Cold-water immersion (CWI), as a common recovery method, has been widely used in the field of post-exercise fatigue recovery. However, there is still a lack of comprehensive and systematic scientific evaluation of the combined effects of cold-water immersion combined with other therapies (CWI plus Other). The aim of this study was to compare the effects of CWI and CWI plus Other in post-exercise fatigue recovery and to explore the potential benefits of CWI plus Other. We systematically searched PubMed, Embase, Web of Science, Cochrane Library and EBSCO databases to include 24 studies (475 subjects in total) and performed a meta-analysis using standardized mean difference (SMD) and 95% confidence intervals (CIs). The results showed that both CWI plus Other (SMD -0.68, 95% CI -1.03 to -0.33) and CWI (SMD -0.37, 95% CI -0.65 to -0.10) were effective in reducing delayed-onset muscle soreness (DOMS). In subgroup analyses of athletes, both CWI plus Other (SMD -1.13, 95% CI -1.76 to -0.49) and CWI (SMD -0.47, 95% CI -0.87 to -0.08) also demonstrated significant effects. In addition, CWI plus Other significantly reduced post-exercise C-reactive protein (CRP) levels (SMD -0.62, 95% CI -1.12 to -0.13), and CWI with water temperatures higher than 10 degreeC also showed a CRP-lowering effect (MD -0.18, 95% CI -0.30 to -0.07), suggesting a potential benefit in anti-inflammation. There were no significant differences between the two interventions in the metrics of creatine kinase (CK; CWI: SMD -0.01, 95% CI -0.27 to 0.24; CWI plus Other: SMD 0.26, 95% CI -0.51 to 1.03) or countermovement jump (CMJ; CWI: SMD 0.22, 95% CI -0.13 to 0.57; CWI plus Other: SMD 0.07, 95% CI -0.70 to 0.85).

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