Episode 174: Cold Water Plunges/Jeff and Juliet do a second take on coaching philosophies

A brief synopsis of the episode's main discussions and takeaways as well as extended references

Author

Jeff Sankoff
July 04, 2025

Table of Contents

Cold water plunges-are they really the key to improved recovery?

Let’s dive into the juicy side of cold plunges, shall we? I mean, who doesn't want to jump into a tub of ice water after a grueling workout, right? But hold your horses, because we’re about to break down what the science really says about these chilly dips. With the resurgence of cold plunge popularity, thanks to social media influencers and pro athletes who swear by it, we take a critical look at whether jumping into icy water actually does anything for recovery. Spoiler alert: it might not be the miracle cure you think it is. We go over some recent articles that suggest cold plunges might even hinder your recovery by reducing blood flow to your muscles. Yup, you heard that right! We dissect the evidence, weigh the pros and cons, and maybe even question why we ever thought freezing our butts off was a good idea in the first place. So if you’re curious about whether you should take the plunge or just stick to hot showers, have a listen to the Medical Mailbag because we’re unraveling the cold hard facts right here! And the end result is this: cold water plunges might make your overall mental state of being somewhat improved but physically they are likely a net negative more than anything else.

Juliet and Jeff chat their coaching philosophies in a second segment following up on their first popular conversation

Let’s talk about the rollercoaster of setting goals in triathlon—because, oh boy, do we have some interesting stories to share! So, you’ve got a new athlete who dreams of qualifying for Kona in their first Ironman, and you’re just sitting there thinking, ‘Bless your heart, but let’s pump the brakes a little.’ We dive into the reality of what it takes to reach these lofty goals and how sometimes, those dreams need a bit of a reality check. It’s not about crushing their spirit, though; it’s about guiding them to set process goals that focus on what they can control rather than the unpredictable nature of competition. We’ll share how to pivot from those lofty aspirations to achievable benchmarks that lead to actual progress. After all, it’s all about the journey, not just the destination, and sometimes that means celebrating the small victories along the way. So buckle up as we explore the balance between ambition and realism in the triathlon world, and how to help your athletes chase their dreams without losing their minds in the process! We also chat about our thoughts on transitions, nutrition and equipment and a few other tidbits that shape our approach to working with our athletes.

Episode takeaways:

  • Transitions in triathlons are basically free speed, and not rocket science, folks!

  • Practicing your transitions can turn you from a back-of-the-packer to a podium contender, just saying!

  • Training should fit into your life, not the other way around; balance is key to triathlon success.

  • Cold plunges are trendy but may actually hinder your recovery—surprise! Who knew?

References used for the MMB

Question: Are cold plunges beneficial for athletes?

Overall:

  • Cold water immersion (CWI), which has been practiced for centuries in various parts of the world, has recently gained popularity, being promoted as a self-care and performance-enhancing practice.

  • However, reported effects of CWI remain inconsistent, with some claiming to improve recovery and others claiming to interfere with recovery and muscle growth.

  • Meta-analysis has shown that CWI could improve several aspects of recovery in active populations, as indicated by improved power performance, reduced creatine kinase levels, reduced delayed onset muscle soreness, and increased perceived recovery after high-intensity exercise.

  • Another meta-analysis also suggests that CWI may improve overall well-being by improving sleep and quality of life among the general population. 

  • For athletes, CWI may be useful in competition settings that require quick turn-arounds or under high temperature environments, but there is not enough justification to implement CWI in preparation phases of training, as several studies point to CWI dampening adaptive responses to training.

  • Overall, papers suggest that while sport performance, immunity, and recovery effects remain inconclusive, cold exposures appear to elicit some physiological changes and could introduce benefits to perceived well-being.

    • Cold temperatures constrict blood vessels, which reduces blood flow and relieves swelling (inflammation) and soreness in the muscles.

    • Cold water instantly lowers body temperature after it gets elevated through exercise, which could be beneficial to those experiencing heat injuries (used for marathon runners).

    • Cold plunges can help your brain focus

    • Anecdotal evidence suggests improvements in sleep

  • It is important to recognize that CWI involves risks (hypothermia, nerve/skin damage, or numbness, cardiovascular stress), especially for those with underlying conditions

  • If one chooses to do CWI, start between 10- 15 °C (50-59 °F) for around 1-2 minutes and gradually increase the duration or lower temperature (do not go below 4°C or 40°F).

Are cold plunges good for you? Here’s what the science says.

By Gretchen Reynolds, Washington Post article published June 4 2025

Key Points:

  • Cold plungers say the practice is beneficial for enhancing the recovery from exercise, soothing aches, uplifting moods, and building mental strength/resilience.

  • While cold plunges have become popular over the years, studies suggest that they may reduce the benefits of workouts by interfering with muscle recovery and growth processes.

  • This outcome is presumed to be the result of cold temperatures shrinking blood vessels that decrease nutrient flow to the muscles.

  • This article notes a recent study by Betz et al. (2025) that used biotrackers to track the movement of protein to muscles in limbs plunged in tepid and icy water while monitoring blood flow using ultrasounds. 

    • They found that both blood flow and protein delivery declined in the limb plunged in icy water, which can lead to less muscle mass and strength over time.

    • Overall, their study, like some others, suggests how cold plunges can impede the desired effects of weight training.

  • More large-scale research is suggested to understand the effect of cold plunges on exercise response and to examine the effects on those who were not represented in the study, like women and older people.

  • In conclusion, the article suggests readers skip ice baths following training due to the bulk of evidence pointing to their limitations on training gains.

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

Moore et al. 2022

Key Points:

  • This systematic review and meta-analysis of 52 studies was the first of its kind to compare the effects of CWI and passive recovery on the following:

    • Recovery of performance measures, including muscular power, strength, endurance, and flexibility

    • Recovery from delayed onset muscle soreness (DOMS)

    • Perceived recovery

    • Recovery of creatine kinase

  • The overall findings of this study were mixed, but CWI may be effective at improving power performance, reducing creatine kinase levels, reducing DOMS, and increasing perceived recovery, particularly 24h after high-intensity exercise.

  • According to the meta-analysis, water temperature and exposure duration had no significant moderating effects on CWI at any time point aside from creatine kinase concentration and endurance performance after high-intensity exercise.

  • The meta-analysis revealed that larger effects on creatine kinase concentrations were observed when participants underwent shorter CWI exposures at lower temperatures.

  • CWI was effective in promoting recovery of muscular power 24h after both eccentric and high-intensity exercise, but had no effect or was not effective on the recovery of endurance and flexibility performance.

  • CWI was moderately effective in reducing DOMS and improving perceived recovery 24h following high-intensity exercise, but there was a non-significant but favorable effect of passive recovery over CWI on DOMS and perceived recovery at 48h and 72h, respectively. 

  • CWI was also moderately effective in reducing DOMS 48h-96h after eccentric exercise and improving perceived recovery 72-96h after eccentric exercise.

  • Reduced creatine kinase was found only at 168h after eccentric exercise using CWI.

  • While this study identified potential benefits of CWI, the nature of the study limits blinding participants, so results could reflect the placebo effects of CWI.

  • Furthermore, it is important to note that past studies investigating the effects of CWI on athletic recovery, perceptual recovery, and creatine kinase levels have reported mixed results.

Introduction: Since studies on the effectiveness of CWI on athletic performance recovery have given mixed or inconclusive results, this study aimed to conduct a meta-analysis to evaluate the effectiveness of CWI compared to passive recovery following eccentric and high-intensity exercise.

Methods: Systematic review conducted using the following databases: Medline, SPORTDiscus, Scopus, Web of Science, Cochrane Library, EmCare, and Embase, to include English publications with physically active participants aged 18+ that were published until September 20, 2021. Studies were peer-reviewed, randomised controlled trials. CWI was used within 15 minutes of a single bout of muscle-damage causing exercise. CWI recovery was compared to passive recovery. 

Results: 52 of the 4849 studies identified in the databases were included in the review. n=20 were included in the eccentric exercise meta-analysis, while n=32 were included in the high-intensity exercise meta-analysis. CWI was effective in promoting the recovery of muscular power 24h after both eccentric and high-intensity exercise. CWI was moderately effective in reducing DOMS and improving perceived recovery 24h following high-intensity exercise, but there was a non-significant but favorable effect of passive recovery over CWI on DOMS and perceived recovery at 48h and 72h, respectively. CWI was also moderately effective in reducing DOMS 48h-96h after eccentric exercise and improving perceived recovery 72-96h after eccentric exercise. Reduced creatine kinase was found only at 168h after eccentric exercise using CWI. Water temperature and exposure duration had no significant moderating effects of CWI at any timepoint aside from creatine kinase after high-intensity exercise. Only 4 studies had female-only cohorts and only 6 studies were mixed cohorts. 

Effects of cold-water immersion on health and wellbeing: A systematic review and meta-analysis

Cain et al. 2025

Key Points:

  • Cold water immersion (CWI), which involves immersing parts of or the entire body in cold water (10-15 °C or 50-59 °F), has been used for centuries in various parts of the world, but has recently gained popularity, being promoted as a self-care and performance-enhancing practice.

  • CWI has been shown to increase respiration rate, oxygen uptake, and cortisol/norepinephrine secretion, which are results seen after exercise, which could help to improve cardiovascular and cognitive health.

  • While this paper notes that while past meta-analysis by Moore et al. (2022) has shown that CWI may also speed up recovery of physical function, reduce muscle soreness, enhance perceived recovery, and reduce post-exercise inflammation, there is a growing number of evidence to suggest that CWI can interfere with muscle growth and muscle strength. 

  • This systematic review and meta-analysis focused on assessing the effects of CWI on the psychological, cognitive, and physiological state of the general population.

  • Overall, results suggest that CWI has some promising effects on general wellbeing with the meta-analysis showing significant reduction in stress 12h after CWI, improved sleep quality, and improved quality of life survey scores until 90 days.

  • However, CWI also showed significantly increased short-term inflammation as well as inconclusive effects on immunity and mood, necessitating further evaluation of the risks and benefits.

  • The number of studies assessing these are limited and vary in protocol, so it remains difficult to draw conclusions on the effects of CWI.

  • As in other studies, the lack of inclusion in participants and the inability of CWI studies to blind participants limits broader applicability of the results and introduces bias.

Introduction:

This study was a systematic review and meta-analysis to assess the psychological, cognitive, and physiological effects of cold-water immersion, which has gained popularity in recent years. 

Methods: Literature review conducted across 10 databases until January 17th, 2024. Randomized, controlled trial studies done on adults aged 18+, with acute or long-term exposure to CWI <=15 deg. C were included. 

Results: Of the 3481 studies identified in the search, 11 randomized studies were included in this review. 3177 participants included. CWI bath or cold shower temperature range was 7C to 15C. Meta analysis performed on inflammation, stress, and immunity. Only 1 study examined mood. Meta-analysis showed significant increase in inflammation immediately and 1h after CWI and significant reduction in stress 12h after CWI, while no significant changes in immunity were observed. No significant differences were observed between CWI and control groups in leukocyte and lymphocyte responses, number of reported sick days, moods (active, energetic, restless, fatigued, exhausted, or alert). On the other hand, sleep quality scores and quality of life survey scores until 90 days were better with CWI compared to passive recovery. However, like many other studies, the lack of inclusion in participants and the inability of CWI studies to blind participants limits broader applicability of the results and introduces bias.

The Benefits and Risks of Cold Plunges

Article by Cleveland Clinic, 2024

Key Points:

  • Dr. Dominic King, DO, recommends that those new to CWI start between 10-15°C (50-59°F) for around 1-2 minutes and gradually increase the duration

  • Experienced individuals often go as low as 4-10°C (39-50°F).

  • Generally, it is recommended not to go below 4°C (~40°F).

  • Following a CWI, 15-30 minutes of sauna therapy can be helpful to level out body temperatures

  • For healthy individuals, CWI may help relieve muscle soreness, improve circulation, and improve sleep.

  • Allan & Mawhinney (2017) report that while CWI may be useful in competition settings that require quick turn-arounds or under high temperature environments, there is not enough justification to implement CWI in preparation phases of training, as it could dampen adaptive responses to training.

  • The article reports the following benefits of CWI:

    • Cold temperatures constrict blood vessels, which reduces blood flow and relieves swelling (inflammation) and soreness in the muscles.

    • Cold water instantly lowers body temperature after it gets elevated through exercise, which could be beneficial to those experiencing heat injuries (used for marathon runners).

    • Cold plunges can help your brain focus

    • Anecdotal evidence suggests improvements in sleep

  • The article also reports the following risks of CWI:

    • It could be dangerous to those with underlying health conditions

    • Prolonged CWI can cause hypothermia, nerve/skin damage, or numbness

    • Hyperventilation can cause dizziness

    • Cold water can constrict vessels, raising blood pressure and inducing cardiovascular stress

Exploring the benefits of cold exposure in health and athletic performance - review of articles

Klimek et al. 2024

Key Points:

  • This was a literature review conducted using PubMed and books to explain the mechanisms, health benefits, and impact of low temperatures on sports performance to evaluate cryotherapy.

  • There are several cryotherapy techniques:

    • Local application of ice or a cold compress, which reduces inflammation

    • Cold showers 

    • Cold water immersions (CWI)

    • Whole body cryotherapy

  • This study notes the following:

    • Cryotherapy affects the cardiovascular system by increasing heart rate, significantly increasing blood pressure, and reducing cerebral artery blood flow by an average of 43%, which could result in fainting, drowsiness, and visual disturbances. 

    • Cryotherapy affects the respiratory system by increasing ventilation (especially when cold water immersion occurs for shorter periods of time in lower temperatures) and decreasing the arterial pressure of CO2.

    • Cryotherapy has also been found to affect the endocrine system by significantly increasing norepinephrine levels. Inconsistent changes in cortisol levels have been reported.

    • The effects of low temperature on immune function remain unclear, with uncertain clinical consequences of biochemical and morphological changes being reported across different studies.

    • A comparison of post-exercise procedures showed that cold immersions are more effective in reducing muscle soreness and increasing muscle power than warm water immersion, active recovery, or contrast water therapy. However, other studies have suggested that CWI can reduce the effect of strength training by reducing protein synthesis and increasing catabolic activity that result in less muscle mass growth.

    • Furthermore, studies have shown that CWI improves perceived stress, well-being, alertness, attentiveness, and feelings of inspiration/pride while decreasing perceived nervousness and depression. fMRI studies have also shown that these increases in positive affect are associated with increased brain activity in regions related to emotion, self-regulation, and attention.

  • Overall, reports in this review suggest that while sport performance, immunity, and recovery effects remain inconclusive, cold exposures appear to elicit some physiological changes and could introduce benefits of perceived well-being. Understanding the mechanisms by which cold exposures affect the body could offer perspective on ways to improve performance, reduce inflammation, and improve immunity.Not a subscriber to the podcast? Click here!

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