OBJECTIVE: Cold water immersion methods are not standardized in terms of operational indicators such as immersion temperature, duration and depth, leading to controversy over the efficacy of recovery from exercise fatigue in skeletal muscle. In this article, we analyze the effects of cold water immersion on muscle injury, muscle soreness and muscle strength recovery under different factors, in order to find the best immersion implementation plan, and thus provide evidence for the recovery of muscle fatigue. METHODS: A search of CNKI, WanFang Data, Web of Science, and PubMed databases was conducted for relevant literature published from January 1, 2000 to August 15, 2023. A total of 4 759 articles were initially retrieved, with 4 735 articles excluded through screening and 24 articles finally included. The Physical Therapy Evidence Database Scale was used to assess the methodological quality of the included literature, and Stata-MP 16 software was used to perform effect size combinations, subgroup analyses, Meta-regression, sensitivity tests, and publication bias analyses. RESULTS: (1) The article included a total of 24 randomized controlled trial studies, including 617 subjects, with overall high legal quality. (2) Meta-analysis showed that cold water immersion can significantly reduce creatine kinase blood value (standardized mean difference (SMD) -0.17, 95% confidence interval (CI) -0.29 to -0.05, p < 0.01), alleviate muscle pain (SMD -0.60, 95% CI -0.81 to -0.38, p < 0.01), and promote maximum muscle strength recovery (SMD 0.17, 95% CI 0.05 to 0.30, p < 0.01). (3) Subgroup analysis showed that: The immersing regimen with water temperature > 14 degreeC (SMD -0.48, 95% CI -0.76 to -0.20, p < 0.01) and duration of 12 to 14 minutes (SMD -0.38, 95% CI -0.61 to -0.15, p < 0.01) had the best effect in reducing creatine kinase blood values, and had a more significant intervention effect on endurance exercise (SMD -0.45, 95% CI -0.71 to -0.20, p < 0.01), while the immersion regimen with water temperature < 10 degreeC (SMD -0.61, 95% CI -0.79 to -0.43, p < 0.01), duration < 12 minutes (SMD -0.76, 95% CI -0.98 to -0.53, p < 0.01), and immersion depth above the iliac spine (SMD -0.74, 95% CI -0.97 to -0.52, p < 0.01) had the best effect on relieving muscle soreness, and had a more significant analgesic effect after endurance exercise (SMD -0.42, 95% CI -0.61 to -0.22, p < 0.01). (4) Meta regression showed that immersion water temperature, immersion duration, and exercise type were important regulatory factors affecting the effect size of creatine kinase; immersing water temperature and immersing depth were important regulatory factors affecting the effect size of visual analogue scale score, while exercise type was an important regulatory factor affecting the maximum isometric muscle strength effect size. CONCLUSIONS: (1) Evidence of extremely low to moderate strength suggests that cold water immersion can effectively reduce muscle damage, alleviate muscle soreness, and promote muscle strength recovery. (2) In terms of reducing muscle injury, immersion water temperature, immersion duration, and exercise type are significant regulatory factors that affect the efficacy of immersing. Among them, immersion water temperature > 14 degreeC and duration of 12 to 14 minutes are the best solutions to reduce muscle injury after exercise, and the immersing effect is better for endurance exercise. (3) In terms of reducing muscle soreness, immersion water temperature and immersion depth are important regulatory factors that affect the intervention effect. Among them, immersion water temperature < 10 degreeC, duration < 12 minutes, and immersing depth above the iliac spine are the best solutions to reduce muscle soreness, and have a better analgesic effect after endurance exercise. (4) In terms of promoting muscle strength recovery, exercise type is a key regulatory factor that affects the maximum isometric muscle strength effect.

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