Effects of cold-water immersion compared with other recovery modalities on athletic performance following acute strenuous exercise in physically active participants: A systematic review, meta-analysis, and meta-regresssion.

Moore E, Fuller JT, Bellenger CR, Saunders S, Halson SL, Broatch JR, Buckley JD. Sports Med. 2022 Dec 17. doi: 10.1007/s40279-022-01800-1. Epub ahead of print. PMID: 36527593.

Full Text Freely Available

Take-Home Message

During recovery after exercise, cold-water immersion (CWI) offers comparable benefits to other recovery methods, including active recovery.


Cold-water immersion (CWI) is one of many methods intended to speed up recovery after training and competitions. However, it is unclear if CWI performs better than other commonly used recovery modalities.

Study Goal

The researchers performed a systematic review and meta-analysis to compare CWI to other modalities with respect to athlete perception, physiologic change, and exercise performance outcomes.


The authors identified 28 articles through an exhaustive literature search for articles meeting specific criteria: (1) peer-reviewed randomized controlled trials, (2) included physically active participants, (3) used CWI follow acute physical activity, (4) included another intervention for recovery, and (5) outcomes included recover of exercise performance, muscular power, or physiological, or perceptual markers of recovery. They excluded articles if the participants received CWI paired with another intervention or if participants completed more than one exercise session. The authors extracted data from included articles: publication information, study methodology, participant information, CWI protocol, comparator recovery protocol, and assessment measures. They then assessed the quality of each study with the SIGN checklist for randomized clinical trials. During analyses, the authors examined follow-up assessments at 1, 24, 48, and 72 hours after treatment. Alternative treatments typically included active recovery, massage, contrast water therapy, warm water immersion, and cryotherapy.


Overall, the quality of included studies was low, with only one deemed “high quality” and 24 being “acceptable quality.” Compared to other recovery methods, the authors found that CWI typically had limited or no effect on the perception of recovery and recovery of 1) delayed-onset muscle soreness, 2) power performance, 3) strength, 4) flexibility, or 5) physiological markers of muscle damage. Water temperature and treatment duration did not relate to outcomes after CWI.


Cold water immersion is comparable to other recovery modalities, if not slightly better. However, the exception was that air cryotherapy, which may outperform CWI, but future studies need to confirm this. Ultimately, CWI is more clinically accessible than air cryotherapy and should be acceptable since it is comparable to other recovery methods. In fact, there was almost no difference between active recovery and CWI, offering a more practical and easily accessible recovery method for recreationally active people and those without access to CWI. It would have been interesting to know if the results for CWI differed if the person did partial or whole-body immersion.

Clinical Implications

Clinicians must be mindful that CWI offers no to minimal improvement in recovery compared to alternative recovery methods. They should communicate these findings to patients so they can make informed treatment decisions about whether to perform CWI, air cryotherapy, or active recovery.

Questions for Discussion

In what circumstances do you, as a clinician, prefer CWI over other recovery methods? What feedback have you gotten from your patients?

Written by Kyle Harris
Reviewed by Jeffrey Driban

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