OBJECTIVE: To evaluate previous research to determine if exercise can improve pre-existing hyperkyphosis by decreasing the angle of thoracic kyphosis in adults aged 45 years and older. DATA SOURCES: PubMed, Embase, and CINAHL databases were searched for studies related to "posture", "exercise", and "age >= 45 years". Online conference proceedings of the American Society for Bone and Mineral Research, American Physiotherapy Association, and Gerontological Society of America were also searched. STUDY SELECTION: Two independent reviewers screened the titles and abstracts and selected studies that tested the effect of exercise on measures of kyphosis, or forward head posture, in individuals with hyperkyphosis at baseline (defined as angle of kyphosis >= 40 degrees). Reviews, letters, and notes were excluded, as well as non-English language studies. DATA EXTRACTION: A pilot-tested abstraction form was used by each reviewer to extract data from each study regarding details of the exercise intervention, participant characteristics, safety, adherence, and results. The Cochrane Collaboration's tool for assessing risk of bias was used to assess methodological quality. Discrepancies on the abstraction forms between the two reviewers were resolved by a third reviewer. A formal meta-analysis was not performed. DATA SYNTHESIS: 13 studies were abstracted and included in the review; of these, 8 studies saw improvements in >= 1 measure of posture. The main sources of bias were related to blinding participants and incomplete outcome data. The adherence reported across studies suggests that exercise is an acceptable intervention for individuals with age-related hyperkyphosis. CONCLUSIONS: The scarcity and quality of available data did not permit a pooled estimate of the effect of exercise on hyperkyphotic posture; however, the positive effects observed in high-quality studies suggest some benefit and support the need for an adequately designed randomized controlled trial examining the effect of exercise on hyperkyphosis.

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