title: Exercise for improving age-related hyperkyphotic posture: a systematic review.
abstract: OBJECTIVE
  To evaluate previous research to determine if exercise can improve preexisting hyperkyphosis by decreasing the angle of thoracic kyphosis in adults aged ≥45 years.
  
  
  METHODS
  PubMed, Embase, and the Cumulative Index to Nursing and Allied Health Literature databases were searched for studies related to posture, exercise, and age ≥45 years. Online conference proceedings of the American Society for Bone and Mineral Research, American Physical Therapy Association, and Gerontological Society of America were also searched.
  
  
  METHODS
  Two independent reviewers screened the titles and abstracts and selected studies that tested the effect of exercise on measures of kyphosis, or forward head posture, in individuals with hyperkyphosis at baseline (defined as angle of kyphosis ≥40°). Reviews, letters, notes, and non-English language studies were excluded.
  
  
  METHODS
  A pilot-tested abstraction form was used by each reviewer to extract data from each study regarding details of exercise intervention, participant characteristics, safety, adherence, and results. The Cochrane Collaboration's tool for assessing risk of bias was used to assess methodologic quality. Discrepancies on the abstraction forms between the 2 reviewers were resolved by a third reviewer. A formal meta-analysis was not performed.
  
  
  RESULTS
  Thirteen studies were abstracted and included in the review; of these, 8 studies saw improvements in ≥1 measure of posture. The main sources of bias were related to blinding participants and incomplete outcome data. The adherence reported across studies suggests that exercise is an acceptable intervention for individuals with age-related hyperkyphosis.
  
  
  CONCLUSIONS
  The scarcity and quality of available data did not permit a pooled estimate of the effect of exercise on hyperkyphotic posture; however, the positive effects observed in high-quality studies suggest some benefit and support the need for an adequately designed randomized controlled trial examining the effect of exercise on hyperkyphosis.
authors.affiliation: Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada.
authors.forename: Symron
authors.initials: S
authors.lastname: Bansal
authors.affiliation: Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, San Francisco, CA.
authors.forename: Wendy B
authors.initials: WB
authors.lastname: Katzman
authors.affiliation: Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada. Electronic address: Lora.giangregorio@uwaterloo.ca.
authors.forename: Lora M
authors.initials: LM
authors.lastname: Giangregorio
mesh_terms: D000368:Aged; D000375:Aging / Q000502:physiology*; D002986:Clinical Trials as Topic; D015444:Exercise / Q000502:physiology*; D005260:Female; D006801:Humans; D007738:Kyphosis / Q000534:rehabilitation*; D008297:Male; D008875:Middle Aged; D011187:Posture / Q000502:physiology*
keywords: Aged; BES; Exercise; ITT; Kyphosis; RCT; Rehabilitation; VCF; back extensor muscle strength; intention-to-treat analysis; randomized controlled trial; vertebral compression fracture