The vertebral column is an S-shaped structure that carries the body weight and transmits it to the feet. Kyphosis, a natural curvature of the spine, can increase with poor posture and muscle weakness, leading to postural kyphosis. This condition results in forward head positioning, rounded shoulders, and scapular winging, causing back pain, poor posture, balance issues, and respiratory difficulties. With technological advances, poor posture habits have become more common, especially in adolescents. Kyphosis can also affect balance, walking speed, and increase the risk of falls in older adults. Exercises like Hatha yoga and reformer Pilates are effective methods for improving posture, muscle strength, and quality of life. The aim of this study is to compare the effects of Hatha yoga and reformer Pilates exercises on posture, pain, balance, quality of life, body image, and respiratory function in individuals with hyperkyphosis.

The vertebral column is an S-shaped structure that supports the weight of the upper extremities, head, and neck, transmitting this load to the pelvis and ultimately to the feet. It consists of 34-35 vertebrae, including cervical, thoracic, lumbar, sacral, and coccygeal vertebrae. The cervical and lumbar regions form concave curves (lordosis), while the thoracic and sacral-coccygeal regions form convex curves (kyphosis). The arrangement of the vertebral column in the sagittal plane enables individuals to perform activities with minimal energy expenditure. Kyphosis is the angular and physiological posture formed by the spine and surrounding muscles, which includes the vertebrae and intervertebral discs.This angle is commonly assessed using the Cobb angle in lateral radiographs, with the angle between the lines drawn perpendicular to the 4th-5th thoracic vertebrae and the 12th thoracic vertebrae being measured. Postural kyphosis is defined as an increase in existing spinal curvature due to muscle weakness and poor posture, and it is considered a more flexible deformity compared to other types of kyphosis.The mechanical changes associated with postural kyphosis can impact various functions. The head in kyphotic posture moves forward, altering cervical alignment. This causes the cervical vertebrae to shift anteriorly, leading to compensatory rounding of the shoulders and scapular winging.Factors such as prolonged sitting at desks, poor posture, inadequate furniture, physical inactivity, and heavy school bags contribute to increased muscle spasms and weakened soft tissues, aggravating kyphotic posture. Additionally, technological advancements, especially the widespread use of computers and smartphones, have led to poor postural habits in individuals, particularly adolescents.Rapid growth during adolescence can also cause abnormal spinal flexion, negatively affecting organ development and increasing the kyphosis angle.A study conducted in 2024 showed that corrective exercises combined with active diaphragmatic breathing led to improvements in chest pain and respiratory function in postmenopausal women after a 12-week program.Postural kyphosis is often asymptomatic, but it can result in a visible hunchback, poor posture, back and neck pain, tension, and sensitivity in the spine.In postural kyphosis, the individual can actively or passively correct the posture, but the curvature is flexible. Structural deformities in the spine do not occur. Incorrect postures increase stress on the joints, impairing their function and leading to pain and edema in the discs.Inadequate posture also strains bones, muscles, and ligaments, leading to pain and negatively impacting the position and function of internal organs.Balance refers to the ability to maintain the center of mass within the limits of a base of support during functional activities, utilizing vestibular, visual, and proprioceptive senses. It is classified into static balance, where the center of mass remains stable in a fixed position, and dynamic balance, which involves maintaining balance during movement. Literature indicates that individuals with increased kyphosis experience balance impairments, but postural kyphosis is not routinely assessed for balance.Some studies suggest that kyphosis negatively impacts physical function, balance, and mortality, while others have found no significant link between kyphosis and balance. Research has shown that kyphosis in older women is associated with slower walking speeds, increased body sway, balance issues, and higher fall rates.However, clinical exercises combined with breathing techniques have demonstrated improvements in quality of life and kyphosis angles.Postural kyphosis can impact both physical and psychological well-being, as it affects an individual's appearance. In young individuals, the normal thoracic kyphosis angle is between 20° and 40°, with angles over 45° considered hyperkyphosis.Exercise positively influences both mental and physical health. In adolescence, body image is crucial, and postural deviations often reflect emotional states, with extension positions fostering happiness and confidence, while flexion positions are associated with sadness.Respiration involves coordinated muscle activity. Although inspiration primarily occurs through diaphragmatic muscle activity, additional inspiratory muscles are engaged during deep inspiration. These muscles assist in expanding and contracting the thoracic cavity and contribute to stabilizing the thorax and abdomen.Postural changes in the body and shoulder girdle directly affect thoracic and diaphragm movements, influencing respiratory function. Restrictions in thoracic expansion or diaphragm movement, such as those caused by hyperkyphosis and scapular winging, limit respiratory capacity.Hyperkyphosis can lead to restrictive pulmonary dysfunction, similar to scoliosis, and increases the antero-posterior diameter of the thorax, reducing lung capacity.Studies have shown that hyperkyphosis is associated with decreased pulmonary function and lung volumes.Conservative treatments are the first line of management for postural kyphosis. Manual therapy techniques,postural correction exercises,postural taping,orthotics and the Schroth method are commonly used. Prevention of postural kyphosis begins in childhood with the teaching of proper posture, supporting exercises, muscle strengthening, and spinal alignment.Yoga and Pilates exercises are among the methods used to address these issues.Multidisciplinary treatment approaches are recommended in complementary therapies, addressing patients not only from a bio-psycho-social perspective but also through a bio-mental-physical-psycho-social understanding. Yoga, a mind-body exercise, is often recommended in group therapies. Originating in India over 4,000 years ago, yoga has developed over time to promote both physical strength and spiritual awareness. Various types of yoga, such as Hatha yoga, are similar to physiotherapy practices.Yoga incorporates postures (asanas), breathing exercises (pranayama), and meditation to improve flexibility, strength, and relaxation.Pilates, developed by Joseph Pilates in the 1900s, focuses on improving spinal stability, breathing control, and kinesthetic awareness, promoting both muscle relaxation and mental relaxation. Clinical Pilates is used in rehabilitation for both healthy individuals and those with various medical conditions.Research has shown that Pilates improves flexibility, reduces pain, and enhances quality of life and functional capacity.Studies also suggest that Pilates and yoga improve posture and balance in individuals with hyperkyphosis, although research comparing both approaches is limited.The aim of this study is to compare the effects of Hatha yoga and reformer Pilates exercises on posture, pain, balance, quality of life, body image, body composition, and respiratory function in individuals with hyperkyphosis.

Inclusion Criteria:

• Postural hyperkyphosis
• Not receiving physiotherapy in the last 6 months

Exclusion Criteria:

• Exercise is not indicated
• Communication problems
• Having a concomitant orthopaedic disorder
• The presence of a concomitant neurological disorder
• Presence of concomitant cardiopulmonary disease
• Presence of recurrent infection
• Presence of open wound and/or incision
• Presence of other spinal conditions such as scoliosis
• Being diagnosed with kyphosis other than postural kyphosis in the classification system
• Previously undergone a related surgery