Objective To investigate the effects of Schroth exercises combined with targeted breathing training on the Cobb angle, angle of trunk rotation (ATR), and quality of life in adolescent idiopathic scoliosis (AIS). Methods A retrospective analysis was conducted on 82 patients with AIS treated in the Department of Rehabilitation Medicine of Hangzhou Xiaoshan District Hospital of Traditional Chinese Medicine from June 2023 to October 2025. According to the rehabilitation regimen documented in medical records, patients were divided into a combined training group (45 cases) and a control group (37 cases). The control group received standardized Schroth exercises, while the combined training group received additional targeted breathing training for 12 weeks. Cobb angle, ATR, Scoliosis Research Society-22 (SRS-22) score, visual analog scale (VAS) score and clinical efficacy were compared between the two groups. Results After intervention, the Cobb angle, ATR, SRS-22 score and VAS score of the two groups were improved compared with those before intervention (all P＜0.05). The improvement range of each index in the combined training group was significantly better than that in the control group (all P＜0.05). The total effective rate of combined training group (84.44%) was significantly higher than that of control group (64.86%) (P＜0.05). Conclusion Schroth exercises combined with targeted breathing training can further improve spinal deformity, ATR, pain and quality of life in patients with AIS, with better short-term efficacy than Schroth exercises alone.