Neuromuscular Training in Professional Esports Players

January 7, 2026 updated by: Doğukan Tongar, Yeditepe University

Effectiveness of Neuromuscular Training Added to Routine Practice on Fatigue and Stress Biomarkers in Professional Esports Players: A Randomized Controlled Trial

Professional esports players engage in prolonged training sessions and experience high physical and mental stress due to intensive competition schedules. These demands can lead to increased fatigue, decreased performance, and health problems. This randomized controlled trial aims to investigate whether adding a structured neuromuscular exercise program to routine esports training reduces fatigue and stress biomarkers and improves performance-related outcomes in professional esports players.

Study Overview

Status

Not yet recruiting

Conditions

Intervention / Treatment

Detailed Description

Esports players often perform long hours of training that require sustained physical and cognitive effort, which may result in musculoskeletal problems, mental fatigue, and elevated stress levels. Most studies in the esports field rely on subjective evaluations and include non-professional populations. Objective assessment of fatigue and stress biomarkers in professional esports athletes is still lacking.

This prospective randomized controlled trial will include 24 professional esports players aged 18-35 who train at least 35 hours per week with their teams. Participants will be randomly assigned to either a neuromuscular training group or a control group. The intervention group will complete an 8-week neuromuscular exercise program three times per week in addition to their regular esports training routine. The control group will receive structured physical activity counseling based on ACSM 5A principles.

Primary outcomes include serum levels of cortisol, testosterone, testosterone/cortisol ratio, C-reactive protein (CRP), creatine kinase (CK), vitamin B12, and iron measured under standardized fasting conditions. Secondary outcomes include muscle strength (myometry), sleep quality (Pittsburgh Sleep Quality Index), physical activity level (IPAQ-SF), quality of life (SF-12), visual and auditory reaction time tests, lactate measures (Lactate Scout), and mood states (POMS). Outcomes will be assessed at baseline and after the 8-week intervention period.

The findings of this study are expected to provide evidence-based recommendations for integrating neuromuscular conditioning into professional esports training to enhance physical health, reduce fatigue and stress, and improve overall performance.

Study Type

Interventional

Enrollment (Estimated)

24

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact Backup

Study Locations

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult

Accepts Healthy Volunteers

Yes

Description

Inclusion Criteria:

  • Age between 18-35 years
  • Currently competing as a contracted professional esports player
  • Playing one of the following games at a professional level:

League of Legends, Counter Strike 2, Overwatch, Valorant, Apex Legends, DOTA2, Rocket League, PUBG

  • Participating in ≥35 hours/week of training with their team
  • Voluntary agreement to participate and sign informed consent

Exclusion Criteria:

  • History or presence of medical conditions affecting safety or performance: metabolic, cardiovascular, renal, neurological, or respiratory disorders

    • Playing esports only at amateur or beginner level
    • Answering "Yes" to any item in the Physical Activity Readiness Questionnaire (PAR-Q)

Removal Criteria:

  • Participating in <35 hours/week esports training during the study
  • Missing ≥2 neuromuscular training sessions (intervention group)
  • Leaving their professional esports organization (roster removal, retirement, etc.)
  • Any illness or injury preventing continuation of esports participation

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Supportive Care
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Neuromuscular Training
Professional esports players will perform a structured neuromuscular training program added to their routine esports practice, 3 sessions per week for 8 weeks. The program includes warm-up, aerobic, strengthening, core stabilization, functional and reaction drills with progressive weekly increases in duration or repetitions.
Behavioral: Neuromuscular Training
A progressive neuromuscular exercise program including dynamic warm-up, aerobic exercises, functional strengthening of lower and upper extremity muscles, core stabilization training, and reaction drills performed 3 times per week for 8 weeks. Duration and repetitions increase biweekly according to a structured progression protocol.
Active Comparator: Physical Activity Counseling
Professional esports players will receive structured physical activity counseling in addition to their routine esports practice. The counseling will follow ACSM 5A principles (Assess, Advise, Agree, Assist, Arrange) to support behavior change and increase physical activity participation weekly for 8 weeks.
Behavioral: Physical Activity Counseling
Structured physical activity counseling based on ACSM 5A principles (Assess, Advise, Agree, Assist, Arrange) delivered weekly for 8 weeks to promote sustainable physical activity behaviors and reduce sedentary time during esports training routines.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Serum cortisol level - Stress Biomarkers
Time Frame: Baseline and 8 weeks
Serum cortisol level will be analyzed under fasting conditions using standardized laboratory protocols.
Baseline and 8 weeks
Testosterone level - Stress Biomarkers
Time Frame: Baseline and 8 weeks
Testosterone level will be analyzed under fasting conditions using standardized laboratory protocols.
Baseline and 8 weeks
C-Reactive Protein Level (CRP) - Fatigue Biomarkers
Time Frame: Baseline and 8 weeks
Serum CRP levels will be analyzed under fasting conditions using standardized laboratory protocols.
Baseline and 8 weeks
Creatine Kinase (CK) Level - Fatigue Biomarkers
Time Frame: Baseline and 8 weeks.
Creatine kinase levels will be analyzed under fasting conditions using standardized laboratory protocols.
Baseline and 8 weeks.
Vitamin B12 Level - Fatigue Biomarkers
Time Frame: Baseline and 8 weeks.
Serum vitamin B12 levels will be analyzed under fasting conditions using standardized laboratory protocols.
Baseline and 8 weeks.
Iron Level - Fatigue Biomarkers
Time Frame: Baseline and 8 weeks.
Serum iron levels will be analyzed under fasting conditions using standardized laboratory protocols.
Baseline and 8 weeks.

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Muscle Strength
Time Frame: Baseline and 8 weeks
Hand, forearm, shoulder, and back muscle strength will be assessed using a handheld myometer; mean of three trials recorded in kilograms.
Baseline and 8 weeks
Sleep Quality
Time Frame: Baseline and 8 weeks

Assessment of subjective sleep quality, sleep duration, sleep disturbances, and overall sleep efficiency with Pittsburgh Sleep Quality Index.

The Pittsburgh Sleep Quality Index (PSQI) consists of 19 items that generate seven component scores, each ranging from 0 to 3, yielding a global score between 0 and 21, with higher scores indicating poorer sleep quality; a total score greater than 5 reflects clinically significant sleep disturbance.
Baseline and 8 weeks
Physical Activity Level
Time Frame: Baseline and 8 weeks
Self-reported physical activity levels converted to MET-minutes per week. (IPAQ-Short Form). The International Physical Activity Questionnaire-Short Form (IPAQ-SF) provides total physical activity expressed in Metabolic Equivalent of Task (MET)-minutes/week, and scores are categorized as follows: <600 MET-minutes/week indicates low activity, 600-3000 MET-minutes/week indicates moderate activity, and >3000 MET-minutes/week indicates high physical activity level.
Baseline and 8 weeks
Reaction Time
Time Frame: Baseline and 8 weeks
Average visual reaction time over 5 trials recorded in milliseconds. Average response latency to an auditory stimulus over 5 trials.
Baseline and 8 weeks
Blood Lactate Concentration
Time Frame: Baseline and 8 weeks
Capillary blood lactate measured to assess metabolic response to neuromuscular training.
Baseline and 8 weeks
Mood State
Time Frame: Baseline and 8 weeks
Assessment of tension, depression, anger, fatigue, and vigor subscales with Profile of Mood States (POMS). The Profile of Mood States (POMS) assesses mood across multiple dimensions and yields a Total Mood Disturbance (TMD) score by summing negative mood subscales and subtracting the vigor score; higher TMD scores indicate greater mood disturbance, whereas lower scores reflect better overall mood.
Baseline and 8 weeks

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Yeditepe University

Collaborators

Istanbul University - Cerrahpasa

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

January 28, 2026

Primary Completion (Estimated)

December 1, 2026

Study Completion (Estimated)

December 1, 2026

Study Registration Dates

First Submitted

November 24, 2025

First Submitted That Met QC Criteria

January 7, 2026

First Posted (Actual)

January 8, 2026

Study Record Updates

Last Update Posted (Actual)

January 8, 2026

Last Update Submitted That Met QC Criteria

January 7, 2026

Last Verified

January 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • E-SPORT-NME-2025-01

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

IPD Plan Description

Individual participant data will not be shared due to privacy protection and confidentiality regulations for professional esports players.

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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