Abstract
<title>Abstract</title> <p>Background Degenerative cervical myelopathy (DCM) is the primary cause of non-traumatic spinal cord impairment in adults. Exercise-based rehabilitation is widely used perioperatively, but its disease-specific efficacy and mechanisms remain unproven. Objective To characterize exercise interventions studied in adults with imaging-confirmed degenerative cervical spinal stenosis (CSS) or DCM, evaluate their neurological and functional effects, and distinguish clinically supported mechanisms from biological hypotheses. Methods We searched PubMed, Scopus, and Google Scholar (January 2006–August 2026) for studies of exercise interventions in adults with imaging-confirmed degenerative CSS or DCM, excluding non-degenerative pathologies. Given heterogeneity across interventions and populations, findings were synthesized narratively, and the certainty of the evidence was rated using the GRADE framework. Results Of 3,192 identified records, 88 met the inclusion criteria. Exercise improved balance, mobility, independence, and pain, with the largest and most consistent gains from multimodal, task-specific programs after surgical decompression. Most controlled studies were small or non-randomized, and postoperative trials showed variable benefit relative to usual care. Evidence for isolated neck strengthening, deep cervical flexor training, postural correction, and aerobic conditioning was indirect or mechanistic. No study demonstrated structural reversal of stenosis or canal expansion. Conclusions Exercise-based rehabilitation improves balance, mobility, independence, and pain in stable mild DCM and after surgical decompression, with the strongest and most consistent gains from multimodal, task-specific programs. It does not reverse stenosis or enlarge the canal, and it must not delay surgical assessment in progressive or severe disease.</p>