The aim of this systematic review was to determine the effects of cold water immersion (CWI) and contrast water therapy (CWT) on the recovery of athletic performance following high-intensity exercise. An electronic literature search was conducted up to February 2014 to identify relevant studies using Medline (via OvidSP) and CINAHL. Quality scoring of studies was performed using the PEDro scale. Data was extracted to calculate the Cohen`s (d) effect size of interventions on measures of athletic performance, muscle damage and perceived muscle soreness. Statistical testing was performed to identify between intervention differences or identify associations between variables. Eleven studies met the inclusion criteria; 10 studies included CWI and 8 studies included CWT. Quality analysis revealed a moderate methodological quality. Pooled effect sizes demonstrated an enhanced effectiveness of CWI over CWT for the recovery of performance, with medium (d=0.62±0.86) and small (d=0.21±0.34) effect sizes respectively. Effect sizes also revealed that CWI was more effective in blunting the rise in CK (d=-0.59±0.31) and reducing muscle soreness (d=1.49±1.14) compared to CWT (d=-0.76±0.13 and d=0.75±0.74 respectively). No associations between effect sizes and water temperature or immersion duration were identified (p>0.05). The results demonstrate that CWI was more effective than CWT on the recovery of physical performance following high-intensity exercise. CWI was able to blunt the rise in CK and reduce perceived muscle soreness more effectively than CWT suggesting less muscle damage and reduced acute inflammation. CWI using water temperatures of 9.2-12±C for immersion durations of 14-18 minutes appear to be most effective.
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