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Placebos and High Performance Sport

A Placebo is something of no intrinsic remedial value that is used to appease or reassure another. There is no completely agreed upon definition of what a placebo is, and the scope of therapy can extend from an ingested agent to a physically inert external treatment.7 The concept of the placebo effect can extend to include every conceivable beneficial biological, social, or human interaction that doesn’t involve some drug well-known to the pharmacopoeia.10 Irving Kirsch hypothesised that the self-fulfilling effects of response expectancies, in which the belief that one will feel different, leads a person to actually feel different. This effect is the placebo effect.8

Despite the vast amount of research in the area of placebos, the phenomenon has remained largely unchallenged in the area of sport and performance.12 In high performance it is likely that there are a great number of therapies and ergogenic aids that are used with no real effect of the athlete. Instead, there is the potential for a placebo effect to occur providing a false positive for improved performance. Expectation and conditioning are among the strongest areas for explaining the placebo effect13 and a large component of high performance sport involves mental training of an athlete by their coaches and support staff.

The placebo effect is a psychobiological reaction attributed to numerous mechanisms including expectation of improvement and Pavlovian conditioning.3,4 These psychological reactions can have performance benefits, and when you look at high performance sport the single highest priority is performance outcome. Numerous studies have been completed where athletes falsely believe they have been administered performance enhancing agents, and obtain performance improvements over baselines and controls.1,2,5,6,10,11 These improvements may only be an increase of 1% however at top levels that can be enough to mean the difference between winning and losing. With restrictions on what agents an athlete can use and what equipment and techniques are allowed win each sport it is necessary to look at every possible option for getting the winning edge on the opposition. Some aids that can be used may only provide a placebo effect on the athlete, but this can lead to real performance outcomes.

By working with sports science, psychological benefits can be enhanced for an athlete resulting in further improved results. Items such as compression garments have no proven benefit for their use, however they have shown no negative impact either, and by combining the placebo effect of using such ergogenic aids with the possibility of real physiological benefits could potentially result in an amplified boost for the athlete. Many items such as these become products that are viewed by the general population as necessary for elite athletes. It is unclear with these products if the use at high performance breeds the idea that they have a physical benefit, or if there is a physical benefit that causes the population to believe that high performance athletes need them to compete on an international stage. What is clear however is that some athletes believe that they need them to perform and as such they have a real impact on the athletes performance, whether it is through a placebo effect or physiological or neurobiological mechanism.

It is shown that false belief may enhance performance. This can be achieved through a conscious decision making process as opposed to any direct somatic or psychological mechanism.3 To be able to determine the real benefit of a placebo however, it would be necessary to look deeper into the actual reasoning for the performance enhancements that are achieved. At the moment the only true way of determining whether there is a placebo effect in place is through performance measures and recording athlete results. If there were some neurobiological mechanism that has a physiological effect on the individual causing these changes, it would be necessary to determine what it is and then measure the impact that it has.

1. Ariel, G. and Saville, W. (1972) Anabolic steroids: the physiological effects of placebos. Medicine and Science in Sport and Exercise 4, 124-126.

2. Beedie, C. J., and Foad, A. J. (2006). The effect of belief on sports performance. Invited symposium, Annual Conference of the British Association of Sport and Exercise Sciences. University of Wolverhampton.

3. Beedie, C. J. (2007). Placebo effects in competitive sport: Qualitative data. J. Sports Sci & Med, 6, 21-28.

4. Benedetti, F., Mayberg, H. S., Wager, T. D., Stohler, C. S., & Zubieta, J.-K. (2005). Neurobiological mechanisms of the placebo effect. J. Neuroscience, 25(45), 10390-10402.

5. Clark, V.R., Hopkins, W.G., Hawley, J.A., and Burke, L.M. (2000) Placebo effect of carbohydrate feeding during a 4-km cycling time trial. Medicine and Science in Sport and Exercise 32, 1642-1647

6. Foster, C., Felker, H., Porcari, J.P., Mikat, R.P. and Seebach, E. (2004) The placebo effect on exercise performance, Medicine and Science in Sport and Exercise 36, Supplement S171

7. Kamper, S.J. & Williams, C.M., (2013) The placebo effect: powerful, powerless or redundant. Br J Sports Med Vol 47 No 1, 6-9

8. Kirsch, I., (1985). Response expectancy as a determinant of experience and behaviour. American Psychologist 40 (11):1189-1202

9. Maganaris, C.N., Collins, D. and Sharp, M. (2000) Expectancy effects and strength training: do steroids make a difference? The Sport Psychologist 14, 272-278

10. Moerman, D.E. and Jonas, W.B. (2002). Deconstructing the placebo effect and finding the meaning response. Ann Intern Med. 136 (6): 471–6

11. Sonetti, D.A., Wetter, T.J. Pegelow, D.F., and Dempsey, J A. (2001) Effects of respiratory muscle training versus placebo on endurance exercise performance. Respiration Physiology 127 (2-3), 185-199.

12. Stedge, H. L., Kroskie, R. M., & Docherty, C. L. (2012). Kinesio Taping and the circulation and endurance ratio of the gastrocnemius muscle. J. Ath. Training, 47(6), 635-642.

13. Stewart-Williams S, Podd J. (2004) The placebo effect: dissolving the expectancy versus conditioning debate. Psychol Bull 130:324–40.

 

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Author:

This blog was started for a Uni subject, and has since evolved into a place where I can voice my thoughts, typically about coaching and sport. I grew up in Sydney, then moved to Canberra for some further study in 2011 and when I finished in 2014 I moved up to Brisbane. I have played, coached and generally been involved with volleyball since 2013. As of 2017 I am now the QAS Volleyball Assistant Coach.

One thought on “Placebos and High Performance Sport

  1. An interesting article and very well thought out and clear explanation of something that can become quite complicated. However, regarding your statement about how the removal of the placebo can be detrimental to performance and so why remove it, perhaps if the athlete was shown the evidence base as to why their belief is wrong then the same detriment would not occur. For example, take a weight lifter who drinks protein shakes because he believes (due to adverts, vicarious experiences and ‘dodgy’ research) that they will increase his protein intake and therefore performance. If you remove his protein shake, his performance will decrease. However, if you show him the research concluding that protein shakes do not have any effect other than psychological, and explain to him that his performance is not due to the protein shakes at all, will his performance still decrease if his belief changes? And will it not save him a lot of money doing so?

    Further to that, consider this. Perhaps removing something that actually aids performance (perhaps to save money), but convincing the athlete that it actually had no benefit. Would performance decrease? Is it the placebo effect or not?

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