Cold water immersion: kill or cure?

Exp Physiol. 2017 Nov 1;102(11):1335-1355. doi: 10.1113/EP086283. Epub 2017 Sep 21.


What is the topic of this review? This is the first review to look across the broad field of 'cold water immersion' and to determine the threats and benefits associated with it as both a hazard and a treatment. What advances does it highlight? The level of evidence supporting each of the areas reviewed is assessed. Like other environmental constituents, such as pressure, heat and oxygen, cold water can be either good or bad, threat or treatment, depending on circumstance. Given the current increase in the popularly of open cold water swimming, it is timely to review the various human responses to cold water immersion (CWI) and consider the strength of the claims made for the effects of CWI. As a consequence, in this review we look at the history of CWI and examine CWI as a precursor to drowning, cardiac arrest and hypothermia. We also assess its role in prolonged survival underwater, extending exercise time in the heat and treating hyperthermic casualties. More recent uses, such as in the prevention of inflammation and treatment of inflammation-related conditions, are also considered. It is concluded that the evidence base for the different claims made for CWI are varied, and although in most instances there seems to be a credible rationale for the benefits or otherwise of CWI, in some instances the supporting data remain at the level of anecdotal speculation. Clear directions and requirements for future research are indicated by this review.

Keywords: cold; cold water; drowning; exercise physiology; hyperthermia; inflamation; treatment.

Publication types

  • Historical Article
  • Review

MeSH terms

  • Adaptation, Physiological
  • Animals
  • Body Temperature Regulation
  • Cold Temperature* / adverse effects
  • Cryotherapy / adverse effects
  • Cryotherapy / history
  • Cryotherapy / methods*
  • Cryotherapy / mortality
  • Drowning / mortality
  • Drowning / physiopathology
  • Exercise Tolerance
  • History, 18th Century
  • History, 19th Century
  • History, 20th Century
  • History, 21st Century
  • History, Ancient
  • Humans
  • Hydrotherapy / adverse effects
  • Hydrotherapy / history
  • Hydrotherapy / methods*
  • Hydrotherapy / mortality
  • Immersion* / adverse effects
  • Risk Assessment
  • Risk Factors
  • Swimming
  • Water* / adverse effects


  • Water