What is the placebo effect?
Endurance athletes improve over time only through intervention. In other words, if an athlete does nothing (i.e., no training), then he/she will not see any positive changes in their fitness and performance. An athlete improves only when intervening through the addition of a training stimulus. Luckily, in today’s sporting world, we have a plethora of research to suggest which approaches to training are best. We also have research documenting the potential effects, or lack thereof, of various substances, tools, pieces of equipment, or psychological tactics. This research is then used by coaches and athletes alike to inform decisions on how to prepare an athlete for better fitness and performance.
We are usually led to believe that if an intervention or training stimulus works, that there is a physiological or biological reason as to its success. However, what if improvements in fitness and performance can be elicited via psychological mechanisms as well? In other words, what if simply believing that something is working will elicit very real physiological and biological changes? Well, a recent area of research that has gained more and more attention is that of the placebo effect, and this phenomenon is exactly that.
The placebo effect is observed when administering something to an individual that might otherwise have no physiological or biological basis for eliciting any positive change indeed leads to a positive change. However, this phenomenon is also observed when specific wording or phrasing of the effectiveness of an evidence-based and proven intervention is used to enhance or augment its anticipated effects.
Here are a few examples:
1. One athlete is given a caffeine pill prior to a 1500-meter race (caffeine is a known performance-enhancing substance for endurance athletes). Another athlete is given the same pill in terms of its size, texture, look, and taste, except this one is caffeine-free. Both athletes are told, however, that they are receiving caffeine and that caffeine may help improve their performance. Both athletes see an improvement in performance. The athlete that saw an improvement in their performance despite receiving a placebo pill is experiencing the placebo effect. In essence, they believed they were receiving something that was going to help them, and this belief elicited very real biological and physiological effects, ultimately yielding an improvement in performance.
2. A coach is going over a taper strategy with an athlete a few weeks out from a big race. Rather than simple telling the athlete what to do each day in their training log, the coach decides to sit down with the athlete and explain the research documenting the beneficial effects on performance that a properly executed taper can have. The athlete listens, gets excited, executes a perfect taper period, and ultimately races well. Some of this performance may be attributable to the athlete’s belief that they executed a perfect taper while knowing that they were helping themselves to improve their performance. This is also the placebo effect at work.
Now that we have defined what the placebo effect is and given a few examples, let’s cover how this phenomenon is relevant to both athletes and coaches, as the use of this knowledge is very different depending on whether you are receiving a training plan or delivering one to someone else.
What should athletes be aware of as it relates to the placebo effect?
Athletes should be aware that the placebo effect is a very powerful phenomenon as it relates to their performance. For example, many products out there on the market that claim to enhance performance, improve recovery time, etc., don’t have much evidence to support their claims. However, some athletes swear that a certain product improves their performance. This can be explained by the placebo effect. This is indeed a positive thing so long as that product is legal and does not come with any unwanted side effects. Recovery boots for example have no research documenting any real physiological effects on enhancing recovery, yet many athletes use them and may report that they feel like it helps them recover faster and better. These athletes may not be lying as they may indeed be experiencing recovery benefits from consistently using a product that they truly believe is helping them.
The key here is their belief. Belief in something is so important as an athlete. Believing in their coach, their training plan, their race plan, and everything that they do essentially will only help them improve the results they see in terms of fitness and performance. If an athlete truly believes something is working for them, then it likely will. However, athletes should still do their research (legitimate research, not google searches and asking other athletes for their opinions) or get reputable information from a reliable source as to the science supporting various products or training approaches out there, as simply hoping the placebo effect will save them isn’t a good enough excuse to recklessly try and do everything that an athlete wants within their training and racing. Also, some products out there that have no science to back up the claims they make can be a massive waste of money when athletes could be putting that money into something that has more evidence to support it. Something that has real physiological and biological effects is still likely to “outwork” any effects that placebo effect might have from using a product that has no real physiological or biological basis for its effects.
What should coaches be aware of as it relates to the placebo effect?
Coaches should know that the words they speak to an athlete have a huge influence on the effectiveness of their coaching and the training plans they prepare for athletes (2). The key with anything and everything coaches do is to get the athlete to buy in and truly believe that the coach is delivering the best possible plan of action for them to achieve their goals. If the athlete believes in it, then it will likely help them. Coaches should be informed on the latest research surrounding relevant topics, and then assure athletes that the evidence-based approaches they are providing to them have documented benefits, and be specific about those benefits. The more an athlete hears of the specific benefits, the more they will buy in and believe it.
A 2011 meta-analysis demonstrated across 14 interventions and 196 placebo group participants that the placebo treatment elicited small to moderate improvements across various strength and endurance-related performance outcomes (1). This is incredibly important to be aware of as this demonstrates how powerful a belief in something is when it comes to athletic performance. Of course, coaches should always deliver evidence-based approaches and tactics when possible as evidence-based approaches are always recommended over blindly doing whatever a coach wants, but getting the athlete to believe in their approach is just as important.
To conclude, know that there is far more at work when an athlete intervenes with a training stimulus or uses a product with the intent of enhancing some aspect of performance. The belief in what they are doing is just as important as actually doing it. A coach could devise the perfect and most evidence-backed plan known to mankind, but if the athlete does not believe in it, then it won’t ever be as effective as it could have otherwise been had the athlete been convinced that it was the best plan known to mankind.
1. Bérdi M, Köteles F, Szabó A, Bárdos G. Placebo effects in sport and exercise: a meta-analysis. European Journal of Mental Health. 2011 Dec 1;6(2):196.
2. Roelands B, Hurst P. The Placebo Effect in Sport: How Practitioners Can Inject Words to Improve Performance. International Journal of Sports Physiology and Performance. 2020 Jun 3;15(6):765-6.
Happy training and racing!
-Ryan Eckert, MS, CSCS