Embedding Physical Activity Guidance During Pregnancy and in Postpartum Care: 'This Mum Moves' Enhances Professional Practice of Midwives and Health Visitors.

INTRODUCTION: The benefits of physical activity during pregnancy and after childbirth are well established, yet many health care professionals do not feel well equipped to provide physical activity guidance to these populations. As such, the objectives of this study were to explore the immediate and longer term effects of training on health care professionals' ability to provide physical activity guidance to pregnant women and new mothers (mums). METHODS: Midwives and health visitors from 5 locations in the United Kingdom were provided with training on the Chief Medical Officers' physical activity guidelines for pregnancy and after childbirth (n = 393). Midwives and health visitors attended training to become This Mum Moves Ambassadors, then disseminated education to colleagues through a cascade training model. Changes in knowledge, confidence, and professional practice were assessed by survey before and immediately after training (n = 247), and follow-up surveys were completed 3 (n = 35) and 6 (n = 34) months posttraining. RESULTS: At all posttraining time points, health care professionals reported a significant increase in their confidence to communicate about physical activity (P < .001). The reported frequency of having conversations about physical activity increased significantly 3 and 6 months following training compared with baseline (pregnant women, P = .017; new mums, P = .005). There were changes in the types of advice and resources offered by health care professionals and an overall increase in health care professionals' own reported physical activity levels. DISCUSSION: The This Mum Moves cascade approach to delivering training in physical activity guidelines improved reported knowledge, confidence and professional practice of midwives and health visitors, both immediately following and 3 and 6 months after training.

The Placebo and Nocebo effect on sports performance: A systematic review.

The aim of this review was to determine the magnitude of the placebo and nocebo effect on sport performance. Articles published before March 2019 were located using Medline, Web of Science, PubMed, EBSCO, Science Direct, and Scopus. Studies that examined placebo and nocebo effects of an objective dependent variable on sports performance, which included a control or baseline condition, were included in the analysis. Studies were classified into two categories of ergogenic aids: (1) nutritional and (2) mechanical. Cohen's d effect sizes were calculated from 32 studies involving 1513 participants. Small to moderate placebo effects were found for both placebo (d = 0.36) and nocebo (d = 0.37) effects and when separated by nutritional (d = 0.35) and mechanical (d = 0.47) ergogenic aids. The pooled effect size revealed a small to moderate effect size across all studies (d = 0.38). Results suggest that placebo and nocebo effects can exert a small to moderate effect on sports performance.

Consensus statement on placebo effects in sports and exercise: The need for conceptual clarity, methodological rigour, and the elucidation of neurobiological mechanisms.

In June 2017 a group of experts in anthropology, biology, kinesiology, neuroscience, physiology, and psychology convened in Canterbury, UK, to address questions relating to the placebo effect in sport and exercise. The event was supported exclusively by Quality Related (QR) funding from the Higher Education Funding Council for England (HEFCE). The funder did not influence the content or conclusions of the group. No competing interests were declared by any delegate. During the meeting and in follow-up correspondence, all delegates agreed the need to communicate the outcomes of the meeting via a brief consensus statement. The two specific aims of this statement are to encourage researchers in sport and exercise science to 1. Where possible, adopt research methods that more effectively elucidate the role of the brain in mediating the effects of treatments and interventions. 2. Where possible, adopt methods that factor for and/or quantify placebo effects that could explain a percentage of inter-individual variability in response to treatments and intervention.

Athletes Intending to Use Sports Supplements Are More Likely to Respond to a Placebo.

PURPOSE: We investigated associations between athletes' use of sport supplements and their responsiveness to placebo and nocebo interventions. METHODS: Participants (n = 627) reported their intention to use, and actual use of, sport supplements. They then completed a 5 × 20 m repeat sprint protocol in the baseline condition, before being randomized to one of three treatments. Participants in the positive-belief treatment were administered an inert capsule described as a potent supplement which would improve sprint performance. Participants in the negative-belief treatment were administered an inert capsule described as a potent supplement which would negatively affect sprint performance. Participants in the control treatment received neither instruction nor capsule. Twenty minutes after baseline trials, all participants completed the same repeat sprint protocol in the experimental condition. RESULTS: Compared with controls, no mean differences in performance were observed between baseline and experimental conditions for the positive-belief treatment (-0.07% ± 0.27%, d = 0.02), but mean differences were observed for the negative-belief treatment (-0.92% ± 0.31%, d = 0.32), suggesting a moderate nocebo effect. In the positive-belief treatment, however, a relationship between intention to use supplements and performance was observed. Performance worsened by -1.10% ± 0.30% compared with baseline for participants not intending to use supplements, worsened by -0.64% ± 0.43% among those undecided about supplement use, but improved by 0.19% ± 0.24% among those participants intending to use supplements. CONCLUSIONS: Information about a harmful supplement worsened repeat sprint performance (a mean nocebo effect), whereas information about a beneficial supplement did not improve performance (no mean placebo effect was observed). However, participants' intention to use sport supplements influenced the direction and magnitude of subsequent placebo responses, with participants intending to use supplements more likely to respond to the positive intervention.

Capitalizing on the Placebo Component of Treatments.

A placebo treatment is traditionally administered in a double-blind randomized controlled trial to control for the "real" effects of the treatment under investigation. In the present article, a broader view of the placebo is proposed, one in which the idea of a potentially "useable" placebo component of a sports or exercise medicine treatment is presented. It is argued that many interventions in sport and exercise psychology might contain a placebo component that could be capitalized upon by practitioners through processes often as simple as communicating positive expectations from a treatment to clients. Research findings relating to factors that might influence an individual's response to a placebo, such as personality, situation, and genetics, are briefly addressed. Ethical considerations for practice and future research are discussed.