Like many people with ADHD liberated women, I hate housework. Much of my childhood was spent hiding behind the couch reading the encyclopedia, hoping my mom wouln't notice that I hadn't cleaned my room yet. Moreover, like many liberated women entering their 50s, I am more of a woman than I used to be (by about 25 lbs.) Now, it turns out that I just haven't been using the "think method"! According to a paper (warning: PDF) coming out in the February issue of Psychological Science, in the course of four weeks hotel cleaning women who had heard a brief presentation exlaining how their work qualifies as good exercise "lost an average of 2 pounds, lowered their BP [blood pressure] by almost 10%, and were significantly healthier as measured by body-fat percentage, BMI [body mass index], and WHR [waist-hip ratio].." Okay, it wasn't really quite as simple as that. They were also exposed to handouts and posters in their lounges offering daily reminders of how much exercise they were getting. Participants who didn't see the presentation did not show the same health benefits.
The article, Mind-set matters: Exercise and the placebo effect is by two Harvard psychologists, Alia Crum and Ellen Langer. Prof. Langer studies conscious and nonconsious influences in health, decision making, aging, perceived control, and stereotyping. The starting point for this paper was the question of "whether the well-known benefits of exercise are in whole or in part the result of the placebo effect. A positive finding would speak to the potentially powerful psychological control people have over their health."
The placebo effect is any effect that is not attributed to an actual pharmaceutical drug or remedy, but rather is attributed to the individual’s mind-set (mindless beliefs and expectations). The therapeutic benefit of the placebo effect is so widely accepted that accounting for it has become a standard in clinical drug trials to distinguish pharmaceutical effects from the placebo effect and the placebo effect from other possible confounding factors, including spontaneous remission and the natural history of the condition (Benson & McCallie, 1979; Brody, 1980; Nesbitt Shanor, 1999; Spiro, 1986). Kirsh and Sapirstein (1998), in a meta-analysis of 2,318 clinical drug trials for antidepressant medication, found that a quarter (25.16%) of the patients' responses were due to the actual drug effect, another quarter (23.87%) were due to the natural history of depression, and half (50.97%) were due to the placebo effect.
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The placebo effect does not have to involve inert pills or sham rocedures. Symbols, beliefs, and expectations can elicit powerful physiological occurrences, both positive and negative (Hahn & Kleinman, 1983; Roberts, Kewman, & Mercie, 1993). For example, the mere presence of a doctor increases patients’ blood pressure (the "white coat effect"), reinterpreting pain in nonthreatening ways (e.g., as sensations) prompts patients to take fewer sedatives and leave the hospital sooner; and the health decline of cancer patients often has less to do with the actual course of the illness and more to do with their negative expectations regarding the disease (Langer, 1989).
Crum and Langer cite various studies linking health perceptions to actual health.
For example, Kaplan and Camacho (1983), in a cohort study of 6,928 adults, found that perceived health was a better predictor of mortality than actual health. Idler and Kasl (1991) concluded that elderly persons who perceived their health as poor are 6 times more likely to die than those who perceive their health as excellent, regardless of actual health status.
Another clue to a possible involvement of the placebo effect in the exercise-health connection lies in very fact that the studies finding this connection have relied on self-reporting of exercise levels.
The results of these studies therefore reflect the relationship between health and perceived levels of physical activity, rather than actual levels. This raises the question of whether some of the positive gains of physical activity are due more to the perception of exercise and its association with health than to the actual performance of exercise.
To eliminate the confounding issue of self-reporting, the researchers looked for an occupation that was intrinisically pysical, but where the workers would probably not view their work as "exercise". This way they could increase the perceived exercise independent of the actual exercise. Hotel room attendants fit the bill.
Hotel room attendants, for example, clean on average 15 rooms a day (each room taking between 20 and 30 min to complete), and engage in exerting activities that require walking, bending, pushing, lifting, and carrying, clearly meeting and exceeding the Surgeon General’s requirements.
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Subjects in the informed condition received a write-up discussing the benefits of exercise and were informed that their daily housekeeping work satisfied the CDC’s recommendations for an active lifestyle. Specifically, they were told that exercise does not need to be hard or painful to be good for one's health, but that it is simply a matter of moving one's muscles and burning calories (accumulating approximately 200 calories per day to meet the recommendations). They were given specific details of the average calorie expenditure for various activities (changing linens for 15 min burns 40 calories, vacuuming for 15 min burns 50 calories, and cleaning bathrooms for 15 min burns 60 calories), and they were told that although these figures were based on results for a 140-pound woman and each of them would burn calories at a different rate, it was clear that they were easily meeting and even exceeding the Surgeon General’s recommendations. This sheet, written in both English and Spanish, was read and explained to the subjects and then posted on the bulletin board in their lounge.
At the onset of the experiment, 66.6% of subjects reported not exercising regularly, and 36.8% reported not getting any exercise. Interestingly, the health of the room attendants reflected their perceived levels of exercise rather than their actual levels: According to their initial physiological measures, the subjects were at risk with respect to BP, BMI, percentage of body fat, and WHR—all important indicators of health. These results suggest the possibility that at the onset of the study, the room attendants were not receiving the full benefits of their exercise because they were not aware that they were getting exercise at work. Of course, there may have been many confounding reasons (e.g., genetics or diet) why these women were unhealthy despite their intense activity levels.
Over the course of the study, the percentage of informed subjects who reported exercising regularly (perceived regular exercise) doubled (39.4% to 79.4%), and the average amount of exercise that subjects in the informed group believed themselves to be getting (perceived amount of exercise) increased by more than 20%. It is important to note that although the informed room attendants did report higher levels of exercise at the end of the study, they did not report getting any additional exercise outside of work. In addition, although the subjects in the informed group showed a significant increase in recognizing their work as a form of exercise, their actual workload did not change. Thus, the changes in reported physical activity appear to be attributable not to actual increases in physical activity, but to a shift in mind-set initiated by the information given to them in the intervention.
This shift in mind-set in the informed group was accompanied by remarkable improvement in physiological measures associated with exercise. After only 4 weeks of knowing that their work is good exercise, the subjects in the informed group lost an average of 2 pounds, lowered their BP by almost 10%, and were significantly healthier as measured by body-fat percentage, BMI, and WHR. These were small but meaningful changes given the state of health the subjects were in, especially considering that the change occurred in just 4 weeks. All of these changes were significantly greater than the changes in the control group. These results support our hypothesis that increasing perceived exercise independent of actual exercise results in subsequent physiological improvements.
But, will the placebo effect work when I clean up if I already know that it's all in my head? I guess I could clean the bathroom to find out. Yeah, I'll try that tomorrow.