The impact of exercise on spinal posture in adolescents: a systematic review

Oliveira-Costa, Ercília; Alonso-Fernández, Diego; Gutiérrez-Sánchez, Águeda

doi:10.1590/1984-0462/2025/43/2025013

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Original Article • Rev. paul. pediatr. 43 • 2025 • https://doi.org/10.1590/1984-0462/2025/43/2025013 linkcopy

The impact of exercise on spinal posture in adolescents: a systematic review

O impacto do exercício na postura da coluna vertebral em adolescentes: uma revisão sistemática

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective: The objective of this study was to analyze research evaluating the impact of various physical exercise programs on improving spinal posture in adolescents.

Methods: A systematic review covering the last six years (2018–2024) was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines across nine databases. Methodological quality was assessed using the Physiotherapy Evidence Database (PEDro) scale.

Results: A total of 152 studies were identified, of which ten met the selection criteria and demonstrated high methodological quality and were included in the review. These studies showed a reduction in the thoracic and lumbar kyphosis angles, lumbar lordosis, and the percentage of pain, as well as an increase in trunk mobility and inclination angle following the implementation of physical exercise programs.

Conclusions: In intervention groups physical exercise has an impact on posture, leading to significant improvements in thoracic and lumbar kyphosis angles compared to control groups.

Keywords:
Posture; Adolescents; Spinal curvatures; Physical exercise

Database	Query
1. Web of Science Core Collection	(ALL=(Posture) OR (Body position or placement) AND (Exercise) OR (Exercise Movement Techniques) OR (Physical Activities) OR (Exercises) OR (Body Practices) OR (Physical Training) AND ALL=(Adolescent) OR (Adolescence) OR (Adolescents) OR (Young) OR (Young people) OR (Youth) OR (Teenager) OR (Teenagers) OR (Teens) AND ALL=(Spinal Curvatures)OR (Defective curvatures of the spine)OR (spinal deviations) and 2018 or 2019 or 2020 or 2021 or 2022 or 2023 or 2024 (Publication Years).
2. MEDLINE/PubMed	(Posture) OR (Body position or placement) AND (Exercise) OR (Exercise Movement Techniques) OR (Physical Activities) OR (Exercises) OR (Body Practices) OR (Physical Training) AND (Adolescent) OR (Adolescence) OR (Adolescents) OR (Young) OR (Young people) OR (Youth) OR (Teenager) OR (Teenagers) OR (Teens) AND (Spinal Curvatures) OR (Defective curvatures of the spine) OR (spinal deviations) Filters: from 2018–2024
3. LILACS (BVS)	(posture) AND (exercise) OR (physical activities) OR (exercises) OR (physical training) AND (adolescent) OR (adolescence) OR (adolescents) OR (young) OR (young people) OR (youth) OR (teenager) OR (teenagers) OR (teens) AND (spinal curvatures) OR (defective curvatures of the spine) OR (spinal deviations) AND (db: (LILACS).
4. PEDro	Exercise adolescents Posture
5. CINAHL (EBSCOhost)	(MH "Posture" OR "Body position or placement") AND ("Exercise" OR "Physical Activity" OR "Exercises" OR "Body Practices" OR "Balance Training, Physical") AND (MH "Adolescence" OR "Adolescents") AND (MH "Spinal Curvatures" OR "Defective curvatures of the spine" OR "spinal deviations").
6. Scopus	(ALL (posture) AND ALL (exercise) OR (physical AND activities) OR (exercises) OR (physical AND training) AND ALL (adolescent) OR (adolescence) OR (adolescents) OR (young) OR (young AND people) OR (youth) OR (teenager) OR (teenagers) OR (teens) AND ALL (spinal AND curvatures) OR (defective AND curvatures AND of AND the AND spine) OR (spinal AND deviations))AND PUBYEAR>2017 AND PUBYEAR<2025.
7. ERIC	(Posture) AND (Exercise) AND (Adolescent) AND (Spinal Curvatures)
8. SportDiscus (EBSCOhost)	(MH "Posture" OR "Body position or placement") AND ("Exercise" OR "Physical Activity" OR "Exercises" OR "Body Practices" OR "Balance Training, Physical") AND (MH "Adolescence" OR "Adolescents") AND (MH "Spinal Curvatures" OR "Defective curvatures of the spine" OR "spinal deviations").
9. Cochrane Library	(Posture) AND (Exercise) AND (Adolescents) AND (Spinal Curvatures).
10. ScienceDirect	(Posture) AND (Exercise) AND (Adolescents) AND (Spinal Curvatures).

Studies	Criteria											Point	Rating
Studies	1*	2	3	4	5*	6*	7	8	9	10	11	Point	Rating
Shadi et al.²⁸	-	1	0	1	0	0	0	1	1	1	1	6	High
Firouzjah et al.¹⁹	-	1	0	1	0	0	0	1	1	1	1	6	High
Yang²⁹	-	1	0	1	0	0	0	1	1	1	1	6	High
Elpeze and Usgu²⁶	-	1	0	1	0	0	0	0	0	1	1	4	Moderate
González-Gálvez et al.³⁰	-	1	0	1	0	0	1	1	1	1	1	7	High
González-Gálvez et al.¹⁴	-	1	0	1	0	0	0	0	1	1	1	5	Moderate
López-Ruiz and López-Miñarro²⁷	-	1	1	0	0	1	0	1	0	1	1	6	High
Batistão et al.³¹	-	1	0	1	0	0	0	0	1	1	1	5	Moderate
Katarzyna et al.³²	-	1	0	1	0	0	0	1	0	1	1	5	Moderate
Feng et al.¹¹	-	1	0	1	0	1	0	1	1	1	1	7	High

Studies	Characteristics	Evaluation instruments	Intervention (duration and frequency)
Shadi et al.²⁸	45 adolescents ♀ (average 14.06–15.00 years old); PG=15/CE=15/AT=15	Postural Evaluation: Flexicurve ruler; Hoppenfeld method	3x/60 min/week; 6 weeks of intervention
Firouzjah et al.¹⁹	30 adolescents ♂ (average 16.46–16.80 years old); CG=15/EG=15	Weighing scale – Postural Evaluation: Flexible ruler; Photograph; AutoCAD software; Tape measure; Scapulohumeral slip test; CKCUEST	3x/30-70 min/week; 10 weeks of intervention
Yang²⁹	60 adolescents (average 15.13–15.45 years); 30♀/30♂	Measurement of body indexes – Postural Evaluation: Physical fitness assessed by pre- and post-intervention tests: sit-and-reach, 50 and 1,000 m run, lung capacity, standing long jump, and timed ascent.	2x/45 min/week; 24 weeks of intervention
Elpeze and Usgu²⁶	62 adolescents ♂ (average 13.5–14.7 years old); CG=19/CCEP=21/TEP=22	Skin markers; Pedobarography – Postural Evaluation: Flexible ruler; Smartphone inclinometer	3x/40-50 min/week; 12 weeks of intervention
González-Gálvez et al.³⁰	97 adolescents (average 13.48 years old); CG=48/PG=49	Relaxed standing position and sit and reach position; A-SLR and P-SLR tests; Postural Evaluation: Spinal Mouse system	2x/15 min/week; 38 weeks of intervention
González-Gálvez et al.¹⁴	236 adolescents (average 13.15 years old); CG=118/ EG=118; 112♀/124♂	Stadiometer – Relaxed and active standing positions; A-SLR and P-SLR tests; TT; Postural Evaluation: PAQ-A; Spinal Mouse system	2x/15 min/week; 38 weeks of intervention
López-Ruiz and López-Miñarro²⁷	62 adolescents ♂ (average 16.05 years old)	PRL test and distance achieved in the sit-and-reach test; Postural Evaluation: Spinal Mouse system; Sagittal arrangement of the spine in relaxed standing and in the maximum trunk flexion position in the sit-and-reach test	2x/70 sec/week; 5 weeks of intervention
Batistão et al.³¹	171 adolescents (average 11.5 years old); CG=94/ EG=77; 115♀/56♂	Standardized demographic form; Scale; Reflective markers; Gyratory platform; Digital camera; Tripod; Postural Evaluation: Nordic Musculoskeletal Questionnaire; Questionnaire with body diagrams; Plumb line; Software (PAS/SAPO); Photogrammetric technique	2x/50 min/week; 8 weeks of intervention
Katarzyna et al.³²	152 adolescents (average 10.5 years old); CG=76/EG Karate=76; 32♀ /120♂	Mobile stadiometer; Electronic Scale; Dermatograph; Postural Evaluation: Inclinometer	2x/60 min/week; 52 weeks of intervention
Feng et al.¹¹	164 adolescents (average 13.5–14.2 years old); CG=83/EG=81	Postural Evaluation: Spinal Mouse system; Adam’s Test; Forward flexion; Matthiass test	2x/15-20 min/week; 8 weeks of intervention

Studies	Results and conclusions	Δ/Effect Size
Shadi et al.²⁸	CE and AT: ↓FH, RS, k (p<0.01); PE: no significant change.	CE: FH Δ=-6.3^°, RS Δ=-5.5^°, K Δ=-6.4^° AT: FH Δ=-5.9^°, RS Δ=-4.7^°, K Δ=-5.3^° PE: FH Δ=-1.9^°, RS Δ=-0.6^°, K Δ=-1.0^°
Firouzjah et al.¹⁹	↓FHA, FSA and k (EG; p<0.01).	FHA Δ=-4.1^°, FSA Δ=-3.0^°, K Δ=-3.4^°
Yang²⁹	↑Orthostatic posture, muscular strength, flexibility, coordination and endurance (p<0.01).	♂Flexion +4.9 cm, 50 m -0.65 s, 1,000 m -0.74 min, Lung +613 mL, Jump +26.7 cm, Pull ups+5.5; ♀ Flexion +5.4 cm, 50 m -1.0 s, 1,000 m -0.95 min, Lung +786.5 mL, Jump +20.8 cm, Sit ups+10.6
Elpeze and Usgu²⁶	↓Angle of thoracic kyphosis (CCEP and TEP) ↑Postural perception (CCEP).	KA: CCEP Δ=-8.93^° (p=0.000, η²=0.304), TEP Δ=-4.33^° (p=0.001, η² =0.247) PPT: CCEP Δ=+10.48 (p=0.000, η² =0.580)
González-Gálvez et al.³⁰	↓Thoracic angle in relaxed standing position (adjusted between groups); ↓lumbar lordosis within PG; ↑ Thoracic curvature and pelvic tilt in sit-and-reach (PG); only pelvic tilt showed significant adjusted difference between groups; ↓lumbar lordosis (PG and CG).	Thoracic angle (adjusted Δ=-5.6^°, p=0.003); Pelvic tilt (adjusted Δ=-2.9^°, p=0.03); Lumbar angle (Δ=+4.0^°, p=0.001); A-SLR/P-SLR (Δ=+6.4^° to +15°, p<0.0001)
González-Gálvez et al.¹⁴	↑Thoracic kyphosis in a relaxed standing position CG; ↓Lumbar curvature and pelvic tilt in relaxed standing position EG	Thoracic kyphosis (CG): Δ=5.98^°, p=0.000; Lumbar curvature (EG): Δ=+3.63^°, p=0,000; Pelvic tilt (EG): −2.25^°, p=0.008
López-Ruiz and López-Miñarro²⁷	↓Thoracic curve in the posttest; ↓Pelvic tilt at posttest. There was no significant difference between the pre- and posttest in the relaxed standing position.	Thoracic curve: Δ=-2.12^°, p=0.039, Cohen’s d =0.22 Pelvic tilt: Δ=+2.11^°, p=0.003, Cohen’s d=0.16
Batistão et al.³¹	IG presented lower rate of worsening in shoulder posture (p=0.04); ↑Percentage of improvement for the musculoskeletal pain (p=0.04); ↓Trunk mobility (CG), ↑Trunk mobility (IG) non- significant.	Trunk mobility (CG): 1,8^º Trunk mobility (IG): 5,0^º
Katarzyna et al.³²	↓Sacral inclination (Karate group) ↑Th12–L1 intervertebral space (Karate group).	ALPHA 1 (sacral inclination): Karate Δ=-4.68^°, p<0.0001 BETA Th/L (Th12–L1 space): Karate Δ=+2.29^°, p=0.023
Feng et al.¹¹	↓Angle of thoracic kyphosis CG and IG. ↓Incline angle in both groups (anterior shift); ↑Thoracic ROM (IG); ↓Sacral angle in CG and IG.	KA CG (Δ=-3.88^°) and IG (Δ=-8.78^°), p<0.0001; Sacral angle in IG (Δ=-3.27^°), p<0.0001; and CG (Δ=-1.36^°), p<0.01; Thoracic ROM (IG): Δ=+7.97^º, p=0.003

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[T1FN1] MEDLINE: Medical Literature Analysis and Retrieval System Online; PubMed: United States National Library of Medicine; LILACS: Latin American and Caribbean Health Sciences Literature; PEDro: Physiotherapy Evidence Database; CINAHL: Cumulative Index to Nursing and Allied Health Literature; ERIC: Education Resources Information Center.