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Details of cold-water immersion

All studies employed some form of CWI intervention after ex-ercise. The most popular water

immersion temperature was be-tween 10°C and 15°C, which was used by just over 75% of

studies; the remainder used lower temperatures of 9°C or 5°C. In 10 studies, treatment

involved continuous immersion for between 5 and 24 minutes; the average treatment duration

across these studies was 12.6 minutes. The remaining studies undertook CWI in sets where

 participants got out of the water at predetermined time points; treatment therefore consisted

of: three to five sets of one minute immersions, two sets of five minute immersions, or two

sets of 15 minute immersions. Three studies reported that the water was periodically agitated

during immersion. CWI was undertaken to approximately the level of the waist, sternum or

shoulder. CWI was confined to the arm or lower leg muscles. The timing of initiating CWI

after exercise was generally consistent across studies; initiated immediately after, or within

approximately 10 minutes or 20 minutes after finishing treatment.

Details of comparisons

Studies comparing CWI with passive intervention (no CWI or rest); studies comparing CWI

with contrast immersion; studies comparing CWI with warm-water immersion; studies

comparing CWI with active recovery; studies comparing CWI with compresion garments;

and studies comparing two different dosages of CWI. Used more than one relevant treatment

comparison and therefore appear in two different sections.

Cold-water immersion versus passive (no intervention/rest)

CWI was compared with a passive intervention defined as either seated rest or nointervention.

Cold-water immersion versus contrast immersion

Contrast immersion involved alternate immersions in cold (between 8°C and 15°C) and

warm-water (38°C to 45°C). The overall duration of contrast treatment varied across groups:

12 minutes (2 minutes cold: 2 minutes hot x 3 sets); 14 minutes (1 minute cold: 1 minute hot

x 7 sets); 15 minutes (1 minute cold: 2 minute hot x 5 sets); or 24 minutes (3 minutes hot: 1

minute cold x 6 sets).

Cold-water immersion versus warm-water immersion

Four studies used this comparison (Kuligowski 1998; Rowsell 2009; Sellwood 2007a; Vaile

2008c) but the details of warm-water immersion across studies. Three (Kuligowski 1998;

Rowsell 2009; Vaile 2008c) used immersion in water between 34°C and 40°C, and one

(Sellwood 2007a) used water temperatures of 24°C. The total duration of warm-water

immersion was: 3 (Sellwood 2007a), 5 (Rowsell 2009), 14 (Vaile 2008c) and 24 minutes

(Kuligowski 1998).

Cold-water immersion versus active recovery

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One study (King 2009) compared CWI with an active recovery intervention, which involved

15 minutes of jogging at a predeter-mined and controlled speed; the exercise in this study was

a single bout of netball related running.

Cold-water immersion versus compression

One study (Montgomery 2008) compared CWI with compres-sion therapy over the course of

a three day (one game per day) bas-ketball tournament. Participants in the compression group

wore full length compression garments (18 mm/Hg) post game and at night (18 hours), over

the tournament; CWI involved a single im-mersion after each game

Cold-water immersion versus cold-water immersion (different dosage)

One study (Yanagisawa 2003a) specifically compared two differ-ent treatment dosages of

CWI. Both groups completed a CWI treatment immediately after exercise, and one group

undertook an additional treatment 24 hours later.

(Bleakley, 2012)

Recovery

Recovery is def ined as ‘the return of the muscle to its pre exercise state following exercise’

(Tomlin and Wenger, 2001). Aerobic metabolism remains elevated in the recovery phase

after exercise. Known as excess post-exercise oxygen consumption (EPOC) it assists in

replenishing the body stores (Bahr and Maehlum, 1986). EPOC consists of a fast and slow

component (Gaesser and Brooks, 1984). The fast component restores 70% of ATP and PCr

energy stores within 30 s (Hultman et al., 1967) and reloads plasma haemoglobin and muscle

myoglobin (Bahr, 1992). The slow component is observed after strenuous exercise and has

 been associated with increased cardiac and respiratory functions, elevated core temperature

and removal of metabolic waste products (Gaesser and Brooks, 1984; Sahlin, 1992).

Dependent on the exercise intensity it may take up to 24 h for the slow component to return

to its resting levels (Gaesser and Brooks, 1984). Phosphagen stores take 3  –  5 min to fully

recover (Hultman et al., 1967) compared to an hour or more for the resting return of lactate

and pH. The rise in lactate production and H+ accumulation can disrupt the muscle contractile

 processes and the existing transport and metabolic pathways can become less efficient

(Tomlin and Wenger, 2001).The use of passive (no exercise, massage, contrast hydrotherapy)or active recovery (light exercise) for replenishing fuel stores and removal of metabolic

wastes has implications for accelerating post exercise recovery rates