title: Quantifying the placebo effect in psychological outcomes of exercise training: a meta-analysis of randomized trials.
abstract: BACKGROUND
  The placebo effect could account for some or all of the psychological benefits attributed to exercise training. The magnitude of the placebo effect in psychological outcomes of randomized controlled exercise training trials has not been quantified. The aim of this investigation was to estimate the magnitude of the population placebo effect in psychological outcomes from placebo conditions used in exercise training studies and compare it to the observed effect of exercise training.
  
  
  METHODS
  Articles published before 1 July 2013 were located using Google Scholar, MEDLINE, PsycINFO, and The Cochrane Library. To be included in the analysis, studies were required to have (1) a design that randomly assigned participants to exercise training, placebo, and control conditions and (2) an assessment of a subjective (i.e., anxiety, depression, energy, fatigue) or an objective (i.e., cognitive) psychological outcome. Meta-analytic and multi-level modeling techniques were used to analyze effects from nine studies involving 661 participants. Hedges' d effect sizes were calculated, and random effects models were used to estimate the overall magnitude of the placebo and exercise training effects.
  
  
  RESULTS
  After adjusting for nesting effects, the placebo mean effect size was 0.20 (95% confidence interval [CI] -0.02, 0.41) and the observed effect of exercise training was 0.37 (95% CI 0.11, 0.63).
  
  
  CONCLUSIONS
  A small body of research suggests both that (1) the placebo effect is approximately half of the observed psychological benefits of exercise training and (2) there is an urgent need for creative research specifically aimed at better understanding the role of the placebo effect in the mental health consequences of exercise training.
authors.affiliation: Department of Kinesiology, University of Georgia, 330 River Road, Athens, GA, USA, Jakel@uga.edu.
authors.forename: Jacob B
authors.initials: JB
authors.lastname: Lindheimer
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: O'Connor
authors.forename: Rod K
authors.initials: RK
authors.lastname: Dishman
mesh_terms: D001007:Anxiety / Q000628:therapy; D003071:Cognition; D003863:Depression / Q000628:therapy; D015444:Exercise / Q000523:psychology*; D005221:Fatigue / Q000628:therapy; D006801:Humans; D059408:Pain Management; D015990:Placebo Effect; D016032:Randomized Controlled Trials as Topic