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The Effects of Regular Cold-Water Immersion Use on Training-Induced Changes in Strength and Endurance Performance: A Systematic Review with Meta-Analysis



Cold-water immersion (CWI) is one of the main recovery methods used in sports, and is commonly utilized as a means to expedite the recovery of performance during periods of exercise training. In recent decades, there have been indications that regular CWI use is potentially harmful to resistance training adaptations, and, conversely, potentially beneficial to endurance training adaptations. The current meta-analysis was conducted to assess the effects of the regular CWI use during exercise training on resistance (i.e., strength) and endurance (i.e., aerobic exercise) performance alterations.


A computerized literature search was conducted, ending on November 25, 2019. The databases searched were MEDLINE, Cochrane Central Register of Controlled Trials, and SPORTDiscus. The selected studies investigated the effects of chronic CWI interventions associated with resistance and endurance training sessions on exercise performance improvements. The criteria for inclusion of studies were: (1) being a controlled investigation; (2) conducted with humans; (3) CWI performed at ≤ 15 °C; (4) being associated with a regular training program; and (5) having performed baseline and post-training assessments.


Eight articles were included before the review process. A harmful effect of CWI associated with resistance training was verified for one-repetition maximum, maximum isometric strength, and strength endurance performance (overall standardized mean difference [SMD] = − 0.60; Confidence interval of 95% [CI95%] = − 0.87, − 0.33; p < 0.0001), as well as for Ballistic efforts performance (overall SMD = − 0.61; CI95% = − 1.11, − 0.11; p = 0.02). On the other hand, selected studies verified no effect of CWI associated with endurance training on time-trial (mean power), maximal aerobic power in graded exercise test performance (overall SMD = − 0.07; CI95% = − 0.54, 0.53; p = 0.71), or time-trial performance (duration) (overall SMD = 0.00; CI95% = − 0.58, 0.58; p = 1.00).


The regular use of CWI associated with exercise programs has a deleterious effect on resistance training adaptations but does not appear to affect aerobic exercise performance.

Trial Registration

PROSPERO CRD42018098898.

Graphic Abstract

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One-repetition maximum


Confidence interval of 95%


Cold-water immersion


Delayed onset muscle soreness


Maximal aerobic power


Messenger ribonucleic acid


Peroxisome proliferator-activated receptor-γ coactivator-1α


Standardized mean difference


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ESM, YMD and AMZ contributed to the study conception, design, material preparation, data collection and analysis. ESM, YMD, JRB, DJB, and AMZ contributed to data interpretation and manuscript writing. All authors read and approved the final manuscript.

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Correspondence to Alessandro M. Zagatto.

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Elvis Malta, Yago Dutra, James Broatch and David Bishop declare no conflicts of interest.


Elvis de Souza Malta was supported by São Paulo Research Foundation (FAPESP) fellowship (no. 2017/21724-8). This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior – Brasil (CAPES) – Finance Code 001.

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Malta, E.S., Dutra, Y.M., Broatch, J.R. et al. The Effects of Regular Cold-Water Immersion Use on Training-Induced Changes in Strength and Endurance Performance: A Systematic Review with Meta-Analysis. Sports Med 51, 161–174 (2021).

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