Bleakley Chris, McDonough Suzanne, Gardner Evie, Baxter G David, Hopkins J Ty, Davison Gareth W
Health and Rehabilitation Sciences, University of Ulster, Newtownabbey, UK.
Cochrane Database Syst Rev. 2012 Feb 15;2012(2):CD008262. doi: 10.1002/14651858.CD008262.pub2.
Many strategies are in use with the intention of preventing or minimising delayed onset muscle soreness and fatigue after exercise. Cold-water immersion, in water temperatures of less than 15°C, is currently one of the most popular interventional strategies used after exercise.
To determine the effects of cold-water immersion in the management of muscle soreness after exercise.
In February 2010, we searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials (The Cochrane Library (2010, Issue 1), MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health (CINAHL), British Nursing Index and archive (BNI), and the Physiotherapy Evidence Database (PEDro). We also searched the reference lists of articles, handsearched journals and conference proceedings and contacted experts.In November 2011, we updated the searches of CENTRAL (2011, Issue 4), MEDLINE (up to November Week 3 2011), EMBASE (to 2011 Week 46) and CINAHL (to 28 November 2011) to check for more recent publications.
Randomised and quasi-randomised trials comparing the effect of using cold-water immersion after exercise with: passive intervention (rest/no intervention), contrast immersion, warm-water immersion, active recovery, compression, or a different duration/dosage of cold-water immersion. Primary outcomes were pain (muscle soreness) or tenderness (pain on palpation), and subjective recovery (return to previous activities without signs or symptoms).
Three authors independently evaluated study quality and extracted data. Some of the data were obtained following author correspondence or extracted from graphs in the trial reports. Where possible, data were pooled using the fixed-effect model.
Seventeen small trials were included, involving a total of 366 participants. Study quality was low. The temperature, duration and frequency of cold-water immersion varied between the different trials as did the exercises and settings. The majority of studies failed to report active surveillance of pre-defined adverse events.Fourteen studies compared cold-water immersion with passive intervention. Pooled results for muscle soreness showed statistically significant effects in favour of cold-water immersion after exercise at 24 hour (standardised mean difference (SMD) -0.55, 95% CI -0.84 to -0.27; 10 trials), 48 hour (SMD -0.66, 95% CI -0.97 to -0.35; 8 trials), 72 hour (SMD -0.93; 95% CI -1.36 to -0.51; 4 trials) and 96 hour (SMD -0.58; 95% CI -1.00 to -0.16; 5 trials) follow-ups. These results were heterogeneous. Exploratory subgroup analyses showed that studies using cross-over designs or running based exercises showed significantly larger effects in favour of cold-water immersion. Pooled results from two studies found cold-water immersion groups had significantly lower ratings of fatigue (MD -1.70; 95% CI -2.49 to -0.90; 10 units scale, best to worst), and potentially improved ratings of physical recovery (MD 0.97; 95% CI -0.10 to 2.05; 10 units scale, worst to best) immediately after the end of cold-water immersion.Five studies compared cold-water with contrast immersion. Pooled data for pain showed no evidence of differences between the two groups at four follow-up times (immediately, 24, 48 and 72 hours after treatment). Similar findings for pooled analyses at 24, 48 and 72 hour follow-ups applied to the four studies comparing cold-water with warm-water immersion. Single trials only compared cold-water immersion with respectively active recovery, compression and a second dose of cold-water immersion at 24 hours.
AUTHORS' CONCLUSIONS: There was some evidence that cold-water immersion reduces delayed onset muscle soreness after exercise compared with passive interventions involving rest or no intervention. There was insufficient evidence to conclude on other outcomes or for other comparisons. The majority of trials did not undertake active surveillance of pre-defined adverse events. High quality, well reported research in this area is required.
目前有多种策略用于预防或减轻运动后延迟性肌肉酸痛和疲劳。冷水浸泡（水温低于15°C）是目前运动后最常用的干预策略之一。
确定冷水浸泡对运动后肌肉酸痛管理的效果。
2010年2月，我们检索了Cochrane骨、关节和肌肉创伤组专业注册库、Cochrane对照试验中央注册库（《Cochrane图书馆》（2010年第1期））、MEDLINE、EMBASE、护理及相关健康累积索引（CINAHL）、英国护理索引及存档（BNI）以及物理治疗证据数据库（PEDro）。我们还检索了文章的参考文献列表、手工检索期刊和会议论文集并联系了专家。2011年11月，我们更新了CENTRAL（2011年第4期）、MEDLINE（截至2011年第3周）、EMBASE（至2011年第46周）和CINAHL（至2011年11月28日）的检索，以查找更新的出版物。
随机和半随机试验，比较运动后使用冷水浸泡与以下干预措施的效果：被动干预（休息/无干预）、对比浸泡、温水浸泡、主动恢复、加压或不同持续时间/剂量的冷水浸泡。主要结局为疼痛（肌肉酸痛）或压痛（触诊疼痛）以及主观恢复（恢复到之前的活动且无体征或症状）。
三位作者独立评估研究质量并提取数据。部分数据通过与作者通信获得或从试验报告中的图表提取。如有可能，使用固定效应模型合并数据。
纳入了17项小型试验，共366名参与者。研究质量较低。不同试验中冷水浸泡的温度、持续时间和频率各不相同，运动和环境也存在差异。大多数研究未报告对预定义不良事件的主动监测。14项研究比较了冷水浸泡与被动干预。运动后24小时（标准化均数差（SMD）-0.55，95%可信区间-0.84至-0.27；10项试验）、48小时（SMD -0.66，95%可信区间-0.97至-0.35；8项试验）、72小时（SMD -0.93；95%可信区间-1.36至-0.51；4项试验）和96小时（SMD -0.58；95%可信区间-1.00至-0.16；5项试验）随访时，合并的肌肉酸痛结果显示冷水浸泡具有统计学显著优势。这些结果存在异质性。探索性亚组分析表明，采用交叉设计或跑步类运动的研究显示冷水浸泡的优势更为显著。两项研究的合并结果发现，冷水浸泡组在冷水浸泡结束后立即疲劳评分显著更低（MD -1.70；95%可信区间-2.49至-0.90；10分制，最好至最差），身体恢复评分可能有所改善（MD 0.97；95%可信区间-0.10至2.05；10分制，最差至最好）。5项研究比较了冷水浸泡与对比浸泡。四项随访时间（治疗后立即、24、48和72小时）的合并疼痛数据显示两组之间无差异证据。24、48和72小时随访的合并分析类似结果适用于四项比较冷水浸泡与温水浸泡的研究。仅有单项试验分别比较了冷水浸泡与主动恢复、加压以及24小时的第二次冷水浸泡剂量。
有一些证据表明，与休息或无干预的被动干预相比，冷水浸泡可减轻运动后延迟性肌肉酸痛。对于其他结局或其他比较，证据不足。大多数试验未对预定义不良事件进行主动监测。该领域需要高质量、报告良好的研究。
