Cryotherapy is an increasingly popular recovery strategy used in an attempt to attenuate the negative impact of strenuous physical activity on subsequent exercise. Therefore, this study aimed to assess the effects of whole body cryotherapy (WBC) and cold water immersion (CWI) on markers of recovery following a marathon.
Thirty-one endurance trained males completed a marathon. Participants were randomly assigned to a CWI, WBC or placebo group. Perceptions of muscle soreness, training stress and markers of muscle function were recorded before the marathon and at 24 and 48 h post exercise. Blood samples were taken at baseline, post intervention and 24 and 48 h post intervention to assess inflammation and muscle damage.
WBC had a harmful effect on muscle function compared to CWI post marathon. WBC positively influenced perceptions of training stress compared to CWI. With the exception of C-reactive protein (CRP) at 24 and 48 h, neither cryotherapy intervention positively influenced blood borne markers of inflammation or structural damage compared to placebo.
The findings show WBC has a negative impact on muscle function, perceptions of soreness and a number of blood parameters compared to CWI, contradicting the suggestion that WBC may be a superior recovery strategy. Further, cryotherapy is no more effective than a placebo intervention at improving functional recovery or perceptions of training stress following a marathon. These findings lend further evidence to suggest that treatment belief and the placebo effect may be largely responsible for the beneficial effects of cryotherapy on recovery following a marathon.
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Counter movement jump
Cold water immersion
Daily analysis of the lifestyle demands of athletes
Exercise-induced muscle damage
Maximal voluntary isometric contraction
Reactive strength index
Tumour necrosis factor-α
Whole body cryotherapy
Abaïdia AE, Lamblin J, Delecroix B, Leduc C, McCall A, Nédélec M, Dupont G (2016) Recovery from exercise-induced muscle damage: cold water immersion versus whole body cryotherapy. Int J Sports Physiol Perform. https://doi.org/10.1123/ijspp.2015-0012
Alis R, Sanchis-Gomar F, Primo-Carrau C, Lozano-Calve S, Dipalo M, Aloe R, Lippi G (2015) Hemoconcentration induced by exercise : revisiting the Dill and Costill equation. Scand J Med Sci Sports 25(6):630–637. https://doi.org/10.1111/sms.12393
Armstrong RB (1984) Mechanisms of exercise-induced delayed onset muscular soreness: a brief review. Med Sci Sports Exerc 16(6):529–538
Bailey DM, Erith SJ, Griffin PJ, Dowson A, Brewer DS, Gant N, Williams C (2007) Influence of cold-water immersion on indices of muscle damage following prolonged intermittent shuttle running. J Sports Sci 25(11):1163–1170. https://doi.org/10.1080/02640410600982659
Barnett A (2006) Using recovery modalities between training sessions in elite athletes: Does it help? Sports Med 36(9):781–796. https://doi.org/10.2165/00007256-200636090-00005
Batterham AM, Hopkins WG (2006) Making meaningful inferences about magnitudes. Int J Sports Physiol Perform 1(1):50–57
Beedie C, Whyte G, Lane AM, Cohen E, Raglin J, Hurst P, Coleman D, Foad A (2017) “Caution, this treatment is a placebo. It might work, but it might not”: why emerging mechanistic evidence for placebo effects does not legitimise complementary and alternative medicines in sport. Br J Sports Med. https://doi.org/10.1136/bjsports-2017-097747
Belcastro AN, Shewchuk LD, Raj DA (1998) Exercise-induced muscle injury: a calpain hypothesis. Mol Cell Biochem 179(1–2):135–145. https://doi.org/10.1023/A:1006816123601
Bell PG, McHugh MP, Stevenson E, Howatson G (2014) The role of cherries in exercise and health. Scand J Med Sci Sports 24(3):477–490. https://doi.org/10.1111/sms.12085
Bernecker C, Scherr J, Schinner S, Braun S, Scherbaum WA, Halle M (2013) Evidence for an exercise induced increase of TNFa and IL-6 in marathon runners. Scand J Med Sci Sports 23(2), 207–214. https://doi.org/10.1111/j.1600-0838.2011.01372.x
Bleakley C, Mcdonough S, Gardner E, Baxter GD, Ty J, Davison GW (2012) Cold water immersion cryotherapy for preventing and treating muscle soreness after exercise. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD008262.pub2.Copyright
Bleakley CM, Bieuzen F, Davison GW, Costello JT (2014) Whole-body cryotherapy: empirical evidence and theoretical perspectives. Open Access J Sports Med 5:25–36. https://doi.org/10.2147/OAJSM.S41655
Broatch JR, Petersen A, Bishop DJ (2014) Postexercise cold water immersion benefits are not greater than the placebo effect. Med Sci Sports Exerc 46(11):2139–2147. https://doi.org/10.1249/MSS.0000000000000348
Byrne C, Eston R (2002) The effect of exercise-induced muscle damage on isometric and dynamic knee extensor strength and vertical jump performance. J Sports Sci 20(5):417–425. https://doi.org/10.1080/026404102317366672
Casa DJ, Mcdermott BP, Lee EC, Yeargin SW, Lawrence E, Maresh CM (2007) Cold water immersion: the gold standard for exertional heatstroke treatment. Exerc Sport Sci Rev 35(3):141–149
Cheung K, Hume PA, Maxwell L (2003) Delayed onset muscle soreness: Treatment strategies and performance factors. Sports Med 33(2):145–164. https://doi.org/10.2165/00007256-200333020-00005
Clarkson PM, Hubal MJ (2002) Exercise-induced muscle damage in humans. Am J Phys Med Rehabilit Assoc Acad Phys 81(11 Suppl):S52–S69. https://doi.org/10.1097/01.PHM.0000029772.45258.43
Clifford T, Allerton DM, Brown MA, Harper L, Horsburgh S, Keane KM, Howatson G (2016) Minimal muscle damage after a marathon and no influence of beetroot juice on inflammation and recovery. Appl Physiol Nutr Metab 42(3):263–270
Costello JT, Donnelly AE, Karki A, Selfe J (2014) Effects of Whole Body cryotherapy and cold water immersion on knee skin temperature. Int J Sports Med 35(1):35–40. https://doi.org/10.1055/s-0033-1343410
Costello JT, Baker PR, Minett GM, Bieuzen F, Stewart IB, Bleakley C (2015) Whole-body cryotherapy (extreme cold air exposure) for preventing and treating muscle soreness after exercise in adults. Cochrane Database of Syst Rev https://doi.org/10.1002/14651858.CD010789
Coutts AJ, Slattery KM, Wallace LK (2007) Practical tests for monitoring performance, fatigue and recovery in triathletes. J Sci Med Sport 10(6):372–381. https://doi.org/10.1016/j.jsams.2007.02.007
de Ruiter CJ, van der Linden RM, van der Zijden MJA, Hollander AP, de Haan A (2003) Short-term effects of whole-body vibration on maximal voluntary isometric knee extensor force and rate of force rise. Eur J Appl Physiol 88(4–5):472–475. https://doi.org/10.1007/s00421-002-0723-0
Flanagan EP, Comyns TM (2008) The use of contact time and the reactive strength index to optimize fast stretch-shortening cycle training. Strength Cond J 30(5):32–38
Halson SL, Bridge MW, Meeusen R, Busschaert B, Gleeson M, Jones DA, Jeukendrup AE (2002) Time course of performance changes and fatigue markers during intensified training in trained cyclists. J Appl Physiol, 93(3), 947–956. https://doi.org/10.1152/japplphysiol.01164.2001
Hausswirth C, Louis J, Bieuzen F, Pournot H, Fournier J, Filliard J-R, Brisswalter J (2011) Effects of whole-body cryotherapy vs. far-infrared vs. passive modalities on recovery from exercise-induced muscle damage in highly-trained runners. PLoS one, 6(12), e27749. https://doi.org/10.1371/journal.pone.0027749
Hill J, Howatson G, van Someren KA, Walshe I, Pedlar C (2014) Influence of compression garments on recovery after marathon running. J Strength Cond Res 28(4):2228–2235
Hogarth LW, Burkett BJ, McKean MR (2015) Understanding the fatigue-recovery cycle in team sport athletes. J Sports Med Doping Stud 5(1):1000e143
Hohenauer E, Taeymans J, Baeyens J, Clarys P, Clijsen R (2015) The effect of post-exercise cryotherapy on recovery characteristics : a systematic review and meta-analysis. PLoS one, 10(9), 1–22 e0139028. https://doi.org/10.1371/journal.pone.0139028
Hopkins WG (2015). Spreadsheets for analysis of controlled trials with adjustment for a predictor. Sportscience, (10), 46–50
Howatson G, McHugh MP, Hill JA, Brouner J, Jewell AP, Van Someren KA, Howatson SA (2010) Influence of tart cherry juice on indices of recovery following marathon running. Scand J Med Sci Sports, 20(6):843–852. https://doi.org/10.1111/j.1600-0838.2009.01005.x
Ihsan M, Watson G, Abbiss CR (2016) What are the physiological mechanisms for post-exercise cold water immersion in the recovery from prolonged endurance and intermittent exercise? Sports Med 46(8):1–15. https://doi.org/10.1007/s40279-016-0483-3
Jakeman JR, Macrae R, Eston R (2009) A single 10-min bout of cold-water immersion therapy after strenuous plyometric exercise has no beneficial effect on recovery from the symptoms of exercise-induced muscle damage. Ergonomics 52(4):456–460
Kargotich S, Goodman C, Keast D, Morton AR (1998) The influence of exercise-induced plasma volume changes on the interpretation of biochemical parameters used for monitoring exercise, training and sport. Sports Med 26(2):101–117
Leeder J, Gissane C, van Someren K, Gregson W, Howatson G (2012) Cold water immersion and recovery from strenuous exercise: a meta-analysis. Br J Sports Med 46(4):233–240. https://doi.org/10.1136/bjsports-2011-090061
Leeder J. D. C., Van Someren KA, Bell PG, Spence JR, Jewell P, Gaze D, Howatson G (2015) Effects of seated and standing cold water immersion on recovery from repeated sprinting. J Sport Sci. https://doi.org/10.1080/02640414.2014.996914
Machado AF, Ferreira PH, Micheletti JK, de Almeida AC, Lemes ÍR, Vanderlei FM, Pastre CM (2016) Can water temperature and immersion time influence the effect of cold water immersion on muscle soreness? A systematic review and meta-analysis. Sports Med 46(4):503–514. https://doi.org/10.1007/s40279-015-0431-7
Mawhinney C, Low DA, Jones H, Green DJ, Costello JT, Gregson W (2017) Water mediates greater reductions in limb blood flow than whole body cryotherapy. Med Sci Sports Exerc. https://doi.org/10.1249/MSS.0000000000001223
McClung M, Collins D (2007) Because I know it will!”: placebo effects of an ergogenic aid on athletic performance. J Sport Exerc Psychol 29(3):382–394
Mcdermott BP, Casa DJ, Connor FGO, Adams WB, Armstrong LE, Brennan AH, Lopez RM, Stearns RL, Troyanos C, Yeargin SW (2009) Cold-water dousing with ice massage to treat exertional heat stroke: a case series. Aviat Space Environ Med 80(8):720–722. https://doi.org/10.3357/ASEM.2498.2009
Minett GM, Costello JT (2015) Specificity and context in post-exercise recovery: it is not a one-size-fits-all approach. Front Physiol, 6:1–3. https://doi.org/10.3389/fphys.2015.00130
Mündermann A, Geurts J, Hügle T, Nickel T, Schmidt-Trucksäss A, Halle M, Hanssen H (2016) Marathon performance but not BMI affects post-marathon pro-inflammatory and cartilage biomarkers. J Sports Sci. https://doi.org/10.1080/02640414.2016.1184301
Nevill A, Lane A (2007) Why self-report “Likert” scale data should not be log-transformed. J Sports Sci, 25(1), 1–2. https://doi.org/10.1080/02640410601111183
Pyne DB (1993) Exercise-induced muscle damage and inflammation: a review. Aust J Sci Med Sport 26(3–4):49–58
Robson-Ansley PJ, Gleeson M, Ansley L (2009) Fatigue management in the preparation of Olympic athletes. J Sports Sci 27(13):1409–1420
Scholz J, Woolf CJ (2002) Can we conquer pain?. Nat Neurosci, 5(Supp), 1062–1067
Shanely RA, Nieman DC, Zwetsloot KA, Knab AM, Imagita H, Luo B, Zubeldia JM (2013) Evaluation of Rhodiola rosea supplementation on skeletal muscle damage and inflammation in runners following a competitive marathon. Brain Behav Immun 39:204–210 https://doi.org/10.1016/j.bbi.2013.09.005
Stephens JM, Halson S, Miller J, Slater GJ, Askew CD, Stephens JM, Askew CD (2016) Cold water immersion for athletic recovery: one size does not fit all. Int J Sports Physiol Perform. https://doi.org/10.1123/ijspp.2015-0012
Vaile JM, Gill ND, Blazevich AJ (2007) The effect of contrast water therapy on symptoms of delayed onset muscle soreness. J Strength Cond Res 21(3):697–702
White GGE, Rhind SSG, Wells GGD (2014) The effect of various cold-water immersion protocols on exercise-induced inflammatory response and functional recovery from high-intensity sprint exercise. Eur J Appl Physiol. https://doi.org/10.1007/s00421-014-2954-2
Conflicts of interest
The authors declare no conflict of interest.
No funding was received for this work.
Communicated by Narihiko Kondo.
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Wilson, L.J., Cockburn, E., Paice, K. et al. Recovery following a marathon: a comparison of cold water immersion, whole body cryotherapy and a placebo control. Eur J Appl Physiol 118, 153–163 (2018). https://doi.org/10.1007/s00421-017-3757-z
- Muscle damage
- Muscle function