Impact of different cryotherapy interventions on post-exercise acute delayed-onset muscle soreness, athletic performance, and inflammatory biomarkers: a systematic review and network meta-analysis.

Wu J, Wang A, Hu H, Zhang H

Frontiers in sports and active living · January 1, 2026

Cryotherapy is a widely used physical recovery modality in post-exercise settings; however, systematic evidence identifying the optimal cryotherapy modality based on continuous time-course outcome assessments remains limited. To investigate the comparative effectiveness of different cryotherapy modalities-whole-body cryotherapy (WBC), cold water immersion (CWI), contrast water therapy (CWT), and local cold therapy (LCT)-on delayed-onset muscle soreness (DOMS), countermovement jump, and inflammatory biomarkers (creatine kinase, interleukin-6, and C-reactive protein) at multiple post-intervention time points (immediate, 1 h, 24 h, 48 h, and 72 h), using a systematic review and network meta-analysis approach. A systematic search was conducted in the Web of Science, PubMed, Cochrane Library, Embase, and EBSCO databases for studies published between January 1, 2010, and November 1, 2025. A total of 51 randomized controlled trials comprising 1,243 participants were included. The effects of cryotherapy demonstrated a pronounced time-dependent pattern. Compared with control conditions, no cryotherapy modality significantly reduced DOMS immediately after exercise. CWI significantly attenuated DOMS at 1 h [MD = -1.09, 95% CI (-1.93, -0.24), P < 0.05] and 24 h [MD = -0.89, 95% CI (-1.33, -0.45), P < 0.05], whereas LCT produced the greatest reduction at 48 h [MD = -1.17, 95% CI (-2.19, -0.16), P < 0.05]. Regarding inflammatory biomarkers, WBC resulted in the largest reductions in CK levels at 48 h [MD = -118.24, 95% CI (-173.49, -63.00), P < 0.05] and 72 h [MD = -135.03, 95% CI (-204.40, -65.66), P < 0.05]. CWI was the most effective modality for suppressing IL-6 immediately post-exercise [MD = -0.32, 95% CI (-0.58, -0.06), P < 0.05] and at 24 h [MD = -0.46, 95% CI (-0.92, -0.01), P < 0.05]. In terms of exercise performance, WBC significantly improved countermovement jump performance at 1 h [MD = 9.15, 95% CI (5.12, 13.17), P < 0.05], 24 h [MD = 10.70, 95% CI (1.16, 20.42), P < 0.05], and 48 h [MD = 10.50, 95% CI (3.37, 17.62), P < 0.05], with sustained benefits observed up to 72 h. Cryotherapy is an effective strategy for promoting the recovery of physiological indicators following acute exercise, with its efficacy demonstrating pronounced time-dependent characteristics. Identifier, 2026 CRD420261300174.

PMID: 42088589 · DOI: 10.3389/fspor.2026.1819396