Associations Between Physical Activity and Adolescent Idiopathic Scoliosis: A Systematic Review and Meta-analysis

Objective: To investigate the associations between adolescent idiopathic scoliosis (AIS) and physical activity (PA).Data Sources: MEDLINE, EMBASE, AMED, SPORTDiscus, Cochrane Library, and CINAHL electronic databases were searched from inception to August 2022/plus citation tracking.Study Selection: Observational studies of participants with radiographically confirmed AIS with & GE;10 & DEG; lateral spinal curvature (Cobb method) and comparator groups without AIS that measured PA were selected by 2 reviewers.Data Extraction: Data were extracted independently and cross-checked by 2 reviewers. Risk of bias was evaluated using Newcastle Ottawa Scales and overall confidence in the evidence using the GRADE approach. Data Synthesis: Sixteen studies with 9627 participants (9162, 95% women) were included. A history of vigorous PA significantly reduced the odds of being newly diagnosed with AIS by 24% (odds ratio [OR] 0.76, 95% confidence interval [CI] 0.65-0.89) (high certainty). Moderate PA reduced odds by 13% (moderate certainty) and light PA increased odds by 9% (low certainty), but neither analysis was statistically significant. Ballet or gymnastics (OR 1.47, 95% CI 3.08 (1.90, 5.00) were the only individual sports significantly associated with AIS diagnosis (moderate cer-tainty). Case-control studies of people with and without AIS provided greater evidence that having AIS reduces vigorous PA and sports participa-tion, and less evidence light PA and walking are affected.Conclusion: Adolescents who participate in more vigorous PA are less likely to be diagnosed with AIS. Ballet and gymnastics are associated with AIS diagnosis, but the direction of this association is uncertain. People with AIS are likely to do less vigorous physical and sporting activity com-pared with those without AIS, which could negatively affect health and quality of life. Further research is warranted into the inter-relations between PA and AIS, studies need to be of sufficient size, include men, and evaluate vigorous including higher-impact PA compared with moder-ate or light PA. Archives of Physical Medicine and Rehabilitation 2023;104:1314-30 & COPY; 2023 by the American Congress of Rehabilitation Medicine.