Ironman Triathlons impose intense physiological stresses. Coldwater immersion has been debated to improve recovery, however, no study has examined its effect following an Ironman. Objective: Examine the impact of cold-water immersion on recovery following an Ironman Triathlon. Design: Observational field study. Setting: 2011 Ironman World Championships in Kona, Hawaii (28.9°C, 71% relative humidity). Patients or Other Participants: 33 subjects (n=22 males, 11 females) entered in the Ironman World Championships (Mean±SD: age= 40±11y; height=174.5±9.1cm; percent body fat=11.4±4.1%). Interventions: Ten minutes of cold-water immersion to the sternal notch (10.4±0.2°C) immediately upon race finish. Subjects were randomized post race into a control group (CON) or intervention group (CWI). Data collection occurred prior to (PRE), immediately post (POST), 16 hours (16h) and 40 hours (40h) post race. Main Outcome Measures: Myoglobin (MYO), creatine kinase (CK), interleukin-6 (IL6), cortisol (CORT), C-reactive protein (CRP) and delayed onset muscle soreness (DOMS). A two-way mixed model ANOVA examined differences across time and between groups. Pearson`s ivariate correlations compared finishing time and percent of time spent during bike (%B) and run (%R) sections. Alpha level was set a priori at 0.05. Hedges` g effect sizes were calculated. Results: CWI group (n=12; height=175.8±6.4cm; percent body fat=11.3±4.7%; finish time (hr:min)=10:30±00:50h) was similar (p>0.05) to CON (n=21; height= 173.5±8.4cm; percent body fat=11.5±4.4%; finish time= 11:21±1:33h) except for age (CWI=34±11y vs CON=43±10y; p=0.020). There was no significant difference between CWI and CON for any variable across time (CK, MYO, IL6, CORT, CRP, DOMS). However, an overall effect of time occurred for all variables. CK, MYO, CRP, and DOMS were significantly elevated POST ( 6 3 7 ± 2 9 8 I U / L ( p < 0 . 0 0 1 ) , 43±15nmol/L (p<0.001), 24.76± 15.24nmol/L (p=0.025), 76.8± 13.3mm (p<0.001), respectively) and remained elevated through 40h (706±559IU/L (p<0.001), 4±4nmol/L (p=0.016), 2.34±1.16mg/dL 222.86 ±110.48nmol/L (p<0.001), 63.2± 24.8mm (p<0.001), respectively). IL6 significantly increased POST 0.67±0.18pg/dl; (p<0.001) however, returned to similar PRE values at 40h (0.0 4±0.003pg/dL). CORT was significantly elevated at POST (3461±658nmol/L; (p<0.001). Moderate effect sizes occurred for MYO at 16h (0.40), while small effect sizes occurred at POST for CORT (- 0.29), CK (0.28), and IL6 (-0.30). IL6 was correlated with finish time at 16h (r=0.378, p=0.30) and %B (r=0.454, p=0.008) at POST. %R was correlated with CK at 16h (r=0.349, p-0.047) and 40h (r=0.365, p=0.37). Conclusions: The Ironman resulted in significantly elevated muscle damage and inflammatory markers. No effect of CWI vs CON was observed within the examined time frame. However, indices for muscle damage and DOMS remained elevated through the 40h time point, therefore observation of
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