Using the Placebo Effect to Isolate Control Mechanisms of Athletic Performance: A Research Protocol
DOI:
https://doi.org/10.17140/SEMOJ-1-109Keywords:
Endurance performance, Ergogenic aid, Placebo response, Central fatigue, EEG, fNIRSAbstract
Placebo effects are common in all areas of medicine and beyond and thus, are also present when ergogenic aids are used to enhance performance in athletes. While they usually are regarded as secondary and a nuisance in relation to performance-improving nutritional supplements, we here propose to utilize them to investigate central control mechanisms of athletic performance. Following a brief review of the current literature on placebo effects in sports, we outline a research protocol designed to understand the neurobiological basis of endurance performance, limiting factors and the integration of central and peripheral fatigue mechanisms. A placebo response to ergogenic aids will be elicited to isolate and study both central and peripheral components of performance regulation. This protocol employs endurance performance measurements, electroencephalography, functional near-infrared spectroscopy and ratings of perceived exertion in order to quantify the performance altering placebo response elicited by a nutritional ergogenic aid. A model is proposed integrating the placebo response with current theories of performance determining and limiting factors such as the central governor model and the central fatigue hypothesis. The first experiment is concerned with the influence of the mode of administration of an ergogenic aid on endurance performance. In the second experiment, the cortical processes underlying increased motor performance will be investigated using electroencephalography. The third experiment will employ functional near-infrared spectroscopy to look at the integration of cortico-muscular feed forward and feedback signaling pathways mediating fatigue. This protocol provides an integrative approach for neuroscience and sports science research, investigating cortical processes involved in the placebo induced exploitation of residual central and peripheral resources causing better athletic performance. It also will affect prevention and treatment of diseases which may be caused by a lack of physical activity or which may cause a decrease in the ability to be physically active.
References
Hill AV, Long CNH, Lupton, H. Muscular exercise, lactic acid and the supply and utilisation of oxygen. Proc Biol Sci. 1924; 97: 155-176.
Noakes TD. Fatigue is a brain-derived emotion that regu-lates the exercise behavior to ensure the protection of whole body homeostasis. Front Physiol. 2012; 3: 82. doi: 10.3389/ fphys.2012.00082
Finsterer J, Mahjoub SZ. Fatigue in healthy and diseased individuals. Am J Hosp Palliat Care. 2014; 31: 562-575. doi: 10.1177/1049909113494748
Marino FE, Gard, M, Drinkwater EJ. The limits to exercise performance and the future of fatigue research. Br J Sports Med. 2011; 45: 65-67. doi: 10.1136/bjsm.2009.067611
Noakes TD, St. Clair Gibson A. Logical limitations to the “ca-tastrophe” models of fatigue during exercise in humans. Br J Sport Med. 2004; 38: 648-689.
González-Alonso J, Teller C, Andersen SL, Jensen FB, Hyldig T, Nielsen B. Influence of body temperature on the development of fatigue during prolonged exercise in the heat. J Appl Physiol. 1999; 86: 1032-1039.
Nybo L, Nielsen B, Blomstrand E, Moller K, Secher N. Neu-rohumoral responses during prolonged exercise in humans. J Appl Physiol. 2003; 95: 1125-1131. doi: 10.1152/japplphysi-ol.00241.2003
Noakes TD. Time to move beyond a brainless exercise physi-ology: the evidence for complex regulation of human exercise performance. Appl Physiol Nutr Metab. 2011; 36: 23-35. doi: 10.1139/H10-082
St Clair Gibson A, Noakes TD. Evidence for complex system integration and dynamic neural regulation of skeletal muscle re-cruitment during exercise in humans. Br J Sports Med. 2004; 38: 797-806. doi: 10.1136/bjsm.2003.009852
Newsholme EA, Blomstrand E, Ekblom B.Physical and mental fatigue: Metabolic mechanisms and importance of plas-ma amino acids. Br Med Bull. 1992; 48: 477-495.
Beedie C. Placebo effects in competitive sport: Qualitative data. J Sports Sci Med. 2007; 6: 21-28.
Foad AJ, Beedie CJ, Coleman DA. Pharmacological and psychological effects of caffeine ingestion in 40-km cycling per-formance. Med Sci Sports Exerc. 2008; 40: 158-165.
Trojian TH, Beedie CJ. Placebo effect and athletes. Curr Sports Med Rep. 2008; 7: 214-217. doi: 10.1249/ JSR.0b013e31817ed050
Bérdi M, Köteles F, Szabó A, Bárdos G. Placebo effects in sport and exercise: a meta-analysis. Eur J Mental Health. 2011; 6: 196-212. doi: 10.5708/EJMH.6.2011.2.5
Ariel G, Saville W. Anabolic steroids: the physiological ef-fects of placebos. Med Sci Sports. 1972; 4: 124-126.
Enck P, Bingel U, Schedlowski M, Rief W. The placebo re-sponse in medicine: minimize, maximize or personalize? Nat Rev Drug Discov. 2013; 12: 191-204. doi: 10.1038/nrd3923
Bingel U, Wanigasekera V, Wiech K, et al. The effect of treat-ment expectation on drug efficacy: imaging the analgesic benefit of the opioid remifentanil. Sci Transl Med. 2011; 3: 70ra14. doi: 10.1126/scitranslmed.3001244
Colloca L, Benedetti F. Placebos and painkillers: is mind as real as matter? Nat Rev Neurosci. 2005; 6: 545-552. doi: 10.1038/nrn1705
Doering BK, Rief W. Utilizing placebo mechanisms for dose reduction in pharmacotherapy. Trends Pharmacol Sci. 2012; 33: 165-172. doi: 10.1016/j.tips.2011.12.001
Kaptchuk TJ, Kelley JM, Conboy LA, et al. Components of placebo effect: randomised controlled trial in patients with ir-ritable bowel syndrome. Brit Med J. 2008; 336: 999-1003. doi: 10.1136/bmj.39524.439618.25
Wager TD, Nitschke JB. Placebo effects in the brain: linking mental and physiological processes. Brain Behav Immun. 2005; 19: 281-282. doi: 10.1016/j.bbi.2005.04.009
Clark VR, Hopkins WG, Hawley J, Burke LM. Placebo ef-fect of carbohydrate feedings during a 40-km cycling time trial. Med Sci Sports. 2000; 32: 1642-1647.
Beedie CJ, Stuart EM, Coleman D, Foad AJ. Placebo effects of caffeine on cycling performance. Med Sci Sports. 2006; 38: 2159-2164.
Mikalsen A, Bertelsen B, Flaten MA. Effects of caffeine, caffeine-associated stimuli, and caffeine-related information on physiological and psychological arousal. Psychopharmacol. 2001; 157: 373-380.
Sonetti DA, Wetter TJ, Pegelow DF, Dempsey JA. Effects of respiratory muscle training versus placebo on endurance exercise performance. Resp Physiol. 2001; 127: 185-199. doi: 10.1016/S0034-5687(01)00250-X
Beedie CJ, Foad AJ. The placebo effect in sports perfor-mance: a brief review. Sports Med. 2009; 39: 313-329. doi: 10.2165/00007256-200939040-00004
Pollo A, Carlino E, Benedetti F. The top-down influence of ergogenic placebos on muscle work and fatigue. Eur J Neurosci. 2008; 28: 379-388. doi: 10.1111/j.1460-9568.2008.06344.x
Bérdi M, Köteles F, Hevesi K, Bárdos G, Szabo A. Elite ath-letes’ attitudes towards the use of placebo-induced performance enhancement in sports. Eur J Sport Sci. 2015; 15: 315-321.
Green MW, Taylor MA, Elliman NA, Rhodes O. Placebo expectancy effects in the relationship between glucose and cog-nition. Br J Nutr. 2001; 86: 173-179. doi: 10.1079/BJN2001398
Sievenpiper JL, Ezatagha A, Dascalu A, Vuksan V. When a placebo is not a “placebo”: a placebo effect on postprandi-al glycaemia. Br J Clin Pharmacol. 2007; 64: 546-549. doi: 10.1111/j.1365-2125.2007.02929.x
Blomstrand E. Amino acids and central fatigue. Amino Ac-ids. 2001; 20: 25-34.
Mikalsen A, Bertelsen B, Flaten MA. Effects of caffeine, caffeine-associated stimuli, and caffeine-related information on physiological and psychological arousal. Psychopharmacol. 2001; 157: 373-380.
Testa M, Fillmore M, Norris J. Understanding alcohol expec-tancy effects: Revisiting the placebo condition. Alcohol Clin Exp Res. 2006; 30: 339-348. doi: 10.1111/j.1530-0277.2006.00039.x
Vuksan V, Sievenpiper JL. Herbal remedies in the manage-ment of diabetes: Lessons learned from the study of ginseng. Nutr Metab Cardiovasc Dis. 2005; 15: 149-160. doi: 10.1016/j. numecd.2005.05.001
Petróczi A, Naughton D. Performance enhancement with supplements: incongruence between rationale and practice. J Int Soc Sports Nutr. 2007; 4: 19. doi: 10.1186/1550-2783-4-19
Giang DW, Goodman AD, Schiffer RB, et al. Conditioning of cyclophosphamide-induced leukopenia in humans. J Neuro-psychiatry Clin Neurosci. 1996; 8: 194-201.
Goebel MU, Trebst AE, Steiner J, et al. Behavioral condi-tioning of immunosuppression is possible in humans. FASEB J. 2002; 16: 1869-1873.
Klosterhalfen S, Rüttgers A, Krumrey E, et al. Pavlovian conditioning of taste aversion using a motion sickness paradigm. Psychosom Med. 2000; 62: 671-677.
Szabo A, Bérdi M, Köteles F, Bárdos G. Perceptual charac-teristics of nutritional supplements determine the expected ef-fectiveness in boosting strength, endurance, and concentration performances. Int J Sport Nutr Exerc Metab. 2013; 23: 624-628.
Campbell C, Prince D, Braun M, Applegate E, Casazza G. Carbohydrate-supplement form and exercise performance. Int J Sport Nutr Exerc Metab. 2008; 18: 179-190.
BenedettiF, Lanotte M, Colloca L, Ducati A, Zibetti M, Lopiano L. Electrophysiological properties of thalamic, subtha-lamic and nigral neurons during the anti-parkinsonian placebo response. J Physiol. 2009; 587: 3869-3883. doi: 10.1113/jphysi-ol.2009.169425
de la Fuente-Fernández R, Ruth T, Sossi V. Expectation and dopamine release: mechanism of the placebo effect in Parkin-son’s disease. Science. 2001; 293: 1164-1166. doi: 10.1126/sci-ence.1060937
Lidstone SC, Schulzer M, Dinelle,K, et al. Effects of expec-tation on placebo-induced dopamine release in Parkinson dis-ease. Arch Gen Psychiat. 2010; 67: 857-865.
Fiorio M, Emadi Andani M, Marotta A, Classen J, Tinazzi M. Placebo-induced changes in excitatory and inhibitory corti-cospinal circuits during motor performance. J Neurosci. 2014; 34: 3993-4005. doi: 10.1523/JNEUROSCI.3931-13.2014
Leuchter AF, Cook IA, Witte EA, Morgan M, Abrams M. Changes in brain function of depressed subjects during treat-ment with placebo. Am J Psychiat. 2002; 159: 122-129.
Watson A, El-Deredy W, Vogt BA, Jones AKP. Placebo an-algesia is not due to compliance or habituation: EEG and behav-ioral evidence. Neuroreport. 2007; 18: 771-775. doi: 10.1097/ WNR.0b013e3280c1e2a8
Zhang W, Luo J. The transferable placebo effect from pain to emotion: changes in behavior and EEG activity. Psychophysiol. 2009; 46: 626-634. doi: 10.1111/j.1469-8986.2009.00786.x
Hottenrott K, Taubert M, Gronwald T. Cortical Brain Activ-ity is Influenced by Cadence in Cyclists. The Open Sports Sci-ence Journal. 2013; 6: 9-14.
Nybo L, Nielsen B. Perceived exertion is associated with an altered brain activity during exercise with progressive hyper-thermia. J Appl Physiol. 1985; 91: 2017-2023.
Pontifex MB, Hillman CH. Neuroelectric measurement of cognition during aerobic exercise. Methods. 2008; 45: 271-278. doi: 10.1016/j.ymeth.2008.04.003
Thompson T, Steffert T, Ros T, Leach J, Gruzelier J. EEG applications for sport and performance. Methods. 2008; 45: 279- 288. doi: 10.1016/j.ymeth.2008.07.006
Dalsgaard M, Secher N. The brain at work: A cerebral meta-bolic manifestation of central fatigue? J Neurosci Res. 2007; 85: 3334-3339. doi: 10.1002/jnr.21274
Davis JM, Bailey SP. Possible mechanisms of central ner-vous system fatigue during exercise. Med Sci Sports. 1997; 29: 45-57.
Newsholme EA, Blomstrand, E. Tryptophan, 5-Hydroxy-tryptamine and a possible explanation for central fatigue. Adv Exp Med Biol. 1995; 384: 315-320.
Petruzzello SJ, Ekkekakis P, Hall EE. Physical activity and affect: EEG studies. In: Acevedo EO, Ekkekakis P, eds. Psycho-biology of Exercise and Sport. Human Kinetics, Champaign, IL. 2006; 111-128.
Hatfield BD, Haufler AJ, Hung T, Spalding TW. Electroen-cephalographic Studies of Skilled Psychomotor Performance. J Clin Neurophysiol. 2004; 21: 144-156.
HauflerAJ, Spalding TW, Santa Maria DL, Hatfield BD. Neu-ro-cognitive activity marksmen and novice shooters. Biol Psy-chol. 2000; 53: 131-160. doi: 10.1016/S0301-0511(00)00047-8
Babiloni C, Infarinato F, Marzano N, et al. Intra-hemispheric functional coupling of alpha rhythms is related to golfer’s per-formance: A coherence EEG study. Intern J Psychophysiol. 2011; 82: 260-268. doi: 10.1016/j.ijpsycho.2011.09.008
Baumeister J, Reinecke K, Liesen H, Weiss M. Cortical ac-tivity of skilled performance in a complex sports related mo-tor task. Eur J Appl Physiol. 2008; 104: 625-631. doi: 10.1007/ s00421-008-0811-x
Collins D, Powell, G, Davies I. An electroencephalographic study of hemispheric processing patterns during karate perfor-mance. J Sport Exerc Psychol. 1990; 12: 223-234.
Landers DM, Han M, Salazar W, Petruzzello SJ. Effects of learning on electroencephalographic and electrocardiographic patterns in novice archers. Int J Sport Psychol. 1994; 25: 313- 330.
KakizakiT. Effects of bicycle exercise on occipital EEG am-plitude in male students. Ind Health. 1988; 26: 191-195.
Kubitz KA, Pothakos K. Does aerobic exercise decrease brain activation? J Sport Exerc Psychol. 1997; 19: 291-301.
Crabbe JB, Dishman RK. Brain electrocortical activity dur-ing and after exercise: A quantitative synthesis. Psychophysiol. 2004; 41: 563-574. doi: 10.1111/j.1469-8986.2004.00176.x
Bailey SP, Hall EE, Folger SE, Miller PC. Changes in EEG during graded exercise on a recumbent cycle ergometer. J Sports Sci Med. 2008; 7: 505-511.
Ferrari M, Mottola L, Quaresima V. Principles, techniques, and limitations of Near Infrared Spectroscopy. Can J Appl Physiol. 2004; 29: 463-487.
Queresima V, Lepanto R, Ferrari M. The use of infrared spectroscopy in sports medicine. J Sports Med Phys Fitness. 2003; 43: 1-13.
Hamaoka T, McCully KK, Niwayama M, Chance B. The use of muscle near-infrared spectroscopy in sport, health and medi-cal sciences: recent developments. Philos Trans A Math Phys Eng Sci. 2011; 369: 4591-4604. doi: 10.1098/rsta.2011.0298
Perrey S. Non-invasive NIR spectroscopy of human brain function during exercise. Methods. 2008; 45: 289-299. doi: 10.1016/j.ymeth.2008.04.005
Piper SK, Krueger A, Koch SP, et al. A wearable multi-channel fNIRS system for brain imaging in freely moving sub-jects. NeuroImage. 2014; 85: 64-71. doi: 10.1016/j.neuroim-age.2013.06.062
Pereira MIR, Gomes PSC, Bhambhani YN. A brief review of the use of near infrared spectroscopy with particular inter-est in resistance exercise. Sport Med. 2007; 37: 615-624. doi: 10.2165/00007256-200737070-00005
Borg G. Perceived exertion as an indicator of somatic stress. Scand J Rehab Med. 1970; 2: 92-98.
Borg G. Psychophysical bases of perceived exertion. Med Sci Sport Exerc. 1982; 14: 377-381.
Wenhold F, Meier C, Beckmann J, Elbe AM, Ehrlenspiel F. Sport psychological initial diagnostics-sports motivation. 2008.
Pollo A, Carlino E, Benedetti F. Placebo mechanisms across different conditions: from the clinical setting to physical perfor-mance. Philos Trans R Soc. B Biol Sci. 2011; 366: 1790-1798. doi: 10.1098/rstb.2010.0381
Benedetti F, Pollo A, Colloca L. Opioid-mediated placebo responses boost pain endurance and physical performance: is it doping in sport competitions? J Neurosci. 2007; 27: 11934- 11939.
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
All content published in Sports and Exercise Medicine (SEM) is licensed under the Creative Commons Attribution 4.0 International License (CC BY 4.0). This license allows anyone to copy, distribute, transmit, and adapt the work — including for commercial purposes — provided appropriate credit is given to the original author(s) and source.
