Discussion
’ differing disease severity, exercise frequency, pain
ADVERSE EVENTS, DISEASE
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. Comparing the treatment approaches, daily activity scores, functionality and spinal mobility showed a statistically better improvement in the HS group at week 12. All patients tolerated the planned exercise programs and no adverse events were recorded during the training sessions in either group. Nevertheless, this prospective study did not show improvement in any study outcome at 6-month follow-up.According to the analytical assessment of Hilliere et al. HS improves the physical and mental skills of elderly patients [Potential reasons for heterogeneity in exercise trials on people with AS include participants’ differing disease severity, exercise frequency, intensity, duration and types of exercise. However, the results of systematic reviews of exercise interventions in patients with AS show a high level of consistency, suggesting mild to moderate benefits for disease activity, axial mobility, function and pain. According to a Cochrane review aimed at evaluating the benefits of exercise programs for people with AS, exercise approaches showed a reduction in disease activity with low-quality evidence compared with usual care [A few AS studies have included muscle strength training as part of the exercise program. However, in most of these studies, neither muscle strength nor other relevant physiological responses were measured [A home-based exercise approach is a simple and cost-effective treatment for AS patients. Compared to a control group, there is moderate-quality evidence that home-based or supervised individualized exercise regimens have a positive impact on various measures of spinal mobility in AS patients [Although this study provided novel and important results, some potential shortcomings should be mentioned. While acute-phase reactants, particularly erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), may be quantitative follow-up parameters that can be used to monitor AS patients, our study did not have laboratory tests to define disease activity or progression with interventions. Second, in comparing the two separate exercise regimens, the groups were given the same amount of time to exercise but not the same intensity. Therefore, future studies should compare AS patients who received HS treatment with AS patients who received supervised exercise on land or in water. Another limitation is that we can only generalize our results to individuals with AS with mild disabilities; therefore, caution should be exercised in generalizing the results. Finally, not all measures were collected because of concerns about survey overload. Future studies should include assessment of balance and core muscle activation or endurance. Cost-effectiveness and treatment satisfaction with HP are also issues that need to be investigated.