Effects of post-exercise hot and cold-water immersion on performance recovery and physiological markers in athletes: a systematic review
- Journal
- Frontiers in sports and active living (Q2)
- Published
- 3 July 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Juan Bustos Carvajal, Elkin Pérez Hurtado, Mónica Bustos Carvajal, Diego Mauricio Celis Villamizar, Florencio Arias Coronel
- PMID
- 42491492
- DOI
- 10.3389/fspor.2026.1794029
Why clinicians should know about it
- Picked for Biochemistry (medical) (top studies of the week, 26 July 2026).
Abstract
UNLABELLED: Cold water immersion (CWI) and hot water immersion (HWI) are widely used recovery strategies in sports, yet their comparative efficacy remains unclear. This systematic review evaluates the effects of post-exercise CWI and HWI on performance recovery and physiological markers in athletes. METHODS: Following PRISMA guidelines, a systematic search of Scopus, Web of Science, PubMed, and other databases was conducted up to December 2024. Randomized controlled trials and crossover studies comparing CWI, HWI, and control conditions in athletes or physically active individuals were included. Outcomes included perceptual recovery (DOMS, fatigue), biochemical markers (CK, cytokines), hormonal responses, and performance metrics. RESULTS: Eight studies were included. Neither CWI nor HWI consistently reduced DOMS or improved perceived recovery compared to control. However, HWI significantly improved sleep quality and acute anaerobic power, while CWI impaired immediate power output. Biochemically, chronic HWI reduced CK and increased testosterone, whereas CWI elevated HSP-72. Hormonal and inflammatory responses were modest, with no significant changes in cortisol or testosterone to cortisol ratio. CONCLUSIONS: The effects of water immersion are temperature and context dependent. HWI may benefit sleep and anaerobic performance, while CWI may hinder immediate power and induce cellular stress adaptations. Recovery strategy selection should align with specific athletic goals. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD420251156387, CRD420251156387.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.