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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-Regression

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Abstract

Background

Studies investigating the effects of common recovery modalities following acute strenuous exercise have reported mixed results.

Objectives

This systematic review with meta-analysis and meta-regression compared the effects of cold-water immersion (CWI) against other common recovery modalities on recovery of athletic performance, perceptual outcomes, and creatine kinase (CK) following acute strenuous exercise in physically active populations.

Study Design

Systematic review, meta-analysis, and meta-regression.

Methods

The MEDLINE, SPORTDiscus, Scopus, Web of Science, Cochrane Library, EmCare, and Embase databases were searched up until September 2022. Studies were included if they were peer reviewed, published in English, included participants who were involved in sport or deemed physically active, compared CWI with other recovery modalities following an acute bout of strenuous exercise, and included measures of performance, perceptual measures of recovery, or CK.

Results

Twenty-eight studies were meta-analysed. CWI was superior to other recovery methods for recovering from muscle soreness, and similar to other methods for recovery of muscular power and flexibility. CWI was more effective than active recovery, contrast water therapy and warm-water immersion for most recovery outcomes. Air cryotherapy was significantly more effective than CWI for the promotion of recovery of muscular strength and the immediate recovery of muscular power (1-h post-exercise). Meta-regression revealed that water temperature and exposure duration were rarely exposure moderators.

Conclusion

CWI is effective for promoting recovery from acute strenuous exercise in physically active populations compared with other common recovery methods.

Protocol Registration

Open Science Framework: https://doi.org/10.17605/OSF.IO/NGP7C

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Authors and Affiliations

  1. Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, SA, Australia

    Emma Moore, Clint R. Bellenger, Siena Saunders & Jonathan D. Buckley

  2. Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie Park, NSW, Australia

    Joel T. Fuller

  3. School of Behavioural and Health Sciences, McAuley at Banyo, Brisbane, QLD, Australia

    Shona L. Halson

  4. Institute for Health and Sport (IHES), Victoria University, VIC, Australia

    James R. Broatch

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Correspondence to Emma Moore.

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Funding

Emma Moore is supported by a Research Training Program (Domestic) Scholarship from the Australian Commonwealth Department of Education and Training. No other sources of funding were used to assist in the preparation of this article.

Conflicts of interest

Emma Moore, Joel T. Fuller, Sienna Saunders, Shona L. Halson, James R. Broatch and Clint R. Bellenger declare that they have no conflicts of interest. Jonathan D. Buckley is a recipient of a grant from the Norwood Football Club to evaluate the effects of CWI on recovery of athletic performance. Norwood Football Club had no involvement in the current manuscript.

Author contributions

Emma Moore, Jonathan D. Buckley, Shona L. Halson, James R. Broatch and Clint R. Bellenger contributed to the design of the review and completion of the search strategy. Emma Moore and Sienna Saunders completed data screening and data extraction. Joel T. Fuller was responsible for the meta-analysis. Emma Moore drafted the manuscript. All authors edited and revised the manuscript and approved the final version of the manuscript.

Data availability statement

The datasets generated and/or analysed during the current systematic review are available in the Online Supplementary Material 2–8, see ESM.

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Moore, E., Fuller, J.T., Bellenger, C.R. et al. 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-Regression. Sports Med 53, 687–705 (2023). https://doi.org/10.1007/s40279-022-01800-1

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