Professional esports players engage in prolonged training sessions and experience high physical and mental stress due to intensive competition schedules. These demands can lead to increased fatigue, decreased performance, and health problems. This randomized controlled trial aims to investigate whether adding a structured neuromuscular exercise program to routine esports training reduces fatigue and stress biomarkers and improves performance-related outcomes in professional esports players.

Esports players often perform long hours of training that require sustained physical and cognitive effort, which may result in musculoskeletal problems, mental fatigue, and elevated stress levels. Most studies in the esports field rely on subjective evaluations and include non-professional populations. Objective assessment of fatigue and stress biomarkers in professional esports athletes is still lacking.

This prospective randomized controlled trial will include 24 professional esports players aged 18-35 who train at least 35 hours per week with their teams. Participants will be randomly assigned to either a neuromuscular training group or a control group. The intervention group will complete an 8-week neuromuscular exercise program three times per week in addition to their regular esports training routine. The control group will receive structured physical activity counseling based on ACSM 5A principles.

Primary outcomes include serum levels of cortisol, testosterone, testosterone/cortisol ratio, C-reactive protein (CRP), creatine kinase (CK), vitamin B12, and iron measured under standardized fasting conditions. Secondary outcomes include muscle strength (myometry), sleep quality (Pittsburgh Sleep Quality Index), physical activity level (IPAQ-SF), quality of life (SF-12), visual and auditory reaction time tests, lactate measures (Lactate Scout), and mood states (POMS). Outcomes will be assessed at baseline and after the 8-week intervention period.

The findings of this study are expected to provide evidence-based recommendations for integrating neuromuscular conditioning into professional esports training to enhance physical health, reduce fatigue and stress, and improve overall performance.

Inclusion Criteria:

• Age between 18-35 years
• Currently competing as a contracted professional esports player
• Playing one of the following games at a professional level:

League of Legends, Counter Strike 2, Overwatch, Valorant, Apex Legends, DOTA2, Rocket League, PUBG

• Participating in ≥35 hours/week of training with their team
• Voluntary agreement to participate and sign informed consent

Exclusion Criteria:

• History or presence of medical conditions affecting safety or performance: metabolic, cardiovascular, renal, neurological, or respiratory disorders

  • Playing esports only at amateur or beginner level
  • Answering "Yes" to any item in the Physical Activity Readiness Questionnaire (PAR-Q)

Removal Criteria:

• Participating in <35 hours/week esports training during the study
• Missing ≥2 neuromuscular training sessions (intervention group)
• Leaving their professional esports organization (roster removal, retirement, etc.)
• Any illness or injury preventing continuation of esports participation

Individual participant data will not be shared due to privacy protection and confidentiality regulations for professional esports players.