{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T06:46:27Z","timestamp":1791614787344,"version":"4.3.4"},"reference-count":50,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2025,1,29]],"date-time":"2025-01-29T00:00:00Z","timestamp":1738108800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Medical Research Future Fund","award":["GNT1193862"],"award-info":[{"award-number":["GNT1193862"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Cold-water immersion (CWI) has gained popularity as a health and wellbeing intervention among the general population.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Objective<\/jats:title>\n<jats:p>This systematic review and meta-analysis aimed to evaluate the psychological, cognitive, and physiological effects of CWI in healthy adults.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Electronic databases were searched for randomized trials involving healthy adults aged \u2265\u200918 years undergoing acute or long-term CWI exposure via cold shower, ice bath, or plunge with water temperature \u226415\u00b0C 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.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Results<\/jats:title>\n<jats:p>Eleven studies were included, comprising 3177 total participants and a mean PEDro score of 6.4 (n\u2009=\u20097 moderate quality, n\u2009=\u20094 high quality). CWI interventions were performed in baths (n\u2009=\u200910) or showers (n\u2009=\u20091) at temperatures ranging from 7\u00b0C to 15\u00b0C 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 &lt;\u2009 0.01) and 1 hour post CWI (SMD: 1.26, [95% CI: 0.59, 1.94], p &lt;\u2009 0.01), indicating an acute inflammatory response. A significant reduction in stress was observed 12 hours post-CWI (SMD: \u20131.00, [95% CI: \u20131.40, \u20130.61], p &lt;\u2009 0.01), however, no significant effects on stress were detected immediately (SMD: \u20130.09 [95% CI: \u20130.45, 0.63], p &gt;\u2009 0.05), 1 hour (SMD: \u20130.29 [95% CI: \u20130.66, 0.08], p &gt;\u2009 0.05), 24 hours (SMD: \u20130.06 [95% CI: \u20130.50, 0.38], p &gt;\u2009 0.05), or 48 hours (SMD: 0.09 [95% CI: \u20130.28, 0.46], p &gt;\u2009 0.05) post-exposure. While meta-analysis showed no significant effects on immune function immediately (SMD: \u20130.16 [95% CI: \u20130.82, 0.51], p &gt;\u2009 0.05) or 1 hour (SMD: \u20130.18 [95% CI: \u20131.09, 0.74], p &gt;\u2009 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.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec005\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>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.<\/jats:p>\n<jats:p>PROSPERO (ID: CRD42024500591)<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0317615","type":"journal-article","created":{"date-parts":[[2025,1,29]],"date-time":"2025-01-29T18:34:30Z","timestamp":1738175670000},"page":"e0317615","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":36,"title":["Effects of cold-water immersion on health and wellbeing: A systematic review and meta-analysis"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-3566-9972","authenticated-orcid":true,"given":"Tara","family":"Cain","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacinta","family":"Brinsley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hunter","family":"Bennett","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Max","family":"Nelson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carol","family":"Maher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ben","family":"Singh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,1,29]]},"reference":[{"issue":"3","key":"pone.0317615.ref001","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1007\/s11332-021-00839-3","article-title":"Athlete, coach and practitioner knowledge and perceptions of post-exercise cold-water immersion for recovery: a qualitative and quantitative exploration","volume":"18","author":"R Allan","year":"2021","journal-title":"Sport Sci Health"},{"issue":"1","key":"pone.0317615.ref002","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1007\/s40279-020-01362-0","article-title":"The effects of regular cold-water immersion use on training-induced changes in strength and endurance performance: a systematic review with meta-analysis","volume":"51","author":"ES Malta","year":"2021","journal-title":"Sports Med"},{"key":"pone.0317615.ref003","doi-asserted-by":"crossref","first-page":"1006512","DOI":"10.3389\/fphys.2023.1006512","article-title":"Effects of cold water immersion after exercise on fatigue recovery and exercise performance--meta analysis","volume":"14","author":"F Xiao","year":"2023","journal-title":"Front Physiol"},{"issue":"18","key":"pone.0317615.ref004","doi-asserted-by":"crossref","first-page":"4239","DOI":"10.3390\/jcm10184239","article-title":"The effect of submaximal exercise followed by short-term cold-water immersion on the inflammatory state in healthy recreational athletes: a cross-over study","volume":"10","author":"M Paw\u0142owska","year":"2021","journal-title":"J Clin Med"},{"issue":"1","key":"pone.0317615.ref005","doi-asserted-by":"crossref","first-page":"696","DOI":"10.1080\/02656736.2021.1915504","article-title":"Residual effects of short-term whole-body cold-water immersion on the cytokine profile, white blood cell count, and blood markers of stress","volume":"38","author":"M Eimonte","year":"2021","journal-title":"Int J Hyperthermia"},{"issue":"7","key":"pone.0317615.ref006","doi-asserted-by":"crossref","first-page":"1667","DOI":"10.1007\/s40279-022-01644-9","article-title":"Impact of cold-water immersion compared with passive recovery following a single bout of strenuous exercise on athletic performance in physically active participants: a systematic review with Meta-analysis and Meta-regression","volume":"52","author":"E Moore","year":"2022","journal-title":"Sports Med"},{"issue":"2","key":"pone.0317615.ref007","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1002\/ejsc.12074","article-title":"Throwing cold water on muscle growth: a systematic review with meta-analysis of the effects of postexercise cold water immersion on resistance training-induced hypertrophy","volume":"24","author":"A Pi\u00f1ero","year":"2024","journal-title":"Eur J Sport Sci"},{"issue":"3","key":"pone.0317615.ref008","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1080\/17461391.2022.2033851","article-title":"Effects of post-exercise cold-water immersion on resistance training-induced gains in muscular strength: a meta-analysis","volume":"23","author":"J Grgic","year":"2023","journal-title":"Eur J Sport Sci"},{"issue":"3","key":"pone.0317615.ref009","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1136\/bjsm.2009.065565","article-title":"What is the biochemical and physiological rationale for using cold-water immersion in sports recovery? 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