Marks Daily Apple
Serving up health and fitness insights (daily, of course) with a side of irreverence.
1 May

Does the Placebo Effect Apply to Exercise?

boxjumpA couple weeks ago I highlighted a nutrition study that suggested even the body’s hormonal responses (not just self-reported “feelings”) could be impacted by how we perceive a particular food we eat. It’s the kind of thing that I feel like opens up life and health in an amazing way. Let me be clear that I’m not claiming people can abuse their bodies and then erase it all with the magic of positive thinking. I think most people understand it’s positive thought in tandem with positive action that makes for significant, long term benefit. To a point, I’ve always felt there was something to the psychological overlay in health. We’ve all seen it. People give up on their lives after losing a spouse. They approach their lifestyle changes with resentment and cynicism. On the other hand, some people’s health or weight loss takes off once they address underlying emotional issues even though their routine is generally the same. As an elite level athlete, I knew glaringly well how much my mental attitude influenced my performance. As a trainer, I saw every day how much my clients’ expectations helped or hampered their progress. I’ve been curious lately about the measurable impact behind these general observations. Can we, say, examine fitness and the placebo effect beyond intuition and find actual evidence? What does research say, if anything, about the placebo influence on our body’s exercise benefit – and what should that mean for us?

I mentioned previously, of course, the much cited housekeeper study that measured otherwise unexplained gains in the research sample of hotel housekeepers who were told their daily work met the federal standard for daily exercise. It’s a good place to start because I think too often we apply the concept of positive thinking solely to performance level activity (e.g. marathon winners, Olympic swimmers, etc.).

Yet, the truth is much of the research revolves around performance – and in many studies performance with placebo supplements. Sometimes the placebo effect is studied in a session after a real supplement has been administered in the previous session. The subject then “remembers” and imposes the same benefit (verbally cued by researchers in the second session) onto the “clean” session. It calls into question what exactly constitutes preconditioning in the holistic sense. In one study, for example, lifters improved their output by 3.5-5.2% when they (erroneously) believed they had been given a steroid as they’d experienced in a previous session. Another study found participants doing quadricep work with the suggestion that they’d received a caffeine supplement showed 11% enhancement to their work compared to their previous session. Cyclists produced more power (up to 3.1% over baseline) when they believed they’d ingested a high dose of caffeine. Finally, runners who believed they were being offered “super-oxygenated water” (and watched a video about its purported, but debunked, benefits) ran a 5K session an average of 83 seconds faster (PDF).

This brings me back to everyday fitness endeavors….

The studies out there are few and far between when it comes to general fitness as opposed to performance sessions, truth be told, and they aren’t always consistent. One study sought to replicate the same set-up as the housekeeper research with university custodians. At the end of the study period, however, the two groups showed no significant difference in health measures.

Yet, research is generally consistent in demonstrating psychological effects of exercise even when it’s a matter of perceived versus actual exertion. One study sought to measure the difference in mental well-being in two groups that participated in the same training program. One half was told their program was specifically designed to enhance their psychological well-being, while the other received no message. Although the two groups showed the same VO2 max improvement at the end of the study, the primed group showed a significant advantage in self-esteem assessment.

In a letter to the editor regarding the self-esteem exercise study, one psychologist suggested that the way we think of medical placebo doesn’t entirely match up with psychologically enmeshed situations and that psychological healing and enhancement can come when we are willing to emotionally accept them – the benefit of “effects based on expectations.” One researcher in the area of fitness and placebo even offers that some of the benefits we attribute to better physical functioning are actually the results of psychological effect that comes with exercise. Of particular note, subjects who perceived themselves as more physically fit were better able to cope with stress regardless of actual activity levels (measured by a device during the study period). The mind-matter question is perhaps more nuanced than we tend to give it credit for.

So, if we can measure the placebo effect as we observe it with food, exercise (and even sleep), is there anything the power of the mind doesn’t influence in terms of functioning on some level? I’m interested to read a new book out just this week by behavior change writer, Dr. Joe Dispenza called You Are the Placebo, in which he not only accounts his own healing from a major accident from which he was never to fully recovery but outlines the research (and a protocol) around placebo and health.

Finally, on a non-exercise but (I think) relevant note, the results of a larger, more general study, showed subjects’ perceived assessment of overall health appears to have an impact on our mortality – a more influential factor than actual health itself. Participants who rated their health as poor were six times more likely to die in the nine-year study period than those who described their health as excellent even when perception didn’t match measured medical reality. If our thinking or the psychological suggestions we accept can apparently impact our mortality risk itself, their potential for influencing our quality of life might be one of the best practices we can cultivate for ourselves.

Thanks for reading, everyone. What say you? How has attitude or suggestion influenced your fitness or performance?

You want comments? We got comments:

Imagine you’re George Clooney. Take a moment to admire your grooming and wit. Okay, now imagine someone walks up to you and asks, “What’s your name?” You say, “I’m George Clooney.” Or maybe you say, “I’m the Clooninator!” You don’t say “I’m George of George Clooney Sells Movies Blog” and you certainly don’t say, “I’m Clooney Weight Loss Plan”. So while spam is technically meat, it ain’t anywhere near Primal. Please nickname yourself something your friends would call you.

  1. This makes sense in light of the studies that show that the main thing supercentenarians have in common is that they don’t worry.

    Serena wrote on May 1st, 2014
  2. You Are the Placebo…indeed! Fascinating what the little computer between our ears can do for us, like creating our own “Matrix” worlds. Who needs to swallow a colored pill, when the brain does it all for us?

    Wenchypoo wrote on May 1st, 2014
    • However, I feel like its a little like Inception. It’s very difficult to ‘incept’ a thought. It has to be organic. You have to think you thought of it. I find it hard to make myself think something is a placebo (and get some sort of mental benefit) when I know its really not. It’s the whole rub of the idea of a placebo, you have to genuinely think it is going to work but how is that possible? That’s probably the beauty of our brains, the fact that we are grounded in reality and can’t just trick ourselves at every turn.

      BFBVince wrote on May 1st, 2014
      • That’s not entirely true. If you have a good attitude to begin with then you are more likely to realize the benefits.

        For instance, years ago I was in a horrible bicycle accident. During the recovery period I got up every day and did the occupational and physical therapy. Without fail. Every day. Even with my brain addled by medication and head trauma I felt that I had no other choice.

        I was told by doctors and nurses that some people just give up. Attitude makes a big difference.

        Your point though is if you are in the pit of despair how do you pull yourself out and realize the benefits? That is the trick. I think some people live longer, have better lives because they have a built in positive attitude towards all that they do.

        If we as humans master our mind I wonder what the limits are?

        C L Deards wrote on May 1st, 2014
        • I do agree there is a sense of shaping your own reality and I certainly don’t deny the power of our minds. Maybe Mark is using the placebo effect to get across a much broader concept of maintaining the right attitude.

          BFBVince wrote on May 1st, 2014
      • You don’t need to believe in a placebo 100% to make it work. Smiling is a good example. The act of smiling causes positive chemical changes in the brain and body. When you smile, even if you don’t feel like it, you are telling the brain that you must actually be happy (even though you aren’t) and the brain will act accordingly. The whole fake it till you make it concept.

        I think the big question though,is since the placebo effect accounts for about 25% of the success of any treatment, is it malpractice for a doctor to NOT prescribe a placebo? Should placebos be a standard part of all treatments? So the doctor gives you your chemotherapy but also gives you a shot that he/she tells you enhances the cancer killing potency of the chemo. And under the placebo principle…its works!

        I find it odd that doctors dismiss the placebo effect when in some case it’s more effective then the actual treatment. Doctors will say stupid things like “your migraine went away due to the placebo effect, so it’s not really gone….it’s just the placebo effect making you think it’s gone”.

        As if there is a difference! if you don’t “feel” like you have a migraine, then you don’t have one. If my back doesn’t hurt, then I don’t have back pain.

        Clay wrote on May 2nd, 2014
  3. So those God damned happy morning people are going to outlive me then?

    Groktimus Primal wrote on May 1st, 2014
    • Yes! Next question?

      Tommylee wrote on May 1st, 2014
    • The good news is, after you croak you won’t be unhappy about it, and after they croak they won’t be happy about it. : )

      Rick wrote on May 1st, 2014
      • Hmmm. It appears to me that ornery, grouchy people never die…

        Nocona wrote on May 1st, 2014
        • my grandma used to say “what a pill!” when confronted by grumpy people–even then she knew a good attitude was better than a pill….and she’s still going strong at 99.

          another way wrote on May 1st, 2014
  4. It really has nothing to do with positive thinking, it has to do with the “reality” you’ve chosen. “Positive thinking” in the face of a negative situation that can’t be processed in any other way but negative (like being stabbed or death in the family), is just emotional suppression. Emotional suppression is very strongly linked to stress and chronic disease. What you “choose” after that negative event is coping.

    Functional coping requires you to choose between “equally true” realities. In regards to the previous example, if a family member dies (after grieving) you can choose to feel defeated over the loss or you can choose to learn and grow from the experience, both are equally true. If you’re a maid, you can perceive the action of cleaning as “draining” or as “exercise”, both of these are equally true. The university custodial staff may have had a harder time choosing the “exercise” reality, even with the experimenters suggestion (maybe they needed a placebo).

    In regards to placebo, the placebo makes us more likely to choose the more positive reality. Are you feeling exhausted or do you have reserves left in the tank? If I consumed a placebo caffeine supplement, I would say I’ve got more in the tank, but without the placebo, I may just say that I’m done and give up. The placebo creates an “alternative program” to tap into that frees us from the dichotomous decision of “quit or keep going”. Instead you can access the 3rd placebo choice (drug + keep going) and say, “I took this drug, I will keep going”, which is equally true (in their eyes anyway).

    sean wrote on May 1st, 2014
  5. That makes a lot of sense, Sean; and I agree. I have often been told to “think positive” in certain situations, but I feel that defeats the purpose of intelligent comprehension of the situation. If I was given a logical “choice”, it would negate the need to dispel the “positive thinking mythos” and give my brain something concrete to grasp… even if it wasn’t real. Humans=weird.
    But, ya know, whatever works!

    Vince G wrote on May 1st, 2014
  6. I keep telling myself that 20oz curls count towards exercise.

    Paleo Bon Rurgundy wrote on May 1st, 2014
    • You mean Venti curls?

      another way wrote on May 1st, 2014
  7. This all makes me think that we could do humankind a great service if we would randomly approach each other and say the most positive thing we can think of. Like, “You are so beautiful/handsome!” or “Wow! You really look healthy!” or “You look like you feel really good about yourself!”

    Doesn’t matter if it’s true or not. Just make it positive.

    By the way, MDA readers are the brightest, healthiest, most caring people in the world.

    Don’t ya feel better?

    Dave wrote on May 1st, 2014
    • Can we not do that? I’ve been known to do that relatively often… still societal propriety has me catching myself more often than I’d like and preventing me from doing it. But when I do stop someone I don’t know to say something like “You are an extremely beautiful woman” or “Your outfit looks phenomenal” because I truly mean it, not only do they seem pretty chuffed by it, but I feel freaking fantastic for making someone’s day too. Why do we not do this more????

      Krissy wrote on May 1st, 2014
      • I totally agree!!! I embarrass my daughter regularly by complimenting complete strangers. But it makes the person so happy I do it anyway.

        Rhonda the Red wrote on May 2nd, 2014
      • Right on — I once read that you should never pass up an opportunity to give someone a compliment. It might be the only nice thing they hear all day, and you never know how badly they need it right at that moment. (Happened to me the other day, actually — it wasn’t a compliment, but just someone passing me in the hallway of my office, smiling and saying hello, rather than walking with their head down and not acknowledging the existence of other humans, like usually happens in that building.)

        I don’t think we should *fabricate* compliments, but we shouldn’t hold them back when they’re warranted. Like you said — you could make someone’s day, and if you don’t, well, it cost you nothing, except maybe 10 words worth of breath. ;-)

        Amy B. wrote on May 8th, 2014
  8. Its all about attitude!
    http://youtu.be/FLf51-hZwR8

    Jed Stream wrote on May 1st, 2014
  9. Wisdom that has been around for a long time. :)

    Proverbs 17:22 ESV

    A joyful heart is good medicine, but a crushed spirit dries up the bones.

    Proverbs 23:7
    For as he thinks in his heart, so is he. (NKJV)

    Janet wrote on May 1st, 2014
    • Love that verse. Have it hanging in my laundry room.

      Pdawg wrote on May 1st, 2014
  10. placebo is very powerful, for an excellent review this lengthy paper is worth a read.
    http://physrev.physiology.org/content/93/3/1207.full-text.pdf+html

    Duncan wrote on May 1st, 2014
  11. Maybe not actual physical adaptations, but perhaps effort put in in relation to RPE?

    Dr. Anthony Gustin wrote on May 1st, 2014
  12. My dermatologist had told me about this effect of the mind on the body. Crazy stuff!!!

    Jenna wrote on May 1st, 2014
  13. About a year ago I had an upper GI done for a possible hiatal hernia. While imaging my abdomen, the radiologist told me to think about my favorite food. After asking why, he told me that’s all that was needed to start contractions in the stomach to help move around the imaging junk I drank. He said that’s been known for a long time.

    If just thinking about food can elicit a physical effect like that, I’m sure thinking can have other physical effects too.

    Eric B wrote on May 1st, 2014
    • When I just think of coffee in the morning, it makes me poop.

      Nocona wrote on May 1st, 2014
  14. Wonder what effect would be of writing my Friday Success Story before I am actually the success… I’m going to give it a shot!

    Kay wrote on May 1st, 2014
    • Like ;)

      granny gibson wrote on May 1st, 2014
    • That’s actually a brilliant idea! It’s exactly the same concept as the task my life coach has gotten me to do with building a new business. Write my synopsis of my business as I imagine it to be in 10 years. But write as if it’s happened and I’m writing an article etc. It was very powerful… And this was 6 months ago, still trapped in my shitty old job and miserably unhappy… here I am having quit and started. It really gave me the motivation to do it. When you put the language in present/past tense it really does something to your brain!

      Krissy wrote on May 1st, 2014
  15. I read an interesting book years ago that I’ve been meaning to dive into again, which is linked with this idea. It’s specifically about Self-Hypnosis (writing and then recording your own hypnosis scripts, because what voice do you trust more than your own?) but hypnosis generally works on this same concept I think.
    You’re attempting to tap into your sub-conscious to influence your physical body in ways your conscious mind can’t. It’s apparently useful (according to the book, at least) for conditions far beyond quitting smoking or other habit change – I first tried it because I was freaking out about a potential cancer pre-cursor diagnosis and I wanted to feel like I could do something to control it. Turns out I didn’t have any issue, but it certainly made me feel better at the time.

    Now, after a couple of years eating more-or-less Primally (holidays are still hard!) I still have bouts of eczema and I’m going to go back to the book and try again for that issue, because food habits and changing my skin care routine to be as natural as possible haven’t worked and I still rely heavily on corticosteroids. Lets see what happens, maybe I can report back as part of a Friday Success Story on this different aspect of “living Primally” some time in the future!

    Clare wrote on May 1st, 2014
  16. I believe that a positive outlook in life goes a long way. Such an interesting post you have here. I personally think that placebo really is something. The power of BELIEF might be strong enough to make our bodies alter itself. Or maybe it’s just the willpower. or just pure luck?

    Angelina Sophora wrote on May 1st, 2014
  17. I kickstarted a huge weightloss for myself several years ago by using EFT (meridian tapping). Dumping the emotional baggage set my body free to recalibrate itself. I highly recommend.

    Rhonda the Red wrote on May 2nd, 2014
  18. I 100% believe this to be true. It’s just so hard to measure, but experience tells the story. Believing you can do something and refusing to entertain the idea that you can’t will almost always result in success. The hard part is really believing, I guess.

    Michele wrote on May 2nd, 2014
  19. When 20 years old I fell about 30 feet off a cliff landing on my back. After resting for about 2 hours I was in great pain but able to walk while holding my breath. I walked the few miles to the hospital by hyperventilating while standing still and then walking holding my breath. I should have called an ambulance but I wasn’t thinking clearly. Due probably to pain and shock my color vision was greying out and I was also losing peripheral vision. I had the idea that if I stopped walking I might die.

    The hospital fixed my broken arm, said my broken rib would heal on its own, and said there was no need to x-ray my back because I’d walked in. There couldn’t be any bone damage in my back if I’d been able to walk. It would just be terrible bruising and soft tissue damage which would recover on its own.

    I found I couldn’t lift my legs to go up stairs. So I went up stairs backwards sitting on my bum. I had to climb a few flights of stairs every day. I couldn’t lift my legs to get into bed, so I fell backwards onto the bed and then lifted my legs in with my arms. When crossing the road I couldn’t even lift my leg to get back up onto the sidewalk. I had to yank my leg up by crouching a little and then heaving my leg up with my hands beneath the knee. But the docs had said it must be only soft tissue bruising if I’d been able to walk to hospital, and I was very slowly getting better, so I happily kept going. I regarded getting about while so severely crippled as an interesting challenge.

    Recovery took about six months. But for the next fifteen years I was plagued by an easily strained back which crippled me with painful cramps about once every two years. I couldn’t lift heavy things, it hurt to cycle over bumps, and I could only dance carefully. I consulted lots of doctors about it and they all said I either had to live with it getting slowly worse or have an operation to fuse vertebrae which usually worked well, but sometimes made it even worse. I decided no surgery. A gypsy healer told me I could recover in ten years if I walked a lot, but lay down to rest at the slightest pain or fatigue in my back, and stood as much as possible instead of sitting. She was wrong. It took twelve years :-)

    Fast forward to the age of 50. A doc thought I might have ankylosing spondylitis and ordered a full spine x-ray. I didn’t, but he was stunned. He said there was a great deal of ancient lower back damage which seemed well healed over. But he’d never seen a back like that in someone who could walk. If he hadn’t seen me walk into his office and stand beside him looking at the x-ray he’d have thought he was looking at the x-ray of a wheelchair case. What was even more amazing was I walked like a normal person. I showed him my party trick of slowly sitting down until my bum touched my heel, and then slowly standing up again. On one leg. He was most impressed. I attribute that to my lifelong habit of avoiding the use of lifts and escalators, always using stairs, always two at a time.

    I retired from work at age 60 for health reasons, including diabetes and a heart attack. I discovered I was rather weak. I couldn’t walk more than two miles without seriously needing a rest. I couldn’t do even one pull up. All I could do was hang twitching from the bar like a sissy. My doc told me that at age 60 I couldn’t expect to get any stronger by exercising, just slow down the rate at which I was getting weaker. That sounded to me both biologically implausible and an interesting challenge.

    I discovered that I couldn’t get stronger by following the recommended exercise regimes for weak old people. That explained my doc’s opinion. By experimenting with exercise regimes which weak old people should avoid I found what did work. It worked so well that in six months I was doing fifteen pull ups and had damaged my elbows because you can’t strengthen joints as fast as muscles. Took me six months to recover from that joint damage before I could do another pull up.

    Today at age 70 I can walk for several miles carrying seven kg in a backpack without needing a rest. I almost always walk carrying several kg, and I walk a lot. I don’t have a car. Lethal machines which kill their drivers through lack of exercise. I have to be careful not to push my heart too hard (or it’ll be the last thing you do, said the cardiologist), but I can still climb hills faster than an office worker half my age, or even, rather distressingly, faster than a chubby teenager.

    It seems our civilisation is carrying out a rather scary experiment in how much sitting down and junk food the human race can survive.

    Chris Malcolm wrote on May 2nd, 2014
    • Wow, what a story. You overcame quite the obstacle. I was doing a hike the other day and I was passed by a group of 70 year olds. I was just enjoying myself and not going as fast as I could, but they had a fast pace and they weren’t winded at all.

      Benjamin Thomas wrote on May 8th, 2014
  20. In my experience mindset absolutely does impact the results of physical activity. The right mindset is essential for a strong hormetic reaction (which is IMO the ultimate goal of a workout) but also makes people much more aware of using the body correctly. I see a lot of people laying on benches while half assedly doing leg raises while surfing on their phones. Of course nothing is derived as the individual is simply laying in a dis-coordinated pile, technique and a controlled stress response are the tools to changing physiological and psychological composition. The housekeepers in the study perfectly mirror my own 20+ years of training myself and others in trades, music, cooking and strength conditioning settings. The guys who couldn’t get the mindset together on the jobsites never got the strength to perform the tasks correctly, ditto for musicians and difficult passages, and, well we’ve all seen the person vainly wiggling around on there backs vainly attempting to “working out”. Focus, with it you won’t need “supplements”.

    The Tempered Sole wrote on May 5th, 2014

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