title: Can Water Temperature and Immersion Time Influence the Effect of Cold Water Immersion on Muscle Soreness? A Systematic Review and Meta-Analysis.
abstract: BACKGROUND
  Cold water immersion (CWI) is a technique commonly used in post-exercise recovery. However, the procedures involved in the technique may vary, particularly in terms of water temperature and immersion time, and the most effective approach remains unclear.
  
  
  OBJECTIVE
  The objective of this systematic review was to determine the efficacy of CWI in muscle soreness management compared with passive recovery. We also aimed to identify which water temperature and immersion time provides the best results.
  
  
  METHODS
  The MEDLINE, EMBASE, SPORTDiscus, PEDro [Physiotherapy Evidence Database], and CENTRAL (Cochrane Central Register of Controlled Trials) databases were searched up to January 2015. Only randomized controlled trials that compared CWI to passive recovery were included in this review. Data were pooled in a meta-analysis and described as weighted mean differences (MDs) with 95% confidence intervals (CIs).
  
  
  RESULTS
  Nine studies were included for review and meta-analysis. The results of the meta-analysis revealed that CWI has a more positive effect than passive recovery in terms of immediate (MD = 0.290, 95% CI 0.037, 0.543; p = 0.025) and delayed effects (MD = 0.315, 95% CI 0.048, 0.581; p = 0.021). Water temperature of between 10 and 15 °C demonstrated the best results for immediate (MD = 0.273, 95% CI 0.107, 0.440; p = 0.001) and delayed effects (MD = 0.317, 95% CI 0.102, 0.532; p = 0.004). In terms of immersion time, immersion of between 10 and 15 min had the best results for immediate (MD = 0.227, 95% 0.139, 0.314; p < 0.001) and delayed effects (MD = 0.317, 95% 0.102, 0.532, p = 0.004).
  
  
  CONCLUSIONS
  The available evidence suggests that CWI can be slightly better than passive recovery in the management of muscle soreness. The results also demonstrated the presence of a dose-response relationship, indicating that CWI with a water temperature of between 11 and 15 °C and an immersion time of 11-15 min can provide the best results.
authors.affiliation: Departamento de Fisioterapia, Faculdade de Ciências e Tecnologia, Universidade Estadual Paulista, 305 Roberto Simonsen, Presidente Prudente, São Paulo, 19060-900, Brazil.
authors.forename: Aryane Flauzino
authors.initials: AF
authors.lastname: Machado
authors.affiliation: Discipline of Physiotherapy, Faculty of Health Science, The University of Sydney, Sydney, NSW, Australia.
authors.forename: Paulo Henrique
authors.initials: PH
authors.lastname: Ferreira
authors.affiliation: Departamento de Fisioterapia, Faculdade de Ciências e Tecnologia, Universidade Estadual Paulista, 305 Roberto Simonsen, Presidente Prudente, São Paulo, 19060-900, Brazil.
authors.forename: Jéssica Kirsch
authors.initials: JK
authors.lastname: Micheletti
authors.affiliation: Departamento de Fisioterapia, Centro de Ciências Biológicas e da Saúde, Universidade Federal de São Carlos, São Carlos, Brazil.
authors.forename: Aline Castilho
authors.initials: AC
authors.lastname: de Almeida
authors.affiliation: Departamento de Fisioterapia, Faculdade de Ciências e Tecnologia, Universidade Estadual Paulista, 305 Roberto Simonsen, Presidente Prudente, São Paulo, 19060-900, Brazil.
authors.forename: Ítalo Ribeiro
authors.initials: ÍR
authors.lastname: Lemes
authors.affiliation: Departamento de Fisioterapia, Faculdade de Ciências e Tecnologia, Universidade Estadual Paulista, 305 Roberto Simonsen, Presidente Prudente, São Paulo, 19060-900, Brazil.
authors.forename: Franciele Marques
authors.initials: FM
authors.lastname: Vanderlei
authors.affiliation: Departamento de Fisioterapia, Faculdade de Ciências e Tecnologia, Universidade Estadual Paulista, 305 Roberto Simonsen, Presidente Prudente, São Paulo, 19060-900, Brazil.
authors.forename: Jayme
authors.initials: J
authors.lastname: Netto Junior
authors.affiliation: Departamento de Fisioterapia, Faculdade de Ciências e Tecnologia, Universidade Estadual Paulista, 305 Roberto Simonsen, Presidente Prudente, São Paulo, 19060-900, Brazil. pastre@fct.unesp.br.
authors.forename: Carlos Marcelo
authors.initials: CM
authors.lastname: Pastre
mesh_terms: D003080:Cold Temperature; D017679:Cryotherapy / Q000379:methods*; D006801:Humans; D063806:Myalgia / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D013997:Time Factors