Kaptchuk and Miller (2015) described placebo effects as improvements in patients’ symptoms because they took part in a therapeutic encounter, with its rituals, symbols, and interactions. These signs and behaviours include health care paraphernalia and settings, interactions with clinicians, empathy and the laying of hands. In simple terms, we see improvements (in a condition, for example) with no substantial active ingredient). But what happens in sport settings when athletes use caffeine supplementation?
In sport research, when researchers are exploring what works for whom and under which conditions, they often use double-blind and placebo controlled study designs. These designs ensure there is no bias from knowing the substance ingested by the athletes in the study. In this way, the researchers can compare what the athletes ingested compared with athletes in another condition. Researchers craft the placebo effect, a positive outcome created when the participants in the study believe that they have received a positive intervention (which masks the true effect of the intervention). In a nocebo effect, the researchers create a negative outcome because the participants in the study believe they have received a negative intervention.
Saunders and colleagues investigated the effects of supplement identification on exercise performance using caffeine supplementation. Forty-two trained cyclists performed a 30- minute cycling time trial one hour after ingesting a 6 mg/kgBM caffeine or placebo supplementation and one control session without supplementation. Before and after the exercise time-trials, the cyclists identified which supplement they believed they had ingested – caffeine, placebo or don’t know.
In their analyses, the researchers showed that caffeine improved performance against the placebo and control. Those cyclists who correctly identified the placebo (in the placebo condition) showed possible harmful effects on performance compared with control. In short, identifying the supplement appeared to influence exercise outcome, and the researchers suggested it might be a source of bias in sports nutrition.
When the cyclists correctly identified caffeine (especially after the time-trial), cycling performance improved. When the cyclists correctly identified the placebo (before and after the time-trial), performance went down. These cyclists knew about caffeine and its suggested ergogenic effect. With this knowledge, any cyclist who identified the supplement taken as caffeine would believe their performance would improve.
There are several messages here for researchers and athletes. First, doing research with dependable research designs is essential for valuable research outcomes. Second, research using a substance like caffeine is challenging but achievable. Third, athletes know the value of ‘performance-enhancing’ substance like caffeine and where it is physiological or psychological, performance improves. Finally, the power of our belief system in sport and exercise contexts means we can harness our beliefs to gain the most from ourselves and our circumstances.
When we consider the broader scheme of research on the placebo and nocebo effects, the see how helping others manage the challenges they face, pain, endurance, well-being can be a reasonable and often worthwhile goal in the health professions. We may not always be able to change our circumstances, but perhaps we can influence them and gain a little more when we thought it was not possible.
References
Kaptchuk, M. (2015). Placebo effects in medicine. The New England Journal of Medicine, 373(1), 8–9. https://doi.org/10.1056/NEJMp1504023
Saunders, O. (2017). Placebo in sports nutrition: a proof‐of‐principle study involving caffeine supplementation. Scandinavian Journal of Medicine & Science in Sports, 27(11), 1240–1247. https://doi.org/10.1111/sms.12793
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