Stop Living on 1HP: Health and Wellness in Esports

foreign [Music] hi guys I'm Kate I'm a physical therapist and you're probably here because you have some amount of interest in health and wellness for your players at least I hope that's why you're here um so a little bit about me before I get started on today's topic of choice um I'm a doctor of physical therapy I'm a certified emergency first responder and I'm a recovering non-gamer I think the sum total of what I played growing up was some Oregon Trail a little bit of zoombini's logical adventure and like 10 minutes of Ocarina of Time when one of my cousins got fed up with a boss that she couldn't beat do you know how hard it is to try and beat that water temple boss running in a circle wasd to run in a circle uh my first real game was Dota 2 because I want to think of myself something nice and easy with a community well known for being very welcoming but since diving headfirst into that deep end uh I have captained and drafted for an amateur DOTA team I've directed and educated a group of stats people I've done in-game

statistics I've worked on site at DOTA and smash Summits I've worked at a lot of Smash tournaments and somehow found the time to play way too much DOTA Guild Wars Warframe melee Street Fighter for over five and Guilty Gear so I've been doing the Esports thing for about three years now about as long as I've been a physical therapist so while I'm newer to Esports in general I'm not quite so new to the helping people get better while they're playing thing I work for a company called one HP which is myself and one other PT we're a huge company obviously and our motto there is that we want to help players play more and hurt less um so my goals for this presentation uh are to help devs and community members alike understand the value of Health and Wellness as part of community growth to help understand the role of Health and Wellness in player experience player retention and player longevity which probably matter a good deal to everyone here and to understand who you want to

draw in to help you out with that along the way to help you develop health and wellness initiatives and infrastructure unlike traditional Sports we don't really have an infrastructure right now so on the one hand that's great that means we get to build it the way we want it and the way that works for us on the other hand that's less great because we have to build it the way we want it and the way that works for us um so there's there's two exceptionally obvious reasons why health and wellness matter and then there's two more gaming specific regions um and the exceptionally obvious one would be that well you're putting yourself at risk of injury by playing for a long period of time um Matt and I at 1hp classify Esports as a static endurance activity that challenges executive function in a virtual environment and let's dig into that a little bit more static means we're not moving all that much we're seated there's micro movements of hand wrist elbow shoulder they're not moving with large enough velocity or direction to be considered strongly dynamic in the way that say soccer or football or track and field

would be um it also is static because we're in maintaining a position so it's more about maintaining posture than it is about quickly changing postures repeatedly so that that postural awareness is a really key part of helping players avoid injury it's an endurance activity because just like running we're performing the same cyclical repeated movements over an extended period of time our bodies need to be conditioned for that we don't consider most injuries that happen with gaming to be overuse injuries per se we consider them to be under preparation injuries and on the one hand yes that's a matter of semantics on the other hand though what that suggests more accurately is that if you're underprepared and that's the reason you've experienced an injury that there is in fact something you could do to prepare yourself to avoid that injury and that's certainly true we can build up endurance and strength and conditioning and motor control to make players less likely to be hurt while playing and more than that we can help

players to perform better especially in a competitive Esports environment with the right kinds of conditioning the executive functions and the virtual environment are probably a little more self-explanatory executive function being anything involved in the frontal lobe for the most part your working memory your attentional control all of your control of what over what your body does and your ability to process information in and output activity out and it happens within the virtual environment of whatever game a player is playing so we like to hit four different aspects when it comes to health and wellness for players one being probably the most obvious healthy movement posture exercise outside of game time changing position while playing taking breaks and using them accordingly that's probably the the most obvious component of Health and Wellness in gaming and Esports equally important though is a healthy environment one that supports you in your play and that's both physical in terms of your chair your keyboard height

whether or not you're using arm rests the height of your monitor the angle of your back rest whether your feet are on the ground or not if you're short like me you may tend towards the feet not on the ground without a little extra help it also has to do with your social environment one of the things that I really like about the area I work in I work on the East Coast we have this uh this company called the game gym which runs intramural sports League intramural Esports leagues for elementary and middle school and high school kids kind of developing that same healthy social environment that you might get from playing intramural soccer or you know pick up basketball games but with something that these kids already really like just building out a good social structure on top of good gaming behaviors uh we also approach it from the aspect of healthy eating which doesn't just mean you know following any one particular restricted diet but more addressing the General Health and Wellness that comes through good nutrition and good hydration and then the last piece being healthy thinking your mindset about how you're playing your ability to be mentally resilient to

recover from setbacks from things that cause you to stress while you're playing those are kind of the more more obvious aspects of of Health and Wellness in terms of why somebody might be interested in them but if you are specifically designing games you may be interested in why does health and wellness matter to my specific Gaming Community other than well they don't get injured and if they're not injured they can play more for one thing it can significantly contribute to player experience and player of attention for another thing it's really important especially if you're trying to get integrated into an Esports scene to retain and develop top-tier athletes and streamers it also can help you develop kind of those those tier two tier three teams and organizations that that really want to contribute to the community but aren't quite at that top level just yet that being said obviously developing an Esports ecosystem is not viable for every game there is and that's totally fine developing a community though that's not only viable That's essential for every game there is two of the key

areas for player retention would be achievement and friends and that was from a recent research study that came out although probably most of you in gaming already knew this they just you know formalized it with the research paper so when it comes to achievements we want to look at things like enabling Achievement Hunters to feel as though they've progressed within a game health and wellness can be used to link in-game and out of game character growth and I'll expand on that in a minute and players want to be able to gain prominence or reputation or respect for Unique traits so the when it comes to character growth and gaming prominence and reputation I mean every game wants to be able to be shown off and every player wants to be able to show off their prowess at their play so if we put players in a position where not only can they show off how they do in-game but out of game we're suddenly linking those those two communities the online sphere and the IRL development that allows players to kind of Stand Out

not just for their ability to play well but especially when those players who play well additionally stand out because they're doing something incredible with their bodies and think of you know players who rock climb and you know brag about the fact that I went rock climbing this weekend I did a V5 and this was my first time doing it you know solo that's a big deal and if the community gets that that's something else that they can Bond over finding kind of these little sub communities within your gaming Community is a really good way to create a stronger sense of cohesion uh it gives players something to show off and bond over and of course you know everybody wants to bond over having beat a really hard raid or having been a particularly difficult boss or finally overcoming their demon when it comes to a certain matchup we can also develop that in the form of an IRL community sorry about that and the growth of that IRL community supports growth of the online and in-game community

when it comes to friends that kind of shouts back to what I was talking about in the last slide when it comes to the importance of the the social development of a game how the community feels as though they are are tied together so it's really important obviously to develop these cross-linked communities utilizing things like Discord Reddit YouTube twitch and your own gaming forums if you have them you don't want players to just stay isolated on any one of those particular platforms you want them to be able to be moving and migrating between all of those healthy behaviors and healthy content programming can really help that to occur especially if you're doing something like say having a server-wide challenge we've done recently at uh at Genesis and was the last event that I worked we did a planking competition and we had it running the whole day we had it advertised in our Discord server we had it advertised on Twitter we had like this big white board and people were taking pictures and tweeting themselves out I held it for this long I held it for that long and so all the while while these pools are going and people of

course are going oh and twin pools there were people who would come over after they went through pools and kind of just wander through the vendor area would find us and be like oh I can do this this is a thing I can do so even on those occasions where your players are feeling less successful about an in-game Behavior giving them an out of game behavior that they can also control again makes them feel more successful that shouts back to achievement health and wellness behaviors are also really key for Community Development look at what's happening right now with the fit fgc movement look at what's happening with EXO Academy so Excel Academy is kind of neat it's a bit of a unique subset in that they're developing within the FTC Community this team that specifically sponsors two female players per four week cycle before a big gaming event like final round this weekend during those four weeks the players work with an individual coach they have special coaches they had me I have to be honest that I have some bias here they have a media coach they have someone who coaches them on commentary on how to do

an interview and within those communities there's like this whole uh there's this whole degree of excitement about not only are we working on developing a potentially underdeveloped group within the fgc that is female players at a high level but we're also linking it to their healthy behaviors that for a whole first week of their four week cycle they were all posting about oh I did this new stretch this new exercise look at my new weightlifting form again it goes back to allowing that that IRL Community growth which then supports the online and in-game community because the more the players are invested in each other the more they are invested in the game that they're playing together that thing that they share together when it comes to retaining and developing athletes and influencers obviously players who don't get injured play more and play longer that was pretty apparent but this this can also be applied to a little bit more specific interests for both athletes and for

streamers which are two pretty important populations at this point when it comes to influencers or streamers involving healthy behaviors and and healthy gaming content that gives them an opportunity for a new kind of variety streaming it's not just the game that they're playing but they can also be showing off oh here are the stretches that I do between games to make sure that I can play these 8-10 hours that I'm streaming for you here are the exercises that I do to keep myself healthy on my off days here are the healthy behaviors that I engage in that make me able to do what I like to do it allows for increased Community interaction again especially when it comes to developing some kind of competition a good deal of people who play video games like to compete at them a good deal of us like to feel as though we've done something exceptional or special so having you know a friendly rivalry a friendly competition um is absolutely a really easy way to to develop that and again that allows you to build it across multiple platforms Discord Reddit YouTube Etc it also can contribute to the development of parasocial relationships

on the one hand we want to be cautious about the degree to which streamers develop parasocial relationships with their communities and vice versa you don't want you don't ever want streamers to feel as though they are obligated to their communities and we don't want uh gaming communities to feel as though a streamer is closer to them than they actually are in the sense that we don't want an unhealthy connection between the two of them but healthy gaming behaviors promoting not only physical health but also mental health is a really good way to kind of establish a healthier parasocial relationship while still maintaining that degree of community integration and getting players interested in playing this game that their favorite streamer is playing again if they're interested in that person they'll be interested in what they're doing if they're interested in what they're doing they're playing that game when it comes to more of the Esports sphere there's been an increased emphasis on not just injury prevention but on performance enhancement in the last couple of years and I can say that pretty confidently because I've worked

with a number of teams in the past couple of years and the questions I was getting went from okay how do I treat the fact that I've been sitting with horrible posture all this time and how do I deal with this wrist injury and how do I deal with the fact that I got really mad at the international and kicked a curb because I was so mad we got knocked out and now I think I may have broken my toe that was a unique one how do we go from that we well we've now progressed to how do I use these healthy behaviors to make myself a better athlete how does this contribute to my ability to apply at the highest level we've got teams like La Valiant and the immortal Squad have their own physical therapist who does individualized programming for each player not only addressing their specific injury prevention needs but also their overall health and wellness working with the nutritionist develop their healthy eating habits working with a local gym to develop a good routine for them just something simple that they can do together that allows the team to have a bonding

activity that isn't solely directed by we must scream on this game together we must play this game together and develop specifically in game it allows for a more organic connection between them which in turn allows for more Comfort playing together in a competitive environment and when it comes to health and wellness for for athletes in particular development and developer investment can really lead the way so most recently high-res partnered with a local hospital that will be doing basically Esports Health screens for their players at the beginning of Seasons which I'm super excited about other people and they may not geek about about that quite as much as I do but I will say that that's really key because we're kind of Crossing that gap between the Esports community and the medical community and allowing the medical community to develop along with the gaming community and that's something that I'm going to hit on a little later in the presentation as well but for now I'll just say it's really important that the healthcare professionals who become involved in gaming who are contributing

to the development of Health and Wellness programming within gaming and Esports spheres that they have the degree of understanding of what your community is and what your community needs which means it's also really key for developers and communities to be expressing that to be able to have a clear sense of identity and to be able to express that identity so for an example the multi-blood community is clearly and distinctly able to play just about anywhere that is a key part of their Community identity it is they are adaptive they are flexible they are able to make it work in places that gaming possibly maybe should not actually work like bathrooms but you know what that's them that's what they do that's who they are um the the fit fgc movement is kind of a similar subset the idea that players are being known not only for their skill in game but I'm known because I have made this Improvement to my life I have lost this weight I have gained this muscle mass I have been able to do this new

thing that I could not do previously that is that's really key to developing a well-integrated community too um so what are some of the ways you can start to incorporate health and wellness programming within your game whether or not you are an esport whether you're competitive or casual or some mix of the two for one thing uh in-game is is a really easy way to incorporate so toast text those little pop-ups you get for example on the bright side they are minimally disruptive they don't do too much to disrupt the gaming experience which is great because at any stop point you run the risk of losing some degree of players and as much as it we Grace to say have physical health tips as part of a tutorial as much as technical skill or in-game abilities you're more likely to lose your players early when they have less investment in the game than later on in the game when they're invested in in playing more or finishing it so when it comes to toast text because they have to be very short because they involve almost no interaction because they can irritate players to have frequent pop-ups and

because they run the risk of causing players to lose interest or to leave the game if you're going to use toast text as an opportunity to build in health and wellness for your players they should be short and general tips they should be things that are for general not specific habits so things like have a drink of water don't forget to stretch take a break every 30 minutes take three really deep breaths check your posture things like that are a really easy way to involve toast text and in that way you're not risking alienating your players quite so much and contextualized tips and using loading screens and saving quit screens or when you can get a little more specific with contextualized tips after a period of time maybe after a section of your game that you know requires a high APM after a certain number of matches or even within that a certain number of won or lost matches it can be better to put these on loading or saving quit screens because they afford you more space and time players expect to spend more time there and it's a larger space than just a

little tiny pop-up box here you could do something like putting a picture of a stretch or putting a picture of a series of stretches or more specific reminders you can also use something like a lore book or a codex to as a really good space for Achievement Hunters in particular and I will admit to being an achievement hunter anyone in my Guild Wars 2 Guild will tell you that um so if I see a pop-up that I've got something unchecked in my lore book I want to go and look right now I want to see what it is and what I have got and what have I earned so in the same way that you can get entries if say you discover a particular kind of flower in an open world exploration you could use time or a ability gated checkpoints to create healthy habits entries so let's say your game allows you to track when a player has used a certain skill maybe something that involves a multi-button input or a really quick Movement Like say wave dashing and melee or cycling through a chain of skills like invoker and DOTA 2. you could have a toast text that indicates they have a new achievement available to view and it's available after their next break or

their next match Etc so there's no kind of time pressure no immediate pressure to see it and then when they go to check there's an entry in their codecs or whatever it is to use to track achievement in your game that shows you know here's a good stretch to use after you've performed that skill 10 100 a thousand times or here's a good strengthening exercise to make that chain easier to perform it's the kind of thing that could even have the image of one of your characters demonstrating how to do which again kind of ties back into lore stuff and similarly you can have time gated prompt along the lines of you know achievement unlocked X hours of play that corresponds to a codex entry showing a quick one to two minute break routine that players can do to avoid injury so other ways you can also incorporate things is out of game and again I recognize that for not every gaming company is uh out of game or at a tournament or Esports a viable option and and that's okay we're going to go over a couple of ways that this can work regardless of game development size so

yes IRL health and wellness is not just the domain of huge companies like Riot blizzard and valve there's plenty of ways that smaller companies and teams can incorporate health and wellness from professionals as well so definitely one of the the bigger Studio things would be pre-season screening and League setups allowing for players to be assessed for their injury risk at the beginning of a season which then allows for players to have specific injury prevention routines built for them as they go um sponsored clinics at tournaments are are a bit more of a viable option for anywhere from mid to large to your companies something like I mentioned being at Janice Genesis recently we had a community health clinic there where anybody could stop by at any time and they could get an assessment they could get some kind of basic treatment and some suggestions on what they could do to follow up and then on the playoff day on the second third day of the tournament we had a top eight specific Clinic where we were only backstage only working with the top tier players so they felt as though there was something

unique and special and individual being provided to them kind of the same way that an athletic trainer might be available for a traditional sports team before a match and even if your game exists entirely online there are ways you can incorporate professional help for your community you can use graphic guides you can use text-based guides you can use video guides for us we found that Graphics tend to get the best interaction because they're short simple and straightforward you can kind of do them on your own time or Pace and they don't require as much investment in the sense that you don't have to scroll through something you don't have to sit and watch something absolutely text and video have a higher degree of interaction required which can result in kind of a deeper connection but if you want players to quickly pick up on something new and healthy a picture graphic has been in our experience at 1hp the easiest way to go and you can both make use of and grow your cross-linked communities with health content especially if you're incorporating challenges or competitions

and you definitely want to have your community involved in the development of guides and whatever ergonomics and injury prevention folks you end up working with they should be integrated into those communities they should be in a position to seek feedback and get good feedback and good questions so that they know what your community needs and they aren't just developing what they think your community needs so in that regard oops I don't know how that got moved around there um so in that regard the kinds of people that you want involved in your communities could be anything from physical therapists a little bit biased there but also you could involve personal trainers exercise kinesiologists you could use certified strength and conditioning specialists you could use athletic trainers there are a lot of folks who can help contribute to healthy behaviors in your communities but if you're going to do that you need to know what to look for within those individuals what kind of attitudes they should have generally speaking they should be

interested and invested in what your community is doing they shouldn't be just doing this because they've heard that Esports and gaming has a whole bunch of money in it that's also for the benefit of your community in that they're not going to buy into whoever's trying to help them if they don't believe that whoever's new community is actually trying to help them gamers are understandably and justifiably skeptical about non-endemic sources coming in and working with them and I think that's one of the things that Matt and I have really going for us we both play a lot possibly more than I should given that I have a full-time job at an Esports job on top of that but that means we have a degree of understanding uh any professional who's working in your community should also have an understanding of not only what controller your players are using primarily but also kind of specific inputs involved in that I've used the wave dashing analogy before speaking about smash melee specifically but if your community uses specific inputs in a specific order if they are you know there are certain high-level skills that require them to move through a very high

APM your Healthcare professionals who are helping you need to know about that they can't just be like oh okay well I know that they use this type of controller they use a GameCube controller if you don't know what they're doing on the GameCube controller it's not terribly helpful um and last but not least they should really be invested in the growth of your community they should actually give a about whether or not your community gets better they should be in this because they want to see players play more and hurt less um and I think I'm right on time then um this is the part where I remind you of two things thing number one please fill out your survey thing number two this is the part where you can ask all of the questions and if we run out of time for questions we will go to overlook 3024 after this foreign I think there is a microphone in the middle of the room if folks do have questions hi Patrick hi

um so when I grew up playing video games in arcades that often see that like winners don't use drugs screens show up before playing ninja turtles or whatever and so I would expect that like Health stuff around video games and come off as kind of hokey definitely how how have you found players to be engaging with this kind of stuff that's a really good question and one of the biggest things that Matt and I have had to confront so Patrick was asking how do we make it not seem hokey how do we make it not a you know just say no to drugs Nancy Reagan one of the biggest things that we found helps is talking about the injuries we've experienced and making sure that players know to appreciate the person who's giving them the advice so when players and high level competitors in particular are open and honest about the difficulties they've faced and the people they've trusted or the things that they've changed and that's a that's a really good way to get more Community buy-in a good deal of it is out of game education so so being able to make it clear to players why they should give a about this why this should matter to them how this can specifically help

them play better not just avoid being injured injured when it comes to the in-game pop-ups I definitely growing up more than once saw the take a break every 60 minutes and just laughed at it because no no I'm not taking a break you can't make me that's why it's important to kind of use those opportunities where you have more space and time available to you to explain why they should be taking a break every 60 minutes so that's not just feeling like somebody's mom tapping them on the shoulder and saying okay honey you've been in front of the screen for long enough so that it's more clear that it's a this is in your best interest and you can totally come right back to this and that's why the educational component is so key any other questions hey hi hello um question clearly Esports is an extremely competitive landscape and there's all kinds of competing teams

that's what they're there to do in many regards and with something like this and health and wellness being so so important to every human who's participating at an elite level in Competitive Gaming from your perspective how do you address that so in working with different Esports organizations as you may as you maybe are certainly aware of the relevance of all of this no matter which team you're playing for is there a way that you're addressing that opportunity in a way that reinforces the fact that it'll help every player become better in their game but then also addresses some of the concerns that individual Esports organizations might have as this topic of Esports performance continues to be more top of mind for them and perhaps a point of differentiation that you know they might be able to provide their players in terms of helping just their players improve their performance so if you have a general stamp on that I would be super curious to hear about it sure so when it comes to helping players and organizations develop individualized content and what's really key there is understanding what the players need in

the first place that's why it's really important not just to pick the right branch of healthcare professional but also the right type of healthcare professional so if you're if you're thinking about involving someone in your organization you need to make sure that kind of their views are in line with yours or if they're not in line with yours you find what the mismatch is and understand why they feel the way they do about how your players should be getting better and that's also why it's really key that any Healthcare professional working with teams in Esports in particular has a really solid understanding of what that game entails what controllers are used what specific motions are used most frequently and what players are most at risk for because without kind of that underlying knowledge without that that basis players aren't going to trust organizations shouldn't trust and nobody's actually going to get better so when it comes to building that individual sized content it really requires a good degree of investment from the person who is working with you and it really requires a good degree of investment from the players in the

community themselves to be to be willing and comfortable with speaking with that Healthcare professional so it has to be someone who has the trust of the community which generally requires that they at least do some amount of play of the game themselves so we're kind of coming out of this era where players only know how to get better by playing 10 12 14 hours a day and while that's ending there's still a lot of players who play on that kind of frame of mind grind solo q4x days at a time get better so are there methodologies or tactics they use as a motivational tool to get some players to what is effectively eat their vegetables and when it comes to this I have in fact used actually eat your vegetables at Players before but uh generally it does require a bit more than that you're right so when it comes to helping players recognize why the behaviors that they're currently engaging in may not be the healthiest or the most effective way I found that education is still the easiest way to do

it making it clear to players why this is useful for them what the research supports and what the research is in the first place so Matt and I frequently reference something called a heat meter which is you know the idea of in a game if you have a gun you use it a whole bunch of times and it's eventually going to overheat you're going to need to reset and cool all the way down it's a really easy mechanism for explaining to players that hey if you're doing this for this many hours you're going to hit an overheat point and when your body overheats we don't just mean that you know you get a hot sweats or something instead you're going to get injured there are a lot of ways to avoid that let's talk about some of them it's also been really helpful and that us physical Healthcare professionals have been working with a lot more mental health professionals Sports psychologists performance coaches and the likes and using what we know from traditional Sports models of training periodization and training periodization refers to looking at macro Cycles like a preseason in-season off-season or preseason end-season post-season off season and then more micro Cycles which

are within a week or within a day even of how do we structure practice practice to be the most efficient possible how do we make it so that what you're doing all of it is useful directed and actually going to have a result so we found a lot of success in just you know coming to a team and saying hey let's talk about how you're practicing why you practice that way and what you're getting out of it in the first place it's especially good when we can get players to realize well I'm doing this and I'm kind of still stuck at Gold I'm kind of still stuck at you know my 3000 MMR that I've been stuck at for the last three years and I'm going to keep practicing the exact same way and that's weight not going to get me better okay how do I do something different what's the different thing that I do making those options and that knowledge available to players is really really key and organizations not only team organizations but developers are in a really unique position to be able to put that content somewhere where players are absolutely going to find it

and I think if anybody else does have more questions we can all hang out at the Overlook spot but we are at the end of this session time so please make sure to fill out that survey that's how GDC gets all of their updates and changes and such foreign