The Known Placebo

What do you believe? I don’t mean this specifically related to health and fitness.

Although for people nutrition can become a theology and they speak of it as though it were a religion.

I believe eating organic is the only way to go.

I believe that eating meat isn’t healthy.

These statements don’t reference science but instead our beliefs. And sometimes our beliefs can be at odds with science. Just ask Kyrie Irving.

So there are times in life where we believe so strongly in something that we make life decisions based on this belief.

Consider the placebo effect which basically says that a positive health change is due the placebo itself. The placebo has no active medical ingredients and therefore it is our belief that the placebo will work that accounts for the beneficial effect.

We are probably familiar with these types of research studies. One group takes a pill to treat a disease and the control group does not. The pill has no medical ingredients but the study participants don’t know this. They are made to believe the pill will deliver a positive health result. The experimental group, i.e. the ones taking the pills, experience the positive health outcome.

More recently there have been studies involving an open label placebo and a control group.

An open label placebo involves a group of research subjects that know they will be receiving a placebo. The other group of study subjects continue their regular treatment plans known as treatment as usual.

Now it’s important to be clear that the placebo group knew what a placebo was and that is what they would be receiving during the study. I’m imagining the information session for the study going something like this:

You’re not getting any medicine. Instead you’re going to eat Tic Tacs twice a day for 3 weeks. Before we get started we’re going to watch a video on what a placebo is so there’s no confusion as to the fact that you’re receiving a placebo. We’ll give you the pills in a prescription bottle labelled ‘Placebo’ and the pills themselves will also be labelled ‘Placebo’.

The researchers also explained to all the study participants the power of the placebo effect. They talked about how the placebo effect can induce certain behaviours similar to Pavlov’s response. The shared how a positive attitude is necessary for the placebo effect to work. And they stressed how it was essential that the experimental group continue taking the placebo pills for the full 21 days of the experiment.

All of the participants, n = 83, were adults of least 18 years of age and had chronic back pain for the past 3 months. If subjects were taking NSAIDs prior to the study for pain they were allowed to continuing doing so. 6 subjects refused to participate, 3 discontinued in the placebo group and 2 discontinued in the treatment as usual group.

At the beginning, half-way and end of the experiment subjects were assessed for level of low back pain and disability due to pain.

The table on the left shows the improvement in pain. A higher value indicates a more favourable reduction in pain. The table on the right shows disability improvement. A higher value indicates a more favourable improvement in ability. The white bars are the treatment as usual group and grey bars are the open label placebo.

The results showed that the open label placebo group had a 30% greater reduction in pain and disability.

So how do you explain this?

Well, part of it has to do with wanting to please the experimenter. Maybe they were swayed in their subjective responses when asked about their level of pain or disability in order to provide the experimenters with a favourable response.

There are also the potential psychological analgesic effects associated with opening a bottle of pills and swallowing a pill. It could be having the pills in a prescription bottle written out as though it was a true prescription, even though only placebo was written on the bottle. Could the simple act of getting the bottle out of the cupboard, twisting off the child-proof safety lid, pouring a glass a water and swallowing a couple of pills be enough to start the psychological cascade of events to induce pain relief? Maybe it was simply the act of trying something different that may give them some relief.

The last thing I found interesting about this study was at the completion 17 of the study participants wanted the prescription refilled! Crazy, right? I mean these are sane, competent adults eating pills with no medical ingredients asking for more of these pills as it is working for them.

Going forward, do your research on your nutrition, your training and your health. And whatever it is you decide know that believing it will work is just as important as whatever the solution is. Except if you’re Kyrie Irving. That dude’s just crazy.

Here’s the link for the study for any that are interested.

The Love Hate of Fitness

If you are an active person there are probably still aspects of fitness that you don’t enjoy.

For example, we all know someone who is really fit but doesn’t enjoy running. They will do almost anything else rather than run. They will swim, bike, row and even go hiking. But go for a 5 or 10 km run? Never.

This reminds of the dinner hour at the Collins household. Alexandra does a great job of preparing delicious meals each evening. But with two little girls there will be something that’s been prepared they don’t enjoy.

With Vangie, 4 years old, this could be peppers. It doesn’t matter the colour i.e. red, yellow or green, she has an equal distaste for all of them. If you try to hide them in chili or something else she will pick them out and set them off to the side.

Sometimes we have to do the things we don’t like in order to get better.

Given the choice if every meal were ice cream, cookies and pudding she’d be OK with this. And it’s tough for her to recognize that her mom and dad feed her foods to help with her growth, development and overall health.

So there are the foods she’d like to eat and then the ones she needs to eat. And it’s trying to find the balance to make sure gets what she needs and every now and again she gets a little bit of what she wants.

This is kind of be how fitness is for many people.

Maybe we are already active. We go to the gym. We squat, bench and deadlift. The numbers are all going up. We’re getting stronger. And everything is great. Until it’s not.

And it stops being great when we have a new physical demand to face. Maybe it’s going on a ski trip. Or taking the kids to Wibit or some other type of ropes course. Or we get the call from a buddy to come and play men’s league soccer for a game.

Let’s say the event doesn’t end with a knee or Achilles tendon injury. Maybe it’s the next day popping Advil and on the couch watching sports all day. You’re so stiff and sore you can’t move and open waking in the morning you’re quickly aware of every muscle that hasn’t been worked in that way for years, if ever.

This could have been prevented.

And usually it comes back to doing the things that we need rather than we want. For some this is training the backside of the body. It means working the glutes, hamstrings, calves, low back and lats. It’s not uncommon to work on what we see in the mirror after a shower. We see the extra layer of insulation. We see a keg instead of a six-pack. We see soft shoulders and pecs. And so we go to the gym to address these things and improve.

Besides working on what we see, and ignoring what we don’t we can also fall into the trap of doing what suits our body type. For example, a smaller, leaner person will typically choose activities where they have to move their own body and not have to move external load or an opponent. The 145 lbs guy will gravitate towards running triathlons and running marathons but may not look to play rugby.

The opposite is also true. Larger people will tend to sports and training where they can move others or external load. Strong man competitions and powerlifting come to mind. And they won’t be looking to sign up for when they have to move their own bodies on something like American Ninja Warrior.

What about our energy system development?

What do you do for this? Typically sprinters are gifted people. They have the right length of levers, body fat, coordination and muscle fibre type that quick movements come easily. Fast people are just fast. You can work to develop this quality a little bit but it’s not the same as someone who can turn it on in a moments notice.

So far a sprinter they probably don’t do a lot of cardio. They don’t look to go for a 3 hour bike ride or swim a few kilometres at the pool. And yeah I guess you could say because they’ve gotten away with their God-given talents they can be a little bit lazy.

So what is the take home message here?

Well it’s to look at where you are with your health, fitness and performance and we’re you’d like to be. It’s being aware of what you typically do and what you usually avoid. And it’s figuring what you consider more fun and what feels a little more like work.

You don’t need to reluctantly approach every training session because you know you’re going to have to do something you don’t like. But the longer you avoid it the harder it will be to address. Hello, procrastinators, I’m looking at you.

This isn’t the easiest thing to figure out. You need to know all the elements of fitness that contribute to health and performance. You need to know what you are currently doing to improve these qualities. You need to know what your weak links are and how you will address them.

Overwhelmed? Don’t worry.

Reach out to one of our coaches at Okanagan Peak Performance Inc and we can help you figure out a plan and the safest, more efficient way to achieve results. And a bonus, we’re usually pretty good at making it fun as well.

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