The fitness industry has long been filled with exercise ‘myths’ for edgy Instagram accounts to come and ‘bust’.
But the question is, is this exercise myth busting just splitting hairs for a few extra Instagram likes or is it important?
First, let me introduce you to a word called ‘nocebo’…
What is nocebo?
No, nocebo is not a derogatory urban dictionary take on the word placebo; it is its own word. The nocebo complex refers to the enhanced negative effects experienced as a result of negative outcome expectations form an action, differing from placebo, which refers to enhanced positive effects experienced as a result of positive outcome expectations.
What does this mean in practice?
If I tell you that you are about to feel pain in an exercise in the gym, regardless of whether it is dangerous, you may experience heightened feelings of pain.
A 2014 meta-analysis by Petersen et al. (6) found the magnitude of nocebo affects on pain are highly variable but typically moderately to highly. Nocebo has also recently been shown to have the potential to reduce motor performance (3) and exercise performance during a fatigued state (5).
This highlights the importance of a positive perception of exercise in and out of the gym and the potential debilitating effects of installing pessimistic views of exercise on clients, given the links between pain avoidance and a lack of injury recovery (2), in line with previous cognitive-behavioural models (7) (figure 1).
Is the media to blame?
Like anything, it would be reductionist and probably unhelpful to scapegoat such a widespread issue on one source. However, previous research hints at the widescale effect that media coverage can play on our experiences of pain or ailment.
Faasse et al. (2012) performed a pre-post retrospective observational study looking at the effects of a negative news story on the side effects of a thyroid hormone replacement tablet on reported symptoms (1). They found significant increases in reported symptoms after early news reports of the issue, illuding to the potential nocebic effects of the media on illness/pain experiences.
The industry therefore needs to carefully consider the language it uses to avoid the spread of pessimistic views surrounding exercise, given that it can harness into real world issues.
How do we ‘say NO to nocebo?’
1. Avoid pessimism – a pessimistic view of the efficacy and safety of exercise is a likely driving force behind nocebo in the fitness industry. But given that more and more research contradicts the idea that there are inherently ‘good or bad’ exercises (link), this pessimism likely does more harm than good.
2. Adopt optimism – positive expectations of exercise should be installed as best practise in the industry, given the inherent absence of nocebo, but also given that previous research suggests that positive expectations of exercise (in placebo research) can improve sporting performance, with small to moderate effect (4).
Conclusion:
Exercise is good for you. If you have preconceived negative views on certain exercises, based on your own beliefs, or those thrust upon you by others, then it may be time to change so that you can get the best out of your own body and training.
Author:
Ewan Hammond (Bsc; PhD Researcher; Professional Fitness Writer; Personal Trainer; Online Coach)
References:
1. Faasse, K., Gamble, G., Cundy, T. and Petrie, K.J., 2012. Impact of television coverage on the number and type of symptoms reported during a health scare: A retrospective pre–post observational study. Bmj Open, 2(4), p.e001607
2. George, S.Z. and Beneciuk, J.M., 2015. Psychological predictors of recovery from low back pain: a prospective study. BMC musculoskeletal disorders, 16(1), pp.1-7.
3. Horváth, Á., Köteles, F. and Szabo, A., 2021. Nocebo effects on motor performance: A systematic literature review. Scandinavian journal of psychology, 62(5), pp.665-674.
4. Hurst, P., Schipof-Godart, L., Szabo, A., Raglin, J., Hettinga, F., Roelands, B., Lane, A., Foad, A., Coleman, D. and Beedie, C., 2020. The placebo and nocebo effect on sports performance: a systematic review. European journal of sport science, 20(3), pp.279-292.
5. McLemore, B.H., McLemore, S.G., Rogers, R.R., Pederson, J.A., Williams, T.D., Marshall, M.R. and Ballmann, C.G., 2020. Nocebo effects on perceived muscle soreness and exercise performance following unaccustomed resistance exercise: A pilot study. Journal of Functional Morphology and Kinesiology, 5(2), p.40.
6. Petersen, G.L., Finnerup, N.B., Colloca, L., Amanzio, M., Price, D.D., Jensen, T.S. and Vase, L., 2014. The magnitude of nocebo effects in pain: a meta-analysis. Pain®, 155(8), pp.1426-1434.
7. Vlaeyen, J.W., Kole-Snijders, A.M., Boeren, R.G. and Van Eek, H., 1995. Fear of movement/(re) injury in chronic low back pain and its relation to behavioral performance. Pain, 62(3), pp.363-372.
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