OBJECTIVE: To comprehensively compare the effectiveness of cold and heat therapies for delayed onset muscle soreness using network meta-analysis. METHODS: Eight Chinese and English databases were searched from date of establishment of the database to 31 May 2021. Cochrane risk-of-bias tool was used to analyse the included randomized controlled trials. Potential papers were screened for eligibility, and data were extracted by 2 independent researchers. RESULTS: A total of 59 studies involving 1,367 patients were eligible for this study. Ten interventions were examined: contrast water therapy, phase change material, the novel modality of cryotherapy, cold-water immersion, hot/warm-water immersion, cold pack, hot pack, ice massage, ultrasound, and passive recovery. Network meta-analysis results showed that: (i) within 24 h after exercise, hot pack was the most effective for pain relief, followed by contrast water therapy; (ii) within 48 h, the ranking was hot pack, followed by the novel modality of cryotherapy; and (iii) over 48 h post-exercise, the effect of the novel modality of cryotherapy ranked first. CONCLUSION: Due to the limited quality of the included studies, further well-designed research is needed to draw firm conclusions about the effectiveness of cold and heat therapies for delayed onset muscle soreness.

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