Hippotherapy on Functional Capacity and Quality of Life in Parkinson's Disease: a Prospective Study

Parkinson's disease (PD) is associated with motor symptoms such as bradykinesia, rigidity and postural instability 1 which interfere with the patient's independence, and ability to carry out activities of daily life 2. In addition, losses in functional may result in a decreased health-related quality of life (HRQL) 3. Thus, as PD progresses HRQL gets worse 4.

Exercise programs are suggested to improve functional capacity and HRQL in people with PD 3. However, in the later stages of PD, mobility problems restrict the potential to participate in exercise programs, resulting in even greater loss in functional capacity and HRQL. Furthermore, a decline in the efficacy of pharmacological treatment and complications due to motor fluctuations and medication side effects make the role of complementary treatments such as hippotherapy critical to individuals with PD at late stages. Hippotherapy is a therapeutic intervention commonly used in populations with mobility deficits, since they do not require effort or walking from patients who can no exercise in standing position. When is on the horse, the patient exercises as he/she is walking unassisted 5. Neurological conditions are improved by horse's movement stimulations. The set formed by the patient and his horse performs rhythmic and three-dimensional oscillations which trigger very important neuromuscular responses from the rider's postural reflex mechanisms 6. The horse's movements are sensed by the participant on the saddle, and when the horse is slowly walking it has been argued to be similar to the pelvic movement produced by human gait, thereby strengthening the trunk muscles and improving balance 7. The senses are integrated during the act of riding performing sensory stimulation 8. Furthermore, hippotherapy has been demonstrated to be an effective method to improve functional capacity by increasing gait velocity in people with brain disorders 9, functional mobility in elderly 10 and functional strength in people after stroke 11 and in people with spinal cord injury 5. In addition, hippotherapy has been shown to improve HRQL in children and in adults 6.

Considering the potential benefits of hippotherapy to anticipatory postural adjustments and sensory stimulation 9, 11, it could be hypothesized that hippotherapy may increase functional capacity and improve HRQL in individuals with PD. This hypothesis has not been tested yet. Therefore, the purpose of this study was to assess the effects of a hippotherapy program on functional capacity and on HRQL in people with PD.

(4) Methods

Subjects People with confirmed diagnosis of PD by medical report were invited through advertisements on radio, on television, public announcements and posters around the hospitals to participate in the Physical Activities Program for Persons with Neurodegenerative Diseases. Among 81 registered volunteers, 18 participants, six women and twelve men, unable to perform usual physical activity because they were in the late stages according to Hoehn and Yahr scale (H & Y≥ 3), or because they need to use a wheelchair for severe mobility problems were enrolled in the hippotherapy program which formed the sample (n=18). Exclusion criteria were uncontrolled hypertension, unstable cardiovascular disease and had practiced riding or hippotherapy six months before the intervention period. Among the 18 volunteers from the sample, three women and six men were randomized for the intervention group called hippotherapy group (HT) (n=9), which performed ten weeks of hippotherapy sessions (2 familiarization + 8 hippotherapy weeks) twice a week with each session lasting thirty minutes. Nine other participants who were waiting to be allocated to the hippotherapy program in the following semester attended lectures on PD, twice a week for ten weeks, with each session lasting thirty minutes. Demographics and characteristics of the sample can be seen in Table 1. This study was approved by the Research Ethics Committee of the University of Brasilia on 10/10/2013 by the number CAAE 17329213.7.0000.0030. All participants were informed about the procedures and agreed to participate in the study signing the informed consent term.