Cold-Water Immersion for Post-exercise Recovery: An Overlap-Aware Umbrella Review.
5 affiliations
- 1Faculty of Health Sciences and Sports, Macao Polytechnic University, Macao, SAR, China. [email protected].
- 2School of Physical Education and Leisure, Guangdong Ocean University, Zhanjiang, China.
- 3Department of Physical Education, Kunsan National University, Gunsan-si, South Korea.
- 4School of Physical Education and Health, Zunyi Medical University, Zunyi, China.
- 5School of Physical Education and Sports Science, Hengyang Normal University, Hengyang, China.
Abstract
Background
Cold-water immersion (CWI) is widely used after strenuous exercise, but review-level findings vary by outcome, comparator, recovery window, population, and protocol. Reuse of the same primary studies across reviews can also exaggerate apparent consistency.Methods
We searched PubMed, Web of Science, SPORTDiscus, Cochrane Library, Embase, and Scopus from inception to 30 January 2026 for systematic reviews, meta-analyses, and network meta-analyses of post-exercise CWI. Fourteen reviews were included. Primary-study overlap was quantified using the corrected covered area (CCA) overall and for outcome-specific study-to-review mappings. Because overlap was high and review-level estimates were statistically dependent, we did not perform second-order meta-analysis. Source-verified estimates were synthesized in a structured, overlap-aware format. Methodological quality was assessed with AMSTAR 2.Results
Of the 14 included reviews, 13 provided quantitative estimates, whereas one review provided narrative evidence on heart rate variability (HRV). Overall CCA was 12.68% (high); 99 of 165 primary-study families appeared in at least two reviews. Outcome-specific CCA was 15.03% for delayed onset muscle soreness (DOMS; very high) and ranged from 0.00% for interleukin-6 (IL-6) to 25.00% for C-reactive protein (CRP). It was not calculable for HRV, because one review contributed. AMSTAR 2 confidence was low in 2 reviews and critically low in 12. DOMS showed the most consistent favorable pattern: source-review standardized mean differences ranged from -1.04 to -0.37, although the largest estimate was soccer-specific and its 95% prediction interval crossed zero. Because DOMS evidence was highly redundant across the contributing reviews, this apparent consistency does not represent independent replications. Findings for objective performance and biochemical outcomes were inconsistent, time-dependent, or comparator-dependent.Conclusions
Within the available review-level evidence, CWI was associated with the most consistent reduction in self-reported short-term post-exercise DOMS, but the clinical importance of the observed effects remains uncertain. Evidence does not support a uniform benefit across objective performance or inflammatory outcomes. Protocol observations, including commonly studied temperatures and durations, are descriptive and should not be interpreted as an optimized prescription. Trial Registration PROSPERO CRD420261332482.
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BibTeX
@article{liang2026coldwater,
title = {{Cold-Water Immersion for Post-exercise Recovery: An Overlap-Aware Umbrella Review.}},
author = {Weibao Liang and Xiaoge Ma and Guanping Sun and Chuannan Liu and Xujie Yan},
journal = {Sports medicine - open},
year = {2026},
month = oct,
doi = {10.1186/s40798-026-01132-8},
url = {https://europepmc.org/article/MED/42909756},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Cold-Water Immersion for Post-exercise Recovery: An Overlap-Aware Umbrella Review.
AU - Weibao Liang
AU - Xiaoge Ma
AU - Guanping Sun
AU - Chuannan Liu
AU - Xujie Yan
PY - 2026
DA - 2026/10/23
JO - Sports medicine - open
DO - 10.1186/s40798-026-01132-8
UR - https://europepmc.org/article/MED/42909756
AB - Background Cold-water immersion (CWI) is widely used after strenuous exercise, but review-level findings vary by outcome, comparator, recovery window, population, and protocol. Reuse of the same primary studies across reviews can also exaggerate apparent consistency.Methods We searched PubMed, Web of Science, SPORTDiscus, Cochrane Library, Embase, and Scopus from inception to 30 January 2026 for systematic reviews, meta-analyses, and network meta-analyses of post-exercise CWI. Fourteen reviews were included. Primary-study overlap was quantified using the corrected covered area (CCA) overall and for outcome-specific study-to-review mappings. Because overlap was high and review-level estimates were statistically dependent, we did not perform second-order meta-analysis. Source-verified estimates were synthesized in a structured, overlap-aware format. Methodological quality was assessed with AMSTAR 2.Results Of the 14 included reviews, 13 provided quantitative estimates, whereas one review provided narrative evidence on heart rate variability (HRV). Overall CCA was 12.68% (high); 99 of 165 primary-study families appeared in at least two reviews. Outcome-specific CCA was 15.03% for delayed onset muscle soreness (DOMS; very high) and ranged from 0.00% for interleukin-6 (IL-6) to 25.00% for C-reactive protein (CRP). It was not calculable for HRV, because one review contributed. AMSTAR 2 confidence was low in 2 reviews and critically low in 12. DOMS showed the most consistent favorable pattern: source-review standardized mean differences ranged from -1.04 to -0.37, although the largest estimate was soccer-specific and its 95% prediction interval crossed zero. Because DOMS evidence was highly redundant across the contributing reviews, this apparent consistency does not represent independent replications. Findings for objective performance and biochemical outcomes were inconsistent, time-dependent, or comparator-dependent.Conclusions Within the available review-level evidence, CWI was associated with the most consistent reduction in self-reported short-term post-exercise DOMS, but the clinical importance of the observed effects remains uncertain. Evidence does not support a uniform benefit across objective performance or inflammatory outcomes. Protocol observations, including commonly studied temperatures and durations, are descriptive and should not be interpreted as an optimized prescription. Trial Registration PROSPERO CRD420261332482.
SN - 2199-1170
SN - 2198-9761
ER -