Revista Científica y Arbitrada de Ciencias Sociales y Trabajo Social ‘‘Tejedora’’: Vol. 5 (Núm. 9) (ene-jun 2022). ISSN: 2697-3626  
Covid-19 and heart rate based on anxiety in adolescents while playing Fortnite: Ecuador case  
COVID-19 AND HEART RATE BASED ON ANXIETY IN ADOLESCENTS WHILE PLAYING FORTNITE:  
ECUADOR CASE  
COVID-19 Y RITMO CARDIACO EN FUNCIÓN A LA ANSIEDAD EN ADOLESCENTES MIENTRAS  
JUEGAN FORTNITE: CASO ECUADOR  
Bonifaz-Díaz Diego 1  
Tite-Haro María Belén  
Haro-Lara Aida Patricia  
2
3
1
Médico Especialista del Hospital Regional Docente Ambato. Ambato, Ecuador. Correo: diego88191@hotmail.com.  
ORCID ID: https://orcid.org/0000-0002-4235-7089.  
2
Estudiante de Medicina de la Universidad San Francisco de Quito. Quito, Ecuador. Correo:  
tite.belen2001@gmail.com. ORCID ID: https://orcid.org/0000-0001-7416-6167.  
Docente Universidad Técnica de Ambato, Facultad de Jurisprudencia y Ciencias Sociales, Carrera de Trabajo  
3
Social. Ambato, Ecuador. Correo: ap.haro@uta.edu.ec. ORCID ID: https://orcid.org/0000-0002-1472-1365.  
ABSTRACT:  
The objective of the research was to investigate how the heart rate varies according to anxiety in adolescents while  
playing Fortnite in time of COVID-19 understood as a contagious disease that has modified lifestyles apparently  
developed within the contexts of everyday life. Given the emerging measures taken especially by the Ministerial  
Ministry of Education, face-to-face classes took on a virtual learning modality, apparently guaranteed by policies,  
plans and programs that guarantee learning and the use of free time. This aspect has allowed more time to be  
devoted to electronic games, especially fortnite, and generates anxiety. The aforementioned has been verified  
through a quantitative methodology based on the Hamilton Anxiety Scale. Test consisting of 14 descriptors capable  
of identifying both physical and psychological symptoms. Anxiety to play this video game is directly related to an  
increase in heart rate, it is considered a tachycardia problem when the beats per minute exceed the value of 100 in  
moments of sedentary lifestyle, and some of the participants in this research work exceeded this amount when  
playing video games. Which allowed us to conclude that being part of this virtual life for a period of time greater  
than two hours is harmful to health, leading to heart, respiratory and digestive problems, fatigue, exhaustion and  
even gradual loss of sleep.  
Keywords: Electronic games, sport, leisure, health, free time.  
RESUMEN:  
El objetivo de la investigación fue investigar como varía el ritmo cardiaco en función a la ansiedad en adolescentes  
mientras juegan Fortnite en tiempo de COVID-19 entendida como una enfermedad contagiosa que ha modificado  
estilos de vida desarrollados aparentemente dentro de los contextos de la cotidianeidad. Ante las medidas  
emergentes tomadas especialmente por la cartera ministerial de Educación las clases presenciales tomaron una  
modalidad virtual de aprendizaje, aparentemente garantizadas por políticas, planes y programas que garantizan el  
aprendizaje y el uso del tiempo libre. Este aspecto ha permitido que se dedique mayor tiempo a juegos electrónicos  
especialmente de fortnite y se genere ansiedad. Lo mencionado se ha comprobado a través de una metodología  
cuantitativa basada en la Escala de Ansiedad de Hamilton. Test que consta de 14 descriptores capaces de identificar  
síntomas tanto físicos como psicológicos. La ansiedad por jugar este video juego está directamente relacionada al  
aumento de ritmo cardiaco, se considera un problema de taquicardia cuando las pulsaciones por minuto superan el  
valor de 100 en momentos de sedentarismo, y algunos de los participantes de este trabajo investigativo superaron  
esta cantidad al jugar video juegos. Lo que permitió concluir que ser parte de esta vida virtual por un periodo de  
tiempo superior a dos horas es perjudicial para la salud conllevando a problemas cardiacos, respiratorios, digestivos,  
cansancio, agotamiento y hasta pérdida gradual del sueño.  
Palabras Clave: Juegos electrónicos, deporte, ocio, salud, tiempo libre.  
Recibido: 05 de octubre de 2021; Aceptado: 27 de diciembre de 2021; Publicado: 07 de enero de 2022.  
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1
. INTRODUCTION  
On March 11, 2020, a state of emergency  
was declared in several countries worldwide,  
including Ecuador in response to the World  
Health Organization's declaration that  
Covid-19 is a rapidly transmitted pandemic  
Confinement as one of the emerging  
measures taken by governments caused the  
activities usually carried out by the  
population to be altered, especially  
psychological factors, exercise and humor  
that has been replaced by streaming  
platforms associated with video games and  
music (Ortega, 2020).  
(Word, 2020).  
The COVID-19 pandemic and the  
containment measures adopted have  
aroused greater interest in the economic  
impact than in the social impact with  
justifications for low levels of production and  
employment reflected in serious liquidity  
problems, cold statistical figures through  
measurements of gross domestic product  
Technology is no longer just a useful tool for  
employment, it is now used for recreational  
purposes. Global society has reached such a  
point that video games are considered a  
sport. Information supported by the Royal  
Academy of Language under the basis of the  
presence of competitiveness, training,  
regulatory organization and physical activity.  
This is how South Korea, a pioneering  
country in this initiative, created its first  
professional leagues of cyber players in 2000  
(GDP) pending monetary regulation (Inter-  
American Development Bank, 2020).  
In the face of economic attention, it is also  
urgent to attend to the effects of the  
measures contemplated as in the case of  
education that by executive decree was  
considered virtual classes as a process of  
learning and proper use of free time. The  
Constitution of the Republic of 2008  
guarantees rest and the right of people to  
free time depending on the development of  
the personality (National, 2008).  
(Editors of the newspaper El País, 2018).  
Hayer, Kalke, Meyer, Brosowski  
&
(2018:929) “As technology has developed,  
the international gambling market has  
changed markedly in recent years”Also, one  
of the most recent and popular games in the  
global industry is Fortnite, so this research  
will be directed by this prototype. It may  
seem like a new, fresh and innovative topic,  
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Covid-19 and heart rate based on anxiety in adolescents while playing Fortnite: Ecuador case  
but little is said about the negative  
repercussions that this phenomenon  
attributes to the health of individuals who  
are fond of this sport.  
causes a true psychic connection between  
the players, the plot and the space.  
Having  
the effect that each of the  
participants in this population shows  
symptoms of anxiety during and after the  
end of the play time. Once the departure is  
over, they present repetitive symptoms in  
their daily life such as chronic discomfort in  
relation to people and situations that they  
cannot control, repetitive behaviors,  
changes in appetite, muscle tension, body  
aches, affectations in memory and dominant  
feelings of nervousness. While during play  
they share a pattern of behavioral symptoms  
like social isolation, restlessness, walking  
back and forth, startled responses. As well as  
feeling light-headed, imbalance in body  
The concern lies in the various  
manifestations that can cause the excessive  
hours that are being used apparently to  
cover the use of free time l, especially  
nervousness to not have enough coverage,  
so it would be impossible to play, aspect  
associated with anxiety.  
Anxiety is a biological stimulus whose  
function is to alert the individual to some  
type of danger and provide him with the  
concentration and energy necessary for  
defense. However, this manifestation can  
become risky when the sufferer is unable to  
control it. This is when the main causes of  
this clinical picture, genetic, physical and  
environmental factors are analyzed  
temperature,  
stomach  
conditions,  
accelerated thoughts and affectations in the  
heart rhythm (Mardomingo, n.f).  
(
Editores of May Clinic, 2018). The selected  
It has also been decided to verify the  
influence of ergogenic aids because for more  
performance seventy percent of the  
population surveyed for this research work  
has resolved that it consumes at least one  
caffeine-based energizer of 400 ml per game  
to increase performance in the game. Failure  
to understand the health reaching of this  
chemical stimulus could bring risks to  
sample of adolescents between 14 and 17  
years old presents anxiety due to  
environmental factors.  
Being subjected to virtual realities perfectly  
designed to generate sensations of ecstasy  
and concentration, the environment  
manages to absorb them completely. Which  
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Bonifaz-Díaz et al. (2022)  
humanity. For the same reason, it has been  
energy through lipolysis in stored glucose,  
alterations in the digestive system and an  
increase in the heart rate (Editores of  
Colombia, 2018).  
thought vital to compare the scopes of the  
coffee-based drink and that of a placebo, to  
effectively measure the risks of uncontrolled  
movement and pressure in systole and  
diastole as a function of substance A versus  
substance B.  
The purpose of an increase in heart rate is to  
respond to the lack of oxygen and increase  
nutrient or energy levels in case you are in  
risk situations. The real problem arises when  
risk situations do not justify the energy  
released and it is not used. Adding the fact  
that the heart will reach points of exhaustion  
and in extreme cases to a heart attack  
(Pinheiro, 2018). Therefore, if a sedentary  
individual daily finds himself in unreal  
situations of danger he will waste energy  
and long-term damage to the functioning of  
his cardiac system.  
Returning to the explanation of the link  
between anxiety and heart rate it is  
necessary to treat the presence of  
catecholamines.  
Which  
are  
neurotransmitters that are released into the  
blood, their chemical composition consists  
of hormones such as adrenaline,  
norepinephrine and dopamine, hormones.  
Its main function is to help counteract stress.  
It is for this very reason that two  
catecholamines are released into the  
bloodstream when an individual generates  
psychological stimuli of anxiety. The main  
consequences of the presence of this  
neurotransmitter are improved alertness,  
anxiety as well as fear and paranoia are  
psychic states that have evolved in the  
nervous system to help since ancient times  
the human in his survival as in any other  
animal. That is why a state of alertness is  
generated with the contraction of the  
respiratory system, intentional release of  
2. METHODOLOGY  
It should first be noted that the most  
common mechanism for assessing anxiety  
levels and giving a reliable verdict is the  
Hamilton Anxiety Scale. Test consisting of 14  
descriptors capable of identifying both  
physical and psychological symptoms and  
answered the question:  
To what extent do teenagers suffer a  
variation in their heart rate as a function of  
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Covid-19 and heart rate based on anxiety in adolescents while playing Fortnite: Ecuador case  
anxiety caused by playing Fortnite?.  
Confirming the hypothesis: Playing Fortnite  
generates anxiety, which in turn raises heart  
rate levels in adolescents who spend their  
time in the face of Covid -19 confinement.  
adolescents in order to compare the  
results in a broader way.  
✓ The age range between 14 and 17 years,  
to obtain a more homogeneous sample  
where chemical and biological reactions  
are not affected by age.  
By controlling the variables, anxiety and  
heart rate variation were determined:  
✓
The use of the Hamilton Test to assess  
anxiety.  
Anxiety, because it is a clinical picture  
previously identified with the use of the  
Hamilton Anxiety Scale. Their results vary  
between 25 and 38 points. The interview  
was aimed at studying the symptoms that  
the sample subjects presented during and  
after departure. This experimentation  
contains no margin for error because it  
explores the unbiased nature of these  
individuals' behavior.  
✓
The video game Fortnite, is necessary so  
that the research is directed in the same  
direction, where all the participants  
have the facility to connect in the same  
environment. Allowing your anxiety to  
develop under the same factors and  
thus get optimally comparable data.  
Playing time, measurements will be  
made every 10 minutes for two hours on  
each player to get enough data.  
✓
The variation of the heart rate in the  
aforementioned population, because this  
reaction is completely linked to a biological  
process to deal with the feeling of danger  
The materials used were:  
✓
✓
✓
✓
✓
✓
Hamilton's test  
Apple Watch Series 2  
Table of records  
(Gutiérrez, Amat, Ruiz, & Sanchis, 2003). The  
Xbox  
same one that is constantly present by the  
stimuli generated thanks to Fortnite.  
Collaborating to the check the controlled  
variables:  
A Fortnite video game  
The Stopwatch of a Samsung J2 cell  
phone  
✓
The size of the population to be studied,  
it was decided to include only 10  
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A group of first, second and third year high  
of each participant. See Hamilton's range  
table 1.  
school participants from an educational unit  
in the province of Tungurahua were selected  
from the sample at random. Each question  
was directed to know the virtual gaming  
habits corresponding to each individual, with  
the purpose of selecting the most suitable  
participants to explore results consistent  
with the hypothesis.  
Finally, depending on what was planned, the  
players were virtually observed with the help  
of a family member who was asked to follow  
in turn with the stopwatch the times that the  
Apple Watch Series 2 located on the wrists  
of the players recorded based on the  
movement of their heart rate that with the  
aim of identifying signs of anxiety in their  
behavior. Taking into account that the data  
recordings will be carried out every ten  
minutes for two hours.  
Once the group was selected for the  
experiment, virtually everyone was  
interviewed for fifteen minutes to learn  
about their degree of anxiety according to  
the Hamilton Anxiety Scale. Postulates 1, 4,  
6
, 12 and 14 were those that were carried  
3
. RESULTS  
out in this first interview, as they were  
symptoms that could appear after the  
playtime used. While the rest of the literals  
were applied at the time of departure  
through observation, to understand the  
implications of stress transcends dimensions  
of the period of play to be a condition  
present daily.  
At no time was the life of the test subjects in  
danger, nor was any damage caused to the  
environment. All considerations were taken  
for confinement. The condition of the  
alterations in the heart rhythm was always  
controlled by time, so as not to cause fatigue  
or major affections to the cardiovascular  
system of the same. Permission was  
requested from the parents of the players to  
take this test by means of a commitment  
letter and in turn their help was requested.  
Nor was any solid or stimulating substance  
supplied to the participants' diet for better  
results.  
The results of the 10 scales that were  
practiced were added. Once this process was  
completed, the data were grouped in a table  
to compare the values with the ranges that  
indicate the degree of danger of the anxiety  
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Covid-19 and heart rate based on anxiety in adolescents while playing Fortnite: Ecuador case  
Table 1. Ordered data on the results of the Hamilton Anxiety Scale according to the participants of the  
practice (Alvarez).  
Participant Age  
Total  
(numerical  
of  
Number  
(years) interpretation  
Interpretation  
the Hamilton Scale)  
1
2
3
4
5
14  
14  
15  
16  
16  
24  
25  
27  
26  
24  
Clinically Manifest Anxiety  
Clinically Manifest Anxiety  
Clinically Manifest Anxiety  
Clinically Manifest Anxiety  
Clinically Manifest Anxiety  
Source: Prepared by the authors.  
Table 2.  
Participant  
#
1
#2  
#3  
#4  
#5  
Times  
Heart Rhythm (bpm)  
1
2
3
4
5
6
7
8
9
73  
64  
61  
67  
69  
79  
86  
83  
92  
84  
96  
102  
72  
125  
117  
121  
136  
112  
121  
112  
115  
104  
107  
131  
109  
85  
85  
60  
80  
80  
74  
105  
99  
105  
99  
78  
86  
80  
80  
96  
95  
95  
102  
90  
102  
87  
102  
87  
96  
98  
98  
1
1
1
0
1
2
102  
108  
120  
93  
93  
104  
107  
104  
107  
Source: Prepared by the authors.  
They respond to the collection of data from  
the 6 participants in the experiment. In a  
relationship of Time Vs. Heart Rate. Each  
time has a representation of 10 minutes,  
starting with this value. Same that  
determine the moments to collect the data  
of the heart rate measured in (beats per  
minute).  
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Table 3.  
Participant Number Average Heart Rate (bpm)  
1
2
3
4
5
79,66  
90,33  
117,5  
94,58  
76,83  
Source: Prepared by the authors.  
The table shows the average heart rate  
-
Description of Symbology:  
based on the values in Table two, in order to  
give way to a single amount per participant  
in relation to play time, to obtain a more  
efficient analysis of the relationship between  
anxiety and heart rate. It also cave  
emphasize that an average helps to  
represent a value that is presumed as  
constant.  
Q: Average  
Σ: Summation  
x: Values in a dataset  
n: Number of data  
-
Example:  
The values in the Table were used. 2  
푃
7
3 + 64 + 61 + 67 + 69 + 79 + 86 + 83 + 92 + 84 + 96 + 102  
=
1
2
-
Fórmula:  
푃 = 79, 66  
훴푥  
푛
푃 =  
Figure 1. Data Processed  
HEART RATE (bpm) VS. TIMES (t)  
Participant 1  
Participant 4  
Participant 2  
Participant 3  
Participant 6  
Participant 5  
6
5
4
3
2
1
00  
8
5
98  
10 07  
109  
00  
00  
00  
00  
00  
0
69  
7
0
72  
73  
7
7
72  
7
7
79  
73  
10 04  
31  
108  
77  
09 5  
10 02  
112  
90 8  
09 3  
9
80 7  
8
10 05  
80 0  
1
8
121  
115  
104  
96  
107  
102  
125  
136  
112  
121  
117  
120  
102  
96  
90  
72  
74  
78  
86  
60  
8
6
83  
t8  
92  
t9  
84  
96  
102  
7
3
64  
t2  
61  
t3  
67  
t4  
69  
t5  
79  
t6  
t2  
t7  
t10  
t11  
t12  
TIMES (T)  
Source: Prepared by the authors.  
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Covid-19 and heart rate based on anxiety in adolescents while playing Fortnite: Ecuador case  
This graph indicates the variation of the  
actual heart rate data in relation to the  
previous times of the average. Its purpose is  
to show in a more precise way how the  
dependent variable increases or decreases  
as a function of the independent one.  
Figure 2.  
HEART RHYTHM PROMEDIUM VS. ANSIEDAD  
1
1
1
40  
20  
00  
(
Values X)  
(
(
Values X)  
Y values)  
(Y values)  
26; 94,58  
25; 90,33  
8
6
4
2
0
0
0
0
0
24; 79,66  
2
3,5  
24  
24,5  
25  
25,5  
26  
26,5  
27  
27,5  
ANXIETY (HAMILTON SCALE VALUES)  
Source: Prepared by the authors.  
This graph shows the variations of the  
average heart rate (bpm) depending on the  
amount of anxiety of each participant. Same  
values from which a trend line arises that  
makes more visible the direction in which  
the scatter points (data) are accommodated.  
The values in yellow boxes will be used for  
the slope calculation.  
this research work, if it is positive, it will  
affirm the hypothesis and if it is negative, it  
will deny the hypothesis.  
-
Formula:  
푦2 − 푦1  
푥2 − 푥1  
푚 =  
-
Meaning:  
m= Slope  
-
The Slope:  
y2= Final value of the dependent variable  
y1= Initial value of the dependent variable  
x2= Final value of the independent variable  
x1= Initial value of the independent variable  
Mathematical equation used to describe the  
direction and inclination of lines on a graph.  
Its points depend on quantitative values  
corresponding to the dependent variable  
and the independent variable. In the case of  
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-
Resolution:  
that all participants were found affected by  
a degree of Clinically Manifest Anxiety  
although most of the symptoms such as  
respiratory problems, muscle aches,  
unjustified sweats, constant mood swings,  
digestive problems, anguish, nervousness  
and worry took place only during the game.  
The range of these values varies between 24  
and 27, where according to the Hamilton  
Anxiety Scale, which is evaluated on 56  
points (Alvarez).  
1
17, 5 − 76, 83  
7 − 24  
푚 =  
푚 =  
2
38,67  
3
푚 = 12, 89  
4
. DISCUSSION  
Puccinelli, Santos, Seffrin,  
&
Barbosa  
(2021:8) “The level of physical activity was  
significantly reduced during the social  
distancing period. Prior to the COVID-19  
pandemic period, 69% of the volunteers  
King, y otros (2019:141) “A deeper analysis  
of video games may improve the quality of  
our understanding of problematic gaming  
and aid efforts to reduce gaming-related  
harm”. Also during the collection of heart  
rate data, it was easy to intuit the certainty  
of the hypothesis, since the values varied  
between 72 (bpm) as the lowest amount for  
being an initial value, and 120 (bpm) at the  
end of one of the games.  
(83% male and 46% female) were classified  
as very active, and during the social  
distancing period, this percentage dropped  
to 39% (50% male and 31% female)”. Indeed,  
the heart rate of adolescents in confinement  
due to COVID-19 increases depending on the  
levels of anxiety that individual’s experience  
when playing Fortnite.  
Jiménez & Chacón (2012:43) Videogames  
and everything related «to be» in front of a  
screen will be common to future  
generations, and therefore more systematic  
studies are required to determine the long-  
term exposure effects to these devices.It  
was not possible to expect a contrary result,  
taking into account as an indication the fact  
Similarly, Graph 1. , allowed a clearer  
observation of the patterns of heart rate  
change as time increased. Although the data  
did not indicate consistent behavior, they all  
concluded by resembling an ascending line.  
A result that directly relates the proportional  
increase in heart rate as the 10-minute  
intervals also increased. Same observation  
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Covid-19 and heart rate based on anxiety in adolescents while playing Fortnite: Ecuador case  
that allows classifying anxiety as a time-  
dependent variable. Since the greater the  
anxiety, the greater the number of beats per  
minute; and the more time, the more beats  
per minute.  
feasible to use more test subjects in order to  
have a broader appreciation of the data.  
Similarly, as the research was conducted, a  
new variable emerged that related time and  
increased heart rate. Topic that could also  
have represented relevance to it.  
5
. CONCLUSIONS  
Deepening further the credibility of the  
hypothesis pointed out at the beginning of  
this research work: being the positive slope,  
indicates that the line of the average heart  
rate as a function of anxiety increases  
proportionally especially, due to the greater  
number of time that adolescents devoted to  
this activity because they are in confinement  
in the face of a COVID-19 emergency.  
The hypothesis presented is considered  
adequate, since it focuses both dependent  
variable (heart rate) and independent  
variable (anxiety) on a specific group of  
individuals that make the research topic  
more concrete. Likewise, the information  
collected is supported by information  
regarding heart rate, catecholamine cycle  
and anxiety. Similarly, it was an advantage to  
have used two stopwatch systems to have  
more accurate data, the cell phone and the  
one included in the clock that collects the  
amounts.  
Indeed it is already known that the anxiety  
to play this video game is directly related to  
the increase in heart rate. However, these  
results highlight the risk involved in making  
this virtual sport a habit of our daily lives. As  
already mentioned above, it is considered a  
tachycardia problem when the beats per  
minute exceed the value of 100 at times of  
sedentary lifestyle, and some of the  
participants of this research work exceeded  
this amount when playing video games.  
Which allowed us to conclude that being  
part of this virtual life for a period of time of  
more than two hours is harmful to health  
As weak points, identifying the degrees of  
anxiety with the Hamilton Anxiety Scale was  
complicated since the diagnosis depended  
almost entirely on observation and analysis  
of behaviors. Therefore, collecting this kind  
of information took longer than expected,  
especially because the interview was  
repeated up to three times to add credibility  
to the result. It would also have been more  
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Bonifaz-Díaz et al. (2022)  
leading to heart, respiratory, digestive  
Editors of Colombia. (2018). Synthesis and  
Metabolism of Catecholamine’s.  
Obtained from Synthesis and  
Metabolism of Catecholamine’s of  
Colombia:  
problems, tiredness, exhaustion and even  
gradual loss of sleep.  
Finally, video game players, especially  
Fortnite, are recommended to enjoy this  
virtual experience for a time not exceeding  
ONE HOUR with TWENTY MINUTES, where  
the range of the heart rate ranges between  
https://encolombia.com/libreria-  
digital/lmedicina/fisio-  
endocrina/fisiologiaendocrina-  
medula1/  
Editors of the newspaper El País. (2018). 'E-  
sports', the Galactic’s of video  
games. Obtained from El País:  
https://elpais.com/elpais/2018/02/0  
7
2 and 93. While those who from the  
beginning had between 100 and 120 are  
recommended to practice at least forty  
minutes of physical activity, although  
walking, in order to reduce the production of  
6
/eps/1517934606_590806.html  
Gutiérrez, M., Amat, J., Ruiz, A., & Sanchis, C.  
2003). CARDIAC RESPONSE AS A  
MEASURE OF ANXIETY IN RISK  
SPORTS. Journal of Sports  
Psychology, 7-21.  
(
catecholamine’s  
because  
of  
the  
accumulated anxiety and stress.  
Hayer, T., Kalke, J., Meyer, G., & Brosowski,  
T. (2018). Do Simulated Gambling  
Activities Predict Gambling with Real  
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Covid-19 and heart rate based on anxiety in adolescents while playing Fortnite: Ecuador case  
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