Research findings Water Immersion – 3/2020
30 April 2020 / 0 comments

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Every month ProCcare extracts the new research studies on local cryotherapy, water immersion, and whole-body cryotherapy. These studies are the basis of our literature database and form the foundation of our ProCare method. In each newsletter, we provide an overview of the new research studies. Additionally, we offer exciting insights that assist implementation based on the findings of two studies that we selected from the list.

Study: Fuchs, C. J. et al. Hot-water immersion does not increase postprandial muscle protein synthesis rates during recovery from resistance-type exercise in healthy, young males. J. Appl. Physiol.(2020) doi:10.1152/japplphysiol.00836.2019.

Method: 12 healthy male adults performed a single bout of resistance exercise followed by one leg immersion in hot water (46°C/115°F)and one leg immersion in thermoneutral water. Directly after the immersion, a beverage was ingested containing proteins and carbohydrates to assess the impact of hot water immersion on protein synthesis up to five hours in recovery.

Primary findings by the authors: Hot water immersion during recovery from a single bout of resistance-type exercise does not further increase the protein synthesis rates throughout five hours of post-exercise recovery.

ProCcare's take-home message:

Applying water immersion should not be an act on its own; it should be part of the complete recovery approach for athletes. One key aspect of every recovery program is nutrition. This study nicely combines hot water immersion with nutritional proteins to assess its effect on protein synthesis, a process that is essential for muscle recovery. A primary finding which was not emphasized in this study is that a one leg immersion in hot water effectively leads to a significant increase in muscle temperature at 4,5 cm of depth. Actualmuscle temperature measurements are lacking due to ethical considerations and the high costs involved.

Hot water immersion is thought to increase tissue temperature and thereby stimulates enzymatic activity and increase blood flow. This effect results in optimized nutrient delivery, uptake, and subsequent metabolism, ultimately leading to improved muscle recovery. Based on the findings in this study, improved nutrient delivery does not lead to an increase in protein synthesis rates. An important and novel discovery. This study, however, focuses on the physiological mechanisms and less on the practical implications. Hot water immersion in practice should be prescribed full body, for 10-15 minutes only and in a water temperature between 38-42°C/100-108°F, not with only one leg immersion, for 20 minutes in 46°C/115°F. A dosage this high will harm the glycogen synthesis, which is another potentially even more critical aspect of recovery. When in competition, athletes are not looking for increases in muscle mass and strength, for which protein synthesis is an essential process, but are more looking for performance maintenance, for which glycogen synthesis is a crucial process. The use of hot water immersion should be determined by the objective of the athlete/ and trainer and phase in the season. You can learn more about the recover-to-adapt, recover-to-damage, and recover-to-perform phase and the use of water immersion in our online advanced water immersion course)

 How to apply these findings in practice:

We believe using hot water immersion as a recovery modality, still has a place. Hot water immersion should not be the treatment of choice when performance recovery is warranted. For performance recovery when in competition, either cold-water immersion or contrast water immersion should be prescribed. Hot water immersion should not be used, based on the findings from this study, in the recover-to-adapt phase, when muscle mass and strength are the primary focus following strength training. Hot water immersion should be used as part of the contrast water immersion protocols and for enhanced neural transmission, muscle elasticity, joint extensibility, analgesia, and reducing muscle spams.

New studies:

1.           Chaillou,T. & Treigyte, V. Cold water immersion puts the chill on muscle protein synthesis after resistance exercise. J. Physiol. (Lond.) 598,1123–1124 (2020).

2.           Doubt,T. J. & Smith, D. J. COLDEX-86: Physical Work Capacity during Prolonged Cold Water Immersion at 6.1 msw: doi:10.21236/ADA233767.

3.           Connor, J., Shelley, A. & Egan, B. Comparison of hot water immersion at 37.8°C with or without salt for rapid weight loss in mixed martial arts athletes. J Sports Sci 38, 607–611 (2020).

4.           Eröksüz, R. et al. Comparison of intermittent and consecutive balneological outpatient treatment (hydrotherapy and peloidotherapy) in fibromyalgia syndrome: a randomized, single-blind, pilot study. Int J Biometeorol 64, 513–520 (2020).

5.           Choo,H. C. et al. Effect of regular precooling on adaptation to training in the heat. Eur. J. Appl. Physiol. (2020) doi:10.1007/s00421-020-04353-1.

6.           Douma,M. J. et al. First aid cooling techniques for heat stroke and exceptional hyperthermia: A systematic review and meta-analysis. Resuscitation 148,173–190 (2020).

7.           Rostomily,K. A., Jones, D. M., Pautz, C. M., Ito, D. W. & Buono, M. J.Haemoconcentration, not decreased blood temperature, increases blood viscosity during cold water immersion. Diving Hyperb Med 50, 24–27 (2020).

8.           Fuchs,C. J. et al. Hot-water immersion does not increase post-prandial muscle protein synthesis rates during recovery from resistance-type exercise in healthy, young males. J. Appl. Physiol. (2020)doi:10.1152/japplphysiol.00836.2019.

9.         Hurrie,D. M. G. & Giesbrecht, G. G. Is active recovery during cold water immersion better than active or passive recovery in thermoneutral water for post-recovery high-intensity sprint interval performance? Appl Physiol Nutr Metab 45, 251–257 (2020).

10.         Kwiecien,S. Y. Letter to the Editor re ‘Volume of water added to crushed ice affects the efficacy of cryotherapy: a randomized, single-blind, crossover trial’. Physiotherapy(2020) doi:10.1016/

11.         Baláš, J., Kodejška, J., Krupková, D. & Giles, D. Males benefit more from coldwater immersion during repeated handgrip contractions than females despite similar oxygen kinetics. J Physiol Sci 70, 13 (2020).

12.         Hosokawa, Y., Casa, D. J. & Racinais, S. Translating evidence-based practice to clinical practice in Tokyo 2020: how to diagnose and manage exertional heatstroke. Br J Sports Med (2020) doi:10.1136/bjsports-2020-102153.14.        

13.          Romero-Morales, C. et al. Vibration increases multifidus cross-sectional area versus cryotherapy added to chronic non-insertional Achilles tendinopathy eccentric exercise. Phys Ther Sport 42, 61–67 (2020).



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