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Chhabra B, Szabo A. Placebo and Nocebo Effects on Sports and Exercise Performance: A Systematic Literature Review Update. Nutrients 2024; 16:1975. [PMID: 38999724 PMCID: PMC11243088 DOI: 10.3390/nu16131975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2024] [Revised: 06/17/2024] [Accepted: 06/19/2024] [Indexed: 07/14/2024] Open
Abstract
Sports performance could be affected by placebo and nocebo effects. The last literature review on placebo and nocebo effects on sports and exercise performance was published in 2019. In the past five years, several new studies have been published. This review aimed to update the previous synthesis and evaluate the results of new studies focusing on placebo or nocebo interventions in sports and exercise by determining the form and magnitude of their effect. Hence, we searched for empirical studies published from 2019 until the end of May 2024 indexed in PubMed, Medline, Web of Science, EBSCO, and Google Scholar databases. The search yielded 20 eligible studies with control or baseline-control conditions, focusing on nutritional, mechanical, and other mixed ergogenic aids. They yielded small to large placebo effects (Cohen's d) for nutritional (d = 0.86), mechanical (d = 0.38), cream and gel (d = 0.05), and open-label placebo (d = 0.16) interventions. The pooled effect size for placebo effects was moderate to large (d = 0.67), larger than in the earlier review, suggesting that placebo effects can improve motor performance even more than previously reported. However, based on five measures from three studies, the nocebo effects were almost twice as large (d = 1.20). Accordingly, the current findings support and expand the last review in the field by yielding additional support for placebo and nocebo effects in sports and exercise.
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Affiliation(s)
- Bhavya Chhabra
- Institute of Health Promotion and Sport Sciences, Faculty of Psychology and Education, ELTE Eötvös Loránd University, 1075 Budapest, Hungary
- Doctoral School of Education, Faculty of Psychology and Education, ELTE Eötvös Loránd University, 1075 Budapest, Hungary
| | - Attila Szabo
- Faculty of Sport and Health Sciences, Széchenyi István University, 9025 Győr, Hungary
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Horváth Á, Szabo A, Gál V, Suhaj C, Aranyosy B, Köteles F. Are there placebo or nocebo effects in balancing performance? Cogn Res Princ Implic 2023; 8:25. [PMID: 37093367 PMCID: PMC10126169 DOI: 10.1186/s41235-023-00476-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 04/05/2023] [Indexed: 04/25/2023] Open
Abstract
Placebo and nocebo effects could influence the perceived, actual, or both postural stabilities. Therefore, this experiment examined whether postural stability is susceptible to placebo and nocebo effects. Driven by expectations, these cognitions could influence the motor stability of people in physical rehabilitation and those with motion instability. We randomly assigned 78 participants to a placebo, nocebo, or control group. Then, we applied a sham sports cream with positive, negative, or neutral instructions about its impact on balance. Next, we tested postural stability with a modified version of the Modified Clinical Test of Sensory Interaction in Balance, including standard, proprioceptive, visual, and vestibular tests before and after the intervention. Further, we measured expected and perceived performance with visual analog scales and assessed trait anxiety, change in state anxiety, optimism, holistic thinking, persistence, and cooperation with questionnaires. The intervention did not affect actual test performances; similarly, trait and state variables and expectations did not have an impact. Furthermore, the experimental manipulation and trait and state variables did not significantly affect perceived performance. However, the association between expectation and perceived performance was strong (ϱ = 0.627, p < 0.001). These findings suggest that postural stability is not susceptible to placebo and nocebo influences. Still, there is a dissociation between objective and subjective performance, showing that expectations impact perceived but not actual performance, which could fuel motivation in rehabilitation settings.
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Affiliation(s)
- Áron Horváth
- Institute of Psychology, Károli Gáspár University of the Reformed Church in Hungary, Budapest, Hungary
- Institute of Psychology and Institute of Health Promotion and Sport Sciences, ELTE Eötvös Loránd University, 1117, Budapest, Hungary
- Doctoral School of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Attila Szabo
- Institute of Psychology and Institute of Health Promotion and Sport Sciences, ELTE Eötvös Loránd University, 1117, Budapest, Hungary.
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary.
| | - Vera Gál
- Institute of Psychology and Institute of Health Promotion and Sport Sciences, ELTE Eötvös Loránd University, 1117, Budapest, Hungary
| | - Csilla Suhaj
- Institute of Psychology and Institute of Health Promotion and Sport Sciences, ELTE Eötvös Loránd University, 1117, Budapest, Hungary
| | - Blanka Aranyosy
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Ferenc Köteles
- Institute of Psychology, Károli Gáspár University of the Reformed Church in Hungary, Budapest, Hungary
- Institute of Psychology and Institute of Health Promotion and Sport Sciences, ELTE Eötvös Loránd University, 1117, Budapest, Hungary
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Raglin J, Szabo A, Lindheimer JB, Beedie C. Understanding placebo and nocebo effects in the context of sport: A psychological perspective. Eur J Sport Sci 2020; 20:293-301. [PMID: 32023170 PMCID: PMC10181913 DOI: 10.1080/17461391.2020.1727021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Research over the past 15 years on the placebo effect has substantiated its contribution to the efficacy of established treatments for a range of clinical conditions and identified its underlying mechanisms. There is also evidence that placebo effects contribute to the performance benefits of many ergogenic aids, and that performance can worsen when dummy treatments are associated with expectations of a harmful outcome (i.e. nocebo effect). Unfortunately, the bulk of sport research involving placebos and nocebos continues to be hampered by outdated definitions and conceptualizations of placebo effects and their mechanisms. This has implications not only for research but also application, as nearly 50% of athletes report experiencing a beneficial placebo effect, and a similar proportion of coaches report providing placebos to their athletes. The objective of this paper is to attempt to stimulate research by presenting updated definitions of placebo and nocebo effects in the context of sport, describing their major mechanisms and, highlighting the importance of the psychosocial context on placebo effects in the sport setting.
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Affiliation(s)
- John Raglin
- Department of Kinesiology, School of Public Health, Indiana University, Bloomington, IN, USA
| | - Attila Szabo
- Institute of Health Promotion and Sport Sciences, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Jacob B Lindheimer
- William S. Middleton Veterans Memorial Hospital, Madison, WI, USA.,Department of Kinesiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Chris Beedie
- School of Psychology, University of Kent, Canterbury, UK
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Unsolved, Forgotten, and Ignored Features of the Placebo Response in Medicine. Clin Ther 2017; 39:458-468. [DOI: 10.1016/j.clinthera.2016.11.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 11/11/2016] [Accepted: 11/14/2016] [Indexed: 12/14/2022]
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