REF-1321 · Li et al., 2024 · Sports Medicine - Open · Paper · PubMed · Free full text

Which recovery tool works best for endurance athletes?

None showed a consistent benefit across 63 controlled studies of 1100 athletes; next-day gains rest on a handful of small studies. Sleep was not studied.

Main caveat: Vote counting, no pooling. The endurance verdict counts significant results; small studies with non-significant results are read as no effect.
moderate evidenceMeasured on recreational to world-class athletes

Li, Kempe, Brink and Lemmink (University of Groningen) asked which recovery strategies work for endurance athletes between training sessions or competitions.

They searched PubMed, the Cochrane Database of Systematic Reviews and Web of Science to December 2022 for systematic reviews and meta-analyses comparing a recovery strategy with placebo or control after exercise, rated them with AMSTAR 2 (one critically low review excluded) and kept 22: nine systematic reviews, three meta-analyses and ten systematic reviews with meta-analyses, covering 547 studies and 9327 participants of all sports.

Because every review mixed in non-endurance athletes, they went back to the primary studies and kept those done only in endurance athletes with a clear control or placebo group: 63 studies, 1100 athletes, 60 on passive strategies (compression garments, cold and other temperature methods, supplements, massage) and three on active recovery; none on proactive strategies such as sleep or social activity.

Each result was labelled positive, negative, no effect or contradictory.

Compression garments, the most studied tool (28 of 63 studies), improved a performance test twice against 12 non-significant results (and one negative) and a physiological marker twice against 39 non-significant; cold applications showed no performance effect; supplements and massage reported no performance outcomes; massage eased soreness in two of four studies; active recovery lowered blood lactate in two of three.

Only eight studies, all from the five reviews with time-course data, gave effects 8-24 h after exercise; of their eleven effect sizes at 24 h, one had a confidence interval excluding zero (sprint performance after cold-water immersion in 12 cyclists, ES 1.01).

The authors conclude that no single strategy can be advised for endurance athletes, while compression and cold-water immersion look promising for recovery between sessions.

Our reading: the null is honest but partly built by vote counting — many small non-significant studies do not show absence of an effect — and the "promising" claim for compression is not supported by its own Table 3. It agrees with REF-1090 (no modality beat passive rest in endurance athletes) and adds nothing on sleep.

Protocol

Design: umbrella review, PRISMA; PROSPERO CRD42021260509. One reviewer searched PubMed, Web of Science and the Cochrane Database of Systematic Reviews in December 2022 (English, published before December 2022); two reviewers selected and extracted independently in Rayyan.
Eligibility: systematic reviews, meta-analyses or both, of observational or experimental studies of recovery strategies against placebo or control after a training session in adult endurance athletes, recreational to elite (McKay tiers 1 to 5); recovery from injury excluded. Strategies classed as passive, active or proactive (Kellmann).
Quality: AMSTAR 2 (16 items; 13 for reviews without meta-analysis), scored as a percentage: high ≥75%, moderate ≥50%, low <50%, critically low <25%; critically low reviews excluded (one: Born 2013).
Re-extraction: from the 22 reviews, 165 studies with 2473 endurance-athlete participants; after removing duplicates and studies without a clear control or placebo, 63 studies, n = 1100 athletes (835 male, 120 female, 145 not stated); 60 passive (1052 athletes), 3 active (48), 0 proactive. Where a study appeared in several reviews, data from the higher-rated review were used.
Synthesis: for the ten most common outcomes (time to exhaustion, countermovement jump, running economy, lactate, oxygen uptake, VO2max, heart rate, creatine kinase, RPE, muscle soreness), each result classed as positive, negative, no effect or contradictory; a separate look at effects 8-24 h after exercise using the time-course data of five reviews. No meta-analysis by the umbrella authors.
Funding and interests: supported by the Chinese government Ph.D. scholarship under CSC No. 202008440321; all authors declare no competing interests.

Key Results

Reviews (all sports): 22 included (9 SR, 3 MA, 10 SRMA), 547 studies, 9327 participants; passive strategies 19 reviews (460 studies, 8097 participants), active 2 (75 studies, 1103), proactive 1 (12 studies, 127; alcohol). AMSTAR 2: high 3 (two on cryotherapy, one on chocolate milk), moderate 11, low 8.

Among the reproduced pooled results, regular cold-water immersion reduced strength-training gains (SMD −0.60) but not endurance time-trial or maximal aerobic power (SMD −0.07) or time-trial duration (SMD 0.00) — the same figures the base holds in REF-914.

Endurance-athlete studies, vote count by strategy (Results):

Strategy (studies)Performance (TTE, CMJ, RE)Physiological (La, VO2, VO2max, HR, CK)Perceived (soreness, RPE)
Compression garments (28 of 63)2 positive, 12 not significant, 1 negative (TTE)2 positive (lactate, HR), 39 not significantsoreness 2 positive, 4 n.s.; RPE 1 positive, 13 n.s., 1 contradictory
Temperature-based (cold)0 positive, 2 n.s. (TTE)3 positive (HR, CK), 6 n.s.1 positive (soreness), 10 n.s.
Supplementsnone reported1 negative (lactate, carbohydrate vs placebo), 13 n.s.RPE 1 positive, 5 n.s.; soreness 2 n.s.
Massagenone reportedwhole-body vibration n.s. for La, VO2, CKsoreness 2 positive, 2 n.s.
Active recovery (3 studies, 48 athletes)none reportedlactate 2 positive; 3 n.s. (VO2, HR)none reported

Recovery between sessions — effect sizes 24 h after exercise in endurance athletes (Table 3):

OutcomeStrategyStudy (participants)ES (95% CI)
StrengthCryogenic chamberHausswirth (9 well-trained male runners)3.00 (−2.59 to 8.59)
StrengthWhole-body cryotherapyDantas (30 recreational male runners)0.33 (−0.56 to 1.21)
StrengthManual massageDawson (12 competitive runners)0.00 (−0.23 to 0.27)
StrengthWhole-body vibrationEdge (9 competitive male runners)−0.03 (−0.29 to 0.24)
StrengthCompression knee socks / calf sleevesBieuzen (11 highly trained male runners)0.83 (−0.05 to 1.70)
StrengthGraduated compression tightsHill (24 recreational marathon runners)0.35 (−0.46 to 1.16)
JumpCompression knee socks / calf sleevesBieuzen (11)0.48 (−0.37 to 1.33)
SprintCold-water immersionStanley (11 trained male cyclists)0.57 (−0.28 to 1.42)
SprintHydrotherapy incl. cold-water immersionVaile (12 male cyclists)1.01 (0.16 to 1.86)
EnduranceCold-water immersionStanley (11)0.12 (−0.72 to 0.96)
EnduranceHydrotherapyVaile (12)0.10 (−0.70 to 0.90)
Our reading of Table 3: one of eleven intervals excludes zero (Vaile, sprint, 12 cyclists); all three compression intervals (two strength, one jump) and five of the six cryotherapy intervals include zero, so the authors' "promising" has no interval clear of zero for compression and rests on one effect in one 12-rider study for cold water.

Mechanisms

Measured: in endurance athletes, most comparisons of a recovery tool with control showed no significant difference in performance tests, markers or perceived recovery; active recovery lowered blood lactate after short, intense exercise; soreness fell in some compression, cold and massage studies.
Authors' interpretation: endurance athletes may respond differently from team-sport athletes, so mixed-sport reviews mislead; very cold applications (below about 14 °C) may be needed for a physiological effect; massage may act mainly as a short-lived psychological or placebo effect; compression results may depend on pressure and on most studies being in marathon runners wearing stockings while running.
Inference: most included studies tested one bout with one post-measurement in roughly 10-30 athletes, which can detect only large effects; a count of non-significant results is weak evidence of no effect, so "no consistent benefit" means "not shown", not "shown not to work".

Practical Application

Which recovery tool works best for endurance athletes? None showed a consistent benefit across 63 controlled studies of 1100 athletes; next-day gains rest on a handful of small studies. Sleep was not studied.
Spend recovery effort on the basics, not on gadgets (B+, endurance athletes, mostly men): the evidence here does not favour any tool over doing nothing for next-day performance, in line with REF-1090; the base's defaults in SYNTH-70 — an easy day or a rest day, food, sleep — stay first. Sleep was outside this review's evidence; its weight in the base comes from REF-204.
Compression and cold for comfort or soreness, not as a performance promise: compression improved a performance test twice against 12 non-significant results, cold in none of its two; soreness and perceived recovery improved in some studies.Not from this paper; the base's own practice: in race blocks, stage races and camps cold water, compression and massage are all reasonable, and in a build the tools that feel good are used freely, cold water away from strength work (SYNTH-70).
Massage: no evidence of a next-day strength benefit at 24 h (ES 0.00, 95% CI −0.23 to 0.27, 12 runners; −0.03, −0.29 to 0.24, 9 runners); soreness eased in two of four studies.
Cold water after lifting still costs gains: the reproduced pooled result (SMD −0.60 for strength gains; no evidence of an effect on endurance time-trial or maximal aerobic power, SMD −0.07, 95% CI −0.54 to 0.53, mostly in non-endurance athletes) matches REF-914 and REF-011; keep cold water away from strength sessions in a build (SYNTH-70).
Active cool-down: the general active-recovery review (Ortiz; low quality; its ten studies without a control group were excluded from the endurance analysis; the other active review is on foam rolling) favoured 6-10 min of easy activity and suggested the benefit may be psychological — consistent with the base's optional 5-15 min (SYNTH-70, REF-913).

Limitations

Vote counting, no pooling. The endurance verdict counts significant results; small studies with non-significant results are read as no effect. Effect sizes were tabulated only for the eight 8-24-h studies.
Thin evidence where it matters. Eight studies, all with 9-30 participants, measured recovery at 8-24 h; active recovery had three studies (48 athletes) and no performance outcome; no endurance study of proactive strategies such as sleep.
Population. 835 of 1100 athletes were men, 120 women; outcomes were single-bout markers and tests, not adaptation.
AMSTAR 2 used as a score. Reviews were graded by the percentage of items met rather than by the tool's critical domains.
Reporting errors. The text says compression "consistently yielded benefits" for runners at 24 h and that cryotherapy showed three large effects (ES 0.57 to 1.01) and four low ones (0.1 to 0.17), but Table 3 has three compression effects (two strength, one jump), all with intervals including zero, six cryotherapy effects, a largest effect of 3.00 and no 0.17.In Table 1, one reproduced mean difference (4.97) lies outside its own CI (3.2 to 4.7) and the same 4.97 is repeated for a second comparison with a CI of −0.5 to 1.6; one review's CIs carry sign errors (Moore: muscular power 0.06 to −0.62; soreness −1.48 to 0.29 with p = 0.003), as does the cold-water strength-gain CI (0.87 to −0.33); the massage review's line says untrained athletes benefited more (+2.3%, g = 0.17) than trained (+6.5%, g = 0.23), the numbers pointing the other way.The Discussion says 19 of 22 reviews were low to moderate "except for one", while three were rated high.
Funding. A Chinese government Ph.D. scholarship; no competing interests declared. No manufacturer funding.
How this entry was checked and changed
Why this level

read from the full text (Europe PMC, CC BY 4.0). The rubric places an umbrella review at A+; held three steps lower because its endurance-athlete verdict is not built on the reviews' pooled estimates (those mix team-sport and other athletes) but on a count of significant and non-significant results across 63 mostly small controlled studies, in which "not significant" is counted as "no effect"; the 8-24-h analysis rests on eight studies; the source reviews were rated high in 3, moderate in 11 and low in 8; and its tables carry transcription errors (Limitations)

Full text (checked 2026-10-27)
Twenty-two reviews (nine systematic reviews, three meta-analyses, and ten systematic reviews with meta-analyses); sixty-three studies with 1100 endurance athletes were included (full text)
Sixty-three studies (1100 participants: 835 male, 120 female, 145 sex non-mentioned); passive recovery 60 studies, active recovery 3 studies (full text)
AMSTAR 2: three reviews high, eleven moderate, eight low; one review excluded as critically low (full text)
For CG, positive effects on performance variables were found only twice, while non-significant results were apparent 12 times; 39 non-significant effects for the other physiological variables (full text)
Eight studies examined the effects in endurance athletes 8–24 h after exercise (full text)
Vaile et al., 12M cyclists, sprint performance post 24 h: ES 1.01, 95% CI 0.16 to 1.86; endurance performance ES 0.10 (− 0.70 to 0.90) (full text)
Bieuzen et al., 11M highly trained runners, compression, strength post 24 h: ES 0.83 (− 0.05 to 1.70) (full text)
Funding: Chinese government Ph.D. scholarship under CSC No. 202008440321; the authors declare no competing interests (full text)