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Table 1 Characteristics of included studies, NA; not available

From: The effect of various therapeutic exercises on forward head posture, rounded shoulder, and hyperkyphosis among people with upper crossed syndrome: a systematic review and meta-analysis

Author and Year

Participants

Number of participants (Male/Female) (Age ± Standard Deviation)

Interventions

Comparison

Duration of Exercise (weeks), (day/week), (Time/session (min))

Variable / Condition

Result

Salamat et al., 2020 [22]

Students

Corrective Functional Exercises: 12 (12/0) (11.5 ± 1.16)

Corrective Plays: 12 (12/0) (11.33 ± 1.07)

Control Group: 12 (12/0) (11.66 ± 1.07)

Group 1: Functional Corrective Exercises Group 2: Corrective Plays

No Exercise

(8), (3), (NA)

Forward Head, Forward Shoulder, Kyphosis

Significant differences were observed in forward head, forward shoulder, and kyphosis in the intervention groups. Corrective plays had a higher positive effect on the forward head and kyphosis.

Maarouf et al., 2020 [13]

Basketball Players in Wheelchairs

Intervention group: 12 (12/0) (5.08 ± 39.80) Control Group: 12 (12/0) (11.23 ± 43)

Scapular Stability exercises

No Exercise

(8), (5), (60)

Forward Head, Forward Shoulder, Kyphosis

Significant improvement in forward head, forward shoulder, and kyphosis angles in the intervention group

Karimian et al., 2019 [23]

Teachers

Group: 12 (45.2 ± 8.1)

Control Group: 11 (44.1 ± 7.8)

Corrective Exercises with Ergonomic Interventions

No Exercise

(12), (3), (45–60)

Forward Head, Forward Shoulder, Kyphosis

In exercise groups, significant differences were observed in the forward head, forward shoulder, and kyphosis angles.

Piri et al., 2021 [18]

Beautician women

Experimental Group: 20 (0/20) (33.40 ± 2.30)

Control Group: 20 (0/20) (31.95 ± 1.47)

Myofascial Release, Stretching Exercises, and Dynamic Exercises

No Exercise

(12), (3), (60)

Forward Head, Forward Shoulder, Kyphosis

Significantly reduced forward head, forward shoulder, and kyphosis angles in the intervention group

Abdolahzade et al., 2019 [10]

Female Students

Intervention Group: 15 (0/15) (20.53 ± 1.55)

Control Group: 15 (0/15) (20.00 ± 2.00)

Corrective Exercises based on NASM

No Exercise

(8), (3), (30–70)

Forward Head, Forward Shoulder, Kyphosis

Significant improvement was found in the NASM group’s forward head, forward shoulder, and kyphosis angles.

Hajizadeh et al., 2021 [11]

Martial Artists

Intervention group: 15 (15/0) (24.20 ± 4.12)

Control Group: 15 (15/0) (24.66 ± 3.56)

General corrective Exercises

No Exercise

(10), (3), (30–70)

Forward Head, Forward Shoulder, Kyphosis

Significant changes in forward head, forward shoulder, and kyphosis angles in the experimental group

Cheshomi et al., 2017 [24]

Female volleyball and handball players

Intervention group: 18 (18/0) (29.18 ± 4.92)

Control Group: 18 (18/0) (27.11 ± 5.74)

Strengthening and stretching exercises

No Exercise

(6), (3), (NA)

Forward Head, Forward Shoulder, Kyphosis

Significant changes in forward head, forward shoulder, and kyphosis angles in the experimental group

Hosseini and et al., 2016 [25]

Male Students

General corrective exercise group: 15 (15/0) (23.07 ± 2.03)

Vibration group: 15 (15/0) (23.05 ± 2.03)

Control Group: 15 (15/0) (24.40 ± 2.10)

Group 1: General corrective exercises

Group 2: corrective exercises combined with vibration

No Exercise

(6), (3), (30–60)

Forward Head, Forward Shoulder, Kyphosis

Significant reduction in forward head, forward shoulder, and kyphosis angles was observed in both intervention groups—the vibration group showed greater improvement .

Haji Hosseini et al., 2014 [12]

Female Students

Strengthening exercise group: 10 (10/0) (21.50 ± 1.08)

Stretching exercise group: 10 (10/0) (22.10 ± 1.80)

Combined exercise group: 10 (10/0) (22.08 ± 1.97)

Control Group: 10 (10/0) (22.90 ± 2.07)

Group 1: Strength Exercises

Group 2: Stretching Exercises

Group 3: Combined Exercises

No Exercise

(6), (3), (30–70)

Forward Head, Forward Shoulder, Kyphosis

Significant reduction in forward head, forward shoulder, and kyphosis angles was observed in all exercise groups, with the combination group showing the most significant reduction.

Miri et al., 2022 [26]

Female Students

Corrective exercise group: 8 (8/0) (16.75 ± 0.07)

Postural education group: 8 (8/0) (15.50 ± 0.75)

Combined group: 8 (8/0) (16.75 ± 1.03)

Control Group: 8 (8/0) (16.00 ± 1.19)

Group 1: corrective exercises

Group 2: postural training

Group 3: corrective exercises and postural training

No Exercise

(8), (3), (60)

Forward Head, Forward Shoulder, Kyphosis

Significant differences were observed in forward head, forward shoulder, and kyphosis angles in all intervention groups.

Javazi et al., 2019 [27]

Female Students

Intervention group: 12 (12/0) (22.00 ± 1.53)

Control Group: 12 (12/0) (21.58 ± 1.88)

Corrective exercises with physioball

No Exercise

(6), (3), (60)

Forward Head, Forward Shoulder, Kyphosis

Significant differences were observed in the intervention group’s forward head, forward shoulder, and kyphosis angles.

Ahmadi et al, 2022 [28]

Female Students

Intervention Group: 12 (0/12)( 22.4 ± 1.3) Control Group: 12 (0/12)( 22.2 ± 0.33)

Aquatic Corrective Exercises

No Exercise

8), (3), (50–70)

Forward Head, Forward Shoulder, Kyphosis

Significantly reduced forward head, forward shoulder, and kyphosis angles in the aquatic exercise group

Sarvari et al., 2022 [29]

Students

Intervention group: 20 (0/20)( 14.54 ± 1.82 ) Control group: 20 (0/20)( 14.43 ± 1.16)

Online Corrective Exercises

No Exercise

(8), (3), (30–45)

Forward Head, Kyphosis

Significant improvements in forward head and kyphosis angles in intervention group

Seidi et al., 2020 [17]

Students

Intervention group: 12 (12/0)( 25.3 ± 2.5 ) Control group: 12 (12/0)( 25.4 ± 1.5)

Comprehensive Corrective Exercises

No Exercise

(8), (3), (NA)

Forward Head, Forward Shoulder, Kyphosis

No exercise, comprehensive corrective exercises

Yaghoubitajani et al., 2022 [30]

office workers

Workplace group: 12 ( 37.00 ± 8.12) Online-supervised group: 12 ( 38.58 ± 7.34) Control group: 12 ( 38.91 ± 3.87)

Group 1: corrective exercises at the workplace

Group 2: Online-supervised : corrective exercises

No Exercise

(8), (3), (50–60)

Forward Head, Forward Shoulder, Kyphosis

both intervention groups improved from baseline to follow-up for Forward Head, Forward Shoulder, and Kyphosis.

Guo et al., 2023 [31]

College students

Intervention group: 20 (11/9)( 19.00 ± 0.97) Control group: 20(7/13)( 18.85 ± 0.88)

cervical and

thoracic “Daoyin” training.

No Exercise

(8), (5), (NA)

Forward Head, Forward Shoulder

obvious improvement in the forward head

angle, forward shoulder angle,

Park et al., 2014 [32]

children

Intervention group: 20 (10/10)( 13.55 ± 2.21) Control group: 20(10/10)( 13.75 ± 1.80

Strengthening and stretching exercise

No Exercise

(25), (3), (NA)

Forward Head, Forward Shoulder

The complex training improved posture

Firouzjah et al., 2023 [33]

volleyball players

Intervention group: 15 ( 16/46 ± 0/63) Control group: 15 ( 16/80 ± 0/77)

Strengthening and stretching exercise

No Exercise

(10), (3), (30–70)

Forward Head, Forward Shoulder, Kyphosis

significant good effect on forward

head, forward shoulder, and kyphosis.

Ruivo et al., 2016 [34]

adolescents

Intervention group: 42(16/26) (15.5 ± 1.0) Control group: 46(15/31) (15.9 ± 1.1)

Strengthening and stretching exercise in addition to Physical Education classes

Physical Education classes

(32), (2), (NA)

Forward Head, Forward Shoulder

The exercise intervention successfully decreased the forward head and protracted shoulder in adolescents.

Lynch et al.,2010 [5]

National Collegiate Athletic

Intervention group: 14 (19.29 ± 1.44) Control group: 14 (19.29 ± 1.20)

Strengthening and stretching exercise

No Exercise

(8), (3), (NA)

Forward Head, Forward Shoulder

The exercise intervention was successful at decreasing forward head and rounded shoulder

Nitayarak et al., 2021 [35]

women

Intervention group: 19(0/20) (20.26 ± 1.20) Control group: 20(0/20) (20.15 ± 1.27)

d scapular stabilization exercises using elastic bands

No Exercise

(4), (3), (NA)

Forward Head, Forward Shoulder, Kyphosis

significant improvement in the cervical and shoulder angle

Shalamzari et al., 2022 [36]

formal nurses

Intervention group: 31(31/0) (34.77 ± 9.19) Control group: 31(31/0) (37.12 ± 8.76)

Strengthening and stretching exercise

No Exercise

(8), (3), (30–70)

Forward Head, Kyphosis

Significant improvements in forward head and kyphosis angles in the intervention group