Comparative efficacy of different scoliosis-specific exercise protocols on cobb angle in adolescent idiopathic scoliosis: a network meta-analysis

Objective: To compare the efficacy of different scoliosis-specific exercise protocols on the Cobb angle in adolescent idiopathic scoliosis (AIS) using a network meta-analysis, and to rank the five key prescription parameters-exercise type, intervention period, session duration, frequency, and intensity-within a unified evidence framework, thereby moving beyond the traditional question of "whether exercise works" to address "which parameter combinations have the highest probability of producing optimal improvement." Methods: A systematic search was performed in PubMed, Web of Science, Embase, Cochrane Library, CNKI, Wanfang Data, and VIP databases for randomized controlled trials from inception to December 2025. Two researchers independently screened studies, extracted data, and assessed risk of bias. RevMan 5.3 and Stata 16.0 were used for data analysis. Results: A total of 24 studies involving 1,149 patients were included. The network meta-analysis showed that: regarding exercise type, Schroth combined with sensory integration training showed the greatest effect size [MD = -8.01, 95% CI (-11.47, -4.54)]; regarding intervention period, 12-18 weeks showed the greatest effect size [MD = -3.67, 95% CI (-5.52, -1.81)]; regarding session duration, 60 min showed the greatest effect size [MD = -4.00, 95% CI (-5.76, -2.23)]; regarding frequency, three times per week showed the greatest effect size [MD = -3.55, 95% CI (-4.76, -2.35)]; regarding intensity, moderate intensity showed the greatest effect size [MD = -3.78, 95% CI (-5.99, -1.57)]. The SUCRA rankings placed these parameters first in their respective networks. Conclusion: Based on probability ranking, Schroth combined with sensory integration training, delivered at moderate intensity, three times per week, 30-60 min per session, for 12-18 weeks, is likely to be among the most effective protocols for improving the Cobb angle in AIS. However, this finding is derived from a limited number of studies, and each protocol component is supported by sparse evidence within its respective network. These results should be interpreted with caution and must be individualized in clinical practice. Systematic Review Registration: identifier PROSPERO CRD420251249777.