Strategic Application of Post-exercise Cold-Water Immersion to Enhance Performance Recovery and Adaptation: An Umbrella Review of 15 Published Systematic Reviews with Meta-analysis

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• Picked for Biochemistry (medical) (top studies of the week, 4 October 2026): Umbrella review of cold‑water immersion effects

Abstract

BACKGROUND: Athletes commonly implement post-exercise cold-water immersion (CWI), with several meta-analyses having assessed its effectiveness. OBJECTIVES: To thoroughly review, appraise, and summarise existing systematic reviews with meta-analyses (SRMA) examining the effects of post-exercise CWI on the recovery of exercise performance and adaptation. METHODS: An umbrella review was conducted in accordance with the Joanna Briggs Institute guidelines. Methodological quality was assessed using AMSTAR 2, and certainty of evidence using GRADE. PROSPERO registration: (CRD420251103267). Eight databases were searched, including Web of Science, Scopus, SPORTDiscus, CINAHL, Cochrane Library, Embase, MEDLINE, and PubMed. Systematic reviews with meta-analyses of peer-reviewed randomised controlled trials examining post-exercise CWI vs passive rest or other recovery modalities on performance, training adaptation, or physiological, biochemical, and perceptual outcomes in healthy humans were included, with restriction to the English language. RESULTS: Fifteen SRMAs published between 2011 and 2025, comprising 161 unique studies, were included. Overall methodological quality was low to critically low, and certainty of evidence was low to very low, mainly due to inconsistency and imprecision. Protocols of 10-15 min at 10-15 or 5-10 °C appear to be most effective for improving performance and recovery. Post-exercise CWI resulted in significant improvements in muscular power at 24 h post-high-intensity exercise and at 24-48 h post-eccentric exercise, and in jump performance at 24-48 h, despite impaired jump performance in the initial hours after post-exercise CWI. Endurance performance improved immediately after CWI, but CWI produced no later benefits or positive effects on adaptations. CWI did not improve muscular strength performance, and impaired strength and hypertrophic gains. CWI improved heart rate variability immediately after exercise, reduced muscle soreness up to 96 h, and lowered creatine kinase (CK) concentrations between 24 and 72 h, with no significant effects on C-reactive protein or interleukin-6 up to 72 h. No immediate impact on blood lactate or lactate dehydrogenase was found, although some reductions appear 24-72 h post-exercise. CONCLUSIONS: Post-exercise CWI confers outcome-specific recovery benefits but may impair resistance training adaptations with chronic use. These findings support a periodised, context-driven approach to CWI implementation rather than routine application after all exercise sessions.

Abstract as published, via PubMed.