Effects of cold-water immersion on health and wellbeing: A systematic review and meta-analysis
Cain T, Brinsley J, Bennett H, Nelson M, Maher C, Singh B
PloS one · 17 citations
How it was studied
- Design
- Meta-analysis (indexed by PubMed)
- Studied in
- People
- Main outcome
- Health markers and function
Who paid for it
- Funding
- Independent funding
- Government
- Medical Research Future Fund
- Grants
- Medical Research Future Fund (GNT1193862)
Based on 1 listed funder(s) and full-text disclosure statement.
Publication
- Published
- 2025-01-29 · PLoS One · vol. 20 · issue 1 · p. e0317615
- Publisher
- Public Library of Science
- Cited
- 34 citations · more than 100% of similar papers · 10.3× the field average
- Impact
- Top 10% most cited in its field
- References
- 48 works
- Access
- Open access (journal) · CC-BY
- Research areas
- Therapeutic Uses of Natural Elements · Exercise and Physiological Responses · Thermoregulation and physiological responses
- Keywords
- Meta-analysis, Immersion (mathematics), MEDLINE, Medicine, Biology, Mathematics, Internal medicine
- MeSH
- humans, water, immersion, sleep, adult, randomized controlled trials as topic, cold temperature
6 authors
From AU
- Tara Cain · correspondingUniversity of South Australia
- Jacinta BrinsleyUniversity of South Australia
- Hunter BennettUniversity of South Australia
- Maximillian J. NelsonUniversity of South Australia
- Carol Ann MaherUniversity of South Australia
- B. M. SinghUniversity of South Australia
Abstract
Background
Cold-water immersion (CWI) has gained popularity as a health and wellbeing intervention among the general population.
Objective
This systematic review and meta-analysis aimed to evaluate the psychological, cognitive, and physiological effects of CWI in healthy adults.
Methods
Electronic databases were searched for randomized trials involving healthy adults aged ≥ 18 years undergoing acute or long-term CWI exposure via cold shower, ice bath, or plunge with water temperature ≤15°C for at least 30 seconds. Outcomes of interest were sleep, stress, fatigue, energy, skin health, immunity, inflammation, mental wellbeing, depression, anxiety, mood, concentration, and alertness or focus. Meta-analyses were conducted using RevMan software (version 5.4), applying random effects models to calculate standardized mean differences (SMD) between pre- and post-CWI exposure outcomes. Risk of bias was assessed using the PEDro scale.
Results
Eleven studies were included, comprising 3177 total participants and a mean PEDro score of 6.4 (n = 7 moderate quality, n = 4 high quality). CWI interventions were performed in baths (n = 10) or showers (n = 1) at temperatures ranging from 7°C to 15°C and durations ranging from 30 seconds to 2 hours. The meta-analysis revealed significant increases in inflammation immediately (SMD: 1.03, [95% CI: 0.37, 1.68], p 0.05), 1 hour (SMD: -0.29 [95% CI: -0.66, 0.08], p > 0.05), 24 hours (SMD: -0.06 [95% CI: -0.50, 0.38], p > 0.05), or 48 hours (SMD: 0.09 [95% CI: -0.28, 0.46], p > 0.05) post-exposure. While meta-analysis showed no significant effects on immune function immediately (SMD: -0.16 [95% CI: -0.82, 0.51], p > 0.05) or 1 hour (SMD: -0.18 [95% CI: -1.09, 0.74], p > 0.05) post-CWI, narrative synthesis suggested longer-term benefits, including a 29% reduction in sickness absence among participants who took cold showers. Improvements were also observed in sleep quality and quality of life, but not mood.
Conclusions
This systematic review suggests that CWI delivers time-dependent effects on inflammation, stress, immunity, sleep quality, and quality of life, offering potential practical applications for health practitioners considering CWI for stress management and wellbeing support. However, the current evidence base is constrained by few RCTs, small sample sizes, and a lack of diversity in study populations. Future high-quality RCTs are needed to examine the long-term effects of CWI, its impact on diverse health outcomes, and optimal CWI protocols. PROSPERO (ID: CRD42024500591).
Abstract via Europe PMC. Copyright remains with the authors or publisher (CC BY).
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