Postexercise Cold Water Immersion Benefits Are Not Greater than the Placebo Effect

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Sø 2. Physioblog Andreas Bjerregaard 3.Søernesfysioterapi

Postexercise Cold Water Immersion Benefits Are Not Greater than the Placebo Effect

  • Medicine and science in sports and exercise 46(11) · March 2014

Purpose: Despite a general lack of understanding of the underlying mechanisms, cold water immersion (CWI) is widely used by athletes for recovery.

The aim of this study was to examine the effects of cold water immersion on cardiac dynamics (cardiac output, heart rate, cardiac parasympathetic activity), muscle hemodynamics (SmO2 and tHb), thermoregulation (intramuscular and skin temperature), and muscle strength following resistance exercise.

The study also investigated changes in these variables in response to light-intensity exercise or “active recovery” following resistance exercise, because this method is used frequently as a recovery therapy for athletes. These two recovery therapies are very different and are difficult to compare directly. Nevertheless, contrasting physiological effects of these two modalities are a valid reflection of current practices in the training of high-performance athletes. We hypothesized that cold water immersion would reduce tissue temperature and cardiac and peripheral hemodynamics, and delay recovery of strength after resistance exercise, whereas active recovery would have the opposite effect.

This study also examined if the placebo effect is responsible for any acute performance or psychological benefits. They implemented a 15-minutes period of either cold water immersion (-10,3C) thermo-neutral water immersion (-34,7C) (control condition) or the same thermo-neutral condition with addition of a ”recovery olie” following high-intensity cycling exercise. Participants were also given false information, indicating that the addition of this recovery olie (bath soap) would be beneficial.


10 active male performed an acute high-intensity interval training session, comprised of 4 x 30-s sprints, immediately followed by one of the following three 15-min recovery conditions:

  • 10min of CWI (10.3C). The participants were immersed up to the level of the umbilicus
  • Thermoneutral water immersion placebo (TWP) (34.7C) (recovery olie)
  • Thermoneutral water immersion control (TWI) (34.7C).

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An intramuscular thermistor was inserted during exercise and recovery to record muscle temperature. Swelling (thigh girth), pain threshold/tolerance, interleukin 6 concentration, and total leukocyte, neutrophil, and lymphocyte counts were recorded at baseline, postexercise, postrecovery, and 1, 24, and 48 h postexercise.

A maximal voluntary isometric contraction (MVC) of the quadriceps was performed at the same time points, with the exception of postexercise.

Self-assessments of readiness for exercise, fatigue, vigor, sleepiness, pain, and belief of recovery effectiveness were also completed.


Unilateral knee extension exercise

Strenght was the only performance variable measured and the researchers reported no difference in strenght outcome. 2The unilateral knee extension exercise bout did not differ between the active recovery and cold water immersion.

Cardiac Dynamics

Systolic, diastolic, and arterial pressures increased significantly after exercise compared with before exercise and did not differ significantly before the two recovery interventions (Table 1). Systolic blood pressure remained higher after cold water immersion than before exercise, whereas systolic, diastolic, and arterial blood pressure remained higher after active recovery than before exercise. After the recovery interventions.

Skin and Muscle Temperature

Muscle and skin temperatures were higher than preexercise tempera- tures immediately after resistance exercise and before the recovery interventions in both trials.  There were no differences in muscle temperature or skin temperature before the recovery interventions.

Leg strength after the MVC and ratings of readiness for exercise, pain, and vigor were significantly impaired in TWI compared with those in CWI and TWP which were similar to each other.

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Another new and important finding from this study is that cold water immersion prevented any decrease in maximal isometric strength after resistance exercise.

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Fig. 6. Peak isometric torque preexercise (PRE) and at 5, 20, and 40 min in to the recovery period (corresponding to 25, 40, and 65 min after the resistance exercise bout) in the CWI and ACT trials. Gray shaded area indicates the period of CWI or ACT. Note that the x-axis is not drawn to scale. Data are expressed as means 􏰀 SD. *P 􏰃 0.05 vs. preexercise.

Similar to this findings, other studies has reported that cold water immersion helped to maintain maximal isometric strength immediately after 30 min intermittent sprint exercise. By contrast, other research has demonstrated no effect of cold water immersion on maximal isometric strength at rest (i.e., with no prior exercise) or 1–2 h after exhaustive cycling or resistance exercise. This variability may be due to differences in cold water immersion protocols (temperature, duration, or body surface area immersed) and the metabolic and neuromuscular demands of exercise.


In summary, it’s difficult to compare directly the physiological effects of cold water immersion and active recovery. Nevertheless, knowledge of the contrasting effects of these recovery therapies is important to enhance our understanding of which modality to use in different circumstances. This can be attributed to improved ratings of readiness for exercise, pain, and vigor, suggesting that the commonly hypothesized physiological benefits surrounding CWI are at least partly placebo related.

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