PURPOSE: The effectiveness of exercise therapy for moderate adolescent idiopathic scoliosis and its potential benefits when combined with other treatments require further investigation. This systematic review and meta-analysis evaluated the efficacy of exercise therapy as a conservative management strategy for AIS. METHODS: Following PRISMA guidelines, we searched PubMed. Cochrane Library, Embase. and Web of Science up to June 4, 2024, for RCTs. Eligible studies included AIS patients (10 to 18 years, Cobb angle 20 degrees to 45 degrees) undergoing various exercise therapies. such as scoliosis-specific exercises and core stabilization training. Primary outcomes included Cobb angle, ATR, trunk appearance, QoL, and respiratory function. Data extraction and risk-of-bias assessment followed Cochrane guidelines, and study quality was evaluated using the 11-item PEDro scale. Meta-analyses were conducted based on standardized mean differences. RESULTS: Eight RCTs with nine intervention groups were analyzed. At six months, exercise alone showed no significant advantage over bracing in improving Cobb angle, ATR, QoL, or trunk appearance (p < 0.05). However, exercise combined with other therapies significantly improved Cobb angle (MD -6.11, 95% CI -9.21 to -3.02), QoL (SMD 0.89, 95% CI 0.27 to 1.51), and lung function (SMD 0.46, 95% CI 0.13 to 0.80) at three months. These effects persisted for Cobb angle at six months (MD -4.87, 95% CI -8.77 to -0.98). CONCLUSIONS: Low to moderate evidence suggests exercise alone is comparable to bracing for AIS, while exercise combined with other therapies offers short-term benefits for Cobb angle, QoL, and lung function.

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