Effects of hippotherapy simulation exercise vs. conventional home exercises on muscle strength and balance in people with multiple sclerosis: A randomized controlled trial

Published:August 18, 2022DOI:


      • Horse-riding simulation exercises indicate a positive effect on health conditions, balance, mobility skills, and muscle strength in people with multiple sclerosis.
      • For people with multiple sclerosis, horse-riding simulation is a safe workout for the whole body, which is performed using core muscles and many joints.
      • Horse-riding simulation approach can be offered as a practical and cost-effective exercise program.
      • We suggest that future research should focus on how effective horse-riding simulation exercises are in the high disability multiple sclerosis group.



      To determine the efficacy of hippotherapy simulation exercise on the improvement of muscle strength, balance, spasticity, and quality of life in individuals with multiple sclerosis (MS).


      Randomized controlled trial.


      Outpatient clinic at the rehabilitation clinic of University of Usak, Turkey


      Individuals with MS (n = 40) participated in this randomized clinical study.


      Patients in both groups received 36 treatment sessions, 3 times per week for 12 consecutive weeks. Subjects in the study group performed hippotherapy simulation exercise via a hippotherapy simulator device. The control group received conventional home exercises.

      Main Outcome Measures

      The primary outcome measures included the Monitoring My Multiple Sclerosis (MMMS) Scale, the Berg Balance Scale (BBS), and the Timed Up and Go (TUG) test; quadriceps muscle strength was measured with a dynamometer.


      At the level of physical activity, post-intervention MMMS measures showed significant differences in both cases. TUG was significantly lower, and muscle strength and BBS were significantly higher in both post-interventions. No outcome measure showed a significant difference between the groups at both post-intervention and follow-up.


      The results of this study in the field of hippotherapy simulation exercise for people with MS indicate a positive effect on health conditions, balance, mobility skills, and muscle strength. Further studies are necessary to confirm these preliminary results.



      MS (multiple sclerosis), MMMS (The Monitoring My Multiple Sclerosis Scale), BBS (The Berg Balance Scale), TUG (The Timed Up and Go Test), HSE (hippotherapy simulation exercise), CHE (conventional home exercise)
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