Exercise that mimics horseback riding shows benefits in AS in study

Hippotherapy device seen to help patients boost muscle strength

Marisa Wexler MS avatar

by Marisa Wexler MS |

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A form of exercise using a device that mimics horseback riding may be an effective intervention to boost muscle strength, limit disease severity, and improve life quality for people with ankylosing spondylitis (AS), according to a new study.

The novel approach tested in the trial uses a device called a hippotherapy simulator, or HS, to allow patients to get the same sort of exercise as riding a horse without having to actually get on a live animal.

“The social advantage of this clinical trial is the opportunity to introduce a novel recreational exercise approach for AS patients,” the researchers wrote, adding that “the results of this first randomized clinical trial of [horseback-mimicking] exercises … indicate a positive effect on disease activity, quality of life and muscle strength.”

The study, “The effectiveness of hippotherapy simulation exercises for muscle strength, disease activity and quality of life in sedentary adults with ankylosing spondylitis,” was published in the Annals of Medicine.

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Horseback riding, which works the body’s muscles, seen as good exercise for AS

Physical exercise has a wide range of well-established health benefits, and for people with AS, such activity can help to improve mobility and ease symptoms like pain. Getting regular exercise is generally recommended as a key part of living with AS.

“The main components that should be included in the daily exercise routine of individuals with AS should be mobility exercises for the axial [central core] skeleton and peripheral joints, anti-gravity muscle strengthening, stretching methods and cardiorespiratory fitness,” the researchers wrote.

Horseback riding is a form of exercise that particularly builds core strength and works the muscles involved in balance, as a rider needs to continually move in rhythm with the motions of the horse. Horse-based exercise regimes, known as hippotherapy, have shown benefits for people with a wide range of conditions.

Using live horses for hippotherapy has some drawbacks, however, including expense and safety risks — even the most well-trained horse can get spooked and throw a rider, and expert therapists are needed to ensure that traditional hippotherapy can be done safely.

New devices called hippotherapy simulators, or HS for short, have been created with the aim of overcoming such drawbacks. The HS is basically a mechanized seat that mimics the rhythmic motions of the live animal, allowing patients to get the same type of exercise as horseback riding without the horse.

The main components that should be included in the daily exercise routine of individuals with AS should be mobility exercises for the axial [central core] skeleton and peripheral joints, anti-gravity muscle strengthening, stretching methods and cardiorespiratory fitness.

Because HS is a relatively new setup, there are limited data on whether this type of exercise can benefit people with AS. To learn more, a pair of scientists in Turkey conducted a small trial (NCT04713813) enrolling 48 people with AS.

“To our knowledge, there are no current studies examining the effects of exercises with HS in AS patients,” the scientists wrote, adding, “The aim of this study is to research the effects of HS on disease activity, quality of life and muscle strength in adults with AS.”

All but six of the participants — 42 in all — completed the study. The mean patient age was in the mid-30s, and about two-thirds of participants were identified as male.

For comparison, the participants were divided into two groups. One group underwent an exercise regime incorporating HS, while the second group did an exercise program involving balance work, strength training and stretching, but not the horseback riding simulator.

In both groups, participants engaged in four, 40-minute sessions of exercise per week for 12 weeks, or about three months.

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Improvements in seen at week 12 with hippotherapy simulator

Assessments of patients in both groups were done before and after the interventions, and then again three months after the exercise programs ended.

At each of the three assessments, participants underwent a battery of standardized measures of AS-related disease severity and life quality, including the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Bath Ankylosing Spondylitis Functional Index (BASFI), the Bath Ankylosing Spondylitis Metrology Index (BASMI), and the Ankylosing Spondylitis Quality of Life Scale (ASQoL).

Prior to the intervention, all of these measures were comparable in both groups.

The results showed that scores on all of these measures improved significantly after the exercise intervention in both groups. For the BASDAI, BASFI, and BASMI, which respectively measure AS severity, functional impact and spinal mobility, the extent of improvement was significantly greater for patients given HS compared with those who received conventional exercise.

The ASQoL, a measure of life quality, showed similar improvements in both groups. Measures of muscle strength also were comparable in both groups.

“This study demonstrated that 48 sessions of hippotherapy simulation workouts significantly improved functionality, muscle strength and quality of life in individuals with AS leading a sedentary lifestyle,” the researchers wrote.

“Comparing the treatment approaches, daily activity scores, functionality and spinal mobility showed a statistically better improvement in the HS group at week 12,” the team wrote.

At follow-up three months after the intervention ended, all of these scores were comparable between the two groups, and generally were similar to scores before the intervention.

“Future studies should include assessment of balance and core muscle activation or endurance,” the scientists wrote.

The team also noted a need for studies into cost-effectiveness and the possibility of incorporating the horseback riding-like therapy into other types of exercise regimes. A study limitation, the researchers noted, was that results can only be generalized to AS patients with mild disabilities.