Comparison of the Effects of Cold-Water Immersion Applied Alone and Combined Therapy on the Recovery of Muscle Fatigue After Exercise: A Systematic Review and Meta-Analysis

Cold-water immersion (CWI), as a common recovery method, has been widely used in the field of post-exercise fatigue recovery. However, there is still a lack of comprehensive and systematic scientific evaluation of the combined effects of cold-water immersion combined with other therapies (CWI + Other). The aim of this study was to compare the effects of CWI and CWI + Other in post-exercise fatigue recovery and to explore the potential benefits of CWI + Other. We systematically searched PubMed, Embase, Web of Science, Cochrane Library and EBSCO databases to include 24 studies (475 subjects in total) and performed a meta-analysis using standardized mean difference (SMD) and 95% confidence intervals (CIs). The results showed that both CWI + Other (SMD = −0.68, 95% CI: −1.03 to −0.33) and CWI (SMD = −0.37, 95% CI: −0.65 to −0.10) were effective in reducing delayed-onset muscle soreness (DOMS). In subgroup analyses of athletes, both CWI + Other (SMD = −1.13, 95% CI: −1.76 to −0.49) and CWI (SMD = −0.47, 95% CI: −0.87 to −0.08) also demonstrated significant effects. In addition, CWI + Other significantly reduced post-exercise C-reactive protein (CRP) levels (SMD = −0.62, 95% CI: −1.12 to −0.13), and CWI with water temperatures higher than 10 °C also showed a CRP-lowering effect (MD = −0.18, 95% CI: −0.30 to −0.07), suggesting a potential benefit in anti-inflammation. There were no significant differences between the two interventions in the metrics of creatine kinase (CK; CWI: SMD = −0.01, 95% CI: −0.27 to 0.24; CWI + Other: SMD = 0.26, 95% CI: −0.51 to 1.03) or countermovement jump (CMJ; CWI: SMD = 0.22, 95% CI: −0.13 to 0.57; CWI + Other: SMD = 0.07, 95% CI: −0.70 to 0.85).