The Benefits of Contrast Bath Therapy

By Former Wellness Advisor Sara Szal Gottfried, MD

You may have heard of the benefits of deliberate hot water immersion, and perhaps you have heard of the benefits of deliberate cold water immersion. What about when you combine the two by alternating between hot and cold mineral water?

Alternating hot and cold mineral water immersion is one form of contrast bathing. The idea is an ancient concept, recently popularized by advocates such as Wim “The Iceman” Hof and Professor Andrew Huberman. Can you really improve your health through contrast bathing? Throughout Europe and Japan, physicians prescribe soaking in mineral waters of varying temperatures to treat conditions and reduce risk of disease, including reduction of tension and stress and extending to other benefits such as reduction of inflammation, better breathing, and improved athletic recovery. In this blog, we will explore the more commonly known benefits of contrast immersion as well as the lesser known attributes such as enhanced brain chemicals, blood flow to skin and muscles, lactate recovery, and glucose modulation.

BOOK A SOAK AT WORLDSPRINGS

Benefits of Contrast Bathing

Many of the benefits of contrast immersion stem from the study of cold water immersion. Contrast bathing may activate the innate healing capacity of the body, which may relieve various conditions and symptoms. When practiced regularly, positive effects of contrast bathing seem to last longer and may affect cardiovascular circulation, improve chronic inflammation, and perhaps improve fat burning.

Documented benefits are listed below. Note that some of the benefits are directly from cold water immersion whereas other studies investigate contrast bathing.

• Increase oxygenation and blood flow to muscle tissue. In a study of athletes in their twenties, oxygenation and blood flow improved to the calf muscles with contrast bathing, suggesting a potential application in recovery from injury.
• Improve energy, mood, and focus. Cold water exposure triggers release of dopamine, epinephrine (also known as adrenaline), and norepinephrine in the body, though data are mixed perhaps related to body size and fitness level. All are potential feel-good brain chemicals that make you feel more alert and able to focus. Dopamine can take a while to be triggered with cold water immersion, though epinephrine can spike in under one minute. Colder temperatures trigger a more rapid release, with the caveats listed below.
• Lowers blood pressure and heart rate. Cold water immersion to 89.6 degrees Fahrenheit increases your systolic and diastolic blood pressure by 11 to 12 percent, respectively, and reduces heart rate by 15 percent according to older research. While these changes are advantageous for most people, care must be taken not to drop blood pressure and heart rate excessively, to remain well hydrated, and to track carefully how you feel throughout the exposure.
• Rapid recovery after intense exercise, as measured by lactate elimination. In one small study of 11 subjects, men and women showed similar benefit with contrast water immersion for 30 minutes to hasten plasma lactate decrease. Temperatures used were hot (96.8 degrees Fahrenheit) and cold (53.6 degrees Fahrenheit) water baths. Another study in 20 rugby players showed a similar lactate effect. In a meta-analysis of 52 studies of cold water immersion, positive effects were observed in muscle power, muscle soreness, creatine kinase—and that shorter durations and lower temperatures may improve the efficacy of cold water immersion after high intensity exercise.
• Better HRV after intense exercise. Another study in 20 men confirmed the lactate elimination and showed improved post-exercise cardiac autonomic regulation. When you exercise, you activate the sympathetic (fight or flight) response, and contrast cold water immersion appears to accelerate parasympathetic reactivation.
• Better skin blood flow in rheumatoid arthritis, diabetes, and foot/ankle injuries in a systematic review of 10 studies.
• Healthier lung function and few respiratory infections in people with chronic respiratory disease. In particular, inhaling sulfurous mineral waters may help with clearing mucus from the respiratory tract, and cold water immersion appears to lessen the risk of infection in people with chronic respiratory disease.
• Enhanced glucose metabolism and insulin sensitivity. Deliberate cold exposure increases your metabolism because your body has to burn more calories in order to raise core body temperature.
• Muscle soreness. One small study of 26 men found a transient decrease in muscle soreness with contrast bathing compared to use of compression garments, though other measures of athletic performance were not significantly different.

As Professor Andrew Huberman points out, contrast bathing may also increase resilience and grit, though these outcomes are more difficult to demonstrate. On his podcast about deliberate cold exposure, he describes training the prefrontal cortex with cold immersion may help regulate one’s “top-down” control that translate into a skill that applies more broadly to other situations, “allowing you to cope better and maintain a calm, clear mind when confronted with real-world stressors. In other words, deliberate cold exposure is great training for the mind.”

BOOK A SOAK AT WORLDSPRINGS

One meta-analysis of 28 studies showed that cold water immersion may be more advantageous than active recovery, warm water immersion, and even contrast bathing, though data are limited. Find what works best for you.

How to Do It and Keep Safe

Generally you start with warm or hot water first. Finish with cold to allow your body to heat up on it’s own without the assistance of warm water for maximal metabolic benefit.

Use warm but not hot water to adjust slowly. While deliberate hot water immersion includes risks that we have previously described, it’s the cold water immersion that can be riskier because cold shot is possible. You need to find the right temperature for you, go slow, and limit your exposure initially to just a few minutes. Prioritize safety.

For the cold water portion, there are a few tenets to create safety.

• Only immerse your body up to your neck, and keep your head above water. The torso seems to be the most important.
• Keep in mind that some people tolerate cold water better than others. You want to aim for water that is mildly uncomfortable, i.e., cold enough to make you want to get out, but safe enough for you to stay for a few minutes. That may be 60 degrees for some folks, and 45 degrees for others.
• Professor Huberman recommends deliberate cold exposure for a grand total of 11 minutes per week. He advises two to four sessions that last one to five minutes each distributed across a week.

Common sense dictates that you choose safe bodies of water for contrast bathing. Take care to perform slow, deliberate breathing and avoid hyperventilation before or during water immersion.

Conclusion

If you are new to contrast bathing or cold water immersion, take your time to adapt. It may feel uncomfortable at first, but following the instructions that we’ve provided will help you slowly adjust and experience the benefits.

At WorldSprings, you will find various circuits that allow you to perform contrast bathing. Warm to hot mineral baths range from 37.8 up to 40°C in replica of the hot springs of Osek South Korea waters, Yarrangobilly, Australia, and Blue Lagoon of Iceland, and cold plunges that are 55°C.

Metabolism

In the short-term, cold exposure increases metabolism as the body has to burn calories to increase core body temperature. The total calories burned from the cold exposure are not that significant. However, the conversion of white fat (energy storage) to beige or brown fat (which are highly metabolically active) can be beneficial for:

1. Allowing people to feel more comfortable in the cold (i.e., cold adaptation)
2. Triggering further and more sustained increases in metabolism

Of course, calories in (consumed) versus calories out (metabolized) or “CICO” governs whether you gain, lose, or maintain weight. There is no escaping the laws of thermodynamics.

BOOK A SOAK AT WORLDSPRINGS

__________________________________________________

1. Shadgan B, et al. Contrast baths, intramuscular hemodynamics, and oxygenation as monitored by near-infrared spectroscopy. J Athl Train. 2018 Aug;53(8):782-787. doi: 10.4085/1062-6050-127-17. Epub 2018 Sep 13. PMID: 30212235; PMCID: PMC6188085. https://pubmed.ncbi.nlm.nih.gov/30212235/

2. Johnson DG, Hayward JS, Jacobs TP, Collis ML, Eckerson JD, Williams RH. Plasma norepinephrine responses of man in cold water. J Appl Physiol Respir Environ Exerc Physiol. 1977 Aug;43(2):216-20. doi: 10.1152/jappl.1977.43.2.216. PMID: 911386. https://pubmed.ncbi.nlm.nih.gov/911386/; Aizawa Y, Shibata A, Tajiri M, Hirasawa Y. Reflex vasoconstriction to a cold stimulus for non-invasive evaluation of neurovascular function in man. Jpn Heart J. 1979 May;20(3):301-5. doi: 10.1536/ihj.20.301. PMID: 459099. https://pubmed.ncbi.nlm.nih.gov/459099/;

Smith DJ, Deuster PA, Ryan CJ, Doubt TJ. Prolonged whole body immersion in cold water: hormonal and metabolic changes. Undersea Biomed Res. 1990 Mar;17(2):139-47. PMID: 2321318. https://pubmed.ncbi.nlm.nih.gov/2321318/;

3. McMurray RG, Kocher PL, Horvath SM. Aerobic power and body size affects the exercise-induced stress hormone responses to varying water temperatures. Aviat Space Environ Med. 1994 Sep;65(9):809-14. PMID: 7818449. https://pubmed.ncbi.nlm.nih.gov/7818449/; Janský L, Srámek P, Savĺiková J, Ulicný B, Janáková H, Horký K. Change in sympathetic activity, cardiovascular functions and plasma hormone concentrations due to cold water immersion in men. Eur J Appl Physiol Occup Physiol. 1996;74(1-2):148-52. doi: 10.1007/BF00376507. PMID: 8891513. https://pubmed.ncbi.nlm.nih.gov/8891513/

4. Srámek P, Simecková M, Janský L, Savlíková J, Vybíral S. Human physiological responses to immersion into water of different temperatures. Eur J Appl Physiol. 2000 Mar;81(5):436-42. doi: 10.1007/s004210050065. PMID: 10751106. https://pubmed.ncbi.nlm.nih.gov/10751106/

5. Morton RH. Contrast water immersion hastens plasma lactate decrease after intense anaerobic exercise. J Sci Med Sport. 2007 Dec;10(6):467-70. doi: 10.1016/j.jsams.2006.09.004. Epub 2006 Nov 22. PMID: 17118706. https://pubmed.ncbi.nlm.nih.gov/17118706/

6. Hamlin MJ. The effect of contrast temperature water therapy on repeated sprint performance. J Sci Med Sport. 2007 Dec;10(6):398-402. doi: 10.1016/j.jsams.2007.01.002. Epub 2007 Mar 6. PMID: 17339133.

https://pubmed.ncbi.nlm.nih.gov/17339133/

7. Moore E, Fuller JT, Buckley JD, Saunders S, Halson SL, Broatch JR, Bellenger CR. 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. Sports Med. 2022 Jul;52(7):1667-1688. doi: 10.1007/s40279-022-01644-9. Epub 2022 Feb 14. PMID: 35157264; PMCID: PMC9213381. https://pubmed.ncbi.nlm.nih.gov/35157264/

8. Bastos FN, Vanderlei LC, Nakamura FY, Bertollo M, Godoy MF, Hoshi RA, Junior JN, Pastre CM. Effects of cold water immersion and active recovery on post-exercise heart rate variability. Int J Sports Med. 2012 Nov;33(11):873-9. doi: 10.1055/s-0032-1301905. Epub 2012 Jun 21. PMID: 22722961. https://pubmed.ncbi.nlm.nih.gov/22722961/
9. Breger Stanton DE, et al. A systematic review of the effectiveness of contrast baths. J Hand Ther. 2009 Jan-Mar;22(1):57-69; quiz 70. doi: 10.1016/j.jht.2008.08.001. Epub 2008 Oct 22. PMID: 18945584. https://pubmed.ncbi.nlm.nih.gov/18945584/
10. Khaltaev N, et al. Balneotherapy and hydrotherapy in chronic respiratory disease. J Thorac Dis. 2020 Aug;12(8):4459-4468. doi: 10.21037/jtd-gard-2019-009. PMID: 32944359; PMCID: PMC7475532. https://pubmed.ncbi.nlm.nih.gov/32944359/

11. Scott MC, Fuller S. The Effects of Intermittent Cold Exposure on Adipose Tissue. Int J Mol Sci. 2023 Dec 19;25(1):46. doi: 10.3390/ijms25010046. PMID: 38203217; PMCID: PMC10778965. https://pubmed.ncbi.nlm.nih.gov/38203217/
12. French DN, Thompson KG, Garland SW, Barnes CA, Portas MD, Hood PE, Wilkes G. The effects of contrast bathing and compression therapy on muscular performance. Med Sci Sports Exerc. 2008 Jul;40(7):1297-306. doi: 10.1249/MSS.0b013e31816b10d5. PMID: 18580411. https://pubmed.ncbi.nlm.nih.gov/18580411/
13. https://www.hubermanlab.com/newsletter/the-science-and-use-of-cold-exposure-for-health-and-performance, accessed January 31, 2024.

14. Moore E, Fuller JT, Bellenger CR, Saunders S, Halson SL, Broatch JR, Buckley JD. Effects of Cold-Water Immersion Compared with Other Recovery Modalities on Athletic Performance Following Acute Strenuous Exercise in Physically Active Participants: A Systematic Review, Meta-Analysis, and Meta-Regression. Sports Med. 2023 Mar;53(3):687-705. doi: 10.1007/s40279-022-01800-1. Epub 2022 Dec 17. PMID: 36527593. https://pubmed.ncbi.nlm.nih.gov/36527593/