In the field of esports medicine, gaming posture is a hot topic for esports performance benefits or detriments.

The objective of this study was to investigate the cognitive load of posture management through a biofeedback (BF).

Researchers had several hypotheses:

• There will be an attentional trade-off between posture and task performance
• Lower trade-offs will be linked with higher mindfulness levels
• Neck pain & disability will be linked with poor next posture

A population of 42 University students was selected after checking for exclusion criteria like pain while standing/walking, diagnosed mental disorders or any task interference. These students were asked to play a PC game in a crossed randomized order, with and without BF. The measured outcomes were neck shrinkage (posture), dual task cost (measuring BF-linked performance differences), neck disability index (NDI questionnaire) and mindfulness attention awareness scale (MAAS questionnaire).

After a statistical analysis (mixed ANOVA), the results were as follows:

• Neck posture decreased after 6min without BF, but was better if patients previously experimented the BF
• Cognitive performance dropped with BF and was worse when starting 1^st with the BF
• Lower dual-task cost, lower NDI and higher mindfulness levels were all linked to better neck posture retention

Based on these results, we can confidently say all 3 hypothesis were validated.

Posture is hard to change through a biofeedback as it impacts performance. Associating a BF with performance-drops & frustration may lead to lower compliance levels of a patient.

Certain jobs might be easier to target, for example stable office jobs unlinked to performance (managers or coaches in the gaming space).

Mindfulness facilitates an ‘intrinsic BF’ as it doesn’t lower performance while offering higher neck posture retention.

Practicing mindfulness or increasing it through activities like tai-chi could be a viable path towards working on posture without performance drops for athletes.

Neck pain has been linked to poor next posture in this study. The theory behind this would be that individuals having a lower sensitivity to postural discomfort would spend more time in those postures, leading to long-term neck pain & disability.

This study is the first evidence of tradeoff between cognitive performance and posture management while emulating real life well for gamers through a PC game. The inclusion of mindfulness also provides a constructive path to improvement without negative impact on performance.

Nuances must be considered, as BF usually require long-term usage for proper evaluation. The study also used a new game for this population, therefore demanding a higher cognitive effort than a game played previously by a gaming population.

Further measurements of in-game performance, like reaction time or strategic components, would also offer more insights into the cognitive tradeoff than a simple game score measurement as proposed in this study.

Practical guidelines regarding posture management for gamers:

• BF usage impacts performance negatively, therefore requiring proper consideration for usage during competitive seasons and for gamer’s compliance levels
  
  
• Mindfulness exercises can be interesting as they don’t impact performance.
  Proprioceptive exercises or hobbies like tai-chi could be encouraged
  
  
• An acute pathology might benefit from BF usage for objective measurements and active exercise tools, whereas a healthy long-term habit setup will benefit more from mindfulness training
  
  
• Office workers (staff, content,…) or athletes during the off-season can benefit from BF usage with less considerations for performance impact
  

Baer JL, Vasavada A, Cohen RG. Posture biofeedback increases cognitive load. Psychol Res. 2022 Sep;86(6):1892-1903. doi: 10.1007/s00426-021-01622-2. Epub 2022 Feb 3. PMID: 35113210.

https://pubmed.ncbi.nlm.nih.gov/35113210/