Effects of exercise interventions on upper crossed syndrome-related postural abnormalities in students: a systematic review and meta-analysis

Background Upper crossed syndrome (UCS)-related postural abnormalities are commonly reported in students, but the effects of structured exercise interventions remain uncertain. This systematic review and meta-analysis evaluated exercise interventions for forward head posture (FHP), shoulder posture, and thoracic kyphosis angle in students. Methods Seven electronic sources were searched from inception through October 1, 2026, for controlled intervention studies involving students with UCS-related postural abnormalities. Risk of bias was assessed using RoB 2 for randomized trials and ROBINS-I for non-randomized studies. Certainty of evidence was assessed using GRADE. Random-effects meta-analyses were performed using Hedges' g with 95% confidence intervals (CIs). Sensitivity analyses compared random-effects and fixed-effect models, examined alternative pre-post correlation assumptions, and evaluated an RCT-only dataset. The review was registered in PROSPERO (CRD420261381887). Results Fifteen independent studies (14 randomized trials and one non-randomized study) were included. Here, k denotes the number of independent studies contributing to each outcome. Pooled estimates favored exercise interventions for FHP ( k = 14; Hedges' g = −1.95, 95% CI −2.75 to −1.15; I 2 = 86%), shoulder posture ( k = 12; g = −1.68, 95% CI −2.41 to −0.95; I 2 = 84%), and thoracic kyphosis angle ( k = 9; g = −2.47, 95% CI −3.70 to −1.25; I 2 = 89%). Substantial heterogeneity was observed across all three outcomes, and the 95% prediction intervals crossed zero. All three pooled effects were statistically significant ( p ≤ 0.002). Certainty of evidence was very low for FHP and shoulder posture and low for thoracic kyphosis. Conclusions Structured exercise interventions may improve UCS-related postural abnormalities in students, although substantial heterogeneity limits confidence in the magnitude and generalizability of these effects. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420261381887 , identifier: CRD420261381887.