The Sedentary-Stress Paradox in Esports: Neuroendocrine, Metabolic, and Endothelial Pathways to Cardiovascular Risk

Esports and gaming resemble traditional sports and physical activity because both involve sustained cognitive and emotional stress; however, this stress occurs against a background of prolonged sedentary behavior. This narrative review examines the neuroendocrine, metabolic, and endothelial consequences of this "stress without movement" phenotype and its potential implications for long-term cardiovascular health. Activation of the hypothalamic-pituitary-adrenal (HPA) axis and sympathetic nervous system disrupts sleep and circadian rhythms. Continuous neuroendocrine activation may impair muscle-adipose tissue crosstalk and nitric oxide-dependent endothelial function. Although direct longitudinal evidence linking gaming to cardiovascular disease is currently lacking, these convergent mechanisms identify prolonged sedentary gaming as a potential cardiovascular risk amplifier, particularly when combined with occupational sitting, sleep disruption, adiposity, and other cardiometabolic risk factors.