The placebo effect may actually be an integral part of what we call the Champion’s Mindset.
Randomized trials and dedicated placebo studies have given us a much deeper understanding of the placebo effect and all of its complex parts. Researchers have even used things like brain scans to show that there could be a physiological, not just psychological, explanation for it. While there is still much about placebos that we don’t understand, what is becoming clear is that there is more to it than simple deception.
Doctors worry that a more broad acceptance of the placebo effect could be used to justify useless treatments or procedures. On the other hand, in sport and fitness, there is a growing idea that the placebo effect may actually be an integral part of what we call the Champion’s Mindset. This idea has many scientists, coaches, and athletes devoting more time to figuring out how they can use it to their advantage.
What is the Placebo Effect?
First, let’s lay out what exactly we are talking about here. The word placebo is a late 18th-century Latin term which literally means ‘I shall please.’ In modern terms, the definition of a placebo is: a harmless pill, medicine, or procedure prescribed more for the psychological benefit to the patient than for any physiological effect. Or, as they explain at Harvard Medical school: “A favorable response to an intervention—a pill, a procedure, a counseling session, etc—that doesn't have a direct physiological effect.” Take note of the words "harmless" and “direct.” It is important to keep these in mind as we proceed because there are ways that placebos could be harmful and also, as I will get to shortly, there are many indirect effects found.
The most obvious example of a test that involves the placebo effect goes like this: A study participant is given a sugar pill and told it will have a specific effect on them. Even though it is a sugar pill, that individual (or group of individuals) experience some effect or improvement in their condition. Sound familiar? Well, this idea has moved beyond medicine, and similar studies are also being done in sport and fitness.
Placebo effects of varying strengths are reported in studies from weightlifting to endurance sports and everything in between. The findings from these studies suggest that many psychological variables like motivation, conditioning, and outcome expectancy mix with some less tangible physiological variables to create some significant factors for both positive and negative outcomes in sport.
More research is needed, but one thing is certain - they work.
It is not clear how placebos improve athletic performance because the effects are so wide-ranging. In some sports, it could be reduced anxiety that leads to lower muscle tension which makes the body move more efficient and fluid. Or it could be a reduction in perceived exertion and even pain. Or taking a placebo may simply plant a subliminal thought that motivates you to push yourself harder. More research is needed, but one thing is certain—it works.
Placebo in Cycling
I think that one of the greatest examples of the placebo effect at work in sport is contained in a study called Placebo effects of caffeine on cycling performance. What makes this study special is that the researchers explored the placebo effect in cycling performance using both quantitative and qualitative methods.
They took six well-trained male cyclists and had them perform two baseline and three experimental 10-km time trials (which is where a cyclist rides as hard as they can, alone, for 10 km). The cyclists were told that in the experimental trials they would each receive either a placebo, 4.5 mg/kg caffeine, or 9.0 mg/kg caffeine, at random. But in reality, placebos were given during all the experimental trials—there was no caffeine in any of the pills. The researchers also conducted interviews with the cyclists before and after revealing the decaffeinated deception to explore the subjects' experience.
Now comes the coolest part of this study. Not only was there a placebo effect noted during the study but there was a “dose-response relationship” as well. The cyclists produced 1.4% less power than baseline when they believed they had ingested a placebo, 1.3% more power when they believed they had ingested 4.5 mg/kg caffeine, and whopping 3.1% more power when they believed they had ingested 9.0 mg/kg caffeine. On top of that, during the interviews, all the cyclists reported feeling varying caffeine-related symptoms.
The placebo effect isn’t just an on or off factor, it can be dose-dependent.
At the conclusion of the study, the researchers wrote: “Quantitative and qualitative data suggest that placebo effects are associated with the administration of caffeine and that these effects may directly or indirectly enhance performance in well-trained cyclists.” Which means that the placebo effect isn’t just an on or off factor, it can also be dose-dependent. How cool is that?
Can You Give Yourself a Placebo?
Common reasoning behind the success of the placebo effect is that it works because the recipients don't know that they are getting a placebo. It’s all about deception. But what happens if you know you are getting a placebo?
Well, a 2014 study published in Science Translational Medicine delved into this by testing people's reaction to a migraine medication. One group of migraine sufferers took a drug labeled correctly with the name of the drug, another group took a pill that was clearly labeled "placebo," and a third group was simply left to suffer through their migraine. At the end of the study, the researchers found that the bottle that was clearly marked as a placebo was still actually 50% as effective as the real drug.
The researchers were left guessing why this was and eventually came to the conclusion that a driving force beyond this paradoxical response was a byproduct of simply taking a pill. The migraine sufferers were able to activate their body’s natural pain-killing defenses by simply taking a pill.
We see this again and again in the supplement business as well. People pop a vitamin because they heard that it gives them better skin, clearer thoughts, or reduced stress and low and behold, it works. Despite the fact that there is very little scientific evidence that the ingredients do anything at all. And to add insult to injury, there is growing evidence that the supplements many people rely on have a four out of five chance of not containing what was listed on the label at all. So even if the ingredient does have some known effect, it may not be present in that capsule you bought at your local supplement store.
This is also true in sports supplementation and I can tell you many stories of athletes I know popping all kinds of fringe supplements before a big race to (hopefully) get a boost in performance. And you know what? I don’t stop them. As long as there is no danger (other than creating expensive urine) I let them believe because, like the cyclists in the earlier study, it just might work.
Those lifters still lifted heavier weights than they previously had lifted. Even though they were told it was a placebo.
This idea of self-placebo-ing was also demonstrated in a weightlifting study called Expectancy Effects and Strength Training. This study tested the theory on competitive powerlifters by having them take a placebo (sugar pill) a few hours before a weightlifting session. And sure enough, the first group of powerlifters who were told the pill was a steroid went on to lift 4% heavier weights than they usually do.
Then there was a second group who, just like the migraine sufferers, were actually told that they were receiving a placebo. Those lifters still lifted heavier weights than they previously had lifted. Even though they were told it was a placebo.
Now part of my brain thinks: OK, maybe the second group didn’t believe the researchers and thought they were getting fooled into thinking the pill wasn’t going to help them, in some sort of scientific sleight of hand. But this thought is put to rest when we take into account that all the lifters had prior knowledge of how steroids work and that any steroids would take weeks to add any strength or muscle to their body. They all knew that taking any type of steroid just a few hours before a session would have pretty much no effect. And yet, they still performed better.
Believe the Hype
There is an old saying that mathematicians don’t play the lottery because they know the odds of winning are terrible. But sociologists say that the pleasure people get from simply imagining what they would do with all their lottery winnings is worth the price of the ticket. So, even if the majority of the supplements, drinks, injections and crazy devices don’t “work” they are still worth the price of the ticket.
Again, to continue with the lottery analogy, the advertisements for the various lotteries are so enticing, convincing, and pleasant that we can’t help but want to believe or buy into the hype. Well, the hype around the supplements, shoes, recovery tools and other whatnot is equally convincing and exciting and the more hype that we believe, the more gains we will actually experience—placebo or not.
This reminds me of a story that I recently heard runner and sports writer Alex Hutchinson tell, which falls into this same deceptive category. Alex told us that as a college junior, he had been stuck running at 4:01 to 4:02 for 1,500 meters for a couple of years. Then suddenly he ran 3:52 at a small track meet in the Canadian province of Quebec.
He attributes this sudden success in part to his mid-race splits being shouted to him incorrectly and several seconds off what he was really running (perhaps because of the bilingual nature of the part of Canada he was racing in). This error led him to believe that he was running faster than he really was, and after reconciling that pace with his feeling of exertion he was able to dig deeper than he normally would have for the remainder of the race.
In the next two races after that, he continued to get faster and ran 3:49 and then 3:44. Alex said that he has been a believer in the mind’s role in endurance sports ever since. And I take this as a sign that a placebo can come in more than pill, injection, or beverage form. It can even be shouted at you in a Québécois accent.
Is There Any Harm to Placebos?
One man’s placebo is another man’s positive outcome.
My takeaway from all this is that we shouldn’t look down on placebos. As long as the risk of taking them is acceptably low, writing them off as a trick or something fake is truly selling them short. They are as powerful as we need them to be and again, as Alex Hutchinson said in an interview for the podcast Endurance Planet, “one man’s placebo is another man’s positive outcome.”
Whether it is telling our training partner that she will get much faster if she starts doing these cutting edge running drills or allowing ourselves to believe the hype around those new compression pants you've seen all over the internet, the placebo effect can indeed give you an edge. If you can crack the code, there is research showing it can increase our performance between 4-20%. And that is true even if we know it is a placebo.
Finally, if you do find yourself believing the hype around a vitamin, a device, or a cool new piece of gear, perhaps you don’t need to find every shred of scientific evidence to support it before making the purchase. Whether it turns out to be the purchase itself or the placebo effect that is giving you the edge, it is likely worth the price of the ticket.
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