Specific exercises are effective in reducing the loss of correction during brace weaning. Patients performing exercises according to the SEAS protocol were able to achieve the best results in clinical terms, with the lowest percentage of patients worsening (only one patient exceeded 5° Cobb). Those patients who never performed exercises (NO sub-group) had the worst results, but continuity also proved to be important (DIS sub-group). In five cases, (all in the NO and DIS sub-groups) an impressive loss of correction was seen, over 10° Cobb, and in one case even of 18° Cobb was achieved. The effect on the prominence (ATR) was less evident, and it appears this is driven more by the brace than whether exercises were performed or not.
According to these results, we can assume that exercises can prevent a sort of postural collapse[27, 28] becoming evident when the spine is progressively released from the passive support of the brace. Wearing a brace for many years can cause progressive muscular atrophy and loss of strength.[12, 26] If the spinal muscles are not constantly and specifically trained throughout the treatment and particularly during brace weaning, this postural collapse could be more dramatic. Our results support this hypothesis, even if more studies are needed to understand whether an increase of compliance (that was not possible to test accurately in this study) can be implied
The benefit of exercises on ATR stabilization is less evident. ATR is a measure of the deformity. We can aesthetically model the trunk in general and the prominence with braces by pushing on prominences, and the results on aesthetics at the end of brace treatment are significant and persistent[34, 35] Apparently, exercises are not able to influence the possible (in any case reduced – on average 0.5° ATR) loss of correction of ATR. It seems that exercises are not as effective on this bone remodelling as they are on other parameters that could be more related to posture (i.e. loss of correction).
Exercises have already been shown to be effective in the preparation for bracing, during the correction phase and while the brace is worn[15, 18, 36] All the exercises studied in association with bracing in our previous papers have been developed to help the brace action function properly (in a way confirming the importance of specific developed exercises, as proposed by our and other schools,[2, 12] while in this case exercises during the brace-weaning phase are similar to those performed without the brace, in order to avoid postural collapse.
This is the first study that has documented the efficacy of exercises in reducing loss of correction during a truly relevant phase of treatment, namely brace weaning. We are not aware of any previous study on this topic, so we do not have other data against which our results could be compared.