what's going to translate mentally and make you feel better about yourself. So that’s just one of the things I personally feel, even though you might not feel like you have to be in the biggest physical shape, so to speak, for a pro gamer, I really think it’s one of those things that relates. It kind of impacts the mental.

And I see it with my other friends that I know in the “Madden” community. They go through this thing every year where it’s like, “OK, it’s time to go back to the gym.” And you see the ones who stick with it, and they’re like, “Oh, I feel great.” And then there’s other ones that fall off and it’s like, “I need to get back.”

Rotstein: Dr. Zwibel agrees that feeling better physically will translate to the mental side of gameplay. That’s why he recommends all his esports athletes at NYIT implement a training routine to stay on top of their physical fitness, although it’s not yet a requirement under NACE guidelines.

The research team at NYIT is constantly searching for ways to monitor and improve performance, most recently by having its esports athletes wear specially designed shirts with software tracking devices to monitor things such as heart rate, breathing rate and blood pressure. The study has been ongoing for about four to five months now, and Dr. Zwibel said they expect to share the results sometime within the next year.

As Dr. Zwibel notes, there’s still so much data out there to collect and so much more research to be done in the “vacuum” that is the field of collegiate esports. But he’s confident that NYIT, and other institutions like it, will bring all that necessary data to the forefront within the next few years.

Dr. Zwibel: I think the next step is really digging down and showing the complexity of what’s happening during gameplay, both from a cognitive and physical perspective. So that really has not been shown yet.

And I think in order to break the stigma around esports and to really better understand it, research needs to be done, like with the activity-tracker skins and things like that, to showcase the strain that an esports player is going through, that there is a lot of cognitive stress. And once people understand that there are these strains on the body and mind, why is that happening? To understand that it is a team sport where people are working together, strategically planning, and gearing toward a common mission.

As a physician, the reason you go into medicine -- well, the reason you should go into medicine -- is to care for those in front of you. You feel that it’s a calling. And that’s something that we’re talking about. That there are health effects in these players. That they’re coming to your colleges, they’re coming to your high schools, they’re coming to your offices, but they’re not looking for them.

So we’re just going out there and saying, “Hey this is happening and here’s why you should care about it. And here are some things you can do about it.”