Upper body compression wear improves muscle oxygenation following intense video game training: a randomized cross-over study among competitive gamers

Abstract

Background
Esport players require a high number of action moves per minute to play, with substantial contractions of the wrist extensor muscles. Players frequently suffer from acute fatigue. The purpose of this study was to examine the use of below the elbow compression sleeves on Sm02 during intense aim training. Secondly, to examine players’ performance and perception with and without compression.

Methods
This study was conducted at the New York Institute of Technology and enrolled fifteen collegiate esport players, 2 women and 13 men (age 21.2 ± 2.2). All subjects signed written consent. Participants performed 3 high intensity bouts of an aim trainer followed by a 15-minute rest before doing another 3 bouts of high intensity training conducting the other arm of the study. The compression wear order was randomized. The primary outcome included Sm02 of the extensor carpi radialis longus using near-infrared spectrometry. Secondary outcomes included Kills Per Second (KPS), Score, Total Time to Kill (TTK), accuracy, and perceived performance.

Results
Following 15 min of recovery, there was a significant rise in Sm02 while wearing the compression sleeve compared to no compression sleeve (p = 0.004). No change in Sm02 was seen while gaming. In trials 1 and 2, wearing the compression sleeve resulted in a significant increase in KPS and score when compared to not wearing it (p = 0.002,0.006). Although TTK and accuracy did not alter, 46.7% of participants believed the compression sleeve aided their performance.

Conclusions
This study provides support that wearing below the elbow upper body compression sleeves while performing high intensity gaming may reduce fatigue, improve muscle recovery and gaming performance.

Trial registration
Clinicaltrials.gov identifier NCT05037071. Registered 08/09/2021. URL: Arm Compression on Muscle Oxygen Saturation - Full Text View - ClinicalTrials.gov

Full text

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DiFrancisco-Donoghue et al.
BMC Sports Science, Medicine and Rehabilitation (2023) 15:108
https://doi.org/10.1186/s13102-023-00720-5
BMC Sports Science, Medicine
and Rehabilitation
*Correspondence:
Joanne DiFrancisco-Donoghue
jdonoghu@nyit.edu
1Department of Osteopathic Medicine, New York Institute of Technology/
Academic Health Care Center, College of Osteopathic Medicine
(NYITCOM), Northern Blvd, PO Box 8000, Old Westbury, NY 11568, USA
2Department of Interdisciplinary Health Sciences, New York Institute of
Technology (NYIT), Old Westbury, NY, USA
3Department of Research, NYITCOM, Old Westbury, NY, USA
4Department of Family Medicine, NYITCOM, Old Westbury, NY, USA
5School of Health Professions, Department of Physical Therapy, New York
Institute of Technology (NYIT), Old Westbury, NY, USA
Abstract
Background Esport players require a high number of action moves per minute to play, with substantial contractions
of the wrist extensor muscles. Players frequently suer from acute fatigue. The purpose of this study was to examine
the use of below the elbow compression sleeves on Sm02 during intense aim training. Secondly, to examine players’
performance and perception with and without compression.
Methods This study was conducted at the New York Institute of Technology and enrolled fteen collegiate esport
players, 2 women and 13 men (age 21.2 ± 2.2). All subjects signed written consent. Participants performed 3 high
intensity bouts of an aim trainer followed by a 15-minute rest before doing another 3 bouts of high intensity training
conducting the other arm of the study. The compression wear order was randomized. The primary outcome included
Sm02 of the extensor carpi radialis longus using near-infrared spectrometry. Secondary outcomes included Kills Per
Second (KPS), Score, Total Time to Kill (TTK), accuracy, and perceived performance.
Results Following 15min of recovery, there was a signicant rise in Sm02 while wearing the compression sleeve
compared to no compression sleeve (p = 0.004). No change in Sm02 was seen while gaming. In trials 1 and 2,
wearing the compression sleeve resulted in a signicant increase in KPS and score when compared to not wearing
it (p = 0.002,0.006). Although TTK and accuracy did not alter, 46.7% of participants believed the compression sleeve
aided their performance.
Conclusions This study provides support that wearing below the elbow upper body compression sleeves while
performing high intensity gaming may reduce fatigue, improve muscle recovery and gaming performance.
Trial registration Clinicaltrials.gov identier NCT05037071. Registered 08/09/2021. URL: Arm Compression on
Muscle Oxygen Saturation - Full Text View - ClinicalTrials.gov
Keywords Muscle oxygen, Fatigue, Graduated compression, Esports
Upper body compression wear improves
muscle oxygenation following intense video
game training: a randomized cross-over study
among competitive gamers
JoanneDiFrancisco-Donoghue1* , AlexanderRothstein2, Min-KyungJung3, HallieZwibel4 and William GWerner5
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DiFrancisco-Donoghue et al. BMC Sports Science, Medicine and Rehabilitation (2023) 15:108
Background
Muscle deoxygenation and reoxygenation has been stud-
ied in multiple athletic populations [1–3]. Muscle oxygen
saturation (SmO2) is an indirect measure of muscle e-
ciency, which is dened as the balance between the rate
of oxygen consumption by the muscle and the rate of oxy-
gen (O2) being replenished in the muscle.1) It is impor-
tant to all athletic populations, including both endurance
and power athletes, as it is a marker for how ecient a
muscle is during performance as well as recovery [1–3]. If
the supply does not meet the demand of the muscle, then
the muscle metabolism becomes increasingly anaerobic
which can lead to rapid fatigue [1, 4].
A competitive esport player can perform up to 600
mouse and keyboard actions per minute (APM) on a
typical training day [5]. A routine training day for a com-
petitive esport player can range from 5 to 10 h of play
with no break [5]. In comparison, oce workers perform
an average of 130–180 keyboard and mouse inputs per
minute over the course of an 8-hour work day [6]. ese
APMs require sustained wrist extension in conjunction
with repetitive forearm muscle contractions in multiple
planes, as well as shoulder stability and postural stability.
With these ne motor demands, it is common for players
to suer from acute fatigue and chronic overuse poten-
tially resulting in wrist and arm injuries [7].
e use of compression wear has expanded from clini-
cal use into the sports market. Athletes in various sports
wear compression garments with the assumption that it
will improve performance and facilitate muscle recov-
ery. e recommendations to wear compression gear
in athletes is based on an assumption of improvement
in venous blood ow which improves exchange of fresh
blood and blood waste [1, 3]. Anecdotally, Lebron James
and Ray Allen are among many National Basketball
Association (NBA) players that wear upper compression
regularly when competing, as well as professional Major
League Baseball (MLB) player Shohei Ohtani. In the 2016
Olympics, it was estimated that 90% of athletes used
some form of compression performance gear [8].
Compression wear during endurance exercises has
mostly been studied using lower body compression,
with conicting results [1, 9–11].ere is minimal evi-
dence supporting the use of compression sleeves dur-
ing intermittent high-intensity exercise, and even less
so for the use of upper body compression sleeves [9,
12–15]. However, it has been demonstrated that fore-
arm compression sleeves enhance arterial blood ow
[16]. erefore, the performance and recovery of esport
players may be improved by this increased blood ow;
hence this enhanced blood ow may be benecial to their
performance.
Most modern compression gear marketed toward ath-
letes use garments that employ ‘graduated compression’.
is means that the highest amount of pressure is on the
most distal parts of your body (e.g. ankles if you are using
lower body compression, wrists if using upper body com-
pression) and the pressure gradually reduces as it moves
up toward your body. Compression wear varies in pres-
sure range. e amount of compression is measured in
mmHg and light compression can range from 18 to 21
mmHg, moderate 23–32 mmHg, strong 34–46 mmHg
and > 49 mmHg very strong [17]. Most over-the-coun-
ter athletic compression garments range from 18 to 21
mmHg.
Considering esports research is in its early stages, oxi-
dative capacity of the nger and wrist extensors during
prolonged video gaming has never been explored. e
aim of this study is to evaluate the use of upper body
graduated compression gear on Sm02 during high inten-
sity rst person shooter (FPS) game training. Secondly, a
goal is to examine players’ performance with and without
upper body graduated compression, and lastly to exam-
ine perception and comfort level while playing with or
without compression.
Methods and procedures
is study was approved by the New York Institute of
Technology (NYIT) Institutional Review Board and reg-
istered on Clinicaltrials.gov identier NCT05037071.
Fifteen healthy collegiate esport players, 2 women and 13
men (mean age 21.2 ± 2.2), signed written informed con-
sent prior to participation in this study (Fig.1). Inclusion
criteria included: (1) A ranked esport player with over
500h in their game (self-reported); (2) Non-smoker; (3)
No history of heart disease, pulmonary disease, diabetes,
or other metabolic disease; Exclusion criteria included:
(1) Use of any prescribed or over the counter medica-
tions that would inuence metabolic outcomes or blood
viscosity; (2) Any prior injury to the dominant upper arm
within the past year. (Table1)
Procedures
is study was a randomized cross-over design which
entailed subjects coming to the NYIT esport gaming lab
in Old Westbury, New York for 1 testing day. Subjects
arrived at least one hour post prandial. e room was
kept temperature controlled within 2–3 degrees of 21
degrees Celsius each testing day.
Testing was randomized by subject in order of sequence
regarding use of compression garment(intervention)
versus no compression (control) garments using an
online sequence generator. (RANDOM.ORG - Sequence
Generator)
Sm02
e extensor carpi radialis longus muscle in the forearm
is one of the primary wrist extensor muscles involved
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DiFrancisco-Donoghue et al. BMC Sports Science, Medicine and Rehabilitation (2023) 15:108
in console gaming by facilitating wrist extension dur-
ing camera control, aiming, button pressing, and pre-
cise movements. During gaming sessions, players often
need to perform these repetitive and precise movements
with their thumbs and ngers while also manipulat-
ing the controller with their wrists. e extensor carpi
radialis longus is easily palpable at one third of the line
between the lateral epicondyle and the styloid process
of the radius [13, 14]. is was the location the Sm02
sensor was placed. Near infrared spectroscopy (Moxy™,
Minnesota, USA) was used to assess Sm02. Near infra-
red spectroscopy measures the ratio of the oxyhemoglo-
bin concentration to the total hemoglobin concentration
in the muscle in real time and reports it as a percentage,
which is indicated as muscle oxygen saturation or muscle
oxygenation (SmO2) [18, 19].
FPS training
is study used a Gridshot aim trainer to implement FPS
intense training. A large problem in current esport lit-
erature is the lack of validated outcome measures due to
the variability of each game and the level of competition
someone may compete against. e only way to consis-
tently keep the level uniform across all conditions and to
quantify how many action moves the player performed
with their nger was to use a standardized aim trainer.
Using Gridshot, the following outcome measures were
collected for performance: Kills Per Second (KPS), Time
to Kill (TTK), and Accuracy.
e Moxy sensors were taped into place. Pre-gaming
measurements were conducted following 10min of com-
plete rest. Each subject then played an 8-minute bout of
State Space Lab (STATE SPACE LABS, INC. New York
NY, Statespace) Gridshot AIM trainer with 1 min rest
between training sets. is was repeated 2 more times for
a total of 24min of training.
Dependent on random assignment, participants either
played with or without compression. Under the compres-
sion condition a Juzo™ pressure monitor (Compression
Innovations Inc. Cuyahoga Galls, OH, USA) was inserted
under the compression garment to measure distal and
proximal mmHg of pressure and the pounds per square
inch were recorded.
e subjects then rested for 15min before switching to
the other condition of the study where they repeated the
same three bouts of Gridshot for 8min with 1min rest
between each bout. During this time muscle Sm02 and
heart rate were monitored continuously. Re-oxygenation
during recovery was calculated at 5min, and 15min post
training. Heart rate was collected using Wahoo™ Optical
Fig. 1 Study Flow Diagram
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DiFrancisco-Donoghue et al. BMC Sports Science, Medicine and Rehabilitation (2023) 15:108
Heart Rate armbands with Bluetooth (Wahoo Fitness™,
Atlanta, GA, USA). e Moxy units and the Wahoo HR
monitors both were synced using PerfPro Studio® soft-
ware (Vision Quest Virtual, LLC, Illinois). (Table2)
Compression
Measuring for proper upper body compression
is study used graduated compression garments that t
below the elbow. e dominant arm (arm manipulating
the mouse) was tted according to manufacturer instruc-
tions. (Fig.2)
Statistical analysis
IBM SPSS V.27 was used to carry out all statistical anal-
yses. Statistical signicance for this study was set at
p ≤ 0.05. A two-way repeated measures analysis of vari-
ance was conducted to compare SmO2 and HR at rest,
the nal values of the 3rd trial (minute 24 of Gridshot
training), 5-minute recovery, and 15-minute recovery
following each arm and for all performance outcomes. A
post hoc analysis was conducted when signicance was
found. Signicance was set at p ≤ 0.05.
Results
Gaming and recovery
ere was no change in Sm02 while actively gaming or
at rest between trials 1, 2 and 3 while wearing the arm
compression sleeve compared to not wearing the com-
pression (p value = 0.18,0.11, 0.47,0.72). ere was no
change in HR in either condition (p = 0.35). ere was no
signicant dierence in HR at rest or throughout gaming
(p = 0.59).
Recovery
An increase in Sm02 demonstrates a more rapid recov-
ery of the working muscle. ere was a 4.3% increase
in Sm02 following 15min of recovery in the compres-
sion group (66.7 ± 12.0 to 69.6 ± 14.0) as compared to
a 10% decrease in Sm02 in the no compression group
(67.6 ± 13.2 to 61.5 ± 15.0), this was signicant at p = 0.004.
At 5min recovery there was a 0.5% decrease in the com-
pression group (66.7 ± 12.0 to 66.4 ± 14.6) compared to
an 8.7% decrease in Sm02 in the no compression group
(67.6 ± 13.2 to 62.2 ± 14.7). However, this change was not
signicant at p = 0.12. (Fig.3)
Performance
ere was a signicant dierence of overall scores and
KPS in trials 1 and 2 for compression compared to no
compression (p = 0.002, 0.006), with no change by the
3rd trial. Total time to kill (TTK) was faster in all of the
compression trials, however the dierence did not reach
signicance (p = 0.06). ere was no change in Accuracy
(p = 0.24). (Fig.4)
Exit survey ndings
e study also measured qualitative data utilizing a
mixed methods research approach. Regarding the use
of the compression garments, 46.7% of participants
perceived that the arm compression sleeve “positively
helped” gaming performance (Table3). 26.7% of partici-
pants perceived that it “negatively impacted” on perfor-
mance, while 26.7% perceived that it had no impact on
performance. Most participants who perceived that the
compression sleeve positively helped gaming perfor-
mance commonly noted that it provided stabilization and
Table 1 Demographics
n = 15
Age (SD) 21.2 (2.2)
Weight.Kg (SD) 70.5 (12.2)
Height.inches (SD) 71(4.5)
BMI (SD) 20.9(4.3)
Men (%) 86.7
Right-handed (%) 86.7
Ethnicity (%)
African American 20
Asian 33.3
Caucasian 40
Other 6.7
Primary Game (%)
Halo 6.7
Arma 3 6.7
Valorant 33.3
Overwatch 20
Rocket League 6.7
Dragon Ball Fighterz 6.7
League of Legends 6.7
Casual Hours Played Weekly (%)
under 1h 13.3
1–2h 6.7
3–4h 26.7
5–6h 13.3
more than 6h 40
Competetive Hours Played Weekly (%)
1–2h 40
3–4h 33.3
5–6h 26.7
Table 2 Protocol
Protocol Minutes
Rest 10:00
AIM trainer 8:00
Rest 1:00
AIM trainer 8:00
Rest 1:00
AIM trainer 8:00
Recovery 5:00
Recovery 15:00
Repeat wit h other condition
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DiFrancisco-Donoghue et al. BMC Sports Science, Medicine and Rehabilitation (2023) 15:108
“less burn”. Other comments included “I felt more sup-
ported” or “my arm felt warmer”.
Participants who perceived that the compression sleeve
negatively impacted performance noted that it “felt too
tight”, “the fabric was itchy” and, of note, that the fabric
did not glide smooth on the mouse pad and felt like it was
sticking.
When posed the statement, “I would consider wear-
ing compression in the future”, over 85% agreed that they
would consider wearing it, while over 90% agreed that
they would wear it if it were part of a team uniform.
Discussion
e purpose of this study was to investigate if wearing
a compression sleeve below the elbow aected muscle
tissue oxygenation during and after high-intensity FPS
aim training. One major nding was a considerable rise
in Sm02 observed after 15 min of recovery while wear-
ing the compression sleeve, as well as an improvement in
performance. An interesting nding from this study was
that the wearing of arm compression garments positively
aected performance during an FPS training task. is
is the rst study to show that upper compression sleeves
had a favorable eect on a high-intensity gaming activity.
Fig. 3 Sm02 changes in extensor carpi radialis longus
*Signicance The higher the Sm02, the less fatigued the muscle
Fig. 2 Sensor placement and graduated compression sleeve
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Fig. 4 Changes in Overall Score and Kills Per Second (KPS)
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DiFrancisco-Donoghue et al. BMC Sports Science, Medicine and Rehabilitation (2023) 15:108
Several theories and mechanisms can account for these
ndings.
Performance
In this current study, the players while wearing the
compression sleeve showed signicant improvement
in performance within the rst 8min of training which
continued through 16min of training, despite negligible
changes in Sm02 and HR. is is in line with previous
research that demonstrated cycling improvement with
compression [12, 20].
Applied pressures between 8 and 30mm Hg to a local
area have been shown to signicantly increase blood
ow to the underlying tissue [1, 21, 22]. Bochmann et al.
[16] found an external compression to the forearm rang-
ing from 13 to 23 mmHg signicantly increased arterial
perfusion more than two-fold. e rationale for this is
thought to be a regulatory response that occurs follow-
ing a decrease in transmural vascular pressure, which in
turn triggers a myogenic response. A myogenic response
is a reex response (due to the compression) that changes
blood pressure and vascular wall tension which would
relax vessels, resulting in an increased blood ow [16].
Increased blood ow may delay exhaustion of the muscle
by increasing intramuscular pressure which increases
recruitment of motor units and delays exhaustion or
fatigue while performing an activity [15, 23].
e current evidence on compression sleeves and vari-
ous forms of exercise performance is conicting. For
example, Dascombe and colleagues [24] found lower
body compression garments did not correspond to any
improvement in running endurance in well-trained run-
ners; similarly, Scanlan et al. [10] found no change in
endurance wearing lower leg compression garments on
well-trained cyclists. Whereas other data shows improve-
ment in muscle blood ow and performance during
repeated sprint cycling and time trial performances [12,
20], data on lower limb compression on performance
during jumping, sprinting, or prolonged running or
cycling show little to no benet wearing compression
garments [23]. Kerherve et al. [11] found that using a calf
compression sleeve did not change running performance,
muscle SM02 or heart rate. However, they did nd that
compression changed running biomechanics to be more
ecient, which in turn improved their perception of pain
in the Achilles tendon while trail running. Prior research-
ers proposed that compression may act upon skin recep-
tors which, in turn, may enhance proprioception and
may reduce muscle oscillation [25, 26]. is was noted by
some participant responses stating that the compression
sleeves made them feel more supported. However, this
may also be explained by a placebo eect which is di-
cult to control for. Nevertheless, placebo eects that ben-
et the player can still be benecial to performance.
Recovery
Recovery methods in traditional sports are highly specic
to the type of exercise, the intensity, and the duration.
ere are many extrinsic factors in lieu of or in conjunc-
tion with gaming that can cause fatigue and microtrauma
with repetitive motion. ese may include, but not lim-
ited to, poor posture, poor technique, the types of sur-
faces and accessories being used, and malalignment and
muscle imbalance [27]. Overuse injuries can lead to
chronic muscular inammation or chronic degeneration
of muscle and tendons. Acutely, if a muscle is fatigued,
it can impact grossly on performance. ese intense long
hours of repetitive overuse have left the esport world
struggling for ways to improve recovery, decrease acute
injuries and prevent chronic overuse injury while main-
taining a competitive edge. Some recovery methods used
in traditional sports include ice baths, contrast baths,
massage and even light exercise [27].
A strong nding from this study was the improvement
in muscle reoxygenation and recovery while wearing arm
compression sleeves. At 15min recovery, arm compres-
sion displayed an improvement in muscle reoxygenation
compared to not wearing compression sleeves. is reox-
ygenation was 9.4% higher than resting Sm02 values. is
may be explained by the intensity of the activity. After
vigorous and moderate exercise, it is common for oxygen
saturation to rise above the resting level [28].
Table 3 Study exit survey outcomes
How did compression impact performance?
Negatively 4 (26.7%)
No Impact 4 (26.7%)
Positively 7 (46.7%)
If instructed by a professional or coach to wear would you?
No 1 (6.7%)
Yes 14 (93.3%)
I enjoyed wearing the compression
Disagree 2 (13.3%)
Neutral 5 (33.3%)
Agree 8 (53.3%)
I would consider wearing compression in future
Disagree 2 (13.3%)
Neutral 0 (0.0%)
Agree 13 (86.7%)
Color and look matters to me
Disagree 7 (46.7%)
Neutral 2 (13.3%)
Agree 6 (40.0%)
I would wear compression if part of my team uniform
Disagree 0 (0.0%)
Neutral 1 (6.7%)
Agree 14 (93.3%)
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DiFrancisco-Donoghue et al. BMC Sports Science, Medicine and Rehabilitation (2023) 15:108
Due to the repetitive nature of the activity necessary
for FPS shooting, individual muscle groups may become
fatigued. As a result, increased perfusion and blood ow
may result in increased oxygenation and a faster wash-
out of metabolic products. us, edema, muscular dis-
comfort, and muscle injury may be reduced [15]. More
importantly, higher performance is often the result of
increased muscular recuperation [27].
Limitations
Prior literature concludes that the benets of com-
pression clothing seem to be most pronounced when
it is applied for recovery purposes 12 to 48h after sig-
nicant amounts of muscle-damage-inducing exercise
[27]. is study, however, only observed acute eects.
e muscle studied is only part of the muscular system
associated with hand, wrist and arm movements asso-
ciated with video gaming, as some of the other muscles
involved were unable to be measured using near infrared
spectrometry due to the current technology. erefore,
this study did not fully investigate the changes to all the
muscles associated with mouse gaming devices. Further
research should evaluate the eect of compression on
other muscles, long-term recovery, and injury.
Some studies suggest that wearing compression gar-
ments at rest and at the start of exercise increases skin
blood ow which may elicit an erroneous reading of
increased Sm02 [29, 30]. However, the inuence of skin
blood ow on 02 levels is minimal and Bochmann et al.
[16] found no change in skin temperature when assess-
ing forearm compression. However, not all compression
sleeves are created equal. It should be noted that there
are a variety of compression gear to choose from com-
mercially and medically. e fabric and material used in
compression garments can vary and this component is
rarely noted in studies. Materials used can inuence sub-
ject comfort, heat retention and moisture. During this
study, the forearm compression sleeve used was made up
of 73% nylon and 27% lycra and averaged a distal com-
pression of 24(5.3) mmHg and 16(3.6) mmHg proximal
compression. Future research should focus on the dier-
ences in compression levels and dierent types of materi-
als. Finally, the placebo eect of wearing the compression
garment was not taken into account in this investigation.
Practical applications
is study provides support for the hypothesis that wear-
ing upper body compression sleeves while performing
high intensity video gaming may reduce fatigue, improve
muscle oxygen recovery, and improve gaming perfor-
mance. e improvement in video game performance
suggests that, while it could be attributable to either a
psychosomatic or physiological response to the compres-
sion sleeve, there is a link between wearing compression
and perceived comfort while gaming. is study also
provides evidence for the use of compression sleeves to
re-oxygenate fatigued muscles following high intensity
gaming. It is important to note that this data was col-
lected in subjects who video gamed regularly and played
competitively. In less experienced or trained video gam-
ers, Sm02 results may dier.
Based on the current study, upper body compres-
sion wear has positive eects on acute performance and
recovery following high intensity video gaming. We rec-
ommend the application of upper body compression
for recovery in competitive esport players’ who tolerate
it well, however further research is warranted on upper
body sleeve compression and video game play that can
distinguish between dierent levels of compression and
materials under various conditions.
Abbreviations
APM Action Moves per Minute
KPS Kills Per Second
O2 Oxygen
Sm02 Muscle Oxygen Saturation
TTK Time To Kill
Acknowledgements
We would like to thank Fntic™ for their support of this study and the NYIT
CyBears and NYIT Center for Esport Health for their support.
Authors’ contributions
J.D. A.R. W.W. wrote the main manuscript text and M.J conducted statistical
analysis, manuscript text and design. H.Z. contributed to manuscript design,
and prepared gures.
Funding
The primary Investigator Joanne DiFrancisco-Donoghue has received
corporate support for this project from Fnatic Ltd™. For the remaining authors,
no conict of interest was declared.
Data Availability
The datasets generated and/or analyzed during the current study are
not publicly available due to limited resources but are available from the
corresponding author on reasonable request.
Declarations
Ethics approval and consent to participate
This study was approved by the New York Institute of Technology Institutional
Review Board (BHS-1674) and was performed in accordance with the ethical
standards as laid down in the 1964 Declaration of Helsinki and its later
amendments or comparable ethical standards. All participants signed written
informed consent.
Consent for publication
N/A.
Competing interests
In the interest of full disclosure, we would like to specify that the authors,
JD, AR, MKJ, HZ and WW, during the course of this research, were provided
gaming keyboards and mouse controllers by Fntic Ltd™ to incentivize the
subjects’ participation.
Received: 9 June 2023 / Accepted: 29 August 2023
Content courtesy of Springer Nature, terms of use apply. Rights reserved.

Page 9 of 9
DiFrancisco-Donoghue et al. BMC Sports Science, Medicine and Rehabilitation (2023) 15:108
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