Abstract / Summary
Background/Objectives: Chronic whiplash-associated disorders (WAD) are a common cause of persistent neck pain and disability. Therapeutic exercise is widely used, but its effectiveness remains uncertain. This systematic review evaluated the effects of therapeutic exercise, alone or combined with other interventions, on pain, neck-related disability, and kinesiophobia in adults with chronic WAD. Methods: PubMed, PEDro, and the Cochrane Library were searched from inception to December 2025 for randomized controlled trials (RCTs) including adults with chronic WAD (>3 months). Eligible studies compared exercise-based interventions with minimal intervention, usual care, or other active treatments. Primary outcomes were pain and neck-related disability, with kinesiophobia as a secondary outcome. Methodological quality was assessed using the PEDro scale, risk of bias using Cochrane RoB 2, and certainty of evidence using GRADE. Due to heterogeneity, findings were synthesized without meta-analysis using SWiM principles. Results: Six reports representing five independent RCT cohorts (up to 635 unique participants) were included. Interventions included neck-specific exercise, home-based programmes, multimodal rehabilitation, and exercise combined with manual therapy. Exercise generally produced greater short- to medium-term improvements in pain and disability than minimal intervention or advice, whereas comparisons with other active treatments were heterogeneous and statistically inconclusive. Effects on kinesiophobia were inconsistent. PEDro scores ranged from 7–9/10. RoB 2 indicated predominantly some concerns. GRADE certainty was low for pain and disability and very low for kinesiophobia. Conclusions: Therapeutic exercise may improve pain and disability compared with minimal interventions, but evidence certainty is low. Its superiority over other active treatments and effects on kinesiophobia remain uncertain.