Chunlin Hou

Background: Exercise-induced muscle damage (EIMD) after strenuous exercise can impair neuromuscular function and increase muscle soreness. Although cold-water immersion (CWI), massage, and active recovery are widely used, their comparative effects across recovery time windows remain unclear. Objective: We aimed to compare and rank the effects of post-exercise physical recovery strategies on countermovement jump (CMJ), delayed-onset muscle soreness (DOMS), and creatine kinase (CK) during acute and delayed recovery. Methods: A systematic review and frequentist network meta-analysis were conducted in accordance with PRISMA 2020 and the PRISMA extension for network meta-analyses. Five databases (PubMed, Web of Science, SPORTDiscus, Cochrane Library, and Scopus) were searched. The study protocol and prespecified methods were publicly archived on the Open Science Framework (OSF, DOI:10.17605/OSF.IO/ASWU6). Outcomes were grouped into an acute phase (0–24 h) and a delayed phase (48–72 h). The primary analysis was restricted to the connected main network anchored by passive control. Random-effects models were used to calculate effect sizes with 95% confidence intervals, and P-scores were used to rank interventions. Results: In the acute phase, active recovery and CWI demonstrated the largest effect sizes for CMJ recovery at 24 h, though confidence intervals were wide. For DOMS, both CWI and massage showed beneficial effects immediately after exercise and at 24 h. CWI also reduced CK immediately after exercise and at 24 h. In the delayed phase, most effects diminished, with no significant benefit for CMJ or CK; however, CWI remained associated with lower DOMS at 48 h. Conclusions: Recovery effects appear to be strongly time-dependent. Active recovery may be preferable for short-term restoration of explosive performance, massage for early soreness relief, and CWI for broader short-term recovery support.