Effects of post-exercise hot and cold-water immersion on performance recovery and physiological markers in athletes: a systematic review.
Level 1 - systematic review of randomized trials
Systematic review of randomized controlled trials and crossover studies
PubMed 42491492 · doi:10.3389/fspor.2026.1794029
What was done
A systematic review conducted according to PRISMA guidelines searched Scopus, Web of Science, PubMed, and other databases up to December 2024. It included randomized controlled trials and crossover studies evaluating the effects of post-exercise cold water immersion (CWI) and hot water immersion (HWI) compared with control conditions in athletes or physically active individuals. Assessed outcomes included subjective recovery (DOMS, fatigue), biochemical markers (creatine kinase, cytokines), hormonal responses (testosterone, cortisol), and athletic performance metrics.
What was found
Eight studies were included. The abstract provides qualitative findings without reporting specific numbers or effect sizes. Neither CWI nor HWI consistently reduced DOMS or improved perceived recovery compared to controls. HWI significantly improved sleep quality and acute anaerobic power, while CWI impaired immediate power output. For biomarkers, chronic HWI reduced creatine kinase and increased testosterone, whereas CWI elevated heat shock protein 72 (HSP-72). Overall hormonal and inflammatory changes were modest, with no significant alterations in cortisol or the testosterone-to-cortisol ratio.
Why it matters
Post-exercise water immersion effects depend heavily on water temperature; hot water immersion may support sleep and acute anaerobic performance, whereas cold water immersion can suppress acute power output.
Limits
The review included only eight studies, and the abstract reports no pooled quantitative meta-analysis or numerical effect estimates. Protocols, water temperatures, and immersion durations likely varied substantially across studies, and long-term adaptation versus acute recovery tradeoffs were not clearly resolved.