Effect of immediate and delayed cold water immersion after a high intensity exercise session on subsequent run performance

I have chosen the following paper for our first journal club:

Brophy-Williams N, Landers G, Wallman K. Effect of immediate and delayed cold water immersion after a high intensity exercise session on subsequent run performance. Journal of Sports Science and Medicine; 2011; 10: 665-70

My reasons for choosing the paper are that it’s open access so we can all easily read it and cold water immersion for recovery is an area of interest to me. Have a read of the paper and think about these discussion points:

1. What do you think of the findings of this paper?

2. How should the findings from this paper influence recovery strategies?

You may find it helpful to use PICO when you analyse the paper. Participants, Intervention, Comparisson, Outcome. I find it a useful way to summarise the paper. I’ve also posted some links to critical appraisal websites and articles that you may find helpful (see blog entitled ‘Critical appraisal‘).

I’m looking forward to reading all your comments below. I will summarise the comments on Saturday 21st and the next journal club paper will be posted on 22nd January.

Happy reading!


  1. Hi there Ned,

    Firstly I really enjoyed the paper. I found it interesting how you used qualitative analysis in the results also, you do not often see that combination used in sport science research.
    When conducting the plan for your research, what was it that made you decide on 15*C for water temperature?
    I am currently publishing my own Masters dissertation on ice water immersion. Have you got any developing research plans for the future at all?

    Many thanks and kind regards,
    Dan Anderson

  2. Ned Brophy-Williams

    Hi Dan,
    Thanks for your comments. We carried out qualitative analysis because some of our quantitative analyses were very close, but didn’t quite meet the 0.05 level for significance, As you saw, we came out with some pleasing and relevant results.

    In regard to the water temperature, I simply chose 15*C as it seemed to be most common in other research into CWI that I had read at the time. It’s also an easily achieved temperature (doesn’t take tonnes of ice to reach or maintain!), so can be used in practice.
    That paper was my Honours degree research. I’ve just started an internship at the Australian Institute of Sport, so my personal research plans are limited at the moment, but I’d definitely like to look into it im more depth in the future though.

    I’d be interested to hear about what aspect of CWI you are investigating



Filed under Recovery, Sport Science Journal Club

9 responses to “Effect of immediate and delayed cold water immersion after a high intensity exercise session on subsequent run performance

  1. Merko

    I enjoyed reading this study and thought that it was well put together. Recovery is quite a big subject at the moment with lots of studies looking at different ways of maximising the way athletes recover so they feel fresh for the next training load. It’s obviously vital for any athletes that train on back to back days to prevent injury and overtraining. Lots of rugby clubs have been using cold water baths for a while now.
    My initial thoughts are that recovery is very subjective and it’s extremely difficult to determine if it was in fact CWI that was the cause of performance the following day. A larger study with more participants may help with this. I think it would also be interesting to measure muscle soreness over 2 or 3 days because it often doesn’t reach a peak until the 2nd or 3rd day post exercise. My belief is that CWI has more of a psychological benefit than a physiological benefit. This isn’t to be dismissed because I think the mind plays a strong part in determining sporting success, which is often overlooked. It’s more likely that CWI will be used by teams with greater resources, that have their players coming in on consecutive days. From a practical point of view I think it would also be good to see if the effects have diminished after a couple of days to see how useful it would be for semi-professional teams, with players that train twice a week and matches once or twice a week.
    Finally, whilst this study concentrated on athletes playing high intensity sports it would be interesting to see if there are any effects on endurance athletes, where psychology plays a big part in completing races.

  2. John Feeney

    Really interesting article. Prolonged EPOC may have an impact in mutli-event sports such as hepthalon. In these circumstances, CWI may not always be possible (especially as recreational athlete level) and so it would be interesting to compare CWI against an active recovery. This isn’t really an area that I am that familiar with but I wonder if comparing CWI with an active recovery would identify whether the reduction in inflammation (reducing odema and increasing force production) would be more beneficial and quicker than using an active recovery to help return of lactate and pH to resting levels? I agree with the previous post that there is psychological aspect to this as well which is not a criticism of the study.

  3. Dylan and John – interesting comments. They have given us some food for thought. I’m going to summarise your comments and the paper this weekend. Let me know if you have any suggestions for the next paper.

  4. Ben Brugman

    So often in working with athletes who sit outside the framework of professional sport and therefore do not have the resources available to them that these organizations provide it is about educating the athlete on what they ARE able to do. This article provides solid evidence that CWI is not wasted if the athlete is unable to utilize it immediately. As most people do, these athletes have other aspects of their lives which require attending to which may not allow them to engage in cold water immersion immediately post-performance. The knowledge that CWI up to 3hrs post-exercise can still have a very beneficial effect may mean the difference between them taking CWI on as a recovery modality or undertaking no recovery modality at all. Whether the mechanism of action by which CWI achieves these positive results is 90% physiological and 10% psychological, vice versa or anywhere in between this is still aiding in performance and opening the door for these athletes into stepping toward other methods of recovery.

    Following on from this however, the basics need to be taken care of first and foremost. I cannot reasonably think of a situation where cold water immersion would be put ahead of an athletes sleep (quality and quantity) or nutrition (again, quality of nutritional intake as dictated by the athlete’s needs, environmental context etc.). The question also needs to be asked, what are the physiological and performance differences evident when we compare other recovery modalities aside from a passive recovery to cold water immersion (ie; foam rolling or massage, nutritional supplementation, or a combination of these two amongst others). If anybody could point me in the direction of a study comparing modalities or such a study could make its way into the #ssjournalclub that would be well worth a read!

  5. I was fortunate enough to attend the Sports Medicine Australia Conference in Perth where this paper was presented. The authors, as Ben notes above, made the point that this study may suggest that CWI may still be advantageous to the athlete even if it is not feasible to complete immediately post exercise. For athletes who don’t have access to the plunge pools, it would be interesting to see if cold showers immediately post and 3 hours post may provide a similar performance benefit. There is a growing body of evidence that CWI is beneficial (Vaile et al. 2008, 2010) and some additional performance outcome measures (CMJ or similar muscle strength measure) would have been a great inclusion in this study. What I would personally like to see are studies around CWI or cryotherapy that are feasible for the general population.

  6. Dan Anderson

    Overall I like the study, methodologically it is nice and simple and watertight. More subjects would be beneficial (as is always the case) but with the crossover design this subject number is just enough. The fact that elite athletes have been used is extremely advantageous too. In figure 1, it is clear that athletes performance in the recovery test shows is better (more shuttles completed) in the immediate CWI (37.9) than in CWI after 3 hours (35.7) and control (32.4), but lactate and heart rate data after the test suggest that physiologically, both CWI trails are not different from Control. This gives support to what Dylan and John suggested about a psychological effect, as is always going to be the case with CWI, as it is impossible to control for placebo in such an intensive and obvious treatment.

    Currently, I am writing up my own study on CWI on muscle recovery following team sport specific exercise. In contrast to the current study, no significant differences were seen physiologically in both muscle damage markers (CK) and blood lactate clearance when compared to passive rest. I did find a significant physiological benefit of CWI and interestingly mean power output on an immediate wingate test was significantly reduced following the CWI trials compared with control, giving suggestion that if ensuing exercise is immediate, CWI may not be beneficial.

    Comparing CWI against other recovery interventions would be interesting to see, but is it always best to compare the experimental modality (CWI) with the most effective currently used method, which at present is arguably active recovery and stretching. Cold Water immersion in recovery is certainly a popular study area at present and despite being implemented by many top athletes and teams (Paula Radcliff / Manchester City F.C), its value in recovery remains unclear, as does other recovery modalities. For an interesting balanced review on recovery modalities, and evidence against other recovery modalities like massage, please see Barnett 2006.

    In may be interesting to discuss recovery interventions with an evolutionary view. We have evolved to exhibit a desired response following exercise to allow us to adapt and develop. The immediate inflammatory response is actually necessary to induce adaptation and as seen in some research (Howatson et al. 2009), this adaptation may be compromised. Equally however, excessive muscle damage can cause secondary cell destruction from the inflammatory response. It is therefore important to consider that any attempt to aggressively attenuate these physiological responses is dependent on the muscle damaging extent of the exercise conducted. Therefore future research would benefit from standardising exercise protocols for specific sports in which CWI may be used amongst research to enable us to control for this influential factor.

    – Barnett, A., Using recovery modalities between training sessions in elite athletes – Does it help? Sports Medicine, 2006. 36(9): p. 781-796
    – Howatson, G., S. Goodall, and K.A. van Someren, The influence of cold water immersions on adaptation following a single bout of damaging exercise. Eur J Appl Physiol, 2009. 105(4): p. 615-21.

  7. Dan,

    Thank you for pointing toward that Barnett article. For anyone else interested here is a link for an open access version – http://balsom.wikispaces.com/file/view/Barnett+Recovery+Elite+athletes.pdf

  8. Pingback: Week 1 journal club summary | Becky Canvin

  9. I thought you might be interested to know that a Cochrane review has been published this week on cold water immersion for DOMS. They analysed the results from 17 RCTs and found that there was some evidence to suggest that CWI does reduce DOMS but becuase of the differences in the study design, more research needs to be carried out. Here’s a link to the review: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD008262.pub2/abstract
    I’ve also written a news story on it this week: http://www.bupa.co.uk/individuals/health-information/health-news-index/2012/160212-cold-water-immersion-and-muscle-soreness

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