Multiple Cold-Water Immersions Attenuate Muscle Damage but not Alter Systemic Inflammation and Muscle Function Recovery: A Parallel Randomized Controlled Trial

Thermal Modalities Including Hot Baths and Cold Plunges Play a Unique Role in Injury Prevention and Recovery

There are several different modalities for injury prevention to consider in order to help our patients' reach their ultimate goals. The purpose of this review is to analyze the use of hot and cold therapies to prevent injury. Thermotherapy has been used in clinical rehabilitation settings to treat health conditions. The therapeutic use of cold, known as cryotherapy, is historically the most popular treatment for acute musculoskeletal injury or fatigue. Cold therapy was seen to decrease delayed-onset muscle soreness and help resolve global or generalized muscle injury or fatigue. In sum, both cold and hot therapy play similar but unique roles in injury prevention and recovery. The key to effective use of either depends on understanding the nature of the injury and mastering the appropriate timing of therapeutic application. By leveraging the unique mechanisms of each modality, athletes can optimize their recovery process and reduce the risk of future injury.

Level of Evidence

Level V, expert opinion.

Impact of different doses of cold water immersion (duration and temperature variations) on recovery from acute exercise-induced muscle damage: a network meta-analysis

Objective

This network meta-analysis and systematic review evaluated the recovery impacts of varying cold water immersion (CWI) protocols on acute exercise-induced muscle damage.

Methods

We searched CNKI, PubMed, Cochrane Library, Web of Science, and Embase from January 2000 to September 2024 for randomized controlled trials examining CWI's recovery effects on acute muscle damage. Data extraction, study screening, and risk of bias assessment were conducted independently by two reviewers. Analyses were performed using Stata 16.0.

Results

A total of 55 RCTs were included, with 42 reporting delayed onset muscle soreness (DOMS), 36 reporting jump performance (JUMP), and 30 reporting creatine kinase (CK) levels. Network meta-analysis showed that compared with the control group, MD-MT-CWI: Medium-duration medium-temperature cold water immersion (10-15 min, 11°C-15°C) [SMD = -1.45, 95%CI(-2.13, -0.77), P < 0.01] and MD-LT-CWI: Medium-duration low-temperature cold water immersion (10-15 min, 5°C-10°C) [SMD = -1.12, 95%CI(-1.78, -0.47), P = 0.01] significantly reduced DOMS; MD-LT-CWI (10-15 min, 5°C-10°C) [SMD = 0.48, 95%CI(0.20, 0.77), P = 0.01] and MD-MT-CWI (10-15 min, 11°C-15°C) [SMD = 0.42, 95%CI(0.15, 0.70), P = 0.02] significantly improved JUMP; MD-MT-CWI (10-15 min, 11°C-15°C) [SMD = -0.85, 95%CI(-1.36, -0.35), P = 0.01] and MD-LT-CWI (10-15 min, 5°C-10°C) [SMD = -0.90, 95%CI(-1.46, -0.34), P = 0.02] significantly reduced CK. Cumulative probability ranking showed that MD-LT-CWI (10-15 min, 5°C-10°C) was the most effective for improving JUMP and reducing CK, while MD-MT-CWI (10-15 min, 11°C-15°C) was the most effective for reducing DOMS.

Conclusion

Different dosages of cold water immersion (varying in duration and temperature) had different effects on recovery from acute exercise-induced muscle damage. We found that MD-LT-CWI (10-15 min, 5°C-10°C) was most effective for improving biochemical markers (CK) and neuromuscular recovery, while MD-MT-CWI (10-15 min, 11°C-15°C) was most effective for reducing muscle soreness. In practice, we recommend using MD-LT-CWI (10-15 min, 5°C-10°C) and MD-MT-CWI (10-15 min, 11°C-15°C) to reduce Exercise-induced muscle damage (EIMD). However, due to the limitations of the included studies, further high-quality studies are needed to verify these conclusions.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/, identifier CRD42024602359.

Enhancing Post-Training Muscle Recovery and Strength in Paralympic Powerlifting Athletes with Cold-Water Immersion, a Cross-Sectional Study

(1) Background: The recovery method is important and decisive in the training system. This study aimed to assess the effects of various post-training recovery methods on muscle damage and strength indicators in Paralympic powerlifting athletes. (2) Methods: A crossover study was conducted involving eleven male athletes (25.4 ± 3.3 years, 70.3 ± 12.1 kg). Muscle damage was assessed using blood biochemical markers (cytokines IL-6, IL-10, and TNF-α) and isometric force indicators, including the maximum isometric force (MIF), time to MIF, and Rate of Force Development. The following assessments were performed before, immediately after, and at 24 and 48 h after the recovery protocol: (a) passive recovery (RP) or (b) cold-water immersion (CWI). (3) Results: The main results indicated that maximum isometric force (MIF) significantly improved after 48 h of CWI application (p < 0.05; for all comparison). The analysis of biochemical markers did not yield significant differences between the recovery methods at different time points (p > 0.05). For IL-6, there were significant differences between CWI before (2.29 ± 1.08, 95% CI 1.57-3.01) and CWI 2 h later (2 h) (4.59 ± 2.96, 95% CI 2.60-6.57; p = 0.045), and between CWI 15 min later (15 min) (4.14 ± 2.24, 95% CI 2.63-5.64) and CWI 48 h later (48 h) (2.33 ± 1.25, 95% CI 1.49-3.17; p = 0.034). There were differences between CWI 2 h (4.14 ± 2.24, 95% CI 2.63-5.64) and CWI 48 h later (2.33 ± 1.25, 95% CI 1.49-3.17; p = 0.035; F = 9.202; η2p = 0.479; high effect). (4) Conclusions: CWI significantly improved the post-resistance training muscle damage and strength in Paralympic powerlifting athletes.

Effects of multiple cold-water immersion during pre-season on recovery performance in under-20 male soccer players: A randomized controlled trial

INTRODUCTION

This study was designed to evaluate the effects of multiple cold-water immersions performed daily during the preseason period on biochemical, clinical, and neuromuscular aspects of muscle damage of soccer players.

METHODS

This two-arm, prospectively registered, randomized controlled trial, blinded to statistician and assessors, was conducted at professional football club facilities. Twenty-three under-20 semi-professionals male soccer players were randomly allocated into cold water immersion group (bathtub with water and ice at 10 °C ± 1 °C for 10 min) or control group (rest for 10 min), every day, after training sessions during a preseason. Primary outcome was change in creatine kinase (CK) concentration, and secondary outcomes were changes in vertical jump performance, strength and perception of recovery at baseline (T0) and after protocol training (T1).

RESULTS

Analysis of Covariance (ANCOVA) showed a statistically significant time-group interactions for CK concentration, with an average reduction of 280.39 U/L (CI95% = -519.14, -41.64; d = 0.55) in the cold-water immersion compared to the control group. No differences between groups were observed in any other measures.

CONCLUSION

Multiple cold-water immersions at 10 °C for 10 min decreases CK concentration but does not change any clinical and neuromuscular markers of muscle damage in soccer players during a 9-day preseason.

The effects of hydrotherapy and cryotherapy on recovery from acute post-exercise induced muscle damage-a network meta-analysis

BACKGROUND

This systematic review and network meta-analysis assessed via direct and indirect comparisons the recovery effects of hydrotherapy and cold therapy at different temperatures on exercise induced muscle damage.

METHODS

Five databases were searched in English and Chinese. The included studies included exercise interventions such as resistance training, high-intensity interval training, and ball games, which the authors were able to define as activities that induce the appearance of EIMD. The included RCTs were analyzed using the Cochrane Risk of Bias tool. Eligible studies were included and and two independent review authors extracted data. Frequentist network meta-analytical approaches were calculated based on standardized mean difference (SMD) using random effects models. The effectiveness of each intervention was ranked and the optimal intervention was determined using the surface under the cumulative ranking curve (SUCRA) indicator.

RESULTS

57 studies with 1220 healthy participants were included, and four interventions were examined: Cold Water Immersion (CWI), Contrast Water Therapy (CWT), Thermoneutral or Hot Water Immersion (TWI/HWI), and Cryotherapy(CRYO). According to network meta-analysis, Contrast Water Immersion (SUCRA: 79.9% )is most effective in recovering the biochemical marker Creatine Kinase. Cryotherapy (SUCRA: 88.3%) works best to relieve Delayed Onset Muscle Soreness. In the recovery of Jump Ability, cryotherapy (SUCRA: 83.7%) still ranks the highest.

CONCLUSION

We found that CWT was the best for recovering biochemical markers CK, and CRYO was best for muscle soreness and neuromuscular recovery. In clinical practice, we recommend the use of CWI and CRYO for reducing EIMD.

SYSTEMATIC REVIEW REGISTRATION

[PROSPERO], identifier [CRD42023396067].

Effectiveness of cryo plus ultrasound therapy versus diathermy in combination with high-intensity laser therapy for pain relief in footballers with muscle injuries: A prospective study

BACKGROUND

Muscle injuries are common traumatic events in the clinical practice of the rehabilitation field. There is still a gap in the scientific literature on the effectiveness of physical agent modalities in the management of muscle injuries in athletes.

OBJECTIVE

The aim of this study was to assess the effectiveness of cryo plus ultrasound therapy com-pared to diathermy in combination with high-intensity laser therapy (HILT) for pain relief in professional footballers with muscle injuries.

METHODS

A case-control study was conducted on 31 professional footballers with a muscle injury of the lower limbs. Of these, 17 patients, assigned to a Group A (AG), were treated with HILT and cryoultrasound therapy; the remaining 14 patients, assigned to a Group B (BG), underwent HILT and diathermy. We assessed the extent of the pain, the size of the muscle injury, frequency of recurrence and number of days to recovery, at the time of recruitment, at the end of the rehabilitation and 3 months after the injury.

RESULTS

Group A athletes had a greater benefit on pain (4.65 ± 0.61 vs 3.24 ± 0.63; p< 0.05) and muscle injury recurrence. The return to play in the athletes of group A took place 4.73 days earlier.

CONCLUSION

HILT and cryo plus ultrasound therapy, in combination with therapeutic exercise, rep-resent a valid strategy in the treatment of muscle injuries in professional footballers.

Sodium salicylate ameliorates exercise-induced muscle damage in mice by inhibiting NF-kB signaling

BACKGROUND

Eccentric muscle contraction can cause muscle damage, which reduces the efficiency of exercise. Previous evidence suggested that Sodium salicylate (SS) could improve the repair of aged muscle. This study intends to investigate whether SS can impact skeletal muscle damage caused by eccentric exercise.

METHODS

Eccentric treadmill exercise was performed to induce muscle damage in mice. Plasma levels of muscle damage markers were estimated. RT-qPCR was employed for detecting mRNA levels of proinflammatory mediators in murine gastrocnemius muscle. Immunofluorescence staining of laminin/DAPI was utilized for quantifying centrally nucleated myofibers in the gastrocnemius muscle. Western blotting was implemented to examine protein levels of mitsugumin 53 (MG53), matrix metalloproteinase (MMP)-2/9, and NF-κB signaling-related markers.

RESULTS

SS administration reduced muscle damage marker production in the plasma and decreased the levels of proinflammatory mediators, MG53 and MMP-2/9 in mice after exercise. SS alleviated the severity of muscle damage in the gastrocnemius of mice after eccentric exercise. SS blocked NF-κB signaling pathway in the gastrocnemius muscle.

CONCLUSION

SS administration ameliorates skeletal muscle damage caused by eccentric exercise in the mouse model.

Determination of the Effects of a Series of Ten Whole-Body Cryostimulation Sessions on Physiological Responses to Exercise and Skin Temperature Behavior following Exercise in Elite Athletes

The present study investigated the effects of a series of 10 whole-body cryostimulation (WBC) sessions (3 min; -110 °C) on physiological and thermal responses to a submaximal exercise test in 17 elite athletes. Participants performed an exercise test twice at similar levels of intensity before and after a series of ten WBC sessions. Before and during the test, each participant's oxygen uptake (VO2), heart rate (HR), internal temperature (Ti), and skin temperature in selected areas of the skin were measured, and the mean arterial pressure (MAP), physiological strain index (PSI), and mean skin temperature (Tsk) were calculated. The results show that during exercise, increases in Ti and the PSI were significantly lower after the WBC sessions, and although there were no significant changes in HR or the MAP, the Tsk was significantly higher. Following exercise, an increase in skin temperature asymmetry over the lower-body muscles was detected. A series of WBC sessions induced a tendency toward a decrease in temperature asymmetry over the thigh muscles. In conclusion, a series of ten WBC sessions does not induce significant modifications in physiological variables but does influence the PSI and Ti during exercise. Moreover, a series of ten WBC sessions influences the distribution of skin temperature and the magnitude of temperature asymmetries in the early phase of recovery.

Multiple cryosauna sessions for post-exercise recovery of delayed onset muscle soreness (DOMS): a randomized control trial

The main goal was to investigate the effectiveness of cryosauna in preventing the development of delayed onset muscle soreness and to analyze the regenerative changes within muscles after acute fatigue-induced exercises. Thirty-one volunteers were assigned into two groups: 1) an intervention group that participated in cryostimulation after fatigue-induced exercise protocol (CRYO, n = 16) and a control group that performed fatigue-induced exercise protocol, but without any intervention (CONT, n = 15). Main outcome measures include at baseline: blood sample testing (leukocyte content, myoglobin concentration, and creatine kinase activity) and muscle stiffness of lower extremity; immediately after (stiffness), and 24-48-72-96 h post-exercise (blood samples and stiffness). Both groups performed an exercise-induced muscle damage protocol based on repeated countermovement jumps (10 sets, 10 repetitions). The CRYO group underwent a cryosauna (temperature: -110°C, time: 1.5 min per session) intervention during four sessions (i.e., immediately after, 24-48-72 h post-exercise). Leukocyte content was significantly greater 24-48-72 h after exercise in CONT, compared with the CRYO group (p ≤ 0.05 for all), while creatine kinase activity was greater 24-48-96 h in CONT, compared with the CRYO group (p ≤ 0.05 for all). Muscle stiffness increased significantly in rectus femoris, tibialis anterior, and fibula muscle after 48 h post-exercise (p ≤ 0.05 for all), as well as in tibialis anterior and fibula after 72 h post-exercise (p ≤ 0.05 for all) in the CRYO group. Multiple cryosauna was an effective recovery strategy that reduced blood biomarkers and muscle stiffness after exercise-induced muscle damage. Moreover, the development of delayed onset muscle soreness, expressed by a greater muscle stiffness post-exercise, was attenuated to the first 48 h.

Cold water immersion in recovery following a single bout resistance exercise suppresses mechanisms of miRNA nuclear export and maturation

Cold water immersion (CWI) following intense exercise is a common athletic recovery practice. However, CWI impacts muscle adaptations to exercise training, with attenuated muscle hypertrophy and increased angiogenesis. Tissue temperature modulates the abundance of specific miRNA species and thus CWI may affect muscle adaptations via modulating miRNA expression following a bout of exercise. The current study focused on the regulatory mechanisms involved in cleavage and nuclear export of mature miRNA, including DROSHA, EXPORTIN-5, and DICER. Muscle biopsies were obtained from the vastus lateralis of young males (n = 9) at rest and at 2, 4, and 48 h of recovery from an acute bout of resistance exercise, followed by either 10 min of active recovery (ACT) at ambient temperature or CWI at 10°C. The abundance of key miRNA species in the regulation of intracellular anabolic signaling (miR-1 and miR-133a) and angiogenesis (miR-15a and miR-126) were measured, along with several gene targets implicated in satellite cell dynamics (NCAM and PAX7) and angiogenesis (VEGF and SPRED-1). When compared to ACT, CWI suppressed mRNA expression of DROSHA (24 h p = 0.025 and 48 h p = 0.017), EXPORTIN-5 (24 h p = 0.008), and DICER (24 h p = 0.0034). Of the analyzed miRNA species, miR-133a (24 h p < 0.001 and 48 h p = 0.007) and miR-126 (24 h p < 0.001 and 48 h p < 0.001) remained elevated at 24 h post-exercise in the CWI trial only. Potential gene targets of these miRNA, however, did not differ between trials. CWI may therefore impact miRNA abundance in skeletal muscle, although the precise physiological relevance needs further investigation.

Early Neuromuscular Electrical Stimulation Preserves Muscle Size and Quality and Maintains Systemic Levels of Signaling Mediators of Muscle Growth and Inflammation in Patients with Traumatic Brain Injury: A Randomized Clinical Trial

Objective

To investigate the effects of an early neuromuscular electrical stimulation (NMES) protocol on muscle quality and size as well as signaling mediators of muscle growth and systemic inflammation in patients with traumatic brain injury (TBI).

Design

Two-arm, single-blinded, parallel-group, randomized, controlled trial with a blinded assessment. Setting. Trauma intensive care unit at a university hospital. Participants. Forty consecutive patients on mechanical ventilation (MV) secondary to TBI were prospectively recruited within the first 24 hours following admission. Interventions. The intervention group (NMES; n = 20) received a daily session of NMES on the rectus femoris muscle for five consecutive days (55 min/each session). The control group (n = 20) received usual care. Main Outcome Measures. Muscle echogenicity and thickness were evaluated by ultrasonography. A daily blood sample was collected to assess circulating levels of insulin-like growth factor I (IGF-I), inflammatory cytokines, and matrix metalloproteinases (MMP).

Results

Both groups were similar at baseline. A smaller change in muscle echogenicity and thickness (difference between Day 1 and Day 7) was found in the control group compared to the NMES group (29.9 ± 2.1 vs. 3.0 ± 1.2, p < 0.001; -0.79 ± 0.12 vs. -0.01 ± 0.06, p < 0.001, respectively). Circulating levels of IGF-I, pro-inflammatory cytokines (IFN-y), and MMP were similar between groups.

Conclusion

An early NMES protocol can preserve muscle size and quality and maintain systemic levels of signaling mediators of muscle growth and inflammation in patients with TBI. This trial is registered with https://www.ensaiosclinicos.gov.br under number RBR-2db.

Astaxanthin Supplementation Does Not Affect Markers of Muscle Damage or Inflammation After an Exercise-Induced Muscle Damage Protocol in Resistance-Trained Males

ABSTRACT

Waldman, HS, Bryant, AR, Parten, AL, Grozier, CD, and McAllister, MJ. Astaxanthin supplementation does not affect markers of muscle damage or inflammation after an exercise-induced muscle damage protocol in resistance-trained males. J Strength Cond Res 37(7): e413-e421, 2023-It is well documented that exercise-induced muscle damage (EIMD) decreases exercise performance by elevated inflammation and subjective discomfort. Due to its potent antioxidative properties, astaxanthin (AX) may serve as a potential dietary supplement strategy for mitigating delayed-onset muscle soreness (DOMS) and enhancing recovery and performance. This study aimed to investigate the effects of AX on markers of muscle damage, inflammation, DOMS, and anaerobic performance and substrate metabolism. Thirteen resistance-trained men (mean ± SD , age, 23.4 ± 2.1 years) completed a double-blind, counterbalanced, and crossover design with a 1-week washout period between 2, 4-week supplementation periods at 12 mg·d -1 of AX or placebo. After each supplementation period, subjects completed 2 trials, with trial 1 including a graded exercise test (GXT) and a 30-second Wingate and trial 2 including an EIMD protocol followed by the collection of fasting blood samples (pre-post) to measure creatine kinase, advanced oxidative protein products, C-reactive protein, interleukin-6, insulin, and cortisol. Astaxanthin supplementation had no statistical effects on markers of substrate metabolism during the GXT, Wingate variables, or markers of muscle damage, inflammation, or DOMS when compared with placebo (all p > 0.05). However, 4 weeks of AX supplementation did significantly lower oxygen consumption during the final stage of the GXT (12%, p = 0.02), as well as lowered systolic blood pressure (∼7%, p = 0.04), and significantly lowered baseline insulin values (∼24%, p = 0.05) when compared with placebo. Collectively, these data suggest that 4 weeks of AX supplementation at 12 mg·d -1 did not affect markers of muscle damage, inflammation, or DOMS after an EIMD protocol in a resistance-trained male cohort.

Whole body-electromyostimulation effects on serum biomarkers, physical performances and fatigue in Parkinson's patients: A randomized controlled trial

Background

Whole-body electromyostimulation (WB-EMS) was never previously applied to Parkinson's disease (PD) patients. This randomized controlled study aimed to find the most effective and safe WB-EMS training protocol for this population.

Methods

Twenty-four subjects (age: 72.13 ± 6.20 years), were randomly assigned to three groups: a high-frequency WB-EMS strength training group (HFG) (rectangular stimulation at 85 Hz, 350 μs, 4 s stimulation/4 s rest), a low-frequency WB-EMS aerobic training group (LFG) (rectangular stimulation 7 Hz, 350 μs, with a continuous pulse duration), and an inactive control group (CG). Participants of the two experimental groups underwent 24 controlled WB-EMS training sessions, with a duration of 20 min each, during 12-week intervention. Serum growth factors (BDNF, FGF-21, NGF and proNGF), α-synuclein, physical performance and Parkinson's Disease Fatigue Scale (PFS-16) responses were analyzed to evaluate the pre-post variation and differences among groups.

Results

Significant interactions of Time*Groups were detected for BDNF (Time*Groups p = 0.024; Time*CG, b = -628, IC95% = -1,082/-174, p = 0.008), FGF-21 (Time*Groups p = 0.009; Time*LFG b = 1,346, IC95% = 423/2268, p = 0.005), and α-synuclein (Time*Groups p = 0.019; Time*LFG b = -1,572, IC95% = -2,952/-192, p = 0.026). Post hoc analyses and comparisons of ΔS (post-pre), performed independently for each group, showed that LFG increased serum BDNF levels (+ 203 pg/ml) and decreased α-synuclein levels (-1,703 pg/ml), while HFG showed the opposite effects (BDNF: -500 pg/ml; α-synuclein: + 1,413 pg/ml). CG showed a significant BDNF reduction over time. Both LFG and HFG showed significant improvements in several physical performance outcomes and the LFG showed better results than HFG. Concerning PFS-16, significant differences over time (b = -0.4, IC95% = -0.8/-0.0, p = 0.046) and among groups (among all groups p < 0.001) were found, and the LFG exhibited better results than the HFG (b = -1.0, IC95% = -1.3/-0.7, p < 0.001), and CG (b = -1.7, IC95% = -2.0/-1.4, p < 0.001) with this last one that worsened over time.

Conclusion

LFG training was the best choice for improving or maintaining physical performance, fatigue perception and variation in serum biomarkers.

Clinical trial registration

https://www.clinicaltrials.gov/ct2/show/NCT04878679, identifier NCT04878679.

Effects of cold water immersion after exercise on fatigue recovery and exercise performance--meta analysis

Cold water immersion (CWI) is very popular as a method reducing post-exercise muscle stiffness, eliminating fatigue, decreasing exercise-induced muscle damage (EIMD), and recovering sports performance. However, there are conflicting opinions as to whether CWI functions positively or negatively. The mechanisms of CWI are still not clear. In this systematic review, we used meta-analysis aims to examine the effect of CWI on fatigue recovery after high-intensity exercise and exercise performance. A total of 20 studies were retrieved and included from PubMed, PEDro and Elsevier databases in this review. Publication years of articles ranged from 2002 to 2022. In selected studies including randomized controlled trials (RCTs) and Crossover design (COD). Analyses of subjective indicators such as delayed-onset muscle soreness (DOMS) and ratings of perceived exertion (RPE), and objective indicators such as countermovement jump (CMJ) and blood plasma markers including creatine kinase(CK), lactate/lactate dehydrogenase(LDH), C-reactive protein(CRP), and IL-6 were performed. Pooled data showed as follows: CWI resulted in a significant decline in subjective characteristics (delayed-onset muscle soreness and perceived exertion at 0 h); CWI reduced countermovement jump(CMJ) significantly at 0 h, creatine kinase(CK) was lowered at 24 h, and lactate at 24 and 48 h. There was no evidence that CWI affects C-reactive protein(CRP) and IL-6 during a 48-h recovery period. Subgroup analysis revealed that different CWI sites and water temperatures have no effect on post-exercise fatigue recovery. Recommended athletes immersed in cold water immediately after exercise, which can effectively reduce muscle soreness and accelerate fatigue recovery.

Different Cryotherapy Modalities Demonstrate Similar Effects on Muscle Performance, Soreness, and Damage in Healthy Individuals and Athletes: A Systematic Review with Metanalysis

Background: There are extensive studies focusing on non-invasive modalities to recover physiological systems after exercise-induced muscle damage (EIMD). Whole-body cryotherapy (WBC) and Partial-body cryotherapy (PBC) have been recommended for recovery after EIMD. However, to date, no systematic reviews have been performed to compare their effects on muscle performance and muscle recovery markers. Methods: This systematic review with metanalysis compared the effects of WBC and PBC on muscle performance, muscle soreness (DOMS), and markers of muscular damage following EIMD. We used Pubmed, Embase, PEDro, and Cochrane Central Register of Controlled Trials as data sources. Two independent reviewers verified the methodological quality of the studies. The studies were selected if they used WBC and PBC modalities as treatment and included muscle performance and muscle soreness (DOMS) as the primary outcomes. Secondary outcomes were creatine kinase and heart rate variability. Results: Six studies with a pooled sample of 120 patients were included. The methodological quality of the studies was moderate, with an average of 4.3 on a 0–10 scale (PEDro). Results: Both cryotherapy modalities induce similar effects without difference between them. Conclusion: WBC and PBC modalities have similar global responses on muscle performance, soreness, and markers of muscle damage.

Impact of Cold-Water Immersion Compared with Passive Recovery Following a Single Bout of Strenuous Exercise on Athletic Performance in Physically Active Participants: A Systematic Review with Meta-analysis and Meta-regression

Background

Studies investigating the effects of cold-water immersion (CWI) on the recovery of athletic performance, perceptual measures and creatine kinase (CK) have reported mixed results in physically active populations.

Objectives

The purpose of this systematic review was to investigate the effects of CWI on recovery of athletic performance, perceptual measures and CK following an acute bout of exercise in physically active populations.

Study Design

Systematic review with meta-analysis and meta-regression.

Methods

A systematic search was conducted in September 2021 using Medline, SPORTDiscus, Scopus, Web of Science, Cochrane Library, EmCare and Embase databases. Studies were included if they were peer reviewed and published in English, included participants who were involved in sport or deemed physically active, compared CWI with passive recovery methods following an acute bout of strenuous exercise and included athletic performance, athlete perception and CK outcome measures. Studies were divided into two strenuous exercise subgroups: eccentric exercise and high-intensity exercise. Random effects meta-analyses were used to determine standardised mean differences (SMD) with 95% confidence intervals. Meta-regression analyses were completed with water temperature and exposure durations as continuous moderator variables.

Results

Fifty-two studies were included in the meta-analyses. CWI improved the recovery of muscular power 24 h after eccentric exercise (SMD 0.34 [95% CI 0.06–0.62]) and after high-intensity exercise (SMD 0.22 [95% CI 0.004–0.43]), and reduced serum CK (SMD − 0.85 [95% CI − 1.61 to − 0.08]) 24 h after high-intensity exercise. CWI also improved muscle soreness (SMD − 0.89 [95% CI − 1.48 to − 0.29]) and perceived feelings of recovery (SMD 0.66 [95% CI 0.29–1.03]) 24 h after high-intensity exercise. There was no significant influence on the recovery of strength performance following either eccentric or high-intensity exercise. Meta-regression indicated that shorter time and lower temperatures were related to the largest beneficial effects on serum CK (duration and temperature dose effects) and endurance performance (duration dose effects only) after high-intensity exercise.

Conclusion

CWI was an effective recovery tool after high-intensity exercise, with positive outcomes occurring for muscular power, muscle soreness, CK, and perceived recovery 24 h after exercise. However, after eccentric exercise, CWI was only effective for positively influencing muscular power 24 h after exercise. Dose–response relationships emerged for positively influencing endurance performance and reducing serum CK, indicating that shorter durations and lower temperatures may improve the efficacy of CWI if used after high-intensity exercise.

Funding

Emma Moore is supported by a Research Training Program (Domestic) Scholarship from the Australian Commonwealth Department of Education and Training.

Protocol registration

Open Science Framework: 10.17605/OSF.IO/SRB9D.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40279-022-01644-9.

Effect of cold and heat therapies on pain relief in patients with delayed onset muscle soreness: A network meta-analysis

OBJECTIVE

To comprehensively compare the effectiveness of cold and heat therapies for delayed onset muscle soreness using network meta-analysis.

METHODS

Eight Chinese and English databases were searched from date of establishment of the database to 31 May 2021. Cochrane risk-of-bias tool was used to analyse the included randomized controlled trials. Potential papers were screened for eligibility, and data were extracted by 2 independent researchers.

RESULTS

A total of 59 studies involving 1,367 patients were eligible for this study. Ten interventions were examined: contrast water therapy, phase change material, the novel modality of cryotherapy, cold-water immersion, hot/warm-water immersion, cold pack, hot pack, ice massage, ultrasound, and passive recovery. Network meta-analysis results showed that: (i) within 24 h after exercise, hot pack was the most effective for pain relief, followed by contrast water therapy; (ii) within 48 h, the ranking was hot pack, followed by the novel modality of cryotherapy; and (iii) over 48 h post-exercise, the effect of the novel modality of cryotherapy ranked first.

CONCLUSION

Due to the limited quality of the included studies, further well-designed research is needed to draw firm conclusions about the effectiveness of cold and heat therapies for delayed onset muscle soreness.

Athlete, coach and practitioner knowledge and perceptions of post-exercise cold-water immersion for recovery: a qualitative and quantitative exploration

This survey sought to establish current use, knowledge and perceptions of cold-water immersion (CWI) when used for recovery. 111 athletes, coaches and support practitioners completed the anonymous online survey, answering questions about their current CWI protocols, perceptions of benefits associated with CWI and knowledge of controlling mechanisms. Respondents were largely involved in elite sport at international, national and club level, with many having used CWI previously (86%) and finding its use beneficial for recovery (78%). Protocols differed, with the duration of immersion one aspect that failed to align with recommendations in the scientific literature. Whilst many respondents were aware of benefits associated with CWI, there remains some confusion. There also seems to be a gap in mechanistic knowledge, where respondents are aware of benefits associated with CWI, but failed to identify the underlying mechanisms. This identifies the need for an improved method of knowledge transfer between scientific and applied practice communities. Moreover, data herein emphasises the important role of the ‘support practitioner’ as respondents in this role tended to favour CWI protocols more aligned to recommendations within the literature. With a significant number of respondents claiming they were made aware of CWI for recovery through a colleague (43%), the importance of knowledge transfer and context being appropriately applied to data is as important as ever. With the firm belief that CWI is useful for recovery in sport, the focus should now be on investigating the psychophysiological interaction and correct use of this methodology.

Acute Effects of Intermittent Foot Cooling on 1 RM Leg Press Strength in Resistance-Trained Men: A Pilot Study

Inter-set peripheral cooling can improve high-intensity resistance exercise performance. However, whether foot cooling (FC) would increase 1 repetition maximum (RM) lower-limb strength is unclear. This study investigated the effect of intermittent FC on 1 RM leg press strength. Ten recreational male lifters performed three attempts of 1 RM leg press with FC or non-cooling (NC) in a repeated-measures crossover design separated by 5 days. FC was applied by foot immersion in 10 °C water for 2.5 min before each attempt. During the 1 RM test, various physiological measures were recorded. The results showed that FC elicited higher 1 RM leg press strength (Δ [95% CI]; Cohen's d effect size [ES]; 13.6 [7.6-19.5] kg; ES = 1.631) and electromyography values in vastus lateralis (57.7 [8.1-107.4] μV; ES = 0.831) and gastrocnemius (15.1 [-3.1-33.2] μV; ES = 0.593) than in NC. Higher arousal levels (felt arousal scale) were found in FC (0.6 [0.1-1.2]; ES = 0.457) than in NC. In conclusion, the preliminary findings, although limited, suggest intermittent FC has a potential ergogenic role for recreational athletes to enhance maximal lower-limb strength and may partly benefit strength-based competition events.

Physical therapy interventions for the treatment of delayed onset muscle soreness (DOMS): Systematic review and meta-analysis

OBJECTIVE

To evaluate the impact of interventions on pain associated with DOMS.

DATA SOURCES

PubMed, EMBASE, PEDro, Cochrane, and Scielo databases were searched, from the oldest records until May/2020. Search terms used included combinations of keywords related to "DOMS" and "intervention therapy".

ELIGIBILITY CRITERIA

Healthy participants (no restrictions were applied, e.g., age, sex, and exercise level). To be included, studies should be: 1) Randomized clinical trial; 2) Having induced muscle damage and subsequently measuring the level of pain; 3) To have applied therapeutic interventions (nonpharmacological or nutritional) and compare with a control group that received no intervention; and 4) The first application of the intervention had to occur immediately after muscle damage had been induced.

RESULTS

One hundred and twenty-one studies were included. The results revealed that the contrast techniques (p = 0,002 I² = 60 %), cryotherapy (p = 0,002 I² = 100 %), phototherapy (p = 0,0001 I² = 95 %), vibration (p = 0,004 I² = 96 %), ultrasound (p = 0,02 I² = 97 %), massage (p < 0,00001 I² = 94 %), active exercise (p = 0,0004 I² = 93 %) and compression (p = 0,002 I² = 93 %) have a better positive effect than the control in the management of DOMS.

CONCLUSION

Low quality evidence suggests that contrast, cryotherapy, phototherapy, vibration, ultrasound, massage, and active exercise have beneficial effects in the management of DOMS-related pain.

Residual effects of short-term whole-body cold-water immersion on the cytokine profile, white blood cell count, and blood markers of stress

Background: One of the most challenging environmental extremes is immersion in cold/icy water, and consequent common assumption is that even a brief exposure to cold can lead to cold-related illnesses. The increase in the concentrations of the stress hormones cortisol, epinephrine (Epi), and norepinephrine (NE) in response to acute cold stress are thought to suppress the release of proinflammatory cytokines. No previous study has explored the residual consequences of whole-body short-term cold-water immersion (CWI; 14 °C for 10 min) on the immune response in healthy non-acclimated young adult men (aged 20-30 years).Materials and methods: In the current study, we tested the hypothesis that short-term acute whole-body CWI would induce high blood levels of cortisol, NE, and Epi, which in turn would increase circulating leukocyte numbers and delay the production of proinflammatory cytokines (tumor necrosis factor α (TNF-α), interleukin 1β (IL-1β), and IL-6). Results: Short-term whole-body CWI produced a stressful physiological reaction, as manifested by hyperventilation and increased muscle shivering, metabolic heat production, and heart rate. CWI also induced the marked release of the stress hormones Epi, NE, and cortisol. The change in IL-6 concentration after CWI was delayed and TNF-α production was decreased, but IL-1β was not affected within 48 h after CWI. A delayed increase in neutrophil percentage and decrease in lymphocyte percentage occurred after CWI.Conclusion: These findings suggest that, even though CWI caused changes in stress and immune markers, the participants showed no predisposition to symptoms of the common cold within 48 h after CWI.

Recovery during and after a simulated multi-day tennis tournament: Combining active recovery, stretching, cold-water immersion, and massage interventions

The aim of this study was to investigate the effects of a mixed-method recovery intervention (MMR) consisting of active recovery, stretching, cold-water immersion, and massage on physical, technical, physiological, and perceptual recovery during and after a five-day simulated tennis tournament. Nine competitive male tennis players (age, 24.6±4.2 years) with national ranking positions (German Tennis Federation) and Universal Tennis Ratings between approximately 11-13 participated in two singles tennis tournaments, which were separated by a three-month washout period. During the tournaments, participants played five two-and-a-half-hour competitive singles tennis match on five consecutive days. For the assignment to one of two groups, athletes were matched into homogeneous pairs according to their ranking. Then, within each pair, the players were randomly assigned to one of two groups. The first group performed MMR during the first tournament, whereas the other group used passive recovery (PAS). During the second tournament, recovery conditions were interchanged. Measures of physical and technical performance as well as physiological and perceptual responses (heart rate, blood lactate concentration, perceived exertion) were recorded during match-play sessions. Furthermore, muscle soreness, perceived recovery state, blood markers, countermovement jump height (CMJ), and repeated sprint ability (RSA) were determined before, during, and after the five-day tournament periods. Results showed significant changes over time (P < 0.05) in muscle soreness, perceived recovery state, creatine kinase, c-reactive protein, insulin-like growth factor 1, and countermovement jump height. However, no significant differences or recovery strategy x time interactions were noted either for tennis-specific performance (e.g. number of total points won) or any other of the measured parameters between MMR and PAS (P > 0.05). In conclusion, the repeated use of MMR during and after a five-day tennis tournament did not affect match performance, match load, or recovery from repeated days of tennis match play.

The Effects of Regular Cold-Water Immersion Use on Training-Induced Changes in Strength and Endurance Performance: A Systematic Review with Meta-Analysis

BACKGROUND

Cold-water immersion (CWI) is one of the main recovery methods used in sports, and is commonly utilized as a means to expedite the recovery of performance during periods of exercise training. In recent decades, there have been indications that regular CWI use is potentially harmful to resistance training adaptations, and, conversely, potentially beneficial to endurance training adaptations. The current meta-analysis was conducted to assess the effects of the regular CWI use during exercise training on resistance (i.e., strength) and endurance (i.e., aerobic exercise) performance alterations.

METHODS

A computerized literature search was conducted, ending on November 25, 2019. The databases searched were MEDLINE, Cochrane Central Register of Controlled Trials, and SPORTDiscus. The selected studies investigated the effects of chronic CWI interventions associated with resistance and endurance training sessions on exercise performance improvements. The criteria for inclusion of studies were: (1) being a controlled investigation; (2) conducted with humans; (3) CWI performed at ≤ 15 °C; (4) being associated with a regular training program; and (5) having performed baseline and post-training assessments.

RESULTS

Eight articles were included before the review process. A harmful effect of CWI associated with resistance training was verified for one-repetition maximum, maximum isometric strength, and strength endurance performance (overall standardized mean difference [SMD] = - 0.60; Confidence interval of 95% [CI95%] = - 0.87, - 0.33; p < 0.0001), as well as for Ballistic efforts performance (overall SMD = - 0.61; CI95% = - 1.11, - 0.11; p = 0.02). On the other hand, selected studies verified no effect of CWI associated with endurance training on time-trial (mean power), maximal aerobic power in graded exercise test performance (overall SMD = - 0.07; CI95% = - 0.54, 0.53; p = 0.71), or time-trial performance (duration) (overall SMD = 0.00; CI95% = - 0.58, 0.58; p = 1.00).

CONCLUSIONS

The regular use of CWI associated with exercise programs has a deleterious effect on resistance training adaptations but does not appear to affect aerobic exercise performance.

TRIAL REGISTRATION

PROSPERO CRD42018098898.

Intramuscular Temperature Changes in the Quadriceps Femoris Muscle After Post-Exercise Cold-Water Immersion (10°C for 10 min): A Systematic Review With Meta-Analysis

Post-exercise cold-water immersion (CWI) is a widely accepted recovery strategy for maintaining physical performance output. However, existing review articles about the effects of CWI commonly pool data from very heterogenous study designs and thus, do rarely differentiate between different muscles, different CWI-protocols (duration, temperature, etc.), different forms of activating the muscles before CWI, and different thickness of the subcutaneous adipose tissue. This systematic review therefore aimed to investigate the effects of one particular post-exercise CWI protocol (10°C for 10 min) on intramuscular temperature changes in the quadriceps femoris muscle while accounting for skinfold thickness. An electronic search was conducted on PubMed, LIVIVO, Cochrane Library, and PEDro databases. Pooled data on intramuscular temperature changes were plotted with respect to intramuscular depth to visualize the influence of skinfold thickness. Spearman's rho (r_s) was used to assess a possible linear association between skinfold thickness and intramuscular temperature changes. A meta-analysis was performed to investigate the effect of CWI on pre-post intramuscular temperature for each measurement depth. A total of six articles met the inclusion criteria. Maximum intramuscular temperature reduction was 6.40°C with skinfold thickness of 6.50 mm at a depth of 1 cm, 4.50°C with skinfold thickness of 11.00 mm at a depth of 2 cm, and only 1.61°C with skinfold thickness of 10.79 mm at a depth of 3 cm. However, no significant correlations between skinfold thickness and intramuscular temperature reductions were observed at a depth of 1 cm (r _s = 0.0), at 2 cm (r _s = -0.8) and at 3 cm (r _s = -0.5; all p > 0.05). The CWI protocol resulted in significant temperature reductions in the muscle tissue layers at 1 cm (d = -1.92 [95% CI: -3.01 to -0.83] and 2 cm (d = -1.63 [95% CI: -2.20 to -1.06]) but not at 3 cm (p < 0.05). Skinfold thickness and thus, subcutaneous adipose tissue, seems to influence temperature reductions in the muscle tissue only to a small degree. These findings might be useful for practitioners as they demonstrate different intramuscular temperature reductions after a specific post-exercise CWI protocol (10°C for 10 min) in the quadriceps femoris muscle.

The cold truth: the role of cryotherapy in the treatment of injury and recovery from exercise

Cryotherapy is utilized as a physical intervention in the treatment of injury and exercise recovery. Traditionally, ice is used in the treatment of musculoskeletal injury while cold water immersion or whole-body cryotherapy is used for recovery from exercise. In humans, the primary benefit of traditional cryotherapy is reduced pain following injury or soreness following exercise. Cryotherapy-induced reductions in metabolism, inflammation, and tissue damage have been demonstrated in animal models of muscle injury; however, comparable evidence in humans is lacking. This absence is likely due to the inadequate duration of application of traditional cryotherapy modalities. Traditional cryotherapy application must be repeated to overcome this limitation. Recently, the novel application of cooling with 15 °C phase change material (PCM), has been administered for 3-6 h with success following exercise. Although evidence suggests that chronic use of cryotherapy during resistance training blunts the anabolic training effect, recovery using PCM does not compromise acute adaptation. Therefore, following exercise, cryotherapy is indicated when rapid recovery is required between exercise bouts, as opposed to after routine training. Ultimately, the effectiveness of cryotherapy as a recovery modality is dependent upon its ability to maintain a reduction in muscle temperature and on the timing of treatment with respect to when the injury occurred, or the exercise ceased. Therefore, to limit the proliferation of secondary tissue damage that occurs in the hours after an injury or a strenuous exercise bout, it is imperative that cryotherapy be applied in abundance within the first few hours of structural damage.

The Specific Judo Training Program Combined With the Whole Body Cryostimulation Induced an Increase of Serum Concentrations of Growth Factors and Changes in Amino Acid Profile in Professional Judokas

This study aimed to evaluate the effect of a specific training program, supported by 10 sessions of whole body cryostimulation, on growth factors concentrations, amino acids profile and motor abilities in professional judokas. Ultimately, twelve athletes took part in the study. They were randomly assigned to the cryostimulation group (CRY, n = 6) or the control group (CON, n = 6). During 2 weeks of the judo training program, the CRY group performed 10 cryo-sessions (3-min, at a temperature of -110°C) and the CON group rested passively. Anthropometric measurements, a strength test, the Special Judo Efficiency Test (SJET) were assessed 2 days before and after the judo training program. Blood samples were collected at rest, 1 h after the first and the second SJET and 1 h after the first and the last cryo-session to establish growth factors and amino acid concentrations. Lactate level was measured before, immediately after and 1 h after the first and the second SJET. The applied intervention resulted in a significant increase of resting concentrations of brain-derived neurotrophic factor (from 10.23 ± 1.61 to 15.13 ± 2.93 ng⋅ml^-1; p = 0.01) and insulin-like growth factor 1 (IGF-1; from 174.29 ± 49.34 to 300.50 ± 43.80 pg⋅ml^-1; p = 0.00) in the CRY group. A different response was registered 1 h directly post SJET in the CRY group (a significant increase of IGF-1, interleukin 15 and irisin: p = 0.01; p = 0.00; p = 0.03). Additionally, the significant drop of proline and leucine concentrations in the CRY group was obtained. Athletes' performance remained unchanged in both groups. However, subjects perceived positive changes induced by the intervention - not directly after cryostimulation but in response to the specific training workload. The increase of growth factors concentrations and the improvement of amino acid profile (proline and leucine) contributed to maintaining a high level of muscle function.

Effect of Acute Interset Foot Cooling on Lower Limb Strength Training Workout

PURPOSE

The authors investigated the effect of foot cooling (FC) between sets in a leg press pyramid workout with resistance-trained participants.

METHODS

A total of 12 resistance-trained men (age = 21.8 [0.6] y; training experience = 1.7 [1] y) performed a pyramid workout, including 4 sets of 85% to 90% 1-repetition maximum leg press exercise to exhaustion with interset FC or noncooling in a repeated-measures crossover design separated by 5 days. The authors immersed the participants' feet in 10°C water for 2.5 minutes between sets.

RESULTS

Two-way repeated-measures analysis of variance revealed that FC elicited significantly higher repetitions and electromyography (EMG) values of the vastus lateralis (simple main effect of condition) than did noncooling (P < .05) in the second (repetitions: 11 [3.5] vs 7.75 [3.2]; EMG: 63.4% [19.4%] vs 54.5% [18.4%]), third (repetitions: 8.9 [3.2] vs 6.4 [2.1]; EMG: 71.5% [17.4%] vs 60.6% [19.4%]), and fourth (repetitions: 7.5 [2.7] vs 5.1 [2.2]; EMG: 75.2% [19.6%] vs 59.3% [23.5%]) sets. The authors also detected a simple main effect of set in the FC and noncooling conditions on repetitions (P < .05) and in the FC condition on the vastus lateralis EMG values. Although the authors observed no time × trial interactions for the rating of perceived exertion, the authors observed main effects on the sets (7.7-9.6 vs 7.9-9.3, P < .05).

CONCLUSIONS

Interset FC provides an ergogenic effect on a leg press pyramid workout and may offset fatigue, as indicated by higher repetitions and EMG response, without increasing perceived exertion.

In vivo Ca2+ dynamics during cooling after eccentric contractions in rat skeletal muscle

The effect of cooling on in vivo intracellular calcium ion concentration [Ca²⁺]_i after eccentric contractions (ECs) remains to be determined. We tested the hypothesis that cryotherapy following ECs promotes an increased [Ca²⁺]_i and induces greater muscle damage in two muscles with substantial IIb and IIx fiber populations. The thin spinotrapezius (SPINO) muscles of Wistar rats were used for in vivo [Ca²⁺]_i imaging, and tibialis anterior (TA) muscles provided greater fidelity and repeatability of contractile function measurements. SPINO [Ca²⁺]_i was estimated using fura 2-AM and the magnitude, location, and temporal profile of [Ca²⁺]_i determined as the temperature near the muscle surface post-ECs was decreased from 30°C (control) to 20°C or 10°C. Subsequently, in the TA, the effect of post-ECs cooling to 10°C on muscle contractile performance was determined at 1 and 2 days after ECs. TA muscle samples were examined by hematoxylin and eosin staining to assess damage. In SPINO, reducing the muscle temperature from 30°C to 10°C post-ECs resulted in a 3.7-fold increase in the spread of high [Ca²⁺]_i sites generated by ECs (P < 0.05). These high [Ca²⁺]_i sites demonstrated partial reversibility when rewarmed to 30°C. Dantrolene, a ryanodine receptor Ca²⁺ release inhibitor, reduced the presence of high [Ca²⁺] sites at 10°C. In the TA, cooling exacerbated ECs-induced muscle strength deficits via enhanced muscle fiber damage (P < 0.05). By demonstrating that cooling post-ECs potentiates [Ca²⁺]_i derangements, this in vivo approach supports a putative mechanistic basis for how postexercise cryotherapy might augment muscle fiber damage and decrease subsequent exercise performance.

Heat and cold therapy reduce pain in patients with delayed onset muscle soreness: A systematic review and meta-analysis of 32 randomized controlled trials

OBJECTIVE

The aim of this review and meta-analysis was to evaluate the effect of heat and cold therapy on the treatment of delayed onset muscle soreness (DOMS).

METHODS

We followed our protocol that was registered in PROSPERO with ID CRD42020170632. A systematic review and meta-analysis of randomized controlled trials (RCT) was conducted. Nine databases were searched up to December 2020. Data was extracted from the retained studies and underwent methodological quality assessment and meta-analysis.

RESULTS

A total of 32 RCTs involving 1098 patients were included. Meta-analysis showed that, the application of cold therapy within 1 h after exercise could reduce the pain of DOMS patients within 24 h (≤24 h) after exercise (SMD -0.57,95%CI -0.89 to -0.25, P = 0.0005) and had no obvious effect within more than 24 h (>24 h) (P = 0.05). In cold therapies, cold water immersion (SMD -0.48, 95%CI -0.84 to -0.13, P = 0.008) and other cold therapies (SMD -0.68, 95%CI -1.28 to -0.08, P = 0.03) had the significant effects within 24 h. Heat treatment could reduce the pain of patients. It had obvious effects on the pain within 24 h (SMD -1.17, 95%CI -2.62 to -0.09, P = 0.03) and over 24 h (SMD -0.82, 95%CI -1.38 to -0.26, P = 0.004). Hot pack effect was the most obvious, which reduced the pain within 24 h (SMD -2.31, 95%CI -4.33 to -0.29, P = 0.03) and over 24 h (SMD -1.78, 95%CI -2.97 to -0.59, P = 0.003). Other thermal therapies were not statistically significant (P > 0.05). Both cold and heat showed effect in reducing pain of patients, however there was no significant difference between cold and heat group (P = 0.16).

CONCLUSIONS

The current evidence indicated that the application of cold and heat therapy within 1 h after exercise could effectively reduce the pain degree of DOMS patients for 24 h cold water immersion and hot pack therapy, which had the best effect, could promote the recovery of DOMS patients. But more high-quality studies are needed to confirm whether cold or heat therapy work better.

Don't Lose Your Cool With Cryotherapy: The Application of Phase Change Material for Prolonged Cooling in Athletic Recovery and Beyond

Strenuous exercise can result in muscle damage in both recreational and elite athletes, and is accompanied by strength loss, and increases in soreness, oxidative stress, and inflammation. If the aforementioned signs and symptoms associated with exercise-induced muscle damage are excessive or unabated, the recovery process becomes prolonged and can result in performance decrements; consequently, there has been a great deal of research focussing on accelerating recovery following exercise. A popular recovery modality is cryotherapy which results in a reduction of tissue temperature by the withdrawal of heat from the body. Cryotherapy is advantageous because of its ability to reduce tissue temperature at the site of muscle damage. However, there are logistical limitations to traditional cryotherapy modalities, such as cold-water immersion or whole-body cryotherapy, because they are limited by the duration for which they can be administered in a single dose. Phase change material (PCM) at a temperature of 15°C can deliver a single dose of cooling for a prolonged duration in a practical, efficacious, and safe way; hence overcoming the limitations of traditional cryotherapy modalities. Recently, 15°C PCM has been locally administered following isolated eccentric exercise, a soccer match, and baseball pitching, for durations of 3-6 h with no adverse effects. These data showed that using 15°C PCM to prolong the duration of cooling successfully reduced strength loss and soreness following exercise. Extending the positive effects associated with cryotherapy by prolonging the duration of cooling can enhance recovery following exercise and give athletes a competitive advantage.

Inflammation and Skeletal Muscle Regeneration: Leave It to the Macrophages!

Inflammation is usually considered as harmful; however, it is also necessary for tissue recovery after injury. Macrophages exert immune and nonimmune functions throughout this process. During skeletal muscle regeneration, they mount an inflammatory response while exerting trophic roles on muscle and mesenchymal stem cells. Proinflammatory macrophages shift to being anti-inflammatory, triggering the resolution of inflammation. Studies have highlighted that during this shift, a crosstalk ensues, integrating cues for resolution, efferocytosis, cellular metabolism, and signaling pathways. During the restorative phase, macrophages dampen inflammation while promoting stem cell differentiation, angiogenesis, and matrix remodeling. Since blunting the inflammatory phase can be detrimental for muscle regeneration, we suggest that rather than fighting inflammation, it should be allowed to operate and resolve, thus allowing for tissue recovery.

Cold water immersion recovery strategy increases blood pressure levels after high-intensity intermittent exercise

BACKGROUND

This study aimed to investigate the effects of cold water immersion (CWI) recovery strategies on the blood pressure levels and related physiological parameters after high-intensity intermittent exercise (HIIE).

METHODS

This randomized crossover study included 20 men (21.5±1.6 years). Each participant performed a maximum-exertion exercise performance test on a bicycle, and heart rate was measured. Subsequently, six cycles of HIIE (1 minute at 120% heart rate reserve [HRR] and 4 minutes at 40% HRR) were performed in a random sequence, and the recovery period involved either CWI or static rest (SR).

RESULTS

Systolic and diastolic blood pressure levels at the 6th and 20th minute of CWI recovery were significantly higher than those during SR and significantly higher than those during a quiet state at the 6th minute. The heart rates at the 20th minute and 35th minute of CWI recovery were significantly lower than that during SR, and the ratings of perceived exertion (RPE) at the 6th and 20th minute of CWI recovery were significantly lower than that during SR. No significant difference in lactate production was evident between the two recovery strategies. Ear temperature was not significantly different when it was quiet, at the end of exercise, and at the 6th and 35th minute of recovery; however, at the 20th minute of recovery, ear temperature during CWI was significantly higher than that during SR.

CONCLUSIONS

CWI after HIIE reduced the extent to which blood pressure decreased. For the fatigue-related heart rate and RPE indicators, CWI was superior to SR.