Cold as Medicine: A Standardized Comparative Framework for Whole Body Cryotherapy, Local Cryotherapy, and Cold-Water Immersion across Sport, Metabolism, and Clinical Care

Deliberate cold exposure has moved from the margins of recovery practice into mainstream physiology, sports science, and clinical research. Whole-body cryotherapy, local cryotherapy, and cold-water immersion differ in thermal dose, tissue cooling, delivery, and tolerability, but they share a common starting point: each imposes a controlled cold stress that challenges heat balance and prompts a coordinated physiological response. When the stimulus is sufficient, cold can activate brown adipose tissue and non-shivering thermogenesis, raise energy expenditure, and alter substrate use, including lipid and glucose metabolism. These metabolic responses interact with inflammatory and immune signaling, vascular tone, redox balance, and blood rheology. Cold is therefore best understood not as a single recovery method, but as a measurable physiological intervention whose effects depend on modality, dose, timing, and population.Because these systems move together, cold exposure needs to be studied through shared endpoints. Thermoregulatory and metabolic responses can be assessed through core and skin temperature, brown adipose tissue activity, energy expenditure, substrate oxidation, glucose handling, lipid profile, adipokines, body composition, and erythrocyte function. Redox responses can be tracked through catalase, glutathione peroxidase, and superoxide dismutase activity, as well as markers of lipid peroxidation. Hemorheological responses can be measured through red blood cell deformability and aggregation, plasma and whole-blood viscosity, and fibrinogen. These variables give the field a common language. They allow cold modalities to be compared not only by temperature or exposure time, but by biological response.This comparative lens matters across three settings. In sport, cryotherapy and cold-water immersion are used to reduce soreness, manage inflammation, and support short-term recovery after training or competition. Yet repeated use, especially after resistance training, may also alter some training adaptations, making timing and dose central scientific questions. In metabolic health, cold exposure is being tested for its effects on brown fat, glucose regulation, lipid metabolism, body composition, obesity, type 2 diabetes, and metabolic syndrome. In clinical care, cold-based interventions are being explored as adjuncts in conditions shaped by oxidative stress, inflammation, pain, fatigue, and impaired microcirculation, including multiple sclerosis, rheumatoid arthritis, osteoarthritis, and hematological or microcirculatory disorders.Despite this promise, the evidence remains fragmented. Studies often rely on small cohorts, varied protocols, and inconsistent endpoints. Temperature, exposure time, session number, timing relative to exercise or treatment, and outcome measures differ widely across the literature. As a result, dose, duration, safety, tolerability, and benefit remain difficult to compare across modalities and populations.The goal of this Research Topic is to consolidate evidence on cold exposure as a thermoregulatory, metabolic, recovery, and therapeutic intervention, and to organize that evidence around standardized, measurable endpoints. We aim to clarify how whole-body cryotherapy, local cryotherapy, and cold-water immersion affect thermogenesis, energy metabolism, athletic recovery, hemorheology, oxidative-antioxidant balance, inflammation, vascular function, and clinical outcomes. By bringing sport, metabolic, and clinical research into one collection, we seek to move the field from isolated protocol studies toward a comparative framework that can define where cold delivers reproducible benefit, for whom, and under which conditions.We welcome Original Research, Clinical Trials, Study Protocols, Systematic Reviews, Mini Reviews, and Brief Research Reports addressing, but not limited to: Thermoregulation and metabolic adaptation to cold: brown adipose tissue, non-shivering thermogenesis, energy expenditure, and substrate useMetabolic and cardiometabolic responses: lipid profile, adipokines, glucose handling, erythrocyte function, and body composition, including obesity, type 2 diabetes, and metabolic syndromeMetabolic modulation of inflammation, immune signaling, vascular function, and redox balance after cold exposureCold exposure and recovery in athletes: combinations with hypoxia, occlusion, or training loadEffects of cold on muscle damage, soreness, performance, and neuromuscular recoveryRecovery protocols and timing: immediate versus delayed immersion, dose, and effect on training adaptationOxidative-antioxidant balance after cryotherapy and cold-water immersion: enzyme activity, lipid peroxidation, and redox biomarkersCold-based interventions in clinical populations: multiple sclerosis, rheumatoid arthritis, osteoarthritis, and hematological or microcirculatory disordersHemorheological responses: red blood cell deformability and aggregation, plasma and whole-blood viscosity, fibrinogenComparative studies across cold modalities: dose-response relationships for session number, temperature, and exposure timeSafety, tolerability, contraindications, and protocol standardization for metabolic, athletic, and clinical use Topic editors: Bartłomiej Ptaszek, ANETA TELEGŁÓW, Olga Czerwińska-Ledwig, Elvis Souza Malta, Marius Brazaitis Source: https://www.frontiersin.org/research-topics/83228/cold-as-medicine-a-standardized-comparative-framework-for-whole-body-cryotherapy-local-cryotherapy-and-cold-water-immersion-across-sport-metabolism-and-clinical-care