Abstract / Summary
To compare the effects of exercise-related interventions on cardiopulmonary function in adolescents with adolescent idiopathic scoliosis (AIS). We searched PubMed, Embase, other databases, and trial registries for randomized controlled trials that reported cardiopulmonary outcomes in adolescents with AIS. Standardized mean differences (SMDs) were used for forced vital capacity (FVC) and forced expiratory volume in one second (FEV1), and mean differences (MDs) were used for the 6-minute walk distance (6MWD). Direct and indirect evidence was combined using a random-effects network meta-analysis. Intervention rankings were estimated using the surface under the cumulative ranking curve (SUCRA). Risk of bias was assessed with the revised Cochrane Risk of Bias 2 tool, and certainty of evidence was evaluated using Confidence in Network Meta-Analysis. Sensitivity analyses tested the effects of node composition, bracing-related interventions, postoperative or perioperative studies, risk of bias, and alternative assumptions for change-score standard deviations. 24 randomized controlled trials involving 1221 adolescents with AIS were included. Brace combined with exercise training showed the most favourable ranking probability for FVC (SMD 2.87, 95% CI 0.24 to 5.50; SUCRA 93.2; low certainty). Mind–body exercise showed the most favourable ranking probability for FEV1 (SMD 3.28, 95% CI 0.43 to 6.13; SUCRA 92.5; low certainty). For 6MWD, resistance training showed the most favourable ranking probability (MD 143.14 m, 95% CI 110.39 to 175.89; SUCRA 99.3; moderate certainty), followed by aerobic endurance training (MD 121.14 m, 95% CI 93.56 to 148.71; SUCRA 86.7; moderate certainty). Overall, the certainty of evidence ranged from low to moderate. Some findings were limited by heterogeneity, sparse networks, small sample sizes, or possible publication bias. Exercise-related interventions may improve pulmonary function and walking capacity in adolescents with AIS. However, because most comparative evidence was of low to moderate certainty and some rankings were affected by sparse networks and small-study effects, these findings should be interpreted as exploratory rather than as definitive exercise-prescription recommendations.