Wellness
To ice or not to ice? Icing promotes muscle regeneration after mild injury
Cumulative research by a multi-institutional Japanese research collaboration reveals that ‘to ice or not to ice’ may depend on the degree of muscle injury.

Applying ice to a muscle injury is a widespread first-aid treatment, but exactly what effect does this have on the muscle regeneration and does it really help? Cumulative research by a multi-institutional Japanese research collaboration reveals that ‘to ice or not to ice’ may depend on the degree of muscle injury.
In their latest research, the group consisting of Associate Professor ARAKAWA Takamitsu and Master’s student NAGATA Itsuki (from Kobe University’s Graduate School of Health Sciences), and Assistant Professor KAWASHIMA Masato (Kawasaki University of Medical Welfare) et al. have shown that applying ice to muscle damage in a small percentage of muscle fibers in rats promotes muscle regeneration. This is believed to be the first study in the world to show benefits of icing on muscle repair. In conjunction with their previous study on serious muscle injuries (‘Icing muscle injuries may delay recovery’), it is hoped that these results can be used as a basis for more accurate guidelines on whether or not to ice such injuries.
These research findings were first reported in the American Journal of Physiology-Regulatory, Integrative and Comparative Physiology on March 6, 2023.
Main Points
- The experiments showed that applying ice after a mild muscle injury promotes muscle regeneration.
- This is believed to be the first time in the world that a study has shown a positive effect of icing on muscle regeneration.
- The researchers showed that the extent of the injury may have a greater impact on the effectiveness of icing than the method or timing employed.
- The findings of this ongoing research will lead to the spread of more accurate information on the effects of icing throughout hospitals, and in the realms of sports and physical education.
‘RICE treatment’ is a common approach for treating the acute phase of sports injuries. This acronym stands for Rest, Ice, Compression and Elevation and it is also often used in physical education in schools and even clinical settings. There are a variety of subsequent steps that can be taken to treat the injury afterwards, yet opinions vary as to whether or not icing should be applied. However, there is a lack of evidence on the benefits of icing.
The current research team has conducted many experiments to investigate the effectiveness of icing, which led them to publish their previous findings (‘Icing muscle injuries may delay recovery’ ). However, no previous animal experiments have indicated that icing promotes muscle regeneration.
In this study, the researchers focused on altering the severity of the muscle injury in the experiments. The reasoning behind this was that the majority of sports-related muscle injuries are limited; in other words less than 10% of the overall number of muscle fibers (myofibers) are damaged and necrotized. However, all animal experiments up until now had looked at more serious injuries where over 20% of the myofibers were damaged.
Thus, the team devised an animal model for mild muscle injuries, and experimented with applying ice after injury using a similar method as before.
After the animal was anaesthetized, the muscle was exposed and clamped between forceps to induce injury. In their previous experiments, the researchers attached a 500g weight to the forceps, which induced an injury that affected 20% of the total number of fibers in the muscle. In the present study, they tried attaching a 250g weight to the forceps and demonstrated that this could be used to consistently injure 4% of the fibers (Figure 1). This is similar to the degree of injury that often occurs after sports activities such as vigorous exercise or long-distance marathon running.
Icing was carried out by placing polyethylene bags of ice on surface of the skin over three 30-minute sessions per day, with each session being 1.5 hours apart. This was continued until two days after injury for a total of 9 icing sessions (i.e. immediately after injury = 3 sessions, 1 day after injury = 3 sessions, 2 days after injury = 3 sessions). The icing method was the same as in the previously reported study (‘Icing muscle injuries may delay recovery’).
Observations of muscles that were regenerating in the icing group and no-icing group 2 weeks after injury revealed significant differences in the size of regenerating fibers in cross-sections (Figure 2). In other words, this demonstrated the possibility that skeletal muscle regeneration is promoted by icing.
Macrophages are immune cells that orchestrate the reparative process of injured muscle. Pro-inflammatory macrophages accumulate in the damaged site soon after injury occurs, however they express an inducible nitric oxide synthase (iNOS), which has a disadvantageous side-effect of expanding the injury’s size. The results of this team’s experiments revealed that icing after mild muscle injury reduces the accumulation of iNOS-expressing pro-inflammatory macrophages. By causing this phenomenon, icing prevents the expansion of muscle injury size.
In other words, icing attenuates the recruitment of pro-inflammatory macrophages in the injury site. This was also reported in their previous study (‘Icing muscle injuries may delay recovery’), demonstrating that this is an effect caused by icing regardless of whether the muscle injury is serious or mild. In the previous study, icing was found to delay the regeneration of muscle after a serious injury that destroyed many fibers because the pro-inflammatory macrophages were unable to sufficiently phagocytose (*5) the injured muscle. In contrast to this, the current study shows that icing has a positive effect when the muscle injury is mild because it prevents the secondary expansion of the muscle injury caused by the pro-inflammatory macrophages. It suggests that this particular effect of icing is connected to the promotion of muscle regeneration.
Icing has been used in the treatment of muscle injuries for a long time, however the positive effects of icing had yet to be elucidated until now. This study has shown that icing can promote muscle regeneration when used to treat commonly-occurring mild muscle injuries.
However, this does not mean that icing is effective for all types or degree of muscle injury. The researchers aim to further elucidate and raise awareness of this. For example, the group’s previous study showed that icing actually inhibited regeneration in cases of serious muscle injury. In addition, the term ‘muscle injury’ also includes extremely minute injuries that have yet to be observed through the team’s animal experiments, so it is still unclear as to what effect icing has on the repair from such microtraumas.
The researchers’ next challenge is to determine the extent of muscle injury up to which icing is appropriate. By building upon their previous investigations, they aim to contribute towards guidelines that will enable people in sports and clinical rehabilitation to make accurate judgements about whether or not to ice an injury.
Wellness
Keeping fit and building muscle could increase survival rates in cancer patients
Anyone can benefit from higher muscle strength and cardiorespiratory fitness to have reduced mortality. But there are especially positive findings for those patients living with lung cancer and digestive cancer.

Physical fitness and increasing muscle strength could reduce the mortality rate for cancer patients by between 31% to 46%, new research from Edith Cowan University (ECU) has found.
Around 20 million new cancer cases were reported in 2022, with 9.7 million cancer deaths reported world-wide during the same period, with experts expecting the trend to increase in the coming decades.
ECU PhD student Mr Francesco Bettariga noted that in healthy adults, physical fitness and muscle strength has been associated with a 21% reduction in all-cause mortality, as well as a 15% reduction for cardiovascular disease mortality, and a 27% reduction for chronic obstructive pulmonary disease mortality.
Mr Bettariga’s research has found that both muscle strength and cardiorespiratory fitness had a significant impact to lower the risk of all-cause and cancer-specific mortality in patients with any form of cancer and stage.
“Our research found that anyone can benefit from higher muscle strength and cardiorespiratory fitness to have reduced mortality. But when we did our sub-group analysis, we found especially positive findings for those patients living with lung cancer and digestive cancer,” Mr Bettariga said.
“Increased muscle strength and cardiorespiratory fitness had also significant potential to extend the lives of people living with advanced stage of cancer.”
Mr Bettariga said that while physical fitness was beneficial to everyone, increased muscle strength and cardiorespiratory fitness after a cancer diagnosis would still deliver results.
“In practical terms, if a person is diagnosed with cancer and only starts exercising to increase their muscle strength or cardiorespiratory fitness levels after that diagnosis, they will potentially extend their survival and reduce their mortality risk.”
He noted that cardiorespiratory fitness could be particularly increased by aerobic exercises like brisk walking, running, swimming or cycling, while muscle strength could be enhanced by the adoption of resistance exercise programs, including the use of dumbbells, barbell and weight-machine.
“The guidelines are that people should be exercising at least three to five days per week. They can do between 75 minutes and 150 minutes of vigorous-intensity exercise a week, or around 300 minutes of moderate-intensity exercise.
“Resistance exercise training can be done at least twice a week, and would need to incorporate at least two or three sets of each resistance exercise, consisting of around 8 to 15 repetitions each at moderate intensity at least.”
Mr Bettariga said the results from his research underscored the importance of clinical practitioners assessing the physical fitness of cancer patients as part of the process of predicting survival.
“Moreover, from a practical perspective, implementing tailored exercise prescriptions to enhance muscle strength and cardiorespiratory fitness throughout the cancer continuum may contribute to reducing cancer-related mortality.”
Wellness
Physical activity boosts mental health in women with chronic pelvic pain disorders
By using innovative data modeling techniques, we can better understand how lifestyle factors like physical activity interact with health conditions and pave the way for more personalized treatment approaches.

A Mount Sinai study provides compelling evidence that exercise can significantly help the mental well-being of millions of women living with chronic pelvic pain disorders (CPPDs), such as endometriosis and uterine fibroids.
The researchers at the Icahn School of Medicine at Mount Sinai found that activities like brisk walking or aerobic exercise can lead to measurable improvements in mental well-being, regardless of pain levels or history of anxiety or depressive disorders. Their findings were reported in the February 26 online issue of the Journal of Pain Research.
CPPDs affect millions of women worldwide, leading to increased health care costs, reduced quality of life, and a higher risk of anxiety and depression, yet effective management strategies remain limited. This study highlights the potential of physical activity as a simple and accessible way to enhance mental well-being, say the investigators.
“Chronic pelvic pain disorders are incredibly complex and burdensome for those affected, yet we still have very few effective treatment strategies,” says lead corresponding author Ipek Ensari, PhD, an Assistant Professor in the Windreich Department of Artificial Intelligence and Human Health at the Icahn School of Medicine and a member of the Hasso Plattner Institute of Digital Health at Mount Sinai. “Our research suggests that physical activity could be an important tool for improving mental health in these patients, offering them a proactive way to enhance their well-being.”
The study tracked 76 women with CPPDs over 14 weeks using mobile health technology, collecting more than 4,200 days’ worth of data. Participants reported their mental health, physical functioning, and pain levels weekly via an app (ehive), while Fitbit devices recorded their daily physical activity. The researchers used advanced statistical modeling to analyze how movement patterns influenced mental health outcomes over time.
One key finding was that the benefits appear to accumulate over time rather than provide immediate relief. “We were particularly intrigued to find that the positive effects of exercise seem to lag by a few days, meaning the mental health benefits may build up gradually,” says Dr. Ensari. “This insight is vital for both patients and health care providers, as it underscores the importance of consistency in physical activity.”
Beyond its implications for patient care, the study also highlights the growing role of artificial intelligence and mobile health technologies in chronic disease management.
“This study showcases the power of wearable technology and AI-driven analysis to uncover valuable insights about health and behavior in real time,” says Girish N. Nadkarni, MD, Chair of the Windreich Department of Artificial Intelligence and Human Healthat the Icahn School of Medicine, Director of the Hasso Plattner Institute for Digital Health, Irene and Dr. Arthur M. Fishberg Professor of Medicine, and Director of The Charles Bronfman Institute for Personalized Medicine. Dr. Nadkarni is also the inaugural System Chief of the Division of Data-Driven and Digital Medicine within Mount Sinai’s Department of Medicine and Co-Director of the Mount Sinai Clinical Intelligence Center. “By using innovative data modeling techniques, we can better understand how lifestyle factors like physical activity interact with health conditions and pave the way for more personalized treatment approaches.”
While the findings are encouraging, the researchers emphasize that physical activity should not be viewed as a replacement for medical treatment but rather as a complementary strategy. Future research will explore how different types and intensities of exercise impact mental health, pain, and fatigue, with the ultimate goal of developing personalized interventions using wearable technology and mobile apps.
The paper is titled “Trajectories of mHealth-tracked mental health and their predictors in female chronic pelvic pain disorders.”
The remaining authors, all with the Icahn School of Medicine except where indicated, are Emily L. Leventhal, BA: Nivedita Nukavarapu, PhD; Noemie Elhadad, PhD (Columbia University Irving Medical Center); Suzanne R. Bakken, PhD, RN, FAAN, FACMI, FIAHSI (Columbia University School of Nursing); Michal A. Elovitz, MD; Robert P. Hirten, MD; Jovita Rodrigues, MS; Matteo Danieletto, PhD; and Kyle Landell, BA.
Wellness
Move more, age well: Prescribing physical activity for older adults as a recipe for healthy aging
150 minutes of moderate physical activity every week reduced risk of death from all causes by 31%. Physical activity is essential for aging well and can help prevent or reduce disease in more than 30 chronic conditions, such as coronary artery disease, heart failure, type 2 diabetes mellitus, chronic obstructive pulmonary disease, osteoporosis, depression, dementia, and cancer.

Can physical activity extend the lifespans of older adults? A review article published in CMAJ (Canadian Medical Association Journal) summarizes the considerable evidence supporting the important role physical activity plays in preventing or reducing the effects of diseases and discusses how to prescribe effective exercise for older adults.
Canada’s population is aging, with at least 1 in 5 people aged 65 years or older in 2025, and the number of people older than age 85 years is expected to triple in the next 20 years. However, for many people, these added years do not mean healthy years. More than 80% of adults do not meet the recommendations for physical activity from the Canadian Physical Activity Guidelines.
“Physical activity is one of the most important ways to preserve or improve functional independence, including among older adults who are frail or deemed to be at increased risk of falling,” writes Dr. Jane Thornton, associate professor at Schulich School of Medicine & Dentistry, Western University, London, Ontario, and director of health, medicine and science at the International Olympic Committee. “Higher levels of physical activity in older age are associated with improvements in cognition, mental health, and quality of life.”
A 2023 meta-analysis of several large studies found that 150 minutes of moderate physical activity every week reduced risk of death from all causes by 31%. Physical activity is essential for aging well and can help prevent or reduce disease in more than 30 chronic conditions, such as coronary artery disease, heart failure, type 2 diabetes mellitus, chronic obstructive pulmonary disease, osteoporosis, depression, dementia, and cancer.
Benefits of activity include the following:
- Protection against risk of death from any cause
- Falls prevention through increased muscle strength and better balance
- Bone and joint health, including improved bone density and alleviation of some osteoarthritis symptoms
- Improved cognitive function, and better mood and mental health
- Ability to engage in daily activities and improved quality of life
The World Health Organization (WHO) recommends 150–300 minutes weekly of moderate-to-intense physical activity for adults, including older adults.
How can clinicians prescribe physical activity?
“As many older adults live with chronic health conditions or reduced mobility, clinicians should tailor and encourage them to take a gradual approach to increasing their physical activity, which should include resistance training (muscle strengthening) as an essential component,” said Dr. Samir Sinha, professor of medicine at the University of Toronto and director of health policy research, National Institute on Ageing.
The WHO 5-step framework — called the “5As” — can provide clinicians with a roadmap to promote activity in their patients. The authors also suggest inputting physical activity in patient records as a vital sign to follow over time.
“Physical activity is underused as a health intervention both in the community and in the delivery of health care for older adults. Age, frailty, or existing functional impairments should not be viewed as absolute contraindications to physical activity but rather key reasons to prescribe it, considering the benefits of physical activity interventions for older adults. Older adults who become more physically active can potentially add years to their lives as well as higher quality of life to those years,” the authors conclude.
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