Effects of Cold Water Immersion on Athletic Performance and Physiological Adaptations: A Systematic Review and Meta-Analysis

Abstract

Post-exercise recovery is essential for maintaining athletic performance and facilitating physiological adaptation. Cold water immersion (CWI) is widely utilized as a recovery strategy, although its effects on performance and physiological outcomes remain contentious. This systematic review and meta-analysis evaluated recent literature to determine the impact of CWI on athletic performance, recovery, and biochemical markers. In accordance with PRISMA 2020 guidelines, PubMed and Scopus were searched for articles published between 2021 and 2026. Of 1,919 identified articles, 21 met the inclusion criteria. The majority of included studies were rated as moderate to high quality based on the PEDro Scale. Findings indicated that CWI significantly improved countermovement jump (CMJ) performance (MD = 2.62 cm; 95% CI: 1.54 to 3.70; p < 0.00001), reduced blood lactate concentrations (MD = -0.27; 95% CI: -0.44 to -0.09; p = 0.002), and decreased creatine kinase (CK) levels (MD = -46.19; 95% CI: -65.91 to -26.47; p < 0.00001), suggesting enhanced metabolic recovery and reduced muscle damage. Conversely, CWI did not significantly affect sprint performance (MD = -0.02; p = 0.72) or maximal voluntary contraction (MVC) (SMD = 0.44; p = 0.18). Overall, CWI supports short-term recovery but does not consistently enhance high-intensity performance. Its use is most beneficial when rapid recovery is required, such as during competitions, whereas frequent application during training should be limited to avoid potential adverse effects on long-term adaptation.