Physical Exercise Program Helps to Stop Scoliosis Progression, Study Finds

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by Vanda Pinto, PhD |

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A six-month intensive and individualized exercise program prevented the progression of scoliosis, a sideways curvature of the spine, in most girls and women with Rett syndrome taking part in a study.

In two young patients, the intervention completely corrected the spine’s curve. “This result is highly significant as no spontaneous scoliosis curve regression was ever reported in people with RTT [Rett syndrome],” the researchers wrote.

Improvements in motor skills were also observed, further highlighting the potential benefits of exercise for these patients. But larger studies with appropriate control groups are needed to confirm these results, the researchers noted.

The study, “Intensive Postural and Motor Activity Program Reduces Scoliosis Progression in People with Rett Syndrome,” was published in the Journal of Clinical Medicine.

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Scoliosis is known to affect up to 94% of people with Rett syndrome, with a median age of onset around age 10. Starting at age 16, an estimated 85% of Rett patients have some degree of scoliosis.

A curved spine can affect the lungs, causing shortness of breath and risking respiratory failure — a condition that develops when not enough oxygen gets into the blood. Scoliosis can also be painful and make certain movements and everyday activities more difficult, including walking, sitting, and standing.

To help with posture and sitting, a spinal brace is sometimes recommended. But there is no evidence that it can prevent the progression of neuromuscular scoliosis, or that a brace is beneficial in people with Rett. Spinal surgery is reportedly effective at correcting severe curves; however, many patients choose not undergo surgery, the researchers noted.

Physical therapy is also helpful with correcting posture and can delay the need for surgery. But studies into physical therapy programs for Rett patients to date are limited and do not address interventions aimed at scoliosis.

Researchers in Israel and Italy developed and tested a physical activity program to prevent the progression of scoliosis in 20 girls and women diagnosed with classic Rett syndrome.

This six-month physical activity program was personalized for each participant and carried out by their caregivers in their daily environment for one hour a day, five days a week.

Women and girls, with a mean age of 15.6 (age range, 3.8 to 38.3), were enrolled from the Italian Rett Association (AIRett) database. All lived with their parents.

The program consisted of four to seven activities that could be done at home as part of the patients’ daily routine. These activities were designed to correct posture and strengthen the trunk muscles. They included approaches such as sleeping with a “U” shaped pillow under the scoliotic curve on the right side to extend the left side of the trunk, walking small distances while being held by the hand, and using a treadmill for 20 minutes every day with assistance.

A therapist supervised the program’s progress for its first three months through video calls with caregivers, answering questions, making program adjustments as needed, and giving other advice.

Researchers evaluated changes in the Cobb angle, a standard measure of the degree and severity of spinal curvature, before the intervention and one year later. Changes in motor functioning were also assessed. For statistical analysis, patients’ Cobb angle were used to distinguish between those whose scoliosis worsened and those whose curve improved.

As a Cobb angle change of more than 5 degrees is considered to mark scoliosis progression, the researchers noted that 70% of these patients did not worsen their curves by the program’s end, meaning the intervention prevented their scoliosis from progressing.

Patients’ average curve progression was 1.7 degrees over one year, much lower than the annual average reported in Rett literature, which ranges from 14 to 21 degrees, the study noted. Improvements in motor abilities, evaluated using the Rett Syndrome Motor Evaluation Scale, were also observed.

Four of the eight patients with a reduction in their Cobb angle had an easing of at least 5 degrees in the curve, results showed. In contrast, spinal curvature worsened by more than 5 degrees in six of the 12 patients with continuing curvature.

The study’s two youngest children — ages 3.8 and 6.5 and both with unstructured flexible scoliosis, indicating a curvature but no spinal rotation — learned to walk without help during the program, and “the intervention was able to eliminate the scoliotic curve completely,” the researchers wrote.

Another child, almost 13 years old and the only study patient with severe Rett manifestations as measured by the Rett Assessment Rating Scale, showed a 3-degree ease in her curve. The girl, who previously needed to “lie down or be fully supported” during waking hours, also gained an ability to stand and walk with support.

“The above presented cases … reiterate the fact that physical activity is extremely important to those with RTT continuously from a young age and that improvements in functional abilities can be achieved by this group of clients at all severity levels and at all ages,” the researchers wrote.

Among noted study limitations were its small size and lack of a control group. Additional studies with a larger number of patients are needed to confirm these results, the team noted.

Still, the investigators concluded that “the present article proposes an effective intervention to prevent scoliosis progression of people with RTT, a population with no established conservative treatments for spinal asymmetries until now.”