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105: Strength by Suggestion: the Placebo Effect and Exercise
2 Playsin 12 hours
In this episode of the Movement Logic Podcast, Dr. Sarah Court explores the fascinating impact of the placebo effect on sports performance and rehabilitation. Dr. Court discusses recent studies, including a unique experiment involving a pink, calorie-free drink that boosted bench press performance among trained lifters. The episode delves into how beliefs and expectations can lead to measurable physiological changes, the historical context of the placebo effect, and its implications in physical therapy and exercise routines. Dr. Court also emphasizes the significance of positive mindsets in overcoming physical challenges and achieving fitness goals.
01:31 The Pink Drink Study: Exploring the Placebo Effect
02:36 Understanding the Placebo Effect
04:03 Historical Context and Research on Placebo
06:02 Detailed Analysis of the Pink Drink Study
10:19 Implications of the Placebo Effect in Exercise
12:08 Placebo Effect in Rehabilitation and Pain Science
14:49 Practical Takeaways for Enhancing Performance
16:49 Mindset and Belief in Physical Therapy
20:25 Encouragement and Final Thoughts
Bone Density Course Interest List Sign Up Here
References:
The Placebo and Nocebo effect on sports performance: A systematic review
Placebo effects on kayak sprint performance in child athletes
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Transcript
Introductions and Approach to Strength Training
00:00:00
Speaker
I'm Laurel Biebersdorf, strength and conditioning coach. And I'm Dr. Sarah Court, physical therapist. With over 30 years of combined experience in fitness, movement, and physical therapy, we believe in strong opinions loosely held. Which means we're not here to hype outdated movement concepts. or to gatekeep or fearmonger strength training for women. For too long, women have been sidelined in strength training. Oh, you mean handed pink dumbbells and told to sculpt?
00:00:25
Speaker
Whatever that means, we're here to change that with tools, evidence, and ideas that center women's needs and voices. Let's dive in.
Pets and Promotions: Course Highlights
00:00:45
Speaker
Welcome to the Movement Logic Podcast. I'm Dr. Sarah Court. I'm a physical therapist. I have Henry in my lap because this morning he just apparently needs to have as much of his body pressed up against me
00:01:03
Speaker
so we'll see how long that lasts because he's he's just the tiniest bit too big for to be a comfortable lap dog. I mean, he's comfortable. Let's not make any mistake.
00:01:15
Speaker
But am I comfortable? Anyhow, so today we're going to be talking about the placebo effect. Before we get into it, just a quick note that if you are interested in the movement logic bone density course lift for longevity our six-month barbell training course in which we teach you how to lift weights how to use a barbell how to progressively overload and how to positively impact your body in myriad ways not just your bones but your muscles and even your psyche your emotional outlook it's it's a life-changing skill for a lot of women to be able to lift weights
00:01:53
Speaker
And we want you to have that. So if you are at all interested in that or want to hear more about it, you can sign up for our interest list. We used to call it our wait list, but people got confused. So now it's called the interest list.
00:02:04
Speaker
And you can sign up for that at the link in the show notes. Or if you follow us on Instagram, you can also sign up for that list in the link in our bio on Instagram.
00:02:16
Speaker
Okie dokie.
The Pink Drink Study and Placebo Effect
00:02:17
Speaker
So I wanted to talk about this today because I recently saw a study that looked at giving trained lifters, right? So not not beginners, trained lifters, a special pink drink to drink before they lifted.
00:02:31
Speaker
And this special pink drink was apparently going to help them lift more or lift heavier. Except the drink was calorie free. It was sugar free.
00:02:44
Speaker
It was basically flavored water, but the flavor didn't actually matter. What did matter was the fact that it was bright pink.
00:02:56
Speaker
Somehow the pink drink boosted bench press performance in trained lifters. They got no extra carbs. They got no caffeine. Those are things that typically people will take to try to get more out of their lifting, right? No special supplement to optimize their performance, no magic, anything, just a pink colored drink with zero calories and zero sugar.
00:03:20
Speaker
How did that happen? Well, welcome to the weird and wonderful world of the placebo effect. So what exactly is the placebo effect? So the placebo effect is when A beneficial outcome happens after taking a treatment that has no active ingredient because the person believes that the treatment is going to work.
00:03:47
Speaker
For example, giving someone a white pill, telling them that it is a aspirin for their headache when it's actually just like a piece of candy. The placebo effect is when the person reports that their headache is better But we know that there was no aspirin in the pill they took. They just believed it was, and the headache went away.
00:04:08
Speaker
Now, it's not this idea of, oh, it's all in your head. It's not all in your head in the sense that you're imagining things, but it is in your head in the sense that your brain can actually produce real, measurable physiological changes in response to expectations. Okay.
00:04:27
Speaker
And because the brain has receptors for natural pain relieving molecules like endorphins, the expectation of pain relief, such as when you're taking a fake pill,
00:04:40
Speaker
can cause the body to release its own endogenous opioids, which then bind to those receptors and reduce pain. But it's not only about pain reduction, as we found from this pink drink study.
00:04:55
Speaker
So the term placebo actually comes from the Latin for I shall please. And the earliest known description of these kind of placebo type responses go back to the 18th century when Scottish physician William Cullen used the term to describe treatments that were given more to please the patient than to actually cure. So, right, this is this I shall please.
00:05:22
Speaker
But...
Historical and Modern Examples of Placebo
00:05:24
Speaker
A more formal discovery that expectation alone can change your physiology happened during World War II when anesthesiologist Henry Beecher was a medic out on the battlefields and he's in the tent. He's trying to save these wounded and dying soldiers and they start to run out of morphine.
00:05:47
Speaker
So he started going around just giving people saline instead of morphine. and asking them how they felt. And a large number of them reported that they felt fine, that they weren't having any pain.
00:06:01
Speaker
So part of that likely has to do with the expectations, not only around pain relief, but around what would happen to these soldiers following their subsequent discharge, that they would get to go home, that they would get to go be in a hospital, they would get out of the battlefield, right? So in some ways, although they were wounded and having pain, they knew contextually that this meant that they weren't going to have to fight anymore.
00:06:30
Speaker
So that expectation alone, that there was going to be this positive outcome, may have impacted their sense of what their pain was. But since then, we've seen in research placebo effect in pain relief, depression, Parkinson's disease symptoms, and even in sports performance. So let's get into this pink drink study. The study's from 2023, and researchers in Brazil recruited 18 trained men, all roughly in their mid-30s, with at least one year of strength training, and they were all able to bench press at a minimum their own body weight.
00:07:09
Speaker
Now, before we get into it, I do want to say that, yes, this is a single study. There's not a lot of people in this study, right? 18 people. Generally, we encourage looking at research that is really robust, like a meta-analysis or a systematic review, where the paper is collecting data from lots of other studies in an attempt to draw a conclusion about a specific topic.
00:07:29
Speaker
In this instance, we're not trying to use this study to conclude that the placebo effect exists. We already know that it does. We're just looking at this one example because... I think it's really interesting and it has implications for how we all approach our exercise.
00:07:44
Speaker
So the study design was that the participants did three sessions of bench press. Each session, they did five sets to failure at 70% of their one rep max with two minute rests in between.
00:07:59
Speaker
And then before each set, the participants were split up and they either drank 100 milliliters of a pink artificially sweetened, non caloric drink, or and I think this is interesting, they drank an and identical but clear drink.
00:08:16
Speaker
So same taste, same sweetness, no carbs, just wasn't pink, but otherwise identical. And then the third group drank nothing at all. So here's what is I think really interesting.
00:08:27
Speaker
The participants were told that both the clear and the pink drink were carbohydrate-based sports drinks designed to improve performance.
00:08:38
Speaker
when in fact, neither one of the drinks had any carbs in them at all. And the only difference between the pink drink and the clear drink was the color. And then what they found in the results was that the people who took the pink drink did 60 reps total over five sets.
00:08:55
Speaker
The people who did the clear drink did 56 reps total. And the people who drank nothing also did 56 reps total. So that's roughly four to 7% increase in reps for the pink drink compared to the others, despite zero difference in motivation, arousal, mood, perceived exertion.
00:09:17
Speaker
They didn't feel like they were working harder. They just did more work.
00:09:23
Speaker
So what the researchers argue here is that pinkness is really associated across all different kinds of cultures with sweetness, right? We see food or ah candy, something that's colored pink. We think sugar, sugar means carbs.
00:09:39
Speaker
Carbs are a well-known source of improving endurance and sometimes even improving resistance training performance. So this sort of subconscious chain of association may have triggered the brain to expect to have more energy, and then the body delivered a little bit more performance.
00:09:57
Speaker
This isn't the first time that they have studied a pink drink. to make athletes go faster or last longer. a study in Frontiers in Nutrition from 2021 had active adults doing a 30 minute self-paced run while rinsing their mouth with a pink calorie-free solution.
00:10:18
Speaker
They ran faster, the people taking this drink, they ran faster, they covered more distance and they reported more pleasure compared to the same drink when it was clear. Same taste, no calories, just the pinkness alone.
00:10:32
Speaker
And a systematic review from 2020 in the European Journal of Sports Science shows that placebos can create small to moderate improvements in performance across strength, endurance, and skill sports, especially when athletes already believe in the active version of whatever substance they're taking.
00:10:53
Speaker
So it has a lot to do with the person's expectation around what the drink is going to do And that's essentially the placebo effect
Placebo in Sports and Recovery
00:11:05
Speaker
in action. It doesn't work if you don't believe it's going to work, which is so wild.
00:11:12
Speaker
So this isn't the first time that we've seen the placebo effect in action in sports performance. There's a recent study in 2024 done on children. It was the first time they've studied the placebo effect on children.
00:11:24
Speaker
They took child kayakers, and told ah half of them that they were but getting this pill that was going to be performance enhancing, when in reality, it was actually just a tic-tac, like literally a tic-tac.
00:11:38
Speaker
And the children who received this message performed better. They had measurably higher heart rate and paddling distance in a two-minute sprint. So it's incredible what the placebo effect can actually do.
00:11:52
Speaker
But here's the thing. It's not magic. If there's no strong belief or expectation behind the substance or the intervention, the placebo effect tends to be either smaller or just non-existent.
00:12:05
Speaker
So in the pink drink study, the clear drink did not outperform having no drink at all, even though participants were told that it had carbohydrates in it.
00:12:16
Speaker
This suggests that that visual cue of it being pink was the kind of extra oomph that the brain needed to trigger the belief that it was going to enhance their performance.
00:12:29
Speaker
Without that, just the verbal suggestion wasn't enough. And in the reverse situation, in some contexts, placebo can't even produce a negative outcome, right? The nocebo effect.
00:12:43
Speaker
If the person expects harm instead of benefit, if you think something's going to hurt, it's going to hurt. And I see that all the time with my patients, right? So we see this placebo effect, not just in sports performance, but in rehab and especially in pain science, these expectations play an enormous, enormous role, right?
00:13:06
Speaker
I see people doing movements that they tell may cause pain. And it's not that I don't believe them that they're having pain. They're having that experience, but there is no tissue damage. in that area or the prior damage has healed at this point and yet they're still experiencing pain.
00:13:23
Speaker
One of the ways that we sort of reframe this then as clinicians is we will tell patients things like this movement is safe for you to do. And we do find that this improves pain.
00:13:34
Speaker
and improves function faster than either neutral framing or negative framing, right? Telling people, look out, be careful, don't move certain ways, right? This all sets up this nocebic effect where people then become afraid of movement and where the movement does actually start to hurt even if there's no physical tissue damage present.
00:13:55
Speaker
So it's really important in physical therapy and in sports medicine to to build this sort of positive expectations around recovery. I've seen that so many times. I've seen people with the exact same, or it's never exactly exactly the same, but let's say very, very similar diagnoses, maybe a herniated disc in L4, L5, that's pretty common, right?
00:14:17
Speaker
But I would see people's recovery be completely different in And, you know, even though this is completely anecdotal, it's hard not to assign at least some of that recovery to the fact that people who come in with a positive attitude, who think about it like, yes, this is an injury or this is some tissue damage, but we're going to be able to fix it or I'm going to be able to get out of pain, know got out of pain.
00:14:41
Speaker
And the people who were more fixated on it, who took every sensation as proof that they were creating more damage to the tissue, very often would take much, much longer or have a much harder time healing.
00:14:55
Speaker
Chronic pain is one of the hardest conditions to work with. Truly, because it's there's so many different complicated factors going on, and it very often has little to no correlation with the actual situation in the person's physical body, right? Any sort of actual tissue damage is often already healed, or it's no longer something that we could point to as the cause for their pain.
00:15:25
Speaker
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00:15:47
Speaker
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Speaker
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Speaker
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Mindset and Performance Enhancement
00:16:21
Speaker
thank you. Join the wait list now via the link in the show notes.
00:16:30
Speaker
So If you're lifting weights, if we go back to this original study, what's the takeaway? Like, why do I care about this pink chick study, right? What does it mean for me as someone who lifts weights, as someone who exercises generally?
00:16:44
Speaker
So the takeaway is this, if you expect that something is going to help you perform better, whether it is a supplement or a ritual or a particular playlist,
00:16:57
Speaker
That belief can translate into measurable improvement, right? Which might mean more reps before you fatigue. It might mean more total volume in a session.
00:17:10
Speaker
Over weeks and months, it could lead to potentially better adaptations, more muscle, more strength, simply because you can train a little harder. So this made me think about creatine, right, which is hyped a lot as something that women in particular are supposed to be taking so that they can build more muscle.
00:17:30
Speaker
And the research shows that there's an extremely modest, if anything, effect of taking creatine. And you only see it if you're actually also doing resistance training. You don't get any muscle building effect or other adaptations from creatine if you are not also doing resistance training.
00:17:47
Speaker
But... let's say for whatever reason, do you really believe that it's something that you personally are benefiting from and you take it religiously before every workout, you might see slightly higher results, slightly better outcomes than shown in research.
00:18:04
Speaker
You might find that you're building more muscle simply because you believed that you would. And without that belief, you probably wouldn't. It's just, it's so wild, right? But we we think about our physical exercise, right? We think about getting our cardiovascular exercise, getting our weights in, getting all of these different types of ways that we train our bodies.
00:18:32
Speaker
We tend to think purely about the physical aspects of them and how we can best enhance them, whether it is the programming that we're doing or what we're eating or how much recovery time we give ourselves or if we're getting enough sleep, right?
00:18:44
Speaker
As if the only physical aspects of matter, but your mind is an active player in all of these aspects. Now, that doesn't mean that you can just meditate yourself as just this suddenly huge jacked person and you wake up.
00:19:01
Speaker
Now you don't wake up from meditation. You open your eyes from meditation. Suddenly you're Arnold Schwarzenegger, right? That's not how it works. But what it does mean is that your expectations can either enhance or undermine your physical performance.
00:19:19
Speaker
And that the context and the way that a treatment or a supplement or training is presented to us can matter more than we think. And then dismissing placebo effect as fake or just like in people's mind, it kind of misses the point because it produces real physiological changes.
00:19:42
Speaker
It's just a different pathway. So you probably, like me, have some rituals around the way you exercise, whether it's wearing the shorts that you really like to wear or drinking caffeine or listening to your favorite song to get in the right head space.
00:19:58
Speaker
I often, when I'm getting ready to do a heavy lift, scroll through whatever music is playing until I get to exactly the right song that's gonna put me in the right mindset. to do that set because this song in particular or just today this song in particular or right now this song in particular just gets me amped.
00:20:19
Speaker
That's not quite the same thing as the placebo effect, but it's part of creating this sort of positive mindset that actually has a lot of overlap with how the placebo effect works.
00:20:30
Speaker
Sometimes with patients or clients, when I want them to do a new exercise or to do something that they are a little bit intimidated by, it and they might say, you know, I can't do this. Or they'll say, I don't think I can do this.
00:20:43
Speaker
And I immediately respond with, not with that attitude, you won't. And I do it that way on purpose. I do it to kind of break the ice and make them laugh and not, and get out of that kind of like fear space in their head, but also to help people explore like,
00:20:57
Speaker
What is it about their own mindset and their beliefs that make them have this attitude, that that have them look at something challenging with a level of belief that they can't do it?
00:21:12
Speaker
And if you're working with a person or a population that has been often told that something is too hard for them, I don't know, like older women in barbells, perhaps, you might actually have to work through a lot of this nocebic negative condition that they have believed possibly their whole lives to get them to a place where they're willing to even try. I've done that many times with some of my older female patients when I want them to try out lifting barbells.
00:21:45
Speaker
it Sometimes that ramp, that lead up to the barbell is very slow. And we work through a lot of, you know, dumbbell deadlifts and dumbbell squats and proving that they have the capacity to hold something of the equivalent weight. And I say, they okay, now this is the exact same thing. It's just a different shape.
00:22:06
Speaker
So sometimes there's a lot of conditioning, right? A lot of beliefs that someone has. that you have to work through to get them to a place where they can even consider doing something that they used to think was impossible.
00:22:19
Speaker
How is this useful to you, dear listener? Well, it's worth thinking about.
Reflecting on Mindset and Exercise Rituals
00:22:25
Speaker
like what do you do What are your rituals around your exercise? Do you have to tie your shoes a certain way? Do you like to have a particular drink before you work out? Do you eat a specific food? Do you have a particular playlist that you run to because you know it'll make you run faster?
00:22:44
Speaker
Those are all things that can help you enhance your own performance and get you possibly stronger, faster, get you quicker, faster.
00:22:59
Speaker
All of these goals that we have around our own body's capability and exercise. And I would venture to say even if you have negative thoughts about certain types of exercise or about your own capabilities,
00:23:12
Speaker
that that might be worth taking a look at and and seeing what is behind that. I think very often we look at sort of the elite version of an activity and we say, oh, well, I can't do that because I can't do it like that person.
00:23:24
Speaker
Not knowing, right? not Not thinking about the fact that that person trained thousands and thousands of hours to be able to do that. And of course you can't do that straight out the gate, but there are steps to it, right? Maybe it's something as simple as a box jump.
00:23:39
Speaker
It's not actually that simple. But maybe you're, you know, you've signed up for CrossFit and you're going to CrossFit and you see all these people doing box jumps and you're like, there is absolutely no way that my 45-year-old knees are going to be able to do that.
00:23:52
Speaker
And the answer is probably right in that moment, and probably not. But you start with little baby jumps, right? You start with hops. You start with getting your body accustomed to impact. You build more strength in your legs. You build build your way up to it. And there's a strong likelihood, right? a Barring previous injuries, barring other conditions that might make it impossible for you or very difficult for you, there's a strong chance that you'll be able to do it.
00:24:17
Speaker
So is this podcast episode me just saying, just try to be more positive about your exercise? A little bit, yes. But I think it's worth also just paying attention.
00:24:30
Speaker
How is your mood impacting your workout? How is your belief around how this workout is going to go impacting your workout? And see what happens if you flip the script.
00:24:42
Speaker
All right, everybody, just a little quickie this week. Thank you so much for listening. And you will see in our show notes that I have a link to the interest list for a bone density course. So please get yourself on that list if you are interested in maybe pushing your own beliefs around what you can do and thinking maybe barbells is a a mental block for you that's hard to get over.
00:25:12
Speaker
But we've seen hundreds of women, women of middle age. We're not talking like, you know, Olympians, regular, regular people. We've seen hundreds of women learn how to use barbell safely, build their strength, build their capacities for their life, and just flip the script on what they can do.
00:25:38
Speaker
So if that sounds like something you are interested in, definitely get on our interest list. And we will see you in two weeks.