Effect of core-based exercise in people with scoliosis: a systematic review and meta-analysis

Key points

1. 01Pooling nine studies (325 people), core-based exercise lowered the Cobb angle by about 2 degrees versus control.
2. 02Quality of life on the SRS-22 questionnaire improved slightly in the exercise group.
3. 03Trunk rotation (a key cosmetic measure) showed no meaningful difference.
4. 04No serious adverse events were reported and dropout rates were low and similar between groups.
5. 05GRADE-rated evidence quality was low to very low, with high statistical heterogeneity.

How it was conducted

Design

Systematic review and meta-analysis of clinical controlled trials (seven RCTs, two non-RCTs); PROSPERO CRD42020160509

Data sources

PubMed, Embase, Cochrane Library, CINAHL, Web of Science, searched from inception to September 30, 2020

Participants

325 people with scoliosis (mostly adolescent idiopathic scoliosis), mean age 12.1 to 23.6 years

Groups

Core-based exercise (including Schroth with core strengthening, SEAS, Pilates) versus observation or non-core nonsurgical treatment

Primary outcomes

Cobb angle, angle of trunk rotation (ATR), and SRS-22 quality of life

Analysis

Random-effects model in RevMan 5.3, mean difference with 95% CI; risk of bias via RoB 2.0 and MINORS; GRADE for evidence quality

What they found

• Cobb angle across all studies favored core-based exercise: MD = -2.08, 95% CI (-3.89, -0.28), P = 0.02, I2 = 82%.
• Core-exercise-only subgroup (4 studies): MD = -2.91, 95% CI (-5.61, -0.20), P = 0.04, I2 = 86%; comprehensive-exercise subgroup not significant: MD = -1.48, 95% CI (-4.49, 1.53), P = 0.33, I2 = 82%.
• Angle of trunk rotation (3 studies): no significant difference, MD = -0.69, 95% CI (-2.61, 1.22), P = 0.48, I2 = 74%.
• SRS-22 total score favored exercise: MD = 0.25, 95% CI (0.02, 0.49), P = 0.03, I2 = 52%.
• SRS-22 subscales: self-image MD = 0.08 (0.01, 0.14) P = 0.02; function MD = 0.12 (0.03, 0.20) P < 0.05; mental health MD = 0.30 (0.14, 0.46) P < 0.05; pain not significant MD = 0.11 (-0.11, 0.34) P = 0.32.
• Dropout was 3.33% (6/180) in the core-based group versus 3.45% (5/145) in controls, with no adverse events reported.

Limitations

• Only nine small trials were included, two of which were non-randomized, raising the risk of bias.
• Statistical heterogeneity was high (I2 up to 86%), so pooled estimates are uncertain.
• Follow-up was short and studies were single-center, so long-term effects are unknown.
• GRADE-rated evidence quality was low to very low, weakening confidence in the findings.

Why it matters

For patients

If you have scoliosis, core-strengthening exercise appears safe and may modestly help your curve and how you feel, but it is not a guaranteed correction.

For clinicians

Core-based exercise can be offered as a low-risk adjunct that may slightly reduce Cobb angle and improve SRS-22 quality of life, but the weak evidence base means it should not replace established management.

For readers

This review suggests a small short-term benefit of core exercise for scoliosis, though high heterogeneity and low evidence quality mean the conclusions are tentative.