Extended Abstract
1. Objectives
Hyperkyphosis in older adults generates severe complications such as limited physical function, balance impairment and reduced quality of life [1-5]. These can lead to falls, frequent fractures, and severe psychiatric complications [6-8]. However, limited studies have investigated the effect of exercises as an intervention for hyperkyphosis on physical function, balance and the quality of life among the elderly, especially elderly men. In most studies, only the effect of corrective training on the severity of hyperkyphosis has been evaluated [9-13]. Thus, the impact of training programs on the complications of hyperkyphosis has received little attention. Severe complications associated with hyperkyphosis have many negative consequences. Therefore, this study aimed to assess the effect of kyphosis corrective exercises on physical function, postural control, and the quality of life in elderly men with hyperkyphosis.

2. Methods and Materials
The study participants were 24 elderly men with hyperkyphosis (angle >50°). They were randomly divided into test (Mean±SD age=68.75±2.67 years; Mean±SD height=173.66±3.75 cm; Mean±SD weight=73.5±4.75 kg), and control (Mean±SD age=69.50±2.64 years; Mean±SD height=174.41±7.78 cm; Mean±SD weight=75.41±5.21 kg) groups, each with 12 samples. Inclusion criteria were 65-74 years of age; hyperkyphosis >50° ; physicians’ permission to participate in the training program; ability to stand for at least 1 minute and walk 10 meters or more independently or with a conventional cane; no consumption of sedatives or any particular medication affects postural control; the lack of any uncontrollable neurological, respiratory, vascular, metabolic and musculoskeletal diseases; and no serious hearing or visual impairment [5, 24]. 
Exclusion criteria were histories of depression, anxiety or other mental disorders; history of severe articular deformities in the lower extremities and trunk; history of joint replacement in lower extremities; history of balance disorders and vertigo; history of severe pain in the lower extremities and trunk; and receiving physiotherapy program recently or during study [5, 24]. Samples in the test group received a 12-week kyphosis corrective exercises program for 3 sessions per week. Exercises included spinal mobility, occipital muscle stretch, pectoral (chest) muscle stretch, strengthening cervical flexor muscle, and strengthening retractor muscles of the shoulder. 
The thoracic kyphosis angle was measured using a flexible ruler at a distance between T2 and T12 spinous processes. Physical function was examined by 6-min walk test; static balance by sharpened Romberg test (eyes closed and eyes open), and the quality of life by 36-item Short Form Health Survey (SF-36). For analyzing the collected data, Analysis of Covariance (ANCOVA) was performed considering a significance level of P<0.05.

3. Results
ANCOVA results suggest that the kyphosis corrective exercises had a significant effect on the quality of life of samples (F=6.94, P=0.04). Within group evaluation of scores by Independent t test revealed that the mean scores of the subscales of bodily pain (t=2.01, P=0.03), physical function (t=1.89, P=0.04), physical limitation (t=2.3, P=0.02), general health (t=1.93, P=0.04), and mental health (t=4.96, P=0.001), improved significantly after the intervention, compared to the pretest scores. However, posttest mean scores of vitality (t=0.16, P=0.87), social role (t=0.43, P=0.67), and mental limitation (t=1.37, P=0.18) showed no significant differences with their pretest mean scores.

 

 

ANCOVA results demonstrated that kyphosis exercises had a significant effect on balance, walking, and physical function among samples with hyperkyphosis >50° (P<0.05). Within group comparison results indicated that, in the test group, the mean score of static balance with eyes open (t=2.9, P=0.009), and physical function (t=3.8, P=0.001) improved significantly after the intervention. However, the mean score of static balance with eyes closed (t=1.37, P=0.018) showed no significant improvement. Moreover, kyphosis exercises significantly affected the kyphotic angle in the samples (P<0.05). With respect to this effect, within group comparison results revealed that the mean score of kyphotic angle in both groups significantly reduced after the intervention (t=3.74, P=0.001) (Table 1).

4. Conclusion
Kyphosis exercises including stretching exercises, strengthening exercises and spinal movements could improve postural control, physical function, and the quality of life in elderly people with hyperkyphosis >50°. Improving these factors can be effective in reducing the financial burden of diseases and ageing-related problems, and can provide a basis for life satisfaction in the elderly. Therefore, we recommend this intervention program in order to improve physical function, postural control, and the quality of life in the elderly with hyperkyphosis. However, due to some study limitations, more comprehensive research is required to confirm the obtained results.

Ethical Considerations
Compliance with ethical guidelines
All ethical principles were considered in this article. The participants were informed about the purpose of the research and its implementation stages; they were also assured about the confidentiality of their information; Moreover, They were allowed to leave the study whenever they wish, and if desired, the results of the research would be available to them.

Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Authors contributions
Conceptualization: Aynollah Naderi and Shahabeddin Bagheri; Draft preparation: Fatemeh Shaabani, Aynollah Naderi, and Shahabeddin Bagheri; Investigation and resources: Fatemeh Shaabani and Mohammad Hossain Rezvani; Editing: Mohammad Hossain Rezvani and Aynollah Naderi.

Conflict of interest
The authors declared no conflict of interest.

Acknowledgements
Authors would like to thank the authorities of Welfare Organization and the elderly care centers in of Hamedan For their valuable cooperation.



 

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