Placebo - what can we learn, and why bother?

This newsletter is a work in progress - I think the first iteration awaits your input!

I recently read some information that coalesced with previous research stored in my memory. It's a bit like the opposite of when white light is refracted into spectrum colours, this time in reverse. Different areas around a common topic—placebo/power of the mind all come together.

1. Belief That Caffeine Ingestion Improves Performance in a 6-minute Time Trial Test without Affecting Pacing Strategy - Valero et al., 2024. Nutrients. https://www.mdpi.com/2072-6643/16/2/327

This study analysed the placebo effect of caffeine ingestion on running performance.

Results: Placebo ingestion improved running performance in the 6 min time trial test (1668 ± 139 m placebo vs. 1642 ± 158 m control, t = 2.49; p = 0.03; moderate ES = 0.69)

Conclusions: Beliefs of caffeine ingestion can improve running performance at speeds around maximal aerobic speed in recreationally trained runners without affecting pacing strategy, so this "nutritional" strategy could be useful in competition scenarios. As a practical application, recreationally trained runners could improve ≈5 s in 1500m or mile competitions.

2. One of the studies I was trying to find (shoutout to Zhi for finding it https://journals.lww.com/acsm-msse/fulltext/2014/11000/postexercise_cold_water_immersion_benefits_are_not.14.aspx) related to cold water therapy and recovery. Participants were either placed in cold water and told it was therapeutic (intervention), warmer water and told it was therapeutic (placebo), or the same-temperature water and told nothing (control)

Blood tests, physical performances (e.g., MVC), and subjective questions were covered extensively. 

Conclusion: A recovery placebo administered after an acute high-intensity interval training session is superior in recovering muscle strength over 48 h compared with control and is as effective as the intervention. This can be attributed to improved ratings of readiness for exercise, pain, and vigour, suggesting that the commonly hypothesised physiological benefits surrounding cold water immersion are at least partly placebo-related.

It was noted that there were no significant differences between the two groups that were told the process was therapeutic, regardless of the water temperature. Essentially, the belief that the process was therapeutic influenced the outcome.

3. The psychological effect of acute creatine pre-workout supplementation induces performance improvement in resistance exercise - Aguiar et al., 2024 Res Sports Med. https://www.tandfonline.com/doi/full/10.1080/15438627.2022.2090253

This study aimed to test whether believed versus actual acute creatine ingestion (compound known to build muscle) impacted resistance exercise performance. Participants completed squat and bench press exercises and were given; nothing, dextrose, dextrose identified as creatine, and creatine identified as creatine.

Conclusion: In acute measures, belief versus actual ingestion of creatine yields similar exercise performance regarding performing squat exercises.

My take-home

Belief would seem to be an essential factor in generating positive outcomes for clients. How does this help clinically? Well, think about those chronic presentations that you assisted with. So often, clients are confused about their problem, unsure what they can/can't do, and paralysed by 'deer in the headlights'. Personally, I think our professional assistance comes down to developing a positive relationship with each client [link], providing appropriate education, and painting a direction for where they will be in a week, a month, or a year. Essentially, building a bridge with guide rails from where they are to where they want to be.

I see our job as listening to their story, confirming what is happening with tools and other objective measures, and then providing them with a logical analysis and path forward. Critically, we must explain how they will move from their current dis-ease state to a more comfortable and sustainable quality of life.

To do this, we employ the power of belief, hands-on therapy, guided exercise, sleep education, and nutrition to advance their health and well-being.

I look forward to hearing your thoughts and experiences about the power of placebo.