May 24, 2021

Interview with Joanne Donoghue, Esports clinical researcher

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Full Interview Transcript

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RangeMaster Rob 0:04
Well welcome back, everyone to another episode of our video blog, all things having to do with upper extremities, shoulders, and anything else in the medical community. And today we have a very interesting guest, Joanna Donoghue, who is a and Associate Professor and Director of Clinical Research at an osteopathic College in New York and Joanne, why don't you give all the appropriate technical definitions there, so I don't trip over it.

Joanne Donoghue 0:44
So my name is Joanne Donoghue. I do publish under different Cisco down to you if anybody was searching. I am the Director of Clinical Research at New York tech medical school College of Osteopathic Medicine. And I'm also an associate professor, my background is in nutrition and exercise physiology.

RangeMaster Rob 1:05
Well, that's a rather abbreviated encapsulation of what anyone who will follow that link will see, I just want to point out some other interesting things. But first, let me say, Here at rangemaster, we are known that for shoulder pulley exercise, and things related, that have to do with patients that are recovering from shoulder surgery or trying to avoid it. You can't be talking in that area very long without talking about medical exercise without talking about posture, without talking about all the various contributions to how did people get in this bad situation? And what can they do to not just rehabilitate, but to make long term life changes. And so that's why we like to talk to people outside our specific scope, and joy and came into our kind of awareness because lately she's been publishing and speaking about eSports. These are the video game competitors that are aspiring to be professional players, and earn six and seven figure incomes. And you you introduced in an interesting title at a recent conference, you talked about eSports. Where does the medical community fit in? And so I wonder if you could just tell us how you got there is somebody in your family do eSports? Because you're a triathlete. So yeah, my background is I am a marathon runner. I am a triathlete. I've done Iron Man's. My research predominantly was either in Parkinson's disease or in female runners. So how did I get involved three years ago? Funny enough, my vice president said to me, we have an Esports team that's developing on campus, we'd like you to get involved and help out. I had no idea what eSports was, I'm not a video game player. into it, I had the same reaction that a lot of people in rehab and fitness think I said, I can't believe that they have competitive video gaming, I can't believe that it's even got the word sport. In it, I had the same reaction that a lot of people have in the fitness industry. So I met with the team and I started researching it more, and I looked into it a little bit more. And I was actually blown away at the field, I was really amazed at what it entails, how large it is, and the need for this field to be involved in it. So the one thing, the one statistic that really shocked me, was the final match of one of the video games is called League of Legends. That's one of the competitive games that they play for people who don't know video games. And the final of League of Legends had more viewers than the World Series had. Or like, yeah, so and that's what I started looking into it more and I started realizing and I and I realized that there's these athletes are typically 10 to 12 years younger than professional athletes of any other sport. So they're very young. And they're at a very difficult age to do preventative medicine because they're, you know, nobody's thinking about preventative medicine in their teens or 20s. And their average retirement age is 26 years old. from injury, from injury, from injury from musculoskeletal injury, and what might those injuries be?

Joanne Donoghue 4:48
So when we looked into it, we did a research study on collegiate athletes. Predominantly it's wrist, arm and shoulder They do suffer acutely from something called Digital eye fatigue, which blurs them. But that's usually that's not something that's, that's career ending, what's career ending is their wrist injuries, their finger injuries, they do something called action moves per second. And if you take your finger and go like that with it, you know, they could do up to 100 moves per second with that finger, it's, it's really quite alarming how fast they move, they have really tremendous ability

RangeMaster Rob 5:28
100 moves per second,

Joanne Donoghue 5:29
they can, per set act, they call them action moves per second, they could do 30 to 60 per second, but then they go up to like when they're getting competitive, it can get as high as at the pro level. And if you look at the pros, their IQs are actually on par with Grandmaster chess players.

RangeMaster Rob 5:50
No kidding.

Joanne Donoghue 5:51
So there's a lot more to it than, than what meets the eye, I think everybody just assumes they think of the typical teenage kid or younger kids sitting in the basement with a video game in their hands. And it really is quite different than that. It is different than that. But nevertheless, aren't they spending a lot of time in a chair with a mouse and keyboard, a tremendous amount of time, a tremendous amount. And that's where the help, that's where we come into play the health field. So the average player can play three to four hours a day without taking a break. So that's sitting sedentary, three to four hours a day, in a high stress situation, this isn't just office work, we're sitting behind a computer, there actually, when you look at some of the research out there, they their heart rates are changing from stress from cortisol levels now, not the same way that they raise from exercise. And that's a very big misconception. In the field, you might see some articles that are misleading that say, well, heart rate fluctuates during playing this. And that's good, because we're raising our heart rate, like we would with exercise completely two different systems, anybody in the health field, it seems very obvious to us. But for someone who doesn't understand the human body, they don't understand that. And then I tell them, it's equivalent to if you're being scared constantly, that stress if someone jumps behind you, and you jump up and your heart rate goes up, you know, that's epinephrine, that's a chemical. That's an autonomic response. That's not the same response you get from exercise, the heart rate goes up, because you're increasing blood flow blood supply to the muscles, very, very different. And that is something that I tried to get across to a younger population. And also, I think it has it's the responsibility of the research field to make that clear.

RangeMaster Rob 7:40
No, I've never played a video game either. But as I've heard it described, people are trying to stay alive in these environments, and they're shooting other people. And they're running and hiding and shooting and twists and turns and things. And do they even have the capability of stepping out of the game and taking a break without, without losing their, their place, if you will.

Joanne Donoghue 8:08
So yes, and no, I and I always equate it to like maybe a basketball game or soccer game. Some of these games like, can last 20 minutes, something lasts 45 minutes. If you step away, you can lose your place to get back into a game. But you can take a break. And we're not talking about I just, I like to separate it out to people who do regular exercise and taking a break from gaming, it's very different. So if you could exercise, let's just say you're doing your best, you're doing 30 minutes of exercise a day, and then you go game and sit for four hours. That's not enough to negate that that's sitting before hours, they need to take those breaks. And we actually just showed that a six minute walking break made a difference in their executive function that approved their executive function, taking a six minute walking break, as opposed to a six minute break of just lying down and doing nothing. That was a really exciting finding that we had. Another finding that I tried again, this is something I tried to get across that I think health professionals understand. But the world of technology doesn't is that we looked at body composition. And these in these players who sit for so long, because what happens your muscles atrophy, you know, you have no core muscle to support your body to sit that long. And now you're asking your shoulder and your arm to do these constant repetitive overuse motions. And although their body mass index was normal, even compared to healthy controls, body mass index is just looking at their height. It's just looking at their weight and not looking at how much muscle you have, how much fat you have. When we evaluated that using a dexa scan, we found that our players although they had the same BMI, they had significantly higher body fat and to me what's more important is that significantly lowered lean body mass. So they had significantly less muscle mass than than healthy controls their same age match controls. And I think that says a lot for the musculoskeletal injuries that were also saying in a population.

RangeMaster Rob 10:16
Well, look, before we proceed for farther there, in looking at your work, you were already kind of participating in the digital transformation. You're you have done studies related to Parkinson's and wearables. And kind of the effects of people getting that feedback with with wearables. So what did you start to see or think or feel about that with that correlation, because that's an interesting kind of a mash up there between people that are in in a total digital environment. And yet, you've got a background that looks at what's going on with them. Biologically, through digital monitor, what do you what are you saying, What are you seeing?

Joanne Donoghue 11:12
Well, the digital monitoring, it's funny with with eSports, the ones that I've been involved with, with the medical school, we use risk more activity trackers, those are not very effective when it comes to esport players, because again, I was talking about the action moves per minute, their wrist is constantly moving, you got a lot of false readings. So it's not the most appropriate way to track it, we did put smartware on them, and had them play with smartware. We use that that collected heart rate, and we've looked at breathing rate and sweat rate. I think that the wearables are really the way to monitor this population, to really get a good look at what's going on while they're playing.

RangeMaster Rob 11:55
Oh, tell me a little bit about smartware. That's a term that I I'm making up an answer in my mind, but if you've used in research will tell me about that.

Joanne Donoghue 12:05
It's basically collecting the same data that you would in a watch it, it's, it's form fitting neoprene, where they were that's collecting data, it can actually, it's a heart rate sensor, it looks at your breathing rate, it looks at your sweat rate, temperature, a lot of athletes use it, like they'll use it for research, like they use it in football players and lacrosse players out on the field to see where their heart rates going as they're playing. It actually is beneficial for this population. And because one thing is, they're not as active as someone out on the field playing. So it actually records much smoother. So you get really nice data. And it's easy, it's lightweight, they don't know they're wearing it, and it doesn't interfere with their gameplay. And it just helps us to understand what exactly is happening physiologically to them with the stress level of their gaming playing.

RangeMaster Rob 12:53
Got it? Well, now let's get to the hard question to get inside the minds of these, say 12 to 25 year olds, and in and get a behavioral change. So they're not setting themselves up for later in life problems, which later in life to them is 2526. Did you say?

Joanne Donoghue 13:14

RangeMaster Rob 13:16
so how do you? What are you? What are you finding?

Joanne Donoghue 13:18
That's the million dollar question. The way I figured and this is probably the direction that a lot of my research is going now is performance. The only way to get through to any player is can we how can we improve your health while improving your performance, improving your gaming. So if I can convince a 20 year old to do something, and I could tell him, you will be able to play 20 minutes longer, or you'll be moving this much faster if you do this. That's what they care about. They care about what's going to make them more competitive. So that's why our last study we took it, we said, okay, we looked at a six minute walk very simple six minute, low level walk compared to just resting because a lot of times they'll they'll take a break, but they'll go lay on the couch and take a break. Sure. Like, how can we teach them not to do that? Well, we just showed that six minutes of walking, improve the executive function and made them faster, they made better decisions aiming when they came back to it. And we actually, when we looked at the other data, we actually asked them what they preferred. They actually did prefer the walking break. They said it made them feel more alert when they came back to the game. So I think we have to look at ways of what what is going to make them perform better.

RangeMaster Rob 14:37
Where have you published that? Could you or is it still in the process

Joanne Donoghue 14:41
that's actually under review right now in British Journal sports medicine up, I will certainly send it out if when, if it gets out there and we actually presenting that also at the International eSports conference in Paris in December.

RangeMaster Rob 14:56
And in Paris in December, you're going to pay And now it's virtual. I'll be presenting my basement to Paris. I did see that Europe is opening up travel if you're fully vaccinated,

Joanne Donoghue 15:11
oh, well, let's keep our fingers I am back. Let's keep us vaccinated. So maybe they'll let me go,

RangeMaster Rob 15:18
Oh, I think I'd be fascinating. And just that whole that whole concept because of the growing size of, of this population. So there's the 20 minute walk. But I also noted, you have a background in nutrition. So could you explain a little bit about your background? And then let's talk nutrition for these eSports players.

Joanne Donoghue 15:38
So my bachelor's is in nutrition. And my doctorate is in holistic nutrition, which is more alternative nutrition. Very big topic with eSports. Again, somebody might be saying, what kind of nutrition Do you need, you're sitting behind a computer, it's not as if you're exhausting all your glycogen stores while you're sitting there and playing. But the brain utilizes a lot of glucose when you're actually working. You know, some people might think, if, and I know what happens to me, when you're working all day, sometimes behind the computer, you might be starving. When you get up. You're like, why am I so hungry, I wasn't moving, your brain uses a lot of glucose and glycogen. They're their nutrition habits a poor, because for many reasons, one, they simply forget to eat, they're caught up in the game. They don't drink it. Sometimes the reason they don't hydrate themselves is because they don't want to get up and take a break and have to use the bathroom. I always recommend, make sure you drink because it will force you to get up and take a break. Because once you get up once you get up. And this was a study that was done actually a few years ago by an author named smukke. And once in motion, you stay in motion for at least they say about 15 minutes. So hopefully, I always tell them a little trick is if you have to get up and use the bathroom, you might get up and do a few more other things and stay active. Right? Oh, right. And there are a lot of false advertising right now with eSports. Everybody wants to jump on the bandwagon and say, Hey, this is going to make you perform better. Are we using caffeine riddle and things like that, to help keep you awake and alert? I can tell you that there's just no, no data on it. There. You know, it's so in the infant stages, there is no research on it. If any company is claiming something. They're planning it probably from another population, not from eSports.

RangeMaster Rob 17:27
Yeah, yeah. Probably some of your basic nutrition elements are right, though. I mean, as you talked about body fat content, you certainly probably wouldn't want to be contributing to the body fat, although that's an area of some controversies to you know, his body fat and accumulation of unused unused carbohydrate or, or what, you know, what really is going to create that elevated body fat besides their sedentary activity. Any thoughts there on what you'd like to see me?

Joanne Donoghue 18:04
Um, I mean, the one thing that I try to stress to the players going back to their glucose is, you know, low glucose reduces your cognitive ability. So it is important to eat properly and almost pregame nutrition the way we do it with regular athletes, athletes use pregame nutrition. Now, the I think it gets tricky with what you just said, Is there a correlation between being overweight and your performance in gaming? And quite honestly, there might not be. So the only thing that we can maybe correlate is that being overweight with low muscle mass is going to really impact on your musculoskeletal injuries. And that's where the shoulder the wrist arm comes into play, like that month that you need those muscle. It's not just, I think, especially with this age group, and it's with any athlete, it's hard to make that correlation that you need to build up a muscle in your wrist in your shoulder to perform better. No, no. But I also put that on the coach. That's why you have coaches. That's why you have trainers and coaches to make sure that you're following these protocols.

RangeMaster Rob 19:11
Well, you you you said at the outset, you, you know, we talked about your presentation on where does the medical community fit in? And you just touched on it. Some of these, like your college, they're asked you to be engaged. And so other than a walk, what are you having these athletes do? Well,

Joanne Donoghue 19:37
you know, we have exercise programs for them, we tell them, okay, you know, we have people will say you need to do at least a minimum of you know, 30 minutes a day of some sort of exercise and movement and training that because of COVID obviously, nobody is in person anymore. So you could only hope you send people training programs and they follow them and this isn't new to eSports you know, collegiate team faces this, they, they have athletes go home for the summer, and they're supposed to follow a program before they come back and be in shape. And again, you're dealing with a young population. And unless you're really watching over them, are they really following through with it? I think that again, one thing I do want to make a side note of there is a tremendous difference between collegiate level eSports and professional eSports. And right now the research, we're trying to, like, differentiate that because I tell people, it's it's as if you're researching the Dallas Cowboys and a high school football team, it's, it's a tremendous difference. You can't it's comparing apples and oranges. So if you're going to do research on professionals do research on professionals, which is under 1% of the population. Yes, I really think the main focus now as you're looking at so many younger kids playing video games that don't even have to be competitive, that you're going to see these overuse injuries, and they don't have a coach looking over them. They don't have the means of professionals. And I think the big challenge is, how do you get it out to the parents and to others like that, to look for signs of overuse injuries and not being physically active? And, and for that I call out the the manufacturers of these games, because they are the ones who have the contact with them. And they have the means to reach out and say, Hey, time to take a break or do something

RangeMaster Rob 21:28
right for them. Right. Very, very interesting what you said the P word there. So you talked about what what role does the medical community play? But what about parents? I mean, if you could, if you could say something to parents, I'm already wishing you're on Good Morning, America.

Joanne Donoghue 21:50
Something to parents. Now, listen, I am a triathlete. I am one of those parents who said I never have video games in my house. I am always on my kids. And they but I realize in today's day and age, video games are not going anywhere. And it's their social life. It's how they socialize with each other now very different than how we grew up. You know, they communicate and there's, there's so much negative tone to that. But believe it or not, during COVID we did an international study on this. And if you look at the research, it actually was very positive because it was a way of communicating and actually socializing for a lot of younger people. was through video gaming. And for parents, I would say be aware, my kid, you know, I drove it into my kids. Yes, you can sit and play these games. What are you doing for your physical body before that, you know, get up and take a break, take care of your body, everything in moderation. You did receive a spike in video game play time during the pandemic tremendously as tremendous spike in video game during the pandemic. Interestingly enough, and again, we were putting this out. We did we did a study, we put it out in six languages. Not only do we see a spike in video, gaming, competitive gamers and recreational gamers, but we saw in that population, a decrease in stress, improved mood, and increase in activity. They actually did better. They

RangeMaster Rob 23:17

Joanne Donoghue 23:18
Yeah, so I think you're going to see so I think the pandemic was almost one of the best things that could have happened to the esport. Industry, because it was there, it was an outlet for people.

RangeMaster Rob 23:30
Well, as a, as a parent, now my children are our young adults now. But so we get together. And they're talking about what their score is in some game. And these are 20 and 30 year olds that are still, you know, I have a chef and I have a is one of my sons. And his main source of conversation with his older brother, who is an economist, is how they're doing on some Mario Kart game, you know, what's their latest competitive score? And I think just fascinating to me that that's their, that's their touch point. You know, that's where they start. They fall over. Yeah. And I for the record, you know, I

Joanne Donoghue 24:18
am awful at these games, I don't know how to, I always tell people, I could play Pac Man. And that's it. It takes tremendous skill to play some of these games. And it's, and when I say where does the athletic world fit in with this, I think it's beautiful to come from our background because we are coming from an outside perspective of where they're coming from, you know, and I do, I do see the negative tone that comes from certain organizations like acsm and when they kind of roll their eyes and poopoo the whole idea of Esports and I'm like, you know, as health professionals, it's not our job to judge what people are doing. We're here to improve Proof people's performance and keep them healthy. You know, I never get into the argument with people of should it be a sport? Are they athletes? I know, that's not my decision to make my job is to make them healthier and perform better. And

RangeMaster Rob 25:13
that's, that's a, you've taken an elevated position. It's so easy from a parental standpoint to say, you shouldn't be doing this, you should be doing this. And, and that sets up that conflict that probably isn't helpful, you know, in is trying to promote overall health, you know, very interesting. I want to talk to you just a little bit about your, um, your training for triathlons, the Iron Man. kind of fascinating. I watched the video that you did with the hospital for special surgery. Oh, okay. Yeah. My commercial spokesperson for the hospital special surgery. Yes. So you alluded to the fact that you were a college athlete, what, what did you do in college? Soccer. I was a soccer player. And that's why soccer and volleyball but I predominately went to college soccer. I see. And and did you know at that time you were wanting to be a healthcare professional?

Joanne Donoghue 26:19
Yes, I did. I actually. I knew I wanted something with nutrition. Actually, at that point in college, I didn't want to go into rehabilitation until after I had my first knee surgery. And so what it did for me, and that that changed my mind. I said, you know, when you're an athlete, and you're injured, and you don't think you can do what you could do anymore. And you have these therapists getting you back doing that, I saw what it did for me. And that changed my mind completely.

RangeMaster Rob 26:51
What was your was your injury torn ACL at that point?

Joanne Donoghue 26:56
Yeah, I. So this was way back. I tore my ACL severed that and my meniscus. And not a lot of places were doing what they call arthroscopic means of fixing it at the time, they were opening you up and doing it. So I actually found HSS to be the one place that actually did that. And I wasn't able to get back the way I wanted to back then. I did eventually find my outlet and running and triathlons after that.

RangeMaster Rob 27:27
And then you're irritated that D what some 20 years later and come to find out you had a pretty, pretty beat up meniscus,

Joanne Donoghue 27:34
I did I have a pretty good idea. I mean, I was born with a congenital hip issue. And and that kind of affected my knee. So I've had seven knee surgeries, I had surgery there are about a lot of surgeries. And I you know what I tell people like it's minor compared to what I've worked with. You know, I work with people with neurological disorders, you work with people who have such severe injuries. And if you get broke, fix it and you know, I try to rehabilitate as much as I can. And I never take movement or exercise for granted.

RangeMaster Rob 28:06
I enjoyed your comment where you said we don't fix the car. So we can park it in the garage, we pick fix the car, so we can continue using it.

Joanne Donoghue 28:14
Absolutely. I in the comments. I still get the comments. When people like how many more surgeries you're going to have. When are you going to stop running? Why do you why why would I fix myself to sit, sit you fix yourself? Yeah, if your car breaks down, you fix it not to sit in the driveway, you fix it so you could keep driving it. So I'll continue to do what I have to do to do what I you know, to run and to stay active.

RangeMaster Rob 28:37
That's just what that's what a great outlook. Thank you very much. Well, listen, oh 20 other things we could talk about. But this has been a fascinating conversation. And I hope our viewers enjoy it. Let's go again, Julian, if you could tell folks how to contact you, where your publications are trying to just slow down and tell tell people how to find you.

Joanne Donoghue 29:05
So I think the best way to see my publications would probably be on my website. You could just Google my name Joanne Donoghue. For my website. I could also send it an email. My email is (edited out for SPAM control). You could just go on the New York Institute of Technology website and Google my name and find my name there. And I'm on Twitter, Twitter, joannedonoghue4 for is my Twitter feed and I do post things on not just eSports I post things with athletes runners, I do have an obsession with the running world. So I always post things little tips on their LinkedIn, I'm on LinkedIn Also, you can just Google my name on there.

RangeMaster Rob 29:50
Well, thank you for joining us today. And that'll conclude our interview but hang around for a minute. I got a couple of more questions. So I thank you so much. much for having me. Yes, you bet.

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