Placebo in sports and exercise: prevalence, conditioning and open-placebo

• Grant number: 21/06836-0
• Support Opportunities: Research Grants - Young Investigators Grants - Phase 2
• Start date: April 01, 2022
• End date: March 31, 2027
• Field of knowledge: Health Sciences - Physical Education
• Principal Investigator: Bryan Saunders
• Grantee: Bryan Saunders
• Host Institution: Faculdade de Medicina (FM). Universidade de São Paulo (USP). São Paulo , SP, Brazil
• Associated researchers: Alvaro José dos Santos Neto ; Bruno Gualano ; Christopher John Beedie ; Claudia da Costa Leite ; Eimear Bernadette Dolan ; Hamilton Augusto Roschel da Silva ; Luana Farias Oliveira Saunders ; Maria Concepción García Otaduy ; Philip Henry John Hurst
• Associated research grant: 16/50438-0 - Nutritional suplementation and exercise to optimize exercise performance: focus on individual responses and a step towards personalized sports nutrition, AP.JP
• Associated scholarship(s): 25/04119-0 - fMRI Insights into the Neural Responses to Caffeine Ingestion, BP.PD; 25/00793-8 - Reliability of a Cognitive Test Battery Pre and Post Maximal Cycling Exercise, BP.IC; 24/20745-5 - Characterizing the perception of deceptive placebo and open-label placebo among athletes and coaches, BP.MS; + associated scholarships 24/16671-6 - The acute effect of different doses of caffeine supplementation on the performance of trained cyclists with low habitual caffeine intake, BP.IC; 24/16981-5 - Effects of placebo perceived to be caffeine on side-effects associated with caffeine supplementation, BP.IC; 24/14824-0 - The effect of different acute caffeine doses on 4-km cycling time-trial performance in trained cyclists after habituation to caffeine consumption., BP.DD; 24/07857-9 - Assessment of Protein Consumption and its Relationship with Hypertrophy in Strength Training Practitioners, BP.IC; 24/07887-5 - Dietary habits and energy availability of resistance-trained athletes., BP.IC; 24/08082-0 - Effect of strength training on the hormonal profile of resistance-trained athletes, BP.IC; 22/07327-4 - The effects of placebo and open-label placebo in various administration forms on performance, strength, and hypertrophy, BP.DD; 22/10973-5 - Placebo effect on cognitive performance after conditioning to caffeine supplementation, BP.IC; 22/07258-2 - Studies to increase robustness, versatility and efficacy for the determination of alanine, carnosine, catecholamines, caffeine and their metabolites in blood and muscle by LC-MS/MS, BP.PD - associated scholarships

Abstract

Historically in research, placebos have been used as a control treatment that is indistinguishable from the active intervention but has no active component. This allows the intervention arm to be compared to the non-active placebo treatment which, theoretically, should allow determination of the "true" effect of the intervention, through reducing the potential that expectancy, or belief, about the intervention may artificially inflate the estimated response to that intervention. However. placebo effects in sport and exercise nutrition are apparent with studies (including from our group) showing small to moderate positive effects on exercise outcomes and up to 60% of the ergogenic effect shown with nutritional supplements explained by placebo effects. Placebo effects are induced by administering an inert intervention (e.g., sham drugs, nutrients, or equipment), which can elicit a neurobiological response due to verbal suggestions, explicit expectations, or implicit experience. Very little is understood about the physiological effects that occur that explain these performance changes with placebo. This project aims to bridge several important gaps in our knowledge relating to the placebo and placebo effects in sports, health and exercise. Specifically, we aim to elucidate some underlying questions regarding the prevalence of placebo techniques in sport, physiological and metabolomic responses to conditioning and placebo, and the potential for open-label placebo in sport. Study 1 will investigate the effect of caffeine conditioning on physiological parameters and cognitive and exercise performance. Study 2 will employ a metabolomics approach to determine metabolic pathways that are similar when individuals receive caffeine and placebo - the hot-topic called "placebomics". Study 3 will investigate the efficacy of an open-label placebo intervention on exercise performance in men and women and potential mechanisms. Study 4 will determine changes in functional magnetic resonance imaging of the brain following supplementation with caffeine and placebo perceived to be caffeine. These findings will generate important practical information as to the main physiological mechanisms through which placebos work and whether we can optimise these effects for health and performance and predict responses both within and between individuals. Results from these studies will also yield further research, shaping future study designs to better control for this complex phenomenon, with practical implications in sports, health and exercise science. (AU)

Scientific publications

(16)

(References retrieved automatically from Web of Science and SciELO through information on FAPESP grants and their corresponding numbers as mentioned in the publications by the authors)

REZENDE, NATHALIA SAFFIOTI; BESTETTI, GIULIA CAZETTA; DE OLIVEIRA, LUANA FARIAS; MAZZOLANI, BRUNA CARUSO; SMAIRA, FABIANA INFANTE; DUMAS, ALINA; SWINTON, PAUL; SAUNDERS, BRYAN; DOLAN, EIMEAR. Dietary ?-Alanine Intake Assessed by Food Records Does Not Associate With Muscle Carnosine Content in Healthy, Active, Omnivorous Men and Women. INTERNATIONAL JOURNAL OF SPORT NUTRITION AND EXERCISE METABOLISM, v. N/A, p. 8-pg., 2023-03-24. (19/05616-6, 21/06836-0, 22/09025-5, 19/26899-6)

DE SOUZA, RICARDO AUGUSTO SILVA; BARRETO, GABRIEL; FREIRE, PETERSON ADRIANO ALVES; DE ABREU, WILSON CESAR; SAUNDERS, BRYAN; DA SILVA, SANDRO FERNANDES. Sodium bicarbonate improved CrossFit® Benchmark Fran, but not subsequent 500 m rowing performance. RESEARCH IN SPORTS MEDICINE, v. 32, n. 6, p. 16-pg., 2024-03-15. (16/50438-0, 20/12036-3, 21/06836-0)

DURKALEC-MICHALSKI, KRZYSZTOF; KAMINSKA, JOANNA; SAUNDERS, BRYAN; POKRYWKA, ANDRZEJ; LONIEWSKI, IGOR; STEFFL, MICHAL; PODGORSKI, TOMASZ. Does sodium bicarbonate based extra-cellular buffering support reduce high intensity exercise-induced fatigue and enhance short-term recovery assessed by selected blood biochemical indices?. BIOLOGY OF SPORT, v. 41, n. 1, p. 11-pg., 2024-01-01. (16/50438-0, 21/06836-0)

GUARDIEIRO, NATALIA MENDES; BARRETO, GABRIEL; MARTICORENA, FELIPE MIGUEL; OLIVEIRA, TAMIRES NUNES; DE OLIVEIRA, LUANA FARIAS; PINTO, ANA LUCIA DE SA; DO PRADO, DANILO MARCELO LEITE; SAUNDERS, BRYAN; GUALANO, BRUNO. A Cloth Facemask Causes No Major Respiratory or Cardiovascular Perturbations During Moderate to Heavy Exercise. JOURNAL OF PHYSICAL ACTIVITY & HEALTH, v. 20, n. 1, p. 10-pg., 2023-01-01. (21/05847-8, 16/50438-0, 20/12036-3, 17/13552-2, 21/06836-0, 20/04368-6)

NADERI, ALIREZA; GOBBI, NATHAN; ALI, AJMOL; BERJISIAN, ERFAN; HAMIDVAND, AMIN; FORBES, SCOTT C.; KOOZEHCHIAN, MAJID S.; KARAYIGIT, RACI; SAUNDERS, BRYAN. Carbohydrates and Endurance Exercise: A Narrative Review of a Food First Approach. NUTRIENTS, v. 15, n. 6, p. 19-pg., 2023-03-01. (21/06836-0, 16/50438-0, 19/07497-4)

NEWBURY, JOSH W.; SAUNDERS, BRYAN; GOUGH, LEWIS A.. Evening Caffeine Did Not Improve 100-m Swimming Time Trials Performed 60 Min Post-Ingestion or the Next Morning After Sleep. INTERNATIONAL JOURNAL OF SPORT NUTRITION AND EXERCISE METABOLISM, v. 32, n. 6, p. 9-pg., 2022-11-01. (21/06836-0, 16/50438-0)

CARVALHO, ARTHUR; MARTICORENA, FELIPE MIGUEL; GRECCO, BEATRIZ HELENA; BARRETO, GABRIEL; SAUNDERS, BRYAN. Reply to Zhang and Chen's Comment on "Can I Have My Coffee and Drink It? A Systematic Review and Meta-analysis to Determine Whether Habitual Caffeine Consumption Affects the Ergogenic Effect of Caffeine". SPORTS MEDICINE, v. 53, n. 2, p. 2-pg., 2022-10-16. (20/12036-3, 20/02391-0, 21/05847-8, 21/06836-0)

DURKALEC-MICHALSKI, KRZYSZTOF; NOWACZYK, PAULINA M.; SAUNDERS, BRYAN; CARR, AMELIA; KAMINSKA, JOANNA; STEF, MICHAL; PODGORSKI, TOMASZ. Sex-dependent responses to acute sodium bicarbonate different dose treatment: A randomized double-blind crossover study. JOURNAL OF SCIENCE AND MEDICINE IN SPORT, v. 28, n. 2, p. 12-pg., 2025-02-01. (16/50438-0, 21/06836-0)

DE SOUSA, JESSICA BIANCA ALVES; MENDES, GUILHERME FALCAO; ZANDONADI, RENATA PUPPIN; DA COSTA, TERESA HELENA MACEDO; SAUNDERS, BRYAN; REIS, CAIO EDUARDO GONCALVES. Translation and Validation of the Nutrition for Sport Knowledge Questionnaire in Brazil (NSKQ-BR). NUTRIENTS, v. 16, n. 12, p. 11-pg., 2024-06-01. (21/06836-0)

CURRAN-BOWEN, TERENCE; DA SILVA, ANDRE GUEDES; BARRETO, GABRIEL; BUCKLEY, JOHN; SAUNDERS, BRYAN. Sodium bicarbonate and beta-alanine supplementation: Is combining both better than either alone? A systematic review and meta-analysis. BIOLOGY OF SPORT, v. 41, n. 3, p. 9-pg., 2024-01-01. (19/22249-7, 20/12036-3, 21/06836-0)

SAUNDERS, BRYAN; MCNAUGHTON, LARS R.; BARRETO, GABRIEL. Caffeine And Sports Performance: Just A Matter Of Timing? A Pilot Study. MEDICINE AND SCIENCE IN SPORTS AND EXERCISE, v. 56, n. 10, p. 1-pg., 2024-10-01. (21/12116-0, 20/12036-3, 21/06836-0)

CARVALHO, ARTHUR; MARTICORENA, FELIPE MIGUEL; GRECCO, BEATRIZ HELENA; BARRETO, GABRIEL; SAUNDERS, BRYAN. Can I Have My Coffee and Drink It? A Systematic Review and Meta-analysis to Determine Whether Habitual Caffeine Consumption Affects the Ergogenic Effect of Caffeine. SPORTS MEDICINE, v. N/A, p. 12-pg., 2022-05-10. (20/12036-3, 21/05847-8, 20/02391-0, 16/50438-0, 19/20614-0, 21/06836-0)

MENDES, GUILHERME FALCAO; REIS, CAIO EDUARDO GONCALVES; NAKANO, EDUARDO YOSHIO; SPINELI, HIGOR; BARRETO, GABRIEL; NORONHA, NATALIA YUMI; WATANABE, LIGIA MORIGUCHI; NONINO, CARLA BARBOSA; DE ARAUJO, GUSTAVO GOMES; SAUNDERS, BRYAN; et al. Can the Brazilian Caffeine Expectancy Questionnaires Differentiate the CYP1A2 and ADORA2A Gene Polymorphisms?-An Exploratory Study with Brazilian Athletes. NUTRIENTS, v. 14, n. 16, p. 12-pg., 2022-08-01. (18/24069-3, 20/12036-3, 21/06836-0, 16/50438-0, 20/08687-9)

DE AMORIM ROCHA, PEDRO LUCAS; CALDEIRA LIMA, ANNA LUISA; SAUNDERS, BRYAN; GONCALVES REIS, CAIO EDUARDO. Development of a Caffeine Content Table for Foods, Drinks, Medications and Supplements Typically Consumed by the Brazilian Population. NUTRIENTS, v. 14, n. 20, p. 14-pg., 2022-10-01. (16/50438-0, 21/06836-0)

BARRETO, GABRIEL; ESTEVES, GABRIEL P.; MARTICORENA, FELIPE; OLIVEIRA, TAMIRES N.; GRGIC, JOZO; SAUNDERS, BRYAN. Caffeine, CYP1A2 Genotype, and Exercise Performance: A Systematic Review and Meta-analysis. MEDICINE AND SCIENCE IN SPORTS AND EXERCISE, v. 56, n. 2, p. 12-pg., 2024-02-01. (21/12116-0, 20/07860-9, 21/05847-8, 20/12036-3, 21/06836-0, 22/07327-4)

CARVALHO, ARTHUR; DUARTE, BRENO; ELLIOTT-SALE, KIRSTY JAYNE; SAUNDERS, BRYAN. Directions for Future Studies to Determine Dietary Nitrate Efficacy in Female Athletes. TRANSLATIONAL JOURNAL OF THE AMERICAN COLLEGE OF SPORTS MEDICINE, v. 8, n. 4, p. 3-pg., 2023-01-01. (21/06836-0, 21/13799-3, 16/50438-0, 19/06140-5)