“I put it in my head that the supplement would help me”: Open-placebo improves exercise performance in female cyclists

Autoři: Bryan Saunders aff001;  Tiemi Saito aff001;  Rafael Klosterhoff aff001;  Luana Farias de Oliveira aff001;  Gabriel Barreto aff001;  Pedro Perim aff001;  Ana Jéssica Pinto aff001;  Fernanda Lima aff001;  Ana Lucia de Sá Pinto aff001;  Bruno Gualano aff001
Působiště autorů: Applied Physiology and Nutrition Research Group, School of Physical Education and Sport, Rheumatology Division, Faculdade de Medicina FMUSP, University of São Paulo, São Paulo, Brazil aff001;  Institute of Orthopaedics and Traumatology, Faculty of Medicine FMUSP, University of São Paulo, São Paulo, Brazil aff002;  Department of Biochemistry and Molecular Biology, Federal University of Paraná, Curitiba, Paraná, Brazil aff003;  Laboratory of Assessment and Conditioning in Rheumatology (LACRE), Rheumatology Division, Universidade de São Paulo, São Paulo, Brazil aff004
Vyšlo v časopise: PLoS ONE 14(9)
Kategorie: Research Article
doi: 10.1371/journal.pone.0222982


This study investigated the effect of open-placebo on cycling time-trial (TT) performance. Twenty-eight trained female cyclists completed a 1-km cycling TT following a control session or an open-placebo intervention. The intervention consisted of an individual presentation, provided by a medic, in which the concept of open-placebo was explained to the participant, before she ingested two red and white capsules containing flour; 15 min later, they performed the TT. In the control session, the participant sat quietly for 20 min. Heart rate and ratings of perceived exertion (RPE) were monitored throughout exercise, while blood lactate was determined pre- and post-exercise. Post-exercise questionnaires were employed to gain insight into the perceived influence of the supplement on performance. Open-placebo improved time-to-completion (P = 0.039, 103.6±5.0 vs. 104.4±5.1 s, -0.7±1.8 s, -0.7±1.7%) and mean power output (P = 0.01, 244.8±34.7 vs. 239.7±33.2, +5.1±9.5 W) during the TT. Individual data analysis showed that 11 individuals improved, 13 remained unchanged and 4 worsened their performance with open-placebo. Heart rate, RPE and blood lactate were not different between sessions (all P>0.05). Positive expectation did not appear necessary to induce performance improvements, suggesting unconscious processes occurred, although a lack of an improvement appeared to be associated with a lack of belief. Open-placebo improved 1-km cycling TT performance in trained female cyclists. Although the intervention was successful for some individuals, individual variation was high, and some athletes did not respond or even performed worse. Thus, open-placebo interventions should be carefully considered by coaches and practitioners, while further studies are warranted.

Klíčová slova:

Blood – Conditioned response – Exercise – Fatigue – Heart rate – Human performance – Sports – Sports and exercise medicine


1. Beedie C, Benedetti F, Barbiani D, Camerone E, Cohen E, Coleman D, et al. Consensus statement on placebo effects in sports and exercise: The need for conceptual clarity, methodological rigour, and the elucidation of neurobiological mechanisms. Eur J Sport Sci. In press. doi: 10.1080/17461391.2018.1496144 30114971.

2. Benedetti F, Pollo A, Colloca L. Opioid-mediated placebo responses boost pain endurance and physical performance: is it doping in sport competitions? The Journal of neuroscience: the official journal of the Society for Neuroscience. 2007;27(44):11934–9. doi: 10.1523/JNEUROSCI.3330-07.2007 17978033.

3. Amanzio M, Benedetti F. Neuropharmacological dissection of placebo analgesia: expectation-activated opioid systems versus conditioning-activated specific subsystems. The Journal of neuroscience: the official journal of the Society for Neuroscience. 1999;19(1):484–94. 9870976.

4. Price DD, Finniss DG, Benedetti F. A comprehensive review of the placebo effect: recent advances and current thought. Annual review of psychology. 2008;59:565–90. doi: 10.1146/annurev.psych.59.113006.095941 17550344.

5. Lundh L-G. Placebo, belief, and health. A cognitive–emotion model. Scandinavian Journal of Psychology. 1987;28(2):128–43. doi: 10.1111/j.1467-9450.1987.tb00747.x 3317812

6. Beedie C, Whyte G, Lane AM, Cohen E, Raglin J, Hurst P, et al. 'Caution, this treatment is a placebo. It might work, but it might not': why emerging mechanistic evidence for placebo effects does not legitimise complementary and alternative medicines in sport. British journal of sports medicine. 2017;52:817–8. doi: 10.1136/bjsports-2017-097747 28724709.

7. Kaptchuk TJ, Friedlander E, Kelley JM, Sanchez MN, Kokkotou E, Singer JP, et al. Placebos without deception: a randomized controlled trial in irritable bowel syndrome. PloS one. 2010;5(12):e15591. doi: 10.1371/journal.pone.0015591 21203519.

8. Grotle M, Hagen KB. Placebo pills provided without deception may help to reduce pain and disability in people with chronic low back pain. J Physiother. 2017;63(3):183-. doi: 10.1016/j.jphys.2017.05.002 28641895

9. Schaefer M, Harke R, Denke C. Open-Label Placebos Improve Symptoms in Allergic Rhinitis: A Randomized Controlled Trial. Psychotherapy and psychosomatics. 2016;85(6):373–4. doi: 10.1159/000447242 27744433.

10. Schaefer M, Sahin T, Berstecher B. Why do open-label placebos work? A randomized controlled trial of an open-label placebo induction with and without extended information about the placebo effect in allergic rhinitis. PloS one. 2018;13(3):e0192758. doi: 10.1371/journal.pone.0192758 29513699.

11. Kelley JM, Kaptchuk TJ, Cusin C, Lipkin S, Fava M. Open-label placebo for major depressive disorder: a pilot randomized controlled trial. Psychotherapy and psychosomatics. 2012;81(5):312–4. doi: 10.1159/000337053 22854752.

12. Hoenemeyer TW, Kaptchuk TJ, Mehta TS, Fontaine KR. Open-Label Placebo Treatment for Cancer-Related Fatigue: A Randomized-Controlled Clinical Trial. Scientific reports. 2018;8(1):2784. doi: 10.1038/s41598-018-20993-y 29426869.

13. Saunders B, de Oliveira LF, da Silva RP, Painelli VS, Goncalves LS, Yamaguchi G, et al. Placebo in sports nutrition: a proof-of-principle study involving caffeine supplementation. Scand J Med Sci Sports. 2017;27(11):1240–7. doi: 10.1111/sms.12793 27882605.

14. Beedie CJ, Foad AJ, Coleman DA. Identification of placebo responsive participants in 40km laboratory cycling performance. Journal of sports science & medicine. 2008;7(1):166–75. 24150150.

15. Beedie CJ, Stuart EM, Coleman DA, Foad AJ. Placebo effects of caffeine on cycling performance. Med Sci Sports Exerc. 2006;38(12):2159–64. doi: 10.1249/01.mss.0000233805.56315.a9 17146324.

16. Clark VR, Hopkins WG, Hawley JA, Burke LM. Placebo effect of carbohydrate feedings during a 40-km cycling time trial. Med Sci Sports Exerc. 2000;32(9):1642–7. doi: 10.1097/00005768-200009000-00019 10994918.

17. Ross R, Gray CM, Gill JM. Effects of an Injected Placebo on Endurance Running Performance. Med Sci Sports Exerc. 2015;47(8):1672–81. doi: 10.1249/MSS.0000000000000584 25412293.

18. Hurst P, Foad A, Coleman D, Beedie C. Athletes Intending to Use Sports Supplements Are More Likely to Respond to a Placebo. Med Sci Sports Exerc. 2017;49(9):1877–83. doi: 10.1249/MSS.0000000000001297 28419027.

19. Broelz EK, Wolf S, Schneeweiss P, Niess AM, Enck P, Weimer K. Increasing effort without noticing: A randomized controlled pilot study about the ergogenic placebo effect in endurance athletes and the role of supplement salience. PloS one. 2018;13(6):e0198388. doi: 10.1371/journal.pone.0198388 29889868.

20. Bailey SJ, Vanhatalo A, Wilkerson DP, Dimenna FJ, Jones AM. Optimizing the "priming" effect: influence of prior exercise intensity and recovery duration on O2 uptake kinetics and severe-intensity exercise tolerance. J Appl Physiol (1985). 2009;107(6):1743–56. doi: 10.1152/japplphysiol.00810.2009 19797685.

21. Drust B, Waterhouse J, Atkinson G, Edwards B, Reilly T. Circadian rhythms in sports performance—an update. Chronobiology international. 2005;22(1):21–44. 15865319.

22. Decroix L, De Pauw K, Foster C, Meeusen R. Guidelines to Classify Female Subject Groups in Sport-Science Research. Int J Sports Physiol Perform. 2016;11(2):204–13. doi: 10.1123/ijspp.2015-0153 26182438.

23. Landry M, Dornelles AC, Hayek G, Deichmann RE. Patient Preferences for Doctor Attire: The White Coat’s Place in the Medical Profession. The Ochsner Journal. 2013;13(3):334–42. 24052762

24. Borg G. Perceived exertion as an indicator of somatic stress. Scand J Rehabil Med. 1970;2:92–8. 5523831

25. Hurst P, Foad A, Coleman D, Beedie C. Development and validation of the Sports Supplements Beliefs Scale. Performance Enhancement & Health. 2017;5(3):89–97. https://doi.org/10.1016/j.peh.2016.10.001.

26. Bandeira M, Bekou V, Lott KS, Teixeira MA, Rocha SS. Validação transcultural do teste de orientação da vida (TOV-R). Estudos de Psicologia (Natal). 2002;7:251–8.

27. Scheier MF, Carver CS. Optimism, coping, and health: assessment and implications of generalized outcome expectancies. Health psychology: official journal of the Division of Health Psychology, American Psychological Association. 1985;4(3):219–47. 4029106.

28. Swinton PA, Hemingway BS, Saunders B, Gualano B, Dolan E. A Statistical Framework to Interpret Individual Response to Intervention: Paving the Way for Personalized Nutrition and Exercise Prescription. Frontiers in Nutrition. 2018;5(41). doi: 10.3389/fnut.2018.00041 29892599

29. Bellinger PM, Minahan C. Reproducibility of a Laboratory Based 1-km Wattbike Cycling Time Trial in Competitive Cyclists. Journal of Science and Cycling. 2014;3(3):23–8.

30. Paton CD, Hopkins WG. Variation in performance of elite cyclists from race to race. Eur J Sport Sci. 2006;6(1):25–31. doi: 10.1080/17461390500422796

31. Wiles JD, Coleman D, Tegerdine M, Swaine IL. The effects of caffeine ingestion on performance time, speed and power during a laboratory-based 1 km cycling time-trial. Journal of sports sciences. 2006;24(11):1165–71. doi: 10.1080/02640410500457687 17035165.

32. Bellinger PM, Minahan CL. The effect of beta-alanine supplementation on cycling time trials of different length. Eur J Sport Sci. 2016;16(7):829–36. doi: 10.1080/17461391.2015.1120782 26652037.

33. McQuillan JA, Dulson DK, Laursen PB, Kilding AE. Dietary Nitrate Fails to Improve 1 and 4 km Cycling Performance in Highly Trained Cyclists. International journal of sport nutrition and exercise metabolism. 2017;27(3):255–63. doi: 10.1123/ijsnem.2016-0212 27997263.

34. Saunders B, Sale C, Harris RC, Sunderland C. Sodium bicarbonate and high-intensity-cycling capacity: variability in responses. Int J Sports Physiol Perform. 2014;9(4):627–32. doi: 10.1123/ijspp.2013-0295 24155093.

35. Maughan RJ, Burke LM, Dvorak J, Larson-Meyer DE, Peeling P, Phillips SM, et al. IOC consensus statement: dietary supplements and the high-performance athlete. British journal of sports medicine. 2018;52(7):439–55. doi: 10.1136/bjsports-2018-099027 29540367.

36. Klitzman R. Pleasing doctors: when it gets in the way. BMJ. 2007;335(7618):514-. doi: 10.1136/bmj.39325.646887.94

37. Colloca L, Benedetti F. Placebo analgesia induced by social observational learning. Pain. 2009;144(1–2):28–34. doi: 10.1016/j.pain.2009.01.033 19278785.

38. Benedetti F. Placebo and the new physiology of the doctor-patient relationship. Physiol Rev. 2013;93(3):1207–46. doi: 10.1152/physrev.00043.2012 23899563.

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