Impact of Cold-Water Immersion Compared with Passive Recovery Following a Single Bout of Strenuous Exercise on Athletic Performance in Physically Active Participants: A Systematic Review with Meta-analysis and Meta-regression

Abstract

Background: Studies investigating the effects of cold-water immersion (CWI) on the recovery of athletic performance, perceptual measures and creatine kinase (CK) have reported mixed results in physically active populations.

Objectives: The purpose of this systematic review was to investigate the effects of CWI on recovery of athletic performance, perceptual measures and CK following an acute bout of exercise in physically active populations.

Study design: Systematic review with meta-analysis and meta-regression.

Methods: A systematic search was conducted in September 2021 using Medline, SPORTDiscus, Scopus, Web of Science, Cochrane Library, EmCare and Embase databases. Studies were included if they were peer reviewed and published in English, included participants who were involved in sport or deemed physically active, compared CWI with passive recovery methods following an acute bout of strenuous exercise and included athletic performance, athlete perception and CK outcome measures. Studies were divided into two strenuous exercise subgroups: eccentric exercise and high-intensity exercise. Random effects meta-analyses were used to determine standardised mean differences (SMD) with 95% confidence intervals. Meta-regression analyses were completed with water temperature and exposure durations as continuous moderator variables.

Results: Fifty-two studies were included in the meta-analyses. CWI improved the recovery of muscular power 24 h after eccentric exercise (SMD 0.34 [95% CI 0.06-0.62]) and after high-intensity exercise (SMD 0.22 [95% CI 0.004-0.43]), and reduced serum CK (SMD - 0.85 [95% CI - 1.61 to - 0.08]) 24 h after high-intensity exercise. CWI also improved muscle soreness (SMD - 0.89 [95% CI - 1.48 to - 0.29]) and perceived feelings of recovery (SMD 0.66 [95% CI 0.29-1.03]) 24 h after high-intensity exercise. There was no significant influence on the recovery of strength performance following either eccentric or high-intensity exercise. Meta-regression indicated that shorter time and lower temperatures were related to the largest beneficial effects on serum CK (duration and temperature dose effects) and endurance performance (duration dose effects only) after high-intensity exercise.

Conclusion: CWI was an effective recovery tool after high-intensity exercise, with positive outcomes occurring for muscular power, muscle soreness, CK, and perceived recovery 24 h after exercise. However, after eccentric exercise, CWI was only effective for positively influencing muscular power 24 h after exercise. Dose-response relationships emerged for positively influencing endurance performance and reducing serum CK, indicating that shorter durations and lower temperatures may improve the efficacy of CWI if used after high-intensity exercise.

Funding: Emma Moore is supported by a Research Training Program (Domestic) Scholarship from the Australian Commonwealth Department of Education and Training.

Protocol registration: Open Science Framework: 10.17605/OSF.IO/SRB9D.

Fig. 1

PRISMA flowchart for screening of articles. CWI cold-water immersion, RCT randomised controlled trial

Fig. 2

Forest plot illustrating the influence of CWI compared with passive recovery 24 h after exercise on muscular power performance (stratified by exercise intervention modality).CI confidence interval, CWI cold-water immersion, SMD standardised mean difference

Fig. 3

Forest plot illustrating the influence of CWI compared with passive recovery 24 h after exercise on strength performance (stratified by exercise intervention modality). CI confidence interval, CWI cold-water immersion, SMD standardised mean difference

Fig. 4

Meta-regression plots illustrating the influence of CWI duration and temperature on endurance performance and removal of serum CK from the blood at 24 h and 48 h after exercise. a Effect of time at 24 h after exercise; b effect of time at 48 h after exercise; c effect of temperature at 24 h after exercise; d effect of temperature at 48 h after exercise. CK creatine kinase, CWI cold-water immersion, SMD standardised mean difference

Fig. 5

Forest plot illustrating the influence of CWI compared with passive recovery 24 h after exercise on muscle soreness (stratified by exercise intervention modality). CI confidence interval, CWI cold-water immersion, SMD standardised mean difference

Fig. 6

Forest plot illustrating the influence of CWI compared with passive recovery 24 h after exercise on removal of CK (stratified by exercise intervention modality). CI confidence interval, CK creatine kinase, CWI cold-water immersion, SMD standardised mean difference

Fig. 7

Summary of review outcomes presented to allow practitioners easy interpretation. CK creatine kinase, DOMS delayed onset muscle soreness, Endur endurance, Flex flexibility, H hours, PR perceived recovery