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. 2019 Sep 24;14(9):e0222982.
doi: 10.1371/journal.pone.0222982. eCollection 2019.

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

Bryan Saunders  1   2 , Tiemi Saito  1 , Rafael Klosterhoff  1   3 , Luana Farias de Oliveira  1 , Gabriel Barreto  1 , Pedro Perim  1 , Ana Jéssica Pinto  1 , Fernanda Lima  1   4 , Ana Lucia de Sá Pinto  1   4 , Bruno Gualano  1   4
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"I put it in my head that the supplement would help me": Open-placebo improves exercise performance in female cyclists

Bryan Saunders et al. PLoS One. .

Abstract

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.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Time-to-completion for the 1-km cycling time-trial during the control (black bar) and open-placebo (grey bar) session.
*P = 0.039 from Control.
Fig 2
Fig 2. Change in time-to-completion (ΔTTC) of the 1-km cycling time-trial with open-placebo compared to control.
Data are individual ΔTTC ± 50% confidence intervals. The dotted grey lines indicate the smallest worthwhile change in performance. Participant numbers are displayed above or below the data points.
Fig 3
Fig 3. Physiological measures.
Panel A: Mean (HRav) and maximum (HRmax) heart rate during the control and open-placebo sessions. Panel B: Blood lactate concentration pre- and post-exercise during the control and open-placebo sessions. *P<0.001 from pre-exercise. Panel C: Ratings of perceived exertion throughout the 1-km time-trial during control and open-placebo sessions. ^P<0.001 from 500 m.
Fig 4
Fig 4. Change in exercise performance from control (ΔTTC; y-axis) in relation to individual belief of how much the supplement influenced exercise performance (x-axis).
Fig 5
Fig 5. Questionnaire scores according to change in performance.
Panel A: Scores for how much the individuals believed the supplement influenced their performance in the open-placebo session for those who improved, did not change, or worsened their performance. Panel B: Life orientation test (TOV-R) scores separated according to those who improved, did not change, or worsened their performance. Panel C: Sports supplement belief scores separated according to those who improved, did not change, or worsened their performance. [A.U. = Arbitrary units].
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Publication types

Grants and funding

Bryan Saunders (2016/50438-0 and 2017/04973-4), Gabriel Barreto (2017/15314-1), Pedro Perim (2018/01594-5) and Ana Jéssica Pinto (2015/26937-4) have been financially supported by Fundação de Amparo à Pesquisa do Estado de Sao Paulo. This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES) - Finance Code 001. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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