Health Benefits and Physiological Effects of Cold Water Immersion: A Review of Current Research
DOI:
https://doi.org/10.12775/JEHS.2025.83.61851Keywords
cold water immersion, cold water swimming, recovery, thermoregulation, immune response,, mental health, metabolism, exercise physiologyAbstract
Introduction and Purpose: Cold Water Immersion (CWI) has become an increasingly popular method of recovery among athletes and individuals seeking physical and mental health benefits. The purpose of this review is to summarize current scientific findings regarding the physiological mechanisms and therapeutic potential of CWI in various populations. State of Knowledge: CWI triggers a range of physiological responses, including vasoconstriction, vasodilation, and activation of the sympathetic nervous system, leading to increased cortisol and adrenaline secretion. These processes may reduce muscle soreness, promote recovery, and enhance circulation. Regular cold exposure has also been linked to improved insulin sensitivity, immune modulation, and increased activity of brown adipose tissue. Moreover, emerging evidence suggests CWI may positively affect mood, reduce symptoms of depression and anxiety, and improve cognitive performance through neuroendocrine and thermoregulatory pathways. However, outcomes vary based on individual characteristics such as age, body composition, and cold tolerance. Risks include hypothermia, arrhythmias, and cardiovascular stress, particularly in susceptible individuals. Conclusion: CWI presents promising physical and psychological benefits but should be approached with caution and individual adaptation. More standardized protocols and long-term studies are needed to confirm its safety and efficacy in diverse populations.
References
1. Leeder J, Gissane C, van Someren K, Gregson W, Howatson G. Cold water immersion and recovery from strenuous exercise: a meta-analysis. Br J Sports Med. 2012;46(4):233-240. doi:10.1136/bjsports-2011-090061Bleakley, C. M., Davison, G. W., & Ratcliffe, J. (2012). The use of cold therapies in the management of soft tissue injury. Sports Medicine, 42(1), 57-70.
2. Cain T, Brinsley J, Bennett H, Nelson M, Maher C, Singh B. Effects of cold-water immersion on health and wellbeing: A systematic review and meta-analysis. PLoS One. 2025;20(1):e0317615. Published 2025 Jan 29. doi:10.1371/journal.pone.0317615
3. Vaile, L. M., Gill, N. D., & Blazevich, A. J. (2008). Effect of cold water immersion on repeat cycling performance and the subsequent recovery of muscle function. Journal of Sports Sciences, 26(5), 477-484.
4. Castellani JW, Sawka MN, DeGroot DW, Young AJ. Human physiological responses to cold exposure: Acute responses and acclimatization to prolonged exposure. Auton Neurosci. 2016;196:63-74.
5. ADAMS T, HEBERLING EJ. Human physiological responses to a standardized cold stress as modified by physical fitness. J Appl Physiol. 1958;13(2):226-230. doi:10.1152/jappl.1958.13.2.226
6. Walløe L. Arterio-venous anastomoses in the human skin and their role in temperature control. Temperature (Austin). 2015;3(1):92-103. Published 2015 Oct 12. doi:10.1080/23328940.2015.1088502
7. Vanggaard L, Kuklane K, Holmer I, Smolander J. Thermal responses to whole-body cooling in air with special reference to arteriovenous anastomoses in fingers. Clin Physiol Funct Imaging. 2012;32(6):463-469. doi:10.1111/j.1475-097X.2012.01151.x
8. Kox M, van Eijk LT, Zwaag J, van den Wildenberg J, Sweep FC, van der Hoeven JG, et al. Voluntary activation of the sympathetic nervous system and attenuation of the innate immune response in humans. Proc Natl Acad Sci U S A. 2014;111(20):7379-84. doi:10.1073/pnas.1322174111
9. Srámek P, Simecková M, Janský L, Savlíková J, Vybíral S. Human physiological responses to immersion into water of different temperatures. Eur J Appl Physiol. 2000;81(5):436-442. doi:10.1007/s004210050065
10. Shevchuk NA. Adapted cold shower as a potential treatment for depression. Med Hypotheses. 2008;70(5):995-1001. doi:10.1016/j.mehy.2007.04.052
11. Leppäluoto J, Westerlund T, Huttunen P, Oksa J, Smolander J, Dugué B, et al. Effects of long-term whole-body cold exposures on plasma concentrations of ACTH, beta-endorphin, cortisol, catecholamines and cytokines in healthy females. Scand J Clin Lab Invest. 2008;68(2):145-53. doi:10.1080/00365510701614501
12. Rymaszewska J, Ramsey D, Chładzińska-Kiejna S. Whole-body cryotherapy as adjunct treatment of depressive and anxiety disorders. Arch Immunol Ther Exp (Warsz). 2008;56(1):63-8. doi:10.1007/s00005-008-0006-1
13. Charkoudian N. Skin blood flow in adult human thermoregulation: how it works, when it does not, and why. Mayo Clin Proc. 2003;78(5):603-612. doi:10.4065/78.5.603.
14. Johnson JM, Kellogg DL Jr. Local thermal control of the human cutaneous circulation. J Appl Physiol (1985). 2014;116(7):798-805. doi:10.1152/japplphysiol.00004.2014.
15. Clarke J, Benjamin N, Larkin S, Webb D, Maseri A, Davies G. Interaction of neuropeptide Y and the sympathetic nervous system in vascular control in man. Circulation. 1991;83(3):774-777. doi:10.1161/01.cir.83.3.774
16. Charkoudian N. Mechanisms and modifiers of reflex induced cutaneous vasodilation and vasoconstriction in humans. J Appl Physiol (1985). 2010;109(4):1221-1228. doi:10.1152/japplphysiol.00298.2010
17. Tipton M, Eglin C, Gennser M, Golden F. Immersion deaths and deterioration in swimming performance in cold water. Lancet. 1999;354(9179):626-629. doi:10.1016/S0140-6736(99)07273-6
18. Sessler DI. Temperature monitoring and perioperative thermoregulation. Anesthesiology. 2008;109(2):318-338. doi:10.1097/ALN.0b013e31817f6d76
19. Flouris AD, Westwood DA, Mekjavic IB, Cheung SS. Effect of body temperature on cold induced vasodilation. Eur J Appl Physiol. 2008;104(3):491-499. doi:10.1007/s00421-008-0798-3
20. Yasukochi Y, Sera T, Kohno T, Nakashima Y, Uesugi M, Kudo S. Cold-induced vasodilation response in a Japanese cohort: insights from cold-water immersion and genome-wide association studies. J Physiol Anthropol. 2023;42(1):2. Published 2023 Mar 8. doi:10.1186/s40101-023-00319-2
21. Haman F, Blondin DP. Shivering thermogenesis in humans: Origin, contribution and metabolic requirement. Temperature (Austin). 2017;4(3):217-226. Published 2017 May 22. doi:10.1080/23328940.2017.1328999
22. Stocks JM, Taylor NA, Tipton MJ, Greenleaf JE. Human physiological responses to cold water immersion. Aviat Space Environ Med. 2004;75(7):444-457. PMID: 15152898.
23. Blondin DP, Haman F. Shivering and nonshivering thermogenesis in skeletal muscle and brown adipose tissue: Coordinated thermogenic effectors of human cold defense. Temperature (Austin). 2018;5(1):38-56. doi:10.1080/23328940.2017.1412011.
24. Muzik O, Diwadkar VA. Regulation of Brown Adipose Tissue Activity by Interoceptive CNS Pathways: The interaction between Brain and Periphery. Front Neurosci. 2017;11:640. Published 2017 Nov 16. doi:10.3389/fnins.2017.00640
25. Gordon K, Blondin DP, Friesen BJ, Tingelstad HC, Kenny GP, Haman F. Seven days of cold acclimation substantially reduces shivering intensity and increases nonshivering thermogenesis in adult humans. J Appl Physiol (1985). 2019;126(6):1598-1606. doi:10.1152/japplphysiol.01133.2018
26. Vosselman MJ, van der Lans AA, Brans B, et al. Systemic β-adrenergic stimulation of thermogenesis is not accompanied by brown adipose tissue activity in humans. Diabetes. 2012;61(12):3106-3113. doi:10.2337/db12-0288
27. Hayward MG, Keatinge WR. Roles of subcutaneous fat and thermoregulatory reflexes in determining ability to stabilize body temperature in water. J Physiol. 1981;320:229–251. doi:10.1113/jphysiol.1981.sp013946.
28. Greaney JL, O’Donnell DE, Gagnon D, et al. Cardiovascular stress and characteristics of cold-induced vasodilation in women and men during cold-water immersion: A randomized control study. J Physiol. 2005;568(Pt 1):227–237. doi:10.1113/jphysiol.2005.088419.
29. Shattock MJ, Tipton MJ. The initial responses to immersion in cold water. J Physiol. 2012;590(15):3213–3220. doi:10.1113/jphysiol.2012.234727.
30. Jdidi H, Dugué B, de Bisschop C, Dupuy O, Douzi W. The effects of cold exposure (cold water immersion, whole- and partial- body cryostimulation) on cardiovascular and cardiac autonomic control responses in healthy individuals: A systematic review, meta-analysis and meta-regression. J Therm Biol. 2024;121:103857. doi:10.1016/j.jtherbio.2024.103857
31. Keller-Ross ML, McCullough DJ, Smith ML, et al. Cardiovascular stress and characteristics of cold-induced vasodilation in women and men during cold-water immersion: A randomized control study. J Physiol. 2022;600(5):1123–1135. doi:10.1113/jphysiol.2022.000001.
32. Almeida AC, Machado AF, Albuquerque MC, et al. The effects of cold water immersion with different dosages (duration and temperature variations) on heart rate variability post-exercise recovery: A randomized controlled trial. J Sci Med Sport. 2016;19(8):676-681. doi:10.1016/j.jsams.2015.10.003
33. Blondin DP, Labbé SM, Tingelstad HC, et al. Increased brown adipose tissue oxidative capacity in cold-acclimated humans. J Clin Endocrinol Metab. 2014;99(3):E438–E446. doi:10.1210/jc.2013-3901.
34. Hanssen MJW, Hoeks J, Brans B, et al. Short-term cold acclimation improves insulin sensitivity in patients with type 2 diabetes mellitus. Nat Med. 2015;21(8):863–865. doi:10.1038/nm.3891.
35. Greaney JL, Proctor DN, Stoner L, et al. Cardiovascular and mood responses to an acute bout of cold water immersion. Physiol Rep. 2023;11(6):e15594. doi:10.14814/phy2.15594.
36. Wang Z, Ning T, Song A, Rutter J, Wang QA, Jiang L. Chronic cold exposure enhances glucose oxidation in brown adipose tissue. EMBO Rep. 2020;21(11):e50085. doi:10.15252/embr.202050085
37. El-Ansary MRM, El-Ansary AR, Said SM, Abdel-Hakeem MA. Regular cold shower exposure modulates humoral and cell-mediated immunity in healthy individuals. J Therm Biol. 2024;125:103971. doi:10.1016/j.jtherbio.2024.103971
38. Higgins TR, Greene DA, Baker MK. Effects of Cold Water Immersion and Contrast Water Therapy for Recovery From Team Sport: A Systematic Review and Meta-analysis. J Strength Cond Res. 2017;31(5):1443-1460. doi:10.1519/JSC.0000000000001559
39. Faid T, Van Gordon W, Taylor EC. Breathing Exercises, Cold-Water Immersion, and Meditation: Mind-Body Practices Lead to Reduced Stress and Enhanced Well-Being. Adv Mind Body Med. 2022;36(3):12-20.
40. Yankouskaya A, Williamson R, Stacey C, Totman JJ, Massey H. Short-Term Head-Out Whole-Body Cold-Water Immersion Facilitates Positive Affect and Increases Interaction between Large-Scale Brain Networks. Biology (Basel). 2023;12(2):211. Published 2023 Jan 29. doi:10.3390/biology12020211
41. Huttunen P, Kokko L. Winter swimming improves general well-being. Int J Circumpolar Health. 2002;61(4):267–273. doi:10.3402/ijch.v61i4.17503
42. Jones DM, Bailey SP, De Pauw K, et al. Evaluation of cognitive performance and neurophysiological function during repeated immersion in cold water. Brain Res. 2019;1:1–9. doi:10.1016/j.brainres.2019.04.032
43. Kelly S, Bird G. Short-term head-out whole-body cold-water immersion facilitates positive affect and increases interaction between large-scale brain networks. Brain Sci. 2023;12(2):211. doi:10.3390/brainsci12020211
44. Theurot D, Dugué B, Douzi W, et al. Impact of acute partial-body cryostimulation on cognitive performance, cerebral oxygenation, and cardiac autonomic activity. Sci Rep. 2021;11(1):7793. doi:10.1038/s41598-021-87089-y
45. Bleakley CM, Davison GW. What is the biochemical and physiological rationale for using cold-water immersion in sports recovery? Int J Sports Med. 2010;31(8):537-544. doi:10.1055/s-0030-1254361
46. Machado AF, de Lira CA, de Oliveira Silva D, et al. Cold-water immersion and sports massage can improve pain sensation but not functionality in athletes with delayed-onset muscle soreness. J Strength Cond Res. 2023;37(4):e1-e9. doi:10.1519/JSC.0000000000004269
47. Farstad DJ, Dunn JA. Cold Water Immersion Syndrome and Whitewater Recreation Fatalities. Wilderness Environ Med. 2019;30(3):321-327. doi:10.1016/j.wem.2019.03.005
48. Leppäluoto J, Westerlund T, Huttunen P, et al. Effects of long-term whole-body cold exposures on plasma concentrations of ACTH, beta-endorphin, cortisol, catecholamines and cytokines in healthy females. Scand J Clin Lab Invest. 2008;68(2):145-153. doi:10.1080/00365510701614501
49. Batra AS, Silka MJ. Mechanism of sudden cardiac arrest while swimming in a child with the prolonged QT syndrome. J Pediatr. 2002;141(2):283-284. doi:10.1067/mpd.2002.126924
50. Schmid JP, Morger C, Noveanu M, Binder RK, Anderegg M, Saner H. Haemodynamic and arrhythmic effects of moderately cold (22 degrees C) water immersion and swimming in patients with stable coronary artery disease and heart failure. Eur J Heart Fail. 2009;11(9):903-909. doi:10.1093/eurjhf/hfp114
51. Radtke T, Poerschke D, Wilhelm M, et al. Acute effects of Finnish sauna and cold-water immersion on haemodynamic variables and autonomic nervous system activity in patients with heart failure. Eur J Prev Cardiol. 2016;23(6):593-601. doi:10.1177/2047487315594506
52. Glickman EL, Caine-Bish N, Cheatham CC, Blegen M, Potkanowicz ES. The influence of age on thermosensitivity during cold water immersion. Wilderness Environ Med. 2002;13(3):194-202. doi:10.1580/1080-6032(2002)013[0194:tioaot]2.0.co;2
53. Xiao F, Kabachkova AV, Jiao L, Zhao H, Kapilevich LV. Effects of cold water immersion after exercise on fatigue recovery and exercise performance--meta analysis. Front Physiol. 2023;14:1006512. Published 2023 Jan 20. doi:10.3389/fphys.2023.1006512
54. Kox M, van Eijk LT, Zwaag J, et al. Voluntary activation of the sympathetic nervous system and attenuation of the innate immune response in humans. Proc Natl Acad Sci U S A. 2014;111(20):7379-84. doi:10.1073/pnas.1322174111.
55. Hjorth P, Sikjær MG, Løkke A, et al. Cold water swimming as an add-on treatment for depression: a feasibility study. Nord J Psychiatry. 2023;77(7):706-711. doi:10.1080/08039488.2023.2228290
56. Kunutsor SK, Lehoczki A, Laukkanen JA. The untapped potential of cold water therapy as part of a lifestyle intervention for promoting healthy aging. Geroscience. 2025;47(1):387-407. doi:10.1007/s11357-024-01295-w
57. Czarnecki J, Nowakowska-Domagała K, Mokros Ł. Combined cold-water immersion and breathwork may be associated with improved mental health and reduction in the duration of upper respiratory tract infection - a case-control study. Int J Circumpolar Health. 2024;83(1):2330741. doi:10.1080/22423982.2024.2330741
58. Stephens, J. M., et al. (2017). Effect of body composition on physiological responses to cold-water immersion and the recovery of exercise performance. European Journal of Applied Physiology, 117(3), 563–572.
59. Haman F, Rheaume C, Bouchard C, et al. Seven days of cold acclimation substantially reduces shivering intensity and increases nonshivering thermogenesis in adult humans. J Appl Physiol (1985). 2019;126(2):424-431. doi:10.1152/japplphysiol.00799.2018.
60. Huttunen P, Kokko L, Ylijukuri V. Winter swimming improves general well-being. Int J Circumpolar Health.2004;63(2):140–143. doi:10.3402/ijch.v63i2.17714.
61. Meeusen R, Lievens P. The use of cryotherapy in sports injuries. Sports Med. 1986;3(6):398-414. doi:10.2165/00007256-198603060-00002
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