Osteoporosis International

, Volume 28, Issue 10, pp 2831–2841 | Cite as

Targeted spine strengthening exercise and posture training program to reduce hyperkyphosis in older adults: results from the study of hyperkyphosis, exercise, and function (SHEAF) randomized controlled trial

  • W. B. KatzmanEmail author
  • E. Vittinghoff
  • F. Lin
  • A. Schafer
  • R. K. Long
  • S. Wong
  • A. Gladin
  • B. Fan
  • B. Allaire
  • D. M. Kado
  • N. E. Lane
Original Article



A 6-month randomized controlled trial of spine-strengthening exercise and posture training reduced both radiographic and clinical measures of kyphosis. Participants receiving the intervention improved self-image and satisfaction with their appearance. Results suggest that spine-strengthening exercise and postural training may be an effective treatment option for older adults with hyperkyphosis.


The purpose of the present study is to determine in a randomized controlled trial whether spine-strengthening exercises improve Cobb angle of kyphosis in community-dwelling older adults.


We recruited adults ≥60 years with kyphosis ≥40° and enrolled 99 participants (71 women, 28 men), mean age 70.6 ± 0.6 years, range 60–88, with baseline Cobb angle 57.4 ± 12.5°. The intervention included group spine-strengthening exercise and postural training, delivered by a physical therapist, 1-h, three times weekly for 6 months. Controls received four group health education meetings. The primary outcome was change in the gold standard Cobb angle of kyphosis measured from standing lateral spine radiographs. Secondary outcomes included change in kyphometer-measured kyphosis, physical function (modified Physical Performance Test, gait speed, Timed Up and Go, Timed Loaded Standing, 6-Min Walk), and health-related quality of life (HRQoL) (PROMIS global health and physical function indexes, SRS-30 self-image domain). ANCOVA was used to assess treatment effects on change from baseline to 6 months in all outcomes.


There was a −3.0° (95% CI −5.2, −0.8) between-group difference in change in Cobb angle, p = 0.009, favoring the intervention and approximating the magnitude of change from an incident vertebral fracture. Kyphometer-measured kyphosis (p = 0.03) and SRS-30 self-esteem (p < 0.001) showed favorable between-group differences in change, with no group differences in physical function or additional HRQoL outcomes, p > 0.05.


Spine-strengthening exercise and posture training over 6 months reduced kyphosis compared to control. Our randomized controlled trial results suggest that a targeted kyphosis-specific exercise program may be an effective treatment option for older adults with hyperkyphosis.

Trial registration number and name of trial register; identifier NCT01751685


Aging Clinical trials Exercise Radiology Skeletal muscle 



This research was supported by the National Institute on Aging (NIA) RO1AG041921 and by the National Center for Advancing Translational Sciences, National Institutes of Health, through UCSF-CTSI Grant Number UL1 TR000004. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH. The authors wish to acknowledge the Data Safety Monitoring Board for their study oversight, Nicole King and Scott Puracchio for their assistance in data collection, and Lorenzo Nardo for data acquisition.

Compliance with ethical standards

The study protocol was approved by the University of California San Francisco and Kaiser Permanente Northern California Institutional Review Boards.

Conflicts of interest



This research was supported by the National Institute on Aging (NIA) RO1AG041921.


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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2017

Authors and Affiliations

  • W. B. Katzman
    • 1
    Email author
  • E. Vittinghoff
    • 2
  • F. Lin
    • 2
  • A. Schafer
    • 3
    • 4
  • R. K. Long
    • 5
  • S. Wong
    • 1
  • A. Gladin
    • 6
  • B. Fan
    • 7
  • B. Allaire
    • 8
  • D. M. Kado
    • 9
  • N. E. Lane
    • 10
  1. 1.University of CaliforniaSan FranciscoUSA
  2. 2.University of CaliforniaSan FranciscoUSA
  3. 3.University of CaliforniaSan FranciscoUSA
  4. 4.San Francisco Veterans Affairs Health Care SystemSan FranciscoUSA
  5. 5.University of CaliforniaSan FranciscoUSA
  6. 6.Kaiser Permanente Northern CA, San Francisco Medical CenterSan FranciscoUSA
  7. 7.University of CaliforniaSan FranciscoUSA
  8. 8.Beth Israel Deaconess Medical CenterBostonUSA
  9. 9.University of CaliforniaLa JollaUSA
  10. 10.University of CaliforniaSacramentoUSA

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