Carotid Artery Hemodynamics During Competitive Gaming: Feasibility and Preliminary Findings from a Pilot Crossover Study of a 6-Minute Walking Break

Background/Objectives: Competitive esports players spend prolonged periods seated while performing under sustained cognitive demand, creating conditions that may adversely affect cerebrovascular function. Internal carotid artery (ICA) blood flow is a major determinant of cerebral perfusion and may be particularly relevant to the cognitive demands of competitive gaming. To date, no study has evaluated ICA hemodynamics during competitive gaming or the feasibility of repeated Doppler ultrasound assessment in this setting. Therefore, this pilot study aimed to (1) determine the feasibility of measuring ICA hemodynamics during competitive gaming and (2) generate preliminary data on the effects of a 6-minute walking break on ICA blood flow velocity and volume. Methods: Eleven competitive esports players (20.8 ± 2.1 years; 9 male) completed two 2-hour gaming sessions using a randomized crossover design: uninterrupted gaming (continuous condition) and gaming interrupted by a 6-minute walking break at 60 minutes (walking condition). Doppler ultrasound measurements of left ICA blood flow velocity, blood flow volume, and vessel diameter were obtained at baseline and every 30 minutes. Heart rate and blood pressure were also assessed. Feasibility outcomes included recruitment, protocol adherence, and Doppler measurement success. Results: Fourteen participants were screened. Eleven (79%) met eligibility criteria and completed both study visits, resulting in 100% protocol adherence. Doppler ultrasound acquisition was successful in 107 of 110 planned measurements (97.3%). Baseline ICA hemodynamics were similar between conditions. ICA blood flow velocity and vessel diameter did not differ between conditions. In the walking condition, change in ICA blood flow volume improved from −41.0 ± 102.4 mL/min before the walking break to −5.9 ± 132.2 mL/min 30 minutes later, before declining to −43.7 ± 75.9 mL/min at 120 minutes. No significant between-condition differences in ICA blood flow volume were observed. Heart rate was significantly lower following the walking break at 90 minutes (72.7 ± 10.7 vs. 82.2 ± 12.3 beats/min; p = 0.009). Conclusions: Repeated Doppler ultrasound assessment of ICA hemodynamics during competitive gaming is feasible and well tolerated. A transient improvement in ICA blood flow volume following a brief walking break suggests that the physiological benefits of a single break may be short-lived and supports future studies evaluating more frequent movement breaks, such as every 30 minutes, during prolonged gaming.