Effects of different recovery and regeneration modalities on delayed-onset muscle soreness and post-exercise muscle damage markers: a systematic review and network meta-analysis
Year: 2026
Type: review
Study designs: Systematic Review, Meta-Analysis
Abstract: Objective This study employed a systematic review and Bayesian network meta-analysis to compare the effects of multiple post-exercise interventions during the early recovery period, examine whether these effects varied across recovery time points, and provide evidence to inform the selection of post-exercise recovery strategies. Methods PubMed, Embase, the Cochrane Library, and Web of Science were systematically searched, and randomized controlled trials, including parallel-group and crossover designs, were included. A Bayesian random-effects network meta-analysis was used to estimate mean differences (MDs) and 95% credible intervals (CrIs). The revised Cochrane risk-of-bias tool for randomized trials (RoB 2) and the Confidence in Network Meta-Analysis (CINeMA) framework were used to assess risk of bias and confidence in the evidence, respectively. Sensitivity analyses and exploratory univariable network meta-regression analyses were also performed. Results A total of 35 studies were included in this review. For delayed-onset muscle soreness (DOMS), whole-body cryotherapy (WBC) and photobiomodulation/phototherapy-related interventions (PHO) showed relatively large reductions in soreness at both 24 and 48 h after exercise. Compared with the combined control/placebo condition (CON/PBO), the effect estimates for WBC were MD = −38.92 (95% CrI: −69.08 to −9.15) at 24 h and MD = −40.03 (95% CrI: −67.74 to −12.44) at 48 h. The corresponding estimates for PHO were MD = −18.20 (95% CrI: −32.91 to −3.72) and MD = −19.46 (95% CrI: −33.55 to −5.99), respectively. For creatine kinase (CK), low-level laser therapy (LLLT) and PHO were associated with lower CK levels at both 24 and 48 h, with the largest estimated effect for LLLT at 48 h (MD = −499.96, 95% CrI: −831.59 to −203.59). For interleukin-6 (IL-6), CWI showed favorable estimates at both 24 and 48 h, although the evidence base was limited and the network was sparse. Conclusion WBC and PHO showed relatively consistent favorable effects on DOMS at 24 and 48 h, whereas LLLT and PHO showed relatively consistent associations with lower CK levels. The IL-6 findings should be interpreted as exploratory because of the limited evidence base. Selection of post-exercise recovery strategies should consider the target outcome, recovery time window, evidence certainty, and network structure.
Authors: Jianxin Li, Siyu Wang, Ming Wei, Weipeng Liu
Institution: Shenyang Sport University
Language: English
Subfield: Physiology (medical)
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,801
OpenAlex ID: W7223652294