Abstract
Background:
To evaluate the effect of playing violent video games on the heart rate variability (HRV) with different durations in nonhabituated young adults.
Methods:
The present study was a quasi-experimental study, conducted in the department of physiology at an institute after obtaining the ethics approval. A total of 166 healthy participants (males and females aged 18–24 years; 83 in each group) were enrolled in the study and were divided into two groups based on their habit of playing video games. The participants who played violent video games were included in the study group, and participants who played nonviolent video games were included in the control group. HRV (time domain and frequency domain) parameters were measured before the game play, 15 min of game play, and after 30 min of game play.
Results:
The results of our study showed that participants who played nonviolent video games led to increased increased standard deviation of normal to normal intervals (SDNN), root mean square of successive differences (RMSSD), and total power, indicating parasympathetic dominance. Conversely, participants who played violent video games showed decreased SDNN, pNN50%, and RMSSD, reflecting decreased parasympathetic activity and increased low frequency (LF), reflecting sympathetic dominance, suggesting immediate postgame play sympathetic dominance. Minimal changes were observed in the high-frequency percentage in violent video games. A statistically significant difference was also observed in the LF/high frequency ratio, indicating sympathetic activation in the study group. Blood pressure and pulse rate before and after the game play were also significantly increased in the study group.
Conclusion:
Our research findings implicate an upsurge in sympathetic activity and decreased parasympathetic activity in individuals playing violent video games. Monitoring HRV offers insights into cardiovascular fitness and well-being. The study underscores the demerits of playing violent video games on a daily basis.
Keywords: Heart rate variability, violent video games, non-violent video games
Résumé
Contexte:
Évaluer l’effet de la pratique de jeux vidéo violents sur la variabilité de la fréquence cardiaque (VFC) selon différentes durées chez de jeunes adultes non habitués.
Méthodes:
La présente étude était une étude quasi expérimentale, menée dans le département de physiologie d’un institut après obtention de l’approbation éthique. Un total de 166 participants en bonne santé (hommes et femmes âgés de 18 à 24 ans ; 83 dans chaque groupe) ont été inclus dans l’étude et répartis en deux groupes en fonction de leur habitude de jouer aux jeux vidéo. Les participants jouant à des jeux vidéo violents ont été inclus dans le groupe d’étude, tandis que ceux jouant à des jeux vidéo non violents ont été inclus dans le groupe témoin. Les paramètres de la VFC (domaines temporel et fréquentiel) ont été mesurés avant le jeu, après 15 minutes de jeu et après 30 minutes de jeu.
Résultats:
Les résultats de notre étude ont montré que les participants jouant à des jeux vidéo non violents présentaient une augmentation de l’écart-type des intervalles normaux (SDNN), de la racine carrée de la moyenne des carrés des différences successives (RMSSD) et de la puissance totale, indiquant une dominance parasympathique. À l’inverse, les participants jouant à des jeux vidéo violents ont montré une diminution du SDNN, du pNN50 % et du RMSSD, reflétant une réduction de l’activité parasympathique, ainsi qu’une augmentation de la basse fréquence (LF), indiquant une dominance sympathique, suggérant une activation sympathique immédiate après le jeu. Des changements minimes ont été observés dans le pourcentage de haute fréquence lors des jeux vidéo violents. Une différence statistiquement significative a également été observée dans le rapport LF/haute fréquence, indiquant une activation sympathique dans le groupe d’étude. La pression artérielle et la fréquence cardiaque avant et après le jeu ont également augmenté de manière significative dans le groupe d’étude.
Conclusion:
Nos résultats suggèrent une augmentation de l’activité sympathique et une diminution de l’activité parasympathique chez les individus jouant à des jeux vidéo violents. La surveillance de la VFC fournit des informations sur la condition cardiovasculaire et le bien-être. L’étude souligne les effets néfastes de la pratique quotidienne des jeux vidéo violents.
Mots-clés: Variabilité de la fréquence cardiaque, Jeux vidéo violents, Jeux vidéo non violents
INTRODUCTION
In the past decades, video gaming has grown from a niche spreading ceaselessly across the world and well-known leisure activities of young adults.[1] Video games pave the way for harsh emotions such as anger, frustration, and stress, along with shorter sleep duration, excessive fatigue, and prolonged sleep onset.[1]
Indulging in violent video games results in sympathetic overactivity, leading to fluctuation in blood pressure, heart rate, and pulse rate.[2] Excessive use of such games results in Internet gaming disorder (IGD), which is officially listed as a mental disorder in the 11th Revision of the International Classification of Diseases published by the World Health Organization.[3] Studies have reported abnormal autonomic in IGD.[3]
Autonomic functions can be measured by various tests, including invasive and noninvasive tests. Heart rate variability (HRV) is a sensitive, noninvasive electrocardiographic marker that is commonly used to measure autonomic function. HRV is the amount of fluctuation in heart rate as calculated by variation in beat-to-beat interval.[4] Decreased HRV indicates autonomic imbalance and is considered a predictor of morbidity and mortality in vulnerable individuals.[4]
An impaired autonomic function may lead to various health risks such as congestive heart failure, arrhythmias, depression, postcardiac transplant, susceptibility to sudden infant death syndrome, and diabetic neuropathy, coupled with decreased HRV.[5]
Very few studies have been done to prove the effect of violent video games on HRV with different durations of game play in adults.[5]
Thus, the present study was planned to assess the effect of violent video games on HRV with different durations among nonhabitual young adults.
Aim and objectives
To record and compare HRV parameters in nonhabituated young adults with different durations of playing violent and nonviolent video games
To record and compare systolic blood pressure (SBP) and diastolic blood pressure (DBP) and pulse rate in nonhabituated young adults before and after playing violent and nonviolent video games.
METHODS
Study design
The present study was a quasi-experimental study. The study was approved by the institutional ethical committee and carried out in the physiology department of the medical college. The sample size estimation was done based on a study done by Ivarsson et al.[1] considering n1 = 15 with standard deviation [SD] 1 = 2.2 and n2 = 15 with SD2 = 2.4 with considering allowable error d = 1 and 5% level of significance. The total sample size calculated was 166, 83 in each group.
A total of 166 participants participated in the study. The study group comprised 83 participants who played violent video games, and the control group comprised 83 participants who played nonviolent video games.
Participants of either sex in the age group of 18–23 years who played violent and nonviolent video games for <1 h daily were included in the study. Participants suffering from obesity, diabetes mellitus, hypertension, or any other acute or chronic cardiovascular illness and those having a history of taking alcohol or smoking and a history of medication, which affect autonomic functions, were excluded from the study.
Written informed consent was obtained, and a participant information sheet was provided to the participants describing the research study and his/her role. Data about participants’ medical, personal, and family history were collected in a predesigned pro forma.
The participants were instructed to get their mobile phones or tabs for playing video games. They were made comfortable and familiar with the laboratory setup and conditions and instructed not to perform any exercise before the day of the experiment and were asked to avoid intake of beverages containing caffeine or alcohol 12 h before the test. Pulse rate, blood pressure, and all HRV parameters were recorded before game play. The control group was instructed to play nonviolent video games for 15 min and 30 min, and the study group was instructed to play violent games for 15 min and then 30 min.
Measurement of pulse rate
The arterial pulse was recorded for 1 min before and after game play. The pulse rate between 60 and 100 beats/min was considered the normal range.[6]
Measurement of blood pressure
Before the game play, the resting blood pressure was recorded in the right upper arm after the subject had rested for 5 min with the help of a mercury sphygmomanometer in a lying down position. SBP and DBP were recorded. Blood pressure was again recorded postgame play. SBP <120 mmHg and DBP <80 mmHg were considered normal.[6]
Measurement of heart rate variability
HRV parameters were continuously measured at three different time points (pregame play, 15 min after game play, 30 min after game play in both the groups) using ML4818 Power Lab 15T HRV software. The study group played violent video games, and the control group played nonviolent video games.[7,8]
HRV analysis was performed based on an electrocardiogram recording at rest. Electrolyte gel was applied on the skin underneath standard limb leads after cleaning the skin. HRV parameters were obtained under the time and frequency domains. Participants were instructed to take a rest with normal breathing and relax. They were advised not to control their breathing and not to talk to obtain a steady hemodyanamics state before the commencement of the recording.
HRV consists of changes in the time intervals between consecutive heartbeats called interbeat intervals. The analysis includes time domain and frequency domain as power spectral density analysis. All HRV parameters were calculated on “normal to normal” (NN intervals) caused by normal heart contractions paced by sinus node depolarization. All abnormal beats not generated by the sinus node are eliminated from the HRV analysis.
-
Time-domain parameters: These parameters quantify the amount of HRV observed during monitoring periods that may range from 2 min to 24 h. The most important time-domain measures are standard deviation of normal-to-normal intervals (SDNN), standard deviation of average NN intervals (SDANN), root mean square of successive differences (RMSSD), and pNN50%
SDNN: The standard deviation of the normal to normal (NN) intervals. SDNN >50 indicates good autonomic function and stress coping ability and SDNN <20 indicates autonomic dysfunction and high risk of chronic stress-induced disease
pNN50%: The percentage of adjacent NN intervals that differ from each other by more than 50 ms. It indicates parasympathetic nervous system activity
RMSSD: It estimates the vagal mediated changes
Frequency-domain parameters: The most important frequency-domain measures are the total power (TP), very low frequency (VLF), low frequency (LF), high frequency (HF), and LF/HF ratio.
Total power
Individuals with chronic stress or with a disease have decreased TP.
Very-low-frequency band
VLF power is more strongly associated with all-cause mortality than LF or HF power. It is associated with high inflammation, arrhythmic death, and posttraumatic stress disorder.
Low-frequency band
In resting conditions, the LF band reflects baroreflex activity.
High-frequency band
The HF band reflects parasympathetic activity. Lower HF power is correlated with stress, panic, anxiety, or worry.
Low frequency/high frequency ratio
This measure indicates the overall balance between sympathetic and parasympathetic systems. LF/HF ratio >1 indicates sympathovagal imbalance.
The cardiac sympathetic markers LF (ms2) and LF/HF reflect the sympathetic drive and sympathovagal balance of the heart, whereas HF and TP represent the parasympathetic or vagal activity of the heart. SDNN >50 indicates good autonomic function.
Statistical analysis
All statistical analysis was done using SPSS software version 28.0 of IBM (International Business Machines Corporation, 1 New Orchard Road, Armonk, New York, United States.[9] Qualitative variable results were shown by frequency and percentages. Quantitative variable results were shown by descriptive statistics. Paired t-test was used to test the significant mean difference of HRV before and after playing video games in both the groups. Independent t-test was used to test the significant mean difference of HRV between the study and control groups. Throughout results, 5% level of significance was used. All results were shown with 95% of confidence. P < 0.05 was considered statistically significant.
OBSERVATION AND RESULTS
DISCUSSION
The present study showed a statistically significant difference in SBP, DBP, and pulse rate between the study and control groups after playing a game [Table 1 and Graph 1], indicating a higher sympathetic activity in the study group. A statistically significant difference was also found within the study group before and after playing violent video games. However, only SBP and pulse rate showed a significant difference within the control group before and after playing nonviolent video games, and DBP showed no statistically significant difference within the control group [Table 1 and Graph 1].
Table 1.
Systolic blood pressure, diastolic blood pressure, pulse rate of study and control group before and after (30 min) playing game
| Parameters | Duration (min) | Study group (n=83) | Control group (n=83) | P b |
|---|---|---|---|---|
| SBP (mmHg) | Before | 119.93±5.87 | 118.29±5.68 | 0.070* |
| After | 132.75±6.26 | 119.2±5.1 | <0.001*** | |
| P w | <0.001*** | 0.022** | ||
| DBP (mmHg) | Before | 73.33±4.36 | 73.93±3.9 | 0.350* |
| After | 82.1±4.26 | 75.04±5.38 | <0.001*** | |
| P w | <0.001*** | 0.069 | ||
| Pulse rate (bpm) | Before | 72.75±4.31 | 71.59±6.45 | 0.177* |
| After | 81.06±5.4 | 72.86±7.21 | <0.001*** | |
| P w | <0.001*** | <0.001*** |
*P>0.05 statistically not significant, **P<0.05 Statistically significant, ***P<0.001 highly statistically significant, bP value between study and control group, wP value within group. SBP=Systolic blood pressure, DBP=Diastolic blood pressure
Graph 1.
Shows Systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse rate of study and control group before and after (30 minutes) playing game
A study conducted by Yadav et al. found that a significant positive correlation exists between pulse rate and violent video games.[10] Similar results were also observed by Lin et al., as they found significantly higher sympathetic activity and DBP when playing violent video games.[11]
Video games and time-domain parameters of heart rate variability
Time-domain parameters of HRV (SDNN, SDANN, RMSDD, pNN50%, and standard deviation of successive differences [SDSD]), which indicate predominantly parasympathetic activity, were compared between the study and control groups at different durations, i.e., before game play, during game play (15 min of game play), and after 30 min of game play.
Our study found a statistically significant difference in all time-domain parameters of HRV (SDNN, SDANN, RMSDD, and SDSD), except for pNN50% between the study and control groups before and during game play (after 15 min) [Table 2 and Graph 2]. When time-domain parameters were compared between the study and control groups before and after playing video games (30 min of game play), all the parameters showed decreased values with statistically significant difference, indicating reduced parasympathetic activity in the study group as compared to the control group [Table 3 and Graph 2].
Table 2.
Time-domain parameters of study and control group before and during (15 min) of playing game (n=83)
| Parameters | Duration (min) | Study group | Control group | P b |
|---|---|---|---|---|
| SDNN | Before | 53.77±14.08 | 57.54±18.03 | 0.136* |
| During | 50.43± 16.92 | 57.72±19.46 | 0.011** | |
| P w | 0.143* | 0.841* | ||
| SDANN | Before | 51.97±14.5 | 54.76±15.78 | 0.237* |
| During | 49.34±21.37 | 55.82±15.68 | 0.027* | |
| P w | 0.319* | 0.492* | ||
| RMSSD | Before | 56.04±12.04 | 58.7±13.45 | 0.181* |
| During | 52.41±19.19 | 59.14±14.87 | 0.013** | |
| P w | 0.167* | 0.751* | ||
| pNN50% | Before | 45.1±12.3 | 47.81±16.47 | 0.234* |
| During | 41.68±17.33 | 47.05±18.74 | 0.057* | |
| P w | 0.187* | 0.746* | ||
| SDSD | Before | 50.77±12.77 | 52.86±13.54 | 0.308* |
| During | 46.07± 16.57 | 54.70±17.47 | 0.001*** | |
| P w | 0.036** | 0.341* |
*P>0.05; statistically not significant, **P<0.05 statistically significant, ***P<0.001 highly statistically significant, bP value between study and control group, wP value within group. SDNN=Standard deviation of the normal to normal, RMSSD=Root mean square of successive differences, SDANN=Standard deviation of average NN intervals, SDSD=Standard deviation of successive differences
Graph 2.
Time-domain parameters of the study and control groups before, during (15 min), and after (30 min) playing game
Table 3.
Time-domain parameters of study and control group before and after (30 min) playing game (n=83)
| Parameters | Duration (min) | Study group | Control group | P b |
|---|---|---|---|---|
| SDNN | Before | 53.77±14.08 | 57.54±18.03 | 0.136* |
| After | 38.38±10.98 | 57.73±17.43 | <0.001*** | |
| P w | <0.001*** | 0.828* | ||
| SDANN | Before | 51.97±14.5 | 54.76±15.78 | 0.237* |
| After | 33.8±8.63 | 56.51±16.73 | <0.001** | |
| P w | <0.001*** | 0.272* | ||
| RMSSD | Before | 56.04±12.04 | 58.70±13.45 | 0.181 |
| After | 40.16±9.66 | 59.8±15.76 | <0.001** | |
| P w | <0.001*** | 0.484* | ||
| pNN50% | Before | 45.1±12.3 | 47.81±16.47 | 0.234 |
| After | 30.22±10.23 | 48.87±18.20 | <0.001*** | |
| P w | <0.001*** | 0.336* | ||
| SDSD | Before | 50.77±12.77 | 52.86±13.54 | 0.308* |
| After | 36.2±10.85 | 56.02±16.87 | <0.001** | |
| P w | <0.001*** | 0.050* |
*P>0.05 statistically not significant, **P<0.05 statistically significant, ***P<0.001 highly statistically significant, bP value between study and control group, wP value within group. SDNN=Standard deviation of the normal to normal, RMSSD=Root mean square of successive differences, SDANN=Standard deviation of average NN intervals, SDSD=Standard deviation of successive differences
Within the study group, only SDSD showed a statistically significant difference before and during violent game play (after 15 min); however, a highly significant difference was found for all the parameters before and after playing violent video games (30 min of game play) as compared to nonviolent video games. The results indicated a significant decline in parasympathetic activity after 30 min of violent game play in the study group with SDNN 38.38 ± 10.98 as compared to those who played nonviolent video games, with SDNN >50 ms [Tables 2 and 3, Graph 2]. Many studies have also reported similar results of decreased SDNN, indicating increased sympathetic activity during action games.[12,13]
Video games and frequency-domain parameters of heart rate variability
The frequency-domain parameters are TP, VLF, LF, HF, and LF/HF ratio. The frequency-domain parameters LF (ms2) and LF/HF reflect the sympathetic drive and sympathovagal balance of the heart, whereas VLF, HF, and TP represent the parasympathetic or vagal activity of the heart. LF/HF >1 indicates increase sympathetic drive.
Tables 4 - 5 and Graph 3 show reduced values of parasympathetic activity markers of the frequency domain, i.e., VLF (ms2), TP (ms2), and HF (ms2) in the study group as compared to the control group. Our findings also highlight a statistically highly significant difference in the sympathetic activity markers of frequency domain, i.e., LF (ms2) and LF/HF ratio in the study group as compared to the control group.
Table 4.
Frequency-domain parameters of study and control group before and during (15 min) of playing game
| Parameters | Duration (min) | Study group | Control group | P b |
|---|---|---|---|---|
| TP (ms2) | Before | 4132.67±1223.26 | 4217.75±1425.83 | 0.680* |
| During | 3685.93±1785.74 | 4216.99±1543.67 | 0.042** | |
| P w | 0.037** | 0.997* | ||
| VLF (ms2) | Before | 1247.28±1024.97 | 1357.79±1040.59 | 0.492* |
| During | 1016.14±602.50 | 1336.55±1004.84 | 0.014** | |
| P w | 0.078* | 0.881* | ||
| LF (ms2) | Before | 1253.18±1139.46 | 1461.26±987.89 | 0.212* |
| During | 1956.63±1666.93 | 1408.63±1014.70 | 0.012** | |
| P w | <0.001*** | 0.725* | ||
| HF (ms2) | Before | 1118.67±844.47 | 1311.39±870.83 | 0.150* |
| During | 1010.63±781.78 | 1423.28±1699.60 | 0.046** | |
| P w | 0.395* | 0.585* | ||
| LF/HF | Before | 1.17±0.65 | 1±0.54 | 0.070* |
| During | 1.54±0.77 | 1.08±0.58 | <0.001*** | |
| P w | 0.000** | 0.114* |
*P>0.05 statistically not significant, **P<0.05 statistically significant, ***P<0.001 highly statistically significant, bP value between study and control group, wP value within group. TP=Total power, VLF=Very low frequency, LF=Low frequency, HF=High frequency
Table 5.
Frequency-domain parameters of study and control group before and after (30 min) playing game (n=83)
| Parameters | Duration (min) | Study group | Control group | P b |
|---|---|---|---|---|
| TP (ms2) | Before | 4132.67±1223.26 | 4217.75±1425.83 | 0.680* |
| After | 3047.1±1441.71 | 4168.73±1545.78 | <0.001*** | |
| P w | <0.001*** | 0.806* | ||
| VLF (ms2) | Before | 1247.28±1024.97 | 1357.79±1040.58 | 0.492* |
| After | 703.7±475.55 | 1305.21±879.15 | <0.001*** | |
| P w | <0.001*** | 0.609* | ||
| LF (ms2) | Before | 1253.18±1139.46 | 1461.26±987.89 | 0.212* |
| After | 2298.05±1351.07 | 1406.03±716.53 | <0.001*** | |
| P w | <0.001*** | 0.553* | ||
| HF (ms2) | Before | 1118.67±844.47 | 1311.39±870.83 | 0.150* |
| After | 733.85±434.06 | 1431.66±744.63 | <0.001*** | |
| P w | <0.001*** | 0.181* | ||
| LF/HF | Before | 1.17±0.65 | 1.00±0.54 | 0.070* |
| After | 1.85±0.84 | 1.02±0.6 | <0.001*** | |
| P w | <0.001*** | 0.743* |
*P>0.05 statistically not significant, ***P<0.001 highly statistically significant, bP value between study and control group, wP value within group. TP=Total power, VLF=Very low frequency, LF=Low frequency, HF=High frequency
Graph 3.
Frequency-domain parameters of the study and control groups before, during (15 min), and after (30 min) playing game
Within the group, TP, LF, and LF/HF ratios of frequency-domain parameters were statistically significant in the study group before and during (after 15 min) violent video game play, while all the parameters were not significant before and during game play within the control group. Once the duration of game play was increased to 30 min, all frequency-domain parameters showed a statistically significant difference for the study group, but no significant difference was observed within the control group before and after game play. The results of our study indicated high sympathetic activity [Tables 4 and 5, Graph 3].
The results of our study were in accordance with the study conducted on boys aged 12–15 years who reported significantly higher activity of LF when playing violent video games.[14] Another study by Ivarsson et al. found an increase in the activity of the LF/HF, indicating activation of the sympathetic nervous system.[1]
Various mechanisms have been put forth to explain the relation between violent video games and autonomic imbalance. Research results have indicated that cortisol is an essential hormone secreted by the adrenal gland in response to stress along with alpha-amylase during violent video game play.[15] Such unnatural secretion impairs the glutamate system, destroys the nervous synapses, and results in the emergence of anger, aggression, and violence.[16] It has also been found that there is a predominance of the sympathetic nervous system when playing violent video games, leading to hypothalamus–pituitary axis activation. This stimulates the amygdala to trigger Paraventricular nucleus of the hypothalamus releasing adrenocorticotropin from secreting cells via corticotropin-releasing hormone into the blood.[16,17]
The results of our study found that HRV parameters indicating parasympathetic activity (SDNN, SDANN, RMSDD, pNN50%, SDSD VLF, HF, and TP) were statistically significantly reduced, and parameters (LF and LF/HF ratio) indicating sympathetic activity including blood pressure and pulse rate were raised in the study group as compared to the control group. The present study also showed that this effect was more pronounced during longer durations of violent video game play.
CONCLUSION
Our research findings implicate an upsurge in sympathetic activity and decreased parasympathetic activity in individuals playing violent video games. Overstimulation of sympathetic activity may worsen sleep quality, cognitive abilities, behavioral activities, and also prone the individual to develop future risk of cardiovascular diseases. It is the need of the hour to take positive efforts in this direction for the betterment of the individual health with better outcomes. This will help combat the burden of cardiovascular diseases worldwide.
Conflicts of interest
There are no conflicts of interest.
Funding Statement
The study was financially supported by the Indian Council of Medical Research (ICMR-STS).
REFERENCES
- 1.Ivarsson M, Anderson M, Åkerstedt T, Lindblad F. The effect of violent and nonviolent video games on heart rate variability, sleep, and emotions in adolescents with different violent gaming habits. Psychosom Med. 2013;75:390–6. doi: 10.1097/PSY.0b013e3182906a4c. [DOI] [PubMed] [Google Scholar]
- 2.Shao R, Wang Y. The relation of violent video games to adolescent aggression: An examination of moderated mediation effect. Front Psychol. 2019;10:384. doi: 10.3389/fpsyg.2019.00384. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Lee D, Hong SJ, Jung YC, Park J, Kim IY, Namkoong K. Altered heart rate variability during gaming in internet gaming disorder. Cyberpsychol Behav Soc Netw. 2018;21:259–67. doi: 10.1089/cyber.2017.0486. [DOI] [PubMed] [Google Scholar]
- 4.Shaffer F, Ginsberg JP. An overview of heart rate variability metrics and norms. Front Public Health. 2017;5:258. doi: 10.3389/fpubh.2017.00258. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Kim JY, Kim HS, Kim DJ, Im SK, Kim MS. Identification of video game addiction using heart-rate variability parameters. Sensors (Basel) 2021;21:4683. doi: 10.3390/s21144683. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.O’Brien E, Asmar R, Beilin L, Imai Y, Mallion JM, Mancia G, et al. European Society of Hypertension recommendations for conventional, ambulatory and home blood pressure measurement. J Hypertens. 2003;21:821–48. doi: 10.1097/00004872-200305000-00001. [DOI] [PubMed] [Google Scholar]
- 7.Wehrwein EA, Orer HS, Barman SM. Overview of the anatomy, physiology, and pharmacology of the autonomic nervous system. Compr Physiol. 2016;6:1239–78. doi: 10.1002/cphy.c150037. [DOI] [PubMed] [Google Scholar]
- 8.Yugar LB, Yugar-Toledo JC, Dinamarco N, Sedenho-Prado LG, Moreno BV, Rubio TA, et al. The role of heart rate variability (HRV) in different hypertensive syndromes. Diagnostics (Basel) 2023;13:785. doi: 10.3390/diagnostics13040785. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Mahajan BK. In: Methods in Biostatistics for Medical students and Research Workers. 8th ed. New Delhi, India: Jaypee Brothers; 2015. Correlation and regression; pp. p. 167–78. [Google Scholar]
- 10.Yadav RL, Yadav PK, Yadav LK, Agarwal K, Sah SK, Islam MN. Syndrome M. Association between obesity and heart rate variability indices: An intuition toward cardiac autonomic alteration- a risk of CVD, diabetes, metabolic syndrome and obesity. Targets Ther. 2017;10:57–64. doi: 10.2147/DMSO.S123935. [doi: 10.2147/DMSO.S123935] [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11.Lin TC. Effects of gender and game type on autonomic nervous system physiological parameters in long-hour online game players. Cyberpsychol Behav Soc Netw. 2013;16:820–7. doi: 10.1089/cyber.2012.0230. [DOI] [PubMed] [Google Scholar]
- 12.Long K, Zhang X, Wang N, Lei H. Heart rate variability during online video game playing in habitual gamers: Effects of internet addiction scale, ranking score and gaming performance. Brain Sci. 2023;14:29. doi: 10.3390/brainsci14010029. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13.Kim N, Hughes TL, Park CG, Quinn L, Kong ID. Altered autonomic functions and distressed personality traits in male adolescents with internet gaming addiction. Cyberpsychol Behav Soc Netw. 2016;19:667–73. doi: 10.1089/cyber.2016.0282. [DOI] [PubMed] [Google Scholar]
- 14.Ivarson M, Anderson M, Akerstedt T, Lindblad F. Playing a violent television game affects heart rate variability. Acta Paediatr. 2011;100:1283. doi: 10.1111/j.1651-2227.2008.01096.x. [DOI] [PubMed] [Google Scholar]
- 15.Cardinal RN, Parkinson JA, Hall J, Everitt BJ. Emotion and motivation: The role of the amygdala, ventral striatum, and prefrontal cortex. Neurosci Biobehav Rev. 2002;26:321–52. doi: 10.1016/s0149-7634(02)00007-6. [DOI] [PubMed] [Google Scholar]
- 16.Porter AM, Goolkasian P. Video games and stress: How stress appraisals and game content affect cardiovascular and emotion outcomes. Front Psychol. 2019;10:967. doi: 10.3389/fpsyg.2019.00967. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17.Aliyari H, Sahraei H, Daliri MR, Minaei-Bidgoli B, Kazemi M, Agaei H, et al. The beneficial or harmful effects of computer game stress on cognitive functions of players. Basic Clin Neurosci. 2018;9:177–86. doi: 10.29252/nirp.bcn.9.3.177. [DOI] [PMC free article] [PubMed] [Google Scholar]