BACKGROUND: Forward head posture in older adults is associated with cervical–thoracic misalignment, chronic tension-type headache, and impaired respiratory mechanics. This study investigated the synergistic effects of combining cervical stabilization exercises with an AI-driven remote respiratory rehabilitation program.

MATERIAL AND METHODS: This randomized controlled trial enrolled 50 older adults with chronic neck pain and tension-type headache, who were randomly assigned to an experimental group (n=25) or a control group (n=25). After a 12% attrition rate, data from 44 participants (22 per group) who completed a 6-week intervention were analyzed. Both groups performed cervical stabilization exercises, while the experimental group additionally received AI-based remote respiratory training using real-time pressure-threshold analysis to deliver individualized progressive overload at 50% of maximal inspiratory and expiratory pressures (MIP/MEP). In contrast, the control group received a time-matched, conventional self-managed respiratory intervention. Outcomes included pain and disability (VAS, NDI), cervical alignment (CVA), headache impact (HIT-6), pulmonary function (FVC, FEV₁, PEF), respiratory muscle strength (MIP, MEP), and ultrasonographic diaphragmatic thickness.

RESULTS: Compared with the control group, the experimental group demonstrated significantly greater improvements in NDI (d=0.91), CVA (d=0.86), and HIT-6 (d=0.77) (P<0.05). Significant group-by-time interaction effects were observed for MIP (d=0.86) and diaphragmatic thickness during contraction (d=0.51). Pulmonary function parameters also improved to a greater extent in the experimental group.

CONCLUSIONS: Integrating AI-driven remote respiratory rehabilitation with cervical stabilization exercises provided a clinically meaningful and comprehensive approach for improving postural, respiratory, and headache-related outcomes in older adults with forward head posture.

Keywords: Diaphragm, Geriatrics, Neck Pain, Posture, Randomized controlled trial, Respiratory Muscles, Artificial Intelligence, Tele-rehabilitation