Application of Conservative Methods Based on Exercise in Reducing the Kyphotic Angle: A Meta-Analysis

Background: The aim of this research was to evaluate the size of the effect of conservative methods based on exercises on the reduction in the kyphotic angle through a meta-analysis. Methods: In our research, we followed the Cochrane guidelines and the PRISMA guidelines. In October 2024, we searched the following databases: Scopus, Pub Med, Web of Science, and Cochrane Library. The following keywords were used for the search: ("Kyphosis" OR "Hyperkyphosis" OR "Kyphotic angle" OR "Spinal curve" OR "Sagittal spinal") AND ("Conservative methods" OR "Conservative treatment" OR "Corrective exercise" OR "Physical exercise" OR "Exercise therapy" OR "Training"). The risk of bias was assessed for each randomized trial using the Cochrane Risk of Bias Tool and the Methodological Index for Non-Randomized Studies (MINORS). The study's main outcome and estimated effects were the kyphotic angle. R 4.3.2 software with the meta package was used for analyses, and standardized mean difference (SMD) and 95% confidence interval (CI), a randomized model for continuous outcomes, were used as effect size. Results: Twenty-one studies were included in the qualitative analysis, while 19 studies were included in the quantitative analysis. Depending on the analysis, the effect sizes ranged from (SMD = 0.27 to SMD = 0.73). Heterogeneity ranged from 0% to 58%, while the quality of evidence (GRADE) ranged from very low to moderate. Conclusions: Our meta-analysis indicates the positive effects of applying conservative methods based on exercise in subjects without and with osteoporosis diagnosed with hyperkyphosis.