Effectiveness of a School-Based Exercise Intervention for Forward Head Posture and Neck Functional Disability among Adolescents: A Randomized Controlled Trial
DOI:
https://doi.org/10.26911/jepublichealth.2026.11.04.01Abstract
Background: Forward head posture (FHP) is common among adolescents and may affect cervical alignment and neck function. Early intervention may help prevent potential functional consequences. As adolescents spend much of their time at school, the school setting provides a practical opportunity to deliver accessible and structured interventions. Therefore, school-based exercise may be a feasible approach to improving cervical posture and neck function among adolescents with FHP.
Subjects and Method: This randomized controlled trial included 70 adolescents aged 15–17 years with FHP, comprising 35 participants in the school-based exercise group (intervention group) and 35 participants in the ergonomic education group (control group). The outcome variables were cervical posture and neck functional status, assessed using the craniovertebral angle (CVA) and Neck Disability Index (NDI), respectively. The intervention was conducted for three weeks, with assessments performed at four time points: baseline, week 1, week 2, week 3. Longitudinal changes in CVA and NDI were analyzed separately using linear mixed-effects models including treatment group, time, and group × time interaction, with participant included as a random intercept.
Results: A significant group × time interaction was observed for CVA (F = 27.450, p < 0.001), indicating that the trajectory of CVA over time differed between the Intervention and Control groups. The estimated marginal mean (EMM) of CVA increased from 47.943° at baseline to 51.743° at week 3 in the intervention group, compared with an increase from 47.943° to 48.629° in the Control group, corresponding to a between-group difference in change of 3.114° (95% CI 2.35–3.88). A significant group × time interaction was also observed for NDI (F = 13.626, p < 0.001), indicating that the trajectory of NDI over time differed between the Intervention and Control groups. The EMM of NDI decreased from 5.800 to 3.400 in the Intervention group and from 5.857 to 4.857 in the Control group, corresponding to a between-group difference in change of −1.400 (95% CI −1.88 to −0.92).
Conclusion: School-based exercise was associated with greater improvements in cervical posture and reductions in neck disability than ergonomic education among adolescents with FHP. These findings indicate that school-based exercise may be a feasible approach for addressing postural and neck-related problems in school settings, although the short follow-up period limits interpretation of longer-term effects.
Keywords:
forward head posture, school-based exercise, craniovertebral angle, neck disability, adolescentsHow to Cite
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