An Adaptive, Safety-First Protocol

 

What a Recovery Stack Can and Can’t Do

 

What it can do: Reduce soreness and perceived fatigue, support sleep and mood, improve training consistency, and nudge cardiometabolic health when done regularly. Sauna has the strongest long-term human association data; red light has small, acute performance and recovery benefits in targeted contexts; cold can relieve soreness but can blunt hypertrophy if mistimed; HBOT has clear medical indications and emerging but mixed wellness data; NAD IVs lack high-quality outcomes evidence in healthy adults.

What it can’t do: Replace training, nutrition, sleep, or medical care. Acute modalities are stressors; overuse can worsen recovery and sleep and dampen training adaptations.

Safety-first rules: Don’t do cold immersion right after lifting if strength/hypertrophy matter (Roberts 2015). Time heat 1–2 hours before bed if sleep is the goal (Haghayegh 2019). Screen rigorously for HBOT and cold risks; get medical clearance if you have cardiovascular, pulmonary, or ENT issues. Start conservative, progress slowly, and let wearables (HRV, resting HR, sleep) guide dose.

 

Quick Primer on Each Modality: Uses, Typical Dosages, Key Risks

 

HBOT (Hyperbaric oxygen therapy):
- Uses: Indicated for specific conditions (e.g., certain radiation injuries, chronic non-healing wounds). Wellness uses remain off‑label; small studies suggest cognitive/aging biomarker signals but evidence is mixed.
- Typical ranges: 1.5–2.4 ATA, 60–90 min, 20–40 sessions depending on indication. “Mild” 1.3 ATA exists in wellness settings but with limited clinical trial support.
- Key risks: Ear/sinus barotrauma, transient myopia, rare CNS oxygen toxicity seizures, claustrophobia (Hadanny & Efrati 2016). Absolute contraindication: untreated pneumothorax. Relative: severe COPD with bullae/CO2 retention, recent ear/sinus surgery, certain chemotherapy (e.g., bleomycin), uncontrolled fever, active URI. Medical screening is essential. Avoid scuba within 24 h unless advised by a specialist.

Sauna/heat therapy:
- Uses: Cardiometabolic associations (lower CVD/all-cause mortality in cohorts), relaxation, blood pressure modulation, sleep support.
- Typical ranges: Beginners 10–15 min at 70–80°C, 1–3x/week; progress to 15–20+ min, 2–4x/week as tolerated. Hydrate and replace electrolytes.
- Key risks: Dehydration, hypotension/syncope, overheating. Avoid with unstable CVD, recent MI/stroke, severe orthostatic hypotension, acute illness. Pregnancy requires caution and obstetric guidance.

Cold exposure (cold plunge and cryotherapy):
- Uses: Reduce DOMS/fatigue, mood/arousal, possible brown fat/metabolic effects with sustained programs.
- Typical ranges: Water 10–15°C for 1–3 min as a start; up to 5–10 min for recovery. For WBC, follow operator protocols; ensure oxygen monitoring and supervision.
- Key risks: Arrhythmias via “autonomic conflict,” cold shock/hyperventilation, frostbite (Shattock & Tipton 2012; Costello 2015). Avoid sudden full immersion and face dunking if at risk. Do not cold immediately after lifting if hypertrophy/strength matter (Roberts 2015).

Photobiomodulation (PBM, red/near‑infrared therapy):
- Uses: Pre‑exercise PBM can modestly improve acute performance and reduce muscle damage in small RCTs/meta‑analyses; stronger evidence in some clinical indications (e.g., oral mucositis).
- Typical ranges: 4–10 J/cm² per large muscle group, 630–680 nm and/or 800–880 nm, applied 5–60 min pre‑session. Biphasic dose response—more is not better.
- Key risks: Eye exposure to high‑irradiance LEDs/lasers. Use eye protection and avoid staring at emitters.

NAD:
- IV NAD+: As of 2025, no robust RCTs showing benefits for healthy adults on performance/recovery/longevity outcomes. Adverse effects (flushing, nausea, chest tightness) are often infusion‑rate dependent. If pursued, do so only with medical oversight and informed consent.
 - Oral precursors: NR raises NAD+ but with limited functional benefits in healthy adults; NMN improved muscle insulin sensitivity in specific populations. Better characterized safety than IV.

Cryotherapy vs Cold Plunge: What’s Different and Who Should Skip Which

 

Cold plunge/CWI
- Pros: Simple, controllable temp, strong DOMS relief evidence. Good for home users if water temp is measured.
- Cons: Arrhythmia risk in susceptible people; cold shock response; sanitation/ice logistics.
- Who should skip/seek clearance: Known/suspected coronary disease, arrhythmias, uncontrolled hypertension, syncope history, Raynaud’s disease, neuropathy. Avoid solo plunges.

Whole-body cryotherapy (WBC)
- Pros: Very brief sessions, perceived recovery boost.
- Cons: Nitrogen-cooled chambers risk hypoxia/asphyxiation without proper ventilation/monitoring; frostbite risk; variable regulation and quality (Costello 2015).
- Who should skip/seek clearance: Same cardiac risks as CWI; plus anyone with respiratory compromise, cold urticaria, or poor thermal sensation. Choose facilities with oxygen monitoring and trained staff.

 

Order Matters: Principles for Sequencing Heat, Cold, Red Light, HBOT, and NAD

 

Anchor rules
- PBM: Pre‑exercise, 5–60 minutes before, on target muscles at evidence‑based doses (Vanin 2018).
- Cold: Never immediately post‑lift if hypertrophy/strength matter; allow 4–6+ hours. Fine after endurance or on rest days.
- Heat: For sleep, schedule 1–2 hours pre‑bed, moderate duration/intensity (Haghayegh 2019). For relaxation, sauna can follow cold if you rewarm/hydrate between.
- HBOT: Place several hours away from heavy training to reduce additive oxidative/pressure loads and ear barotrauma risk; avoid if congested.
 - NAD IV: Not an ergogenic “pre”; do on low‑stress days; watch for adverse effects; hydrate and keep infusion slow if used.

 

Three Evidence-Informed Stacks (Performance, Recovery, Stress/Focus) with Rationale

 

A) Performance (strength/hypertrophy priority)
- PBM 4–8 J/cm² on prime movers 15–30 min pre‑lift (Vanin 2018).
- Lift.
- Optional sauna 10–15 min at 70–80°C for relaxation; rehydrate.
- No cold for 4–6+ hours (Roberts 2015). If you want cold, use next morning or on rest/endurance days.
- HBOT and NAD: Schedule on non‑lifting days.
- Why: Protect mTOR/anabolic signaling; leverage small PBM performance benefits; keep heat low enough to avoid dehydration/sleep disruption.

B) Recovery/Recomposition or Endurance emphasis
- Light aerobic 10–20 min + mobility.
- CWI 10–15°C for 3–8 min (scale by tolerance) OR contrast (short cold → warm shower).
- Rewarm fully; sauna 10–20 min at 70–85°C; rehydrate/electrolytes.
- PBM 4–8 J/cm² to sore regions if not used pre‑training.
- HBOT on separate day or at least 6+ hours apart.
- Why: Prioritize soreness relief and parasympathetic tone while avoiding interference with strength adaptations.

C) Stress/Focus/Sleep
- Morning PBM 4–6 J/cm² for mood/alertness on large muscle groups or low‑irradiance facial exposure with eye protection; avoid at night.
- Late afternoon/early evening sauna 10–20 min, finish 1–2 h before bed (Haghayegh 2019).
- Breathwork, light stretching. Skip cold after 4 pm if sensitive to sleep disruption.
- NAD: Skip on evenings; if used, place earlier in the day on low‑demand days due to possible flushing/nausea.
- Why: Phase heat to promote sleep onset; avoid stimulating cold late.

 

How Often? Sample Weekly Planner for Different Goals

 

Strength/hypertrophy priority
- Mon/Thu: PBM → Lift → optional short sauna. No cold within 6 h.
- Tue/Sat: Recovery stack with CWI + sauna.
- Wed: Rest or zone 2; no stack or light sauna.
- HBOT/NAD: Wed or Sun if used.

Endurance/recomposition
- Mon/Wed/Fri: Endurance sessions; CWI OK post; sauna after rewarming.
- Tue/Sat: Strength technique or mobility; PBM pre if desired; avoid post‑lift cold.
- HBOT: Thu or Sun if used.

Sleep/stress
- Sauna 3–5 evenings/week, 10–20 min, ending 1–2 h pre‑bed.
- PBM most mornings.
- Cold 2–3 mornings/week (not after lifting; avoid evenings).
- HBOT/NAD: None or 1 day/week max; schedule away from late evenings.

 

Protocol Details: Reasonable Starting Ranges for Healthy Adults

 

- HBOT: 1.5 ATA, 60 min, 1–2x/week for 2–4 weeks if wellness-focused and medically cleared; more intensive courses for medical indications only under clinician direction.
- Sauna: 70–80°C for 10–15 min, 2–3x/week; add 5 min/week up to 15–20+ min; progress temperature only if consistently tolerated. Target 2–4x/week for health benefits; frequent use (4–7x/week) linked with strongest cohort associations (Laukkanen 2015).
- Cold plunge/CWI: 12–15°C for 1–3 min to start; progress to 3–8 min; cap early programs at total weekly cold time of 10–20 min. Always exit with full control of breath.
- WBC: Only in supervised centers with oxygen monitoring; start at shortest exposure; skip if any cold-induced skin numbness beyond normal.
- PBM: 4–10 J/cm² per muscle group; 630–680 nm and/or 800–880 nm; 5–60 min pre‑training. Start at lower end; 2–4x/week.
- NAD IV: If used, medical supervision only; slow infusion (often hours) to reduce adverse effects; start low dose; consider oral alternatives (NR 300–600 mg/d; NMN 250–600 mg/d) recognizing mixed evidence.

 

Timing and Safety Essentials: Hydration, Rewarming, Post-Lift Cold, Eye/Ear Care

 

- Hydration: Weigh in/out around sauna; replace 150% of lost body mass in fluids over 2–4 h; include electrolytes for >20 min sessions or >2x/week frequency.
- Rewarming: After cold, dress warm and move until you stop shivering; avoid very hot showers immediately if dizzy.
- Post-lift cold: Avoid for 4–6+ hours to protect hypertrophy/strength (Roberts 2015).
- Eye care (PBM): Don’t stare at emitters; use goggles with high‑irradiance devices; follow ICNIRP guidance.
- Ear/sinus care (HBOT): Don’t dive or HBOT if congested; learn equalization; report ear pain immediately. Monitor glucose if diabetic. Avoid scuba within 24 h.

 

Who Should Avoid or Get Medical Clearance First: Contraindications and Red Flags

 

- HBOT: Absolute—untreated pneumothorax. Relative—severe COPD with bullae/CO2 retention, recent ear/sinus surgery, certain chemotherapy (bleomycin), uncontrolled fever, active URI, seizure disorders without control, claustrophobia. Clearance required.
- Sauna: Unstable angina, severe aortic stenosis, recent MI/stroke, severe orthostatic hypotension, acute illness/dehydration, uncontrolled hypertension. Pregnancy requires obstetric guidance.
- Cold: Known coronary disease/arrhythmias, uncontrolled hypertension, syncope history, cold urticaria/Raynaud’s, neuropathy, pregnancy (caution), poorly controlled asthma. Never go alone.
- WBC: Add risks of hypoxia/asphyxiation in nitrogen chambers; avoid if pulmonary disease or anemia; facility quality is critical.
- PBM: Active eye disease or retinal issues—avoid facial/high‑irradiance facial use unless cleared; avoid direct eye exposure.
- NAD IV: Given limited evidence and frequent rate‑related side effects, avoid without physician oversight; caution with arrhythmias, migraine, or GI sensitivity.
- Red flags (stop and seek care): Chest pain, syncope, severe dyspnea, palpitations, persistent ear pain/fullness post‑HBOT, visual disturbances, severe headache, frostbite signs, black/bloody stools or severe GI distress during NAD infusions.

 

Personalize with Biomarkers: HRV, Resting HR, Sleep Scores, and Training Logs

 

- Use trends, not single readings. Morning baseline HRV and resting HR are most useful.
- If resting HR ↑ >5–7 bpm above baseline for 3+ days and HRV ↓, or sleep efficiency/total sleep time drop, cut frequency/intensity by 25–50% for a week.
- If DOMS persists >72 h and performance stalls, reduce cold on lift days (protect adaptations) and bias heat for sleep.
- Log: Modality, duration/temp/dose, proximity to training, perceived exertion, soreness, sleep quality. Adjust one variable at a time.

 

At-Home vs Clinic: Device Quality, Settings, and Hygiene Standards

 

HBOT
- Medical indications: Prefer UHMS‑accredited centers with hard chambers and trained staff.
- Wellness 1.3 ATA “mild” chambers: Limited evidence; still require medical screening, rigorous protocols, and emergency procedures.
- Hygiene: Individual masks/hoods sanitized; ear assessment; oxygen monitoring; fire safety protocols.

Sauna
- Evidence base: Finnish‑style dry saunas (~80–100°C). Infrared saunas can be effective at lower temps; some niche data (e.g., Waon therapy in heart failure).
- Build/gear: Ventilation, thermometer/hygrometer, non-toxic materials. Clean benches and floors; avoid communal saunas if you have open wounds or infections.

Cold
- CWI: Use a thermometer; 10–15°C target for recovery; ensure clean, chlorinated/filtered water or frequent water changes.
- WBC: Choose facilities with oxygen monitoring, operator presence, frostbite prevention protocols, and documented maintenance logs.

PBM
- Device specs: Independently verified irradiance and wavelengths (≈660 nm and/or 810–850 nm). Avoid exaggerated output claims.
- Safety: Eye protection; device heatsinks to prevent skin overheating; clear dosing guides.

NAD
- IVs only in medical settings with trained staff, crash cart access, and consent forms. Consider oral NR/NMN first due to better-characterized safety.

 

FAQs: Finish Hot or Cold? Cold After Lifting? HBOT Timing? Red Light Placement? NAD Pace?

 

Should I finish hot or cold?
- For sleep: finish hot (moderate sauna) 1–2 h pre‑bed. For alertness: finish cold in the morning. For hypertrophy: avoid cold for several hours post‑lift.

Cold after lifting—ever OK?
- If hypertrophy/strength are priorities, no. If immediate soreness relief > adaptation (e.g., in-season athlete with dense schedule), informed tradeoff is acceptable (Roberts 2015).

When to time HBOT?
- On non‑lifting days or separated by 6–8+ hours from hard sessions. Skip if congested. Never combine with scuba within 24 h without specialist guidance.

Where to place red light?
- Aim at large muscle groups you will train (quads, glutes, pecs, back) at 4–10 J/cm², 5–60 min pre‑session. Avoid direct eye exposure; use protection.

How fast should an NAD IV run?
- Slowly. Many adverse effects are rate‑dependent. Only with clinical oversight. Consider whether you need IV at all given limited evidence.

 

References

 

HBOT
- Bennett MH, et al. Hyperbaric oxygen therapy for late radiation tissue injury. Cochrane Database Syst Rev. 2016. Link: https://pubmed.ncbi.nlm.nih.gov/?term=Bennett%20hyperbaric%20oxygen%20late%20radiation%202016
- Hadanny A, Efrati S. Side effects of hyperbaric oxygen therapy: a systematic review. Diving Hyperb Med. 2016. Link: https://pubmed.ncbi.nlm.nih.gov/?term=Hadanny%20Efrati%202016%20side%20effects%20hyperbaric
- Hachmo Y, Hadanny A, et al. HBOT increases telomere length and decreases immunosenescence. Aging (Albany NY). 2020. Link: https://pubmed.ncbi.nlm.nih.gov/?term=Hachmo%20Hadanny%20hyperbaric%20telomere%202020

Sauna/heat
- Laukkanen T, et al. Association Between Sauna Bathing and Fatal Cardiovascular and All-Cause Mortality. JAMA Intern Med. 2015. Link: https://pubmed.ncbi.nlm.nih.gov/?term=Laukkanen%202015%20sauna%20mortality%20JAMA%20Internal%20Medicine
- Laukkanen JA, Laukkanen T. Sauna bathing and systemic health: A review. Mayo Clin Proc. 2018. Link: https://pubmed.ncbi.nlm.nih.gov/?term=Laukkanen%202018%20sauna%20Mayo%20Clinic%20Proceedings
- Haghayegh S, et al. Warm bath timing and sleep: systematic review and meta-analysis. Sleep Med Rev. 2019. Link: https://pubmed.ncbi.nlm.nih.gov/?term=Haghayegh%202019%20warm%20bath%20sleep%20meta-analysis

Cold
- Roberts LA, et al. Post-exercise cold water immersion attenuates anabolic signaling and long-term adaptations to strength training. J Physiol. 2015. Link: https://pubmed.ncbi.nlm.nih.gov/?term=Roberts%202015%20cold%20water%20immersion%20strength%20training
- Shattock MJ, Tipton MJ. Autonomic conflict and cold water immersion. J Physiol. 2012. Link: https://pubmed.ncbi.nlm.nih.gov/?term=Shattock%20Tipton%202012%20autonomic%20conflict
- Costello JT, et al. Whole-body cryotherapy: effects and safety. PLoS ONE. 2015. Link: https://pubmed.ncbi.nlm.nih.gov/?term=Costello%202015%20whole-body%20cryotherapy

Photobiomodulation
- Vanin AA, et al. PBM therapy on muscular performance: systematic review and meta-analysis. Lasers Med Sci. 2018. Link: https://pubmed.ncbi.nlm.nih.gov/?term=Vanin%202018%20photobiomodulation%20muscular%20performance
- Mechanisms overview: Hamblin MR. Photobiomodulation mechanisms (reviews 2016–2021). Link: https://pubmed.ncbi.nlm.nih.gov/?term=Hamblin%20photobiomodulation%20review

NAD and precursors
- Elhassan YS, et al. NR augments skeletal muscle NAD+ without improving mitochondrial function in older men. Cell Rep. 2019. Link: https://pubmed.ncbi.nlm.nih.gov/?term=Elhassan%202019%20nicotinamide%20riboside%20Cell%20Reports
- Yoshino M, et al. NMN increases muscle insulin sensitivity in prediabetic women. Science. 2021. Link: https://pubmed.ncbi.nlm.nih.gov/?term=Yoshino%202021%20nicotinamide%20mononucleotide%20Science

Medical disclaimer
This guide is educational and not medical advice. These modalities can carry risks. Consult your clinician—especially if you have cardiovascular, pulmonary, metabolic, neurological, ENT, or pregnancy-related considerations—before starting.