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Changes in Cardiorespiratory Responses and Kinematics with Hippotherapy in Youth with and without Cerebral Palsy

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Title: Changes in Cardiorespiratory Responses and Kinematics with Hippotherapy in Youth with and without Cerebral Palsy
Language: English
Authors: Rigby, Brandon Rhett, Gloeckner, Adam Robert, Sessums, Suzanne, Lanning, Beth Anne, Grandjean, Peter Walter
Source: Research Quarterly for Exercise and Sport. 2017 88(1):26-35.
Availability: Routledge. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
Peer Reviewed: Y
Page Count: 10
Publication Date: 2017
Document Type: Journal Articles
Reports - Research
Descriptors: Biomechanics, Human Body, Metabolism, Responses, Kinetics, Horses, Therapy, Psychomotor Skills, Cerebral Palsy, Youth, Simulation, Physical Activities, Comparative Analysis, Physical Activity Level, Exercise, Exercise Physiology, Measures (Individuals), Intervention, Outcomes of Treatment, Statistical Analysis
Geographic Terms: Texas
DOI: 10.1080/02701367.2016.1266458
ISSN: 0270-1367
Abstract: Purpose: The purpose of this study was to characterize pelvic displacement and cardiorespiratory responses to simulated horseback riding and walking in youth with cerebral palsy and to compare responses to youth without cerebral palsy before and after 8 weeks of hippotherapy. Method: Eight youth with cerebral palsy (M[subscript age] = 10 ± 4 years; M[subscript height] = 137 ± 24 cm; M[subscript weight] = 32 ± 16 kg) and 8 youth without cerebral palsy (M[subscript age] = 11 ± 2 years; M[subscript height] = 149 ± 14 cm; M[subscript weight] = 48 ± 15 kg) underwent a hippotherapy intervention. Participants completed simulated horseback riding at an intensity approximating a fast walk (0.65 Hz) and walked on a treadmill (1 mph, 0% grade) before and after hippotherapy. Pelvic displacement along the anterior-posterior, vertical, and medial-lateral axes, heart rate, oxygen consumption, ventilation, and blood pressure were measured at rest and during steady-state exercise in both exercise modes. Results: Kinematics and cardiorespiratory responses were similar between the 2 groups during simulated horseback riding (p > 0.05 for all) before the intervention. Significantly greater cardiorespiratory responses were observed in the youth with cerebral palsy compared with the group without cerebral palsy while walking before and after the intervention (p < 0.05, effect sizes 26% to 237% greater). Eight weeks of hippotherapy did not alter responses, but anecdotal improvements in gait, balance, posture, and range of motion were observed in those with cerebral palsy. Conclusion: These results contribute to our understanding regarding the efficacy of hippotherapy as an intervention to improve functional abilities in those with cerebral palsy.
Abstractor: As Provided
Number of References: 26
Entry Date: 2017
Accession Number: EJ1131030
Database: ERIC
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  Value: &lt;anid&gt;AN0121333112;rqe01mar.17;2019Mar18.14:21;v2.2.500&lt;/anid&gt; &lt;title id=&quot;AN0121333112-1&quot;&gt;Changes in Cardiorespiratory Responses and Kinematics With Hippotherapy in Youth With and Without Cerebral Palsy.&#160;&lt;/title&gt; &lt;p&gt;Purpose: The purpose of this study was to characterize pelvic displacement and cardiorespiratory responses to simulated horseback riding and walking in youth with cerebral palsy and to compare responses to youth without cerebral palsy before and after 8 weeks of hippotherapy. Method: Eight youth with cerebral palsy (M&amp;lt;sub&amp;gt;age&amp;lt;/sub&amp;gt; = 10 &#177; 4 years; M&amp;lt;sub&amp;gt;height&amp;lt;/sub&amp;gt; = 137 &#177; 24 cm; M&amp;lt;sub&amp;gt;weight&amp;lt;/sub&amp;gt; = 32 &#177; 16 kg) and 8 youth without cerebral palsy (M&amp;lt;sub&amp;gt;age&amp;lt;/sub&amp;gt; = 11 &#177; 2 years; M&amp;lt;sub&amp;gt;height&amp;lt;/sub&amp;gt; = 149 &#177; 14 cm; M&amp;lt;sub&amp;gt;weight&amp;lt;/sub&amp;gt; = 48 &#177; 15 kg) underwent a hippotherapy intervention. Participants completed simulated horseback riding at an intensity approximating a fast walk (0.65 Hz) and walked on a treadmill (1 mph, 0% grade) before and after hippotherapy. Pelvic displacement along the anterior-posterior, vertical, and medial-lateral axes, heart rate, oxygen consumption, ventilation, and blood pressure were measured at rest and during steady-state exercise in both exercise modes. Results: Kinematics and cardiorespiratory responses were similar between the 2 groups during simulated horseback riding (p &amp;gt;.05 for all) before the intervention. Significantly greater cardiorespiratory responses were observed in the youth with cerebral palsy compared with the group without cerebral palsy while walking before and after the intervention (p &amp;lt;.05, effect sizes 26% to 237% greater). Eight weeks of hippotherapy did not alter responses, but anecdotal improvements in gait, balance, posture, and range of motion were observed in those with cerebral palsy. Conclusion: These results contribute to our understanding regarding the efficacy of hippotherapy as an intervention to improve functional abilities in those with cerebral palsy.&lt;/p&gt; &lt;p&gt;Keywords: Children; horseback riding; special populations; walking&lt;/p&gt; &lt;p&gt;The presence of muscle spasticity and weakness, musculoskeletal abnormalities, and reduced pelvic movement makes control of posture, stability, and balance a lifelong challenge in children with cerebral palsy (CP; Silva Borges, da Silva Werneck, da Silva, Gandolfi, &amp;amp; Pratesi, 2011). The range of motion (ROM) of the pelvis and torso is limited, thereby inhibiting the available dynamic and postural reactions needed to maintain proper balance (Quint &amp;amp; Toomey, [&lt;reflink idref=&quot;bib17&quot; id=&quot;ref1&quot;&gt;17&lt;/reflink&gt;]). Inadequate torso and pelvic control may further lead to dysfunction of the upper limbs in children with CP, as pelvic position directly affects alignment of the spine, head, and limbs (Haehl, Giuliani, &amp;amp; Lewis, [&lt;reflink idref=&quot;bib12&quot; id=&quot;ref2&quot;&gt;12&lt;/reflink&gt;]).&lt;/p&gt; &lt;p&gt;Equine therapy has been shown to improve posture (Bertoti, [&lt;reflink idref=&quot;bib2&quot; id=&quot;ref3&quot;&gt;2&lt;/reflink&gt;]; Shurtleff &amp;amp; Engsberg, [&lt;reflink idref=&quot;bib20&quot; id=&quot;ref4&quot;&gt;20&lt;/reflink&gt;]) and balance (Silkwood-Sherer, Killian, Long, &amp;amp; Martin, [&lt;reflink idref=&quot;bib21&quot; id=&quot;ref5&quot;&gt;21&lt;/reflink&gt;]; Sunwoo et al., [&lt;reflink idref=&quot;bib24&quot; id=&quot;ref6&quot;&gt;24&lt;/reflink&gt;]) in individuals with CP and other disorders. It is hypothesized that the horse elicits passive and active stretching from the rider and allows the rider to facilitate righting and equilibrium reactions atop the horse. The rider, then, reproduces movement patterns that are similar to those of natural human activities such as walking (Sterba, Rogers, France, &amp;amp; Vokes, [&lt;reflink idref=&quot;bib23&quot; id=&quot;ref7&quot;&gt;23&lt;/reflink&gt;]). More specifically, it is thought that the pelvic girdle and spine undergo a similar ROM during both riding and walking (Fleck, [&lt;reflink idref=&quot;bib9&quot; id=&quot;ref8&quot;&gt;9&lt;/reflink&gt;]; Garner &amp;amp; Rigby, [&lt;reflink idref=&quot;bib10&quot; id=&quot;ref9&quot;&gt;10&lt;/reflink&gt;]; Goldmann &amp;amp; Vilimek, [&lt;reflink idref=&quot;bib11&quot; id=&quot;ref10&quot;&gt;11&lt;/reflink&gt;]). Therefore, direct benefits of equine therapy are thought by some to translate to improved activities of daily living (ADLs).&lt;/p&gt; &lt;p&gt;In hippotherapy, which is a form of equine-assisted activity and therapy conducted by physical, occupational, and speech therapists, the movement of the horse elicits righting and balance reactions of the rider. The execution of these reactions may provide the necessary foundation for transition to normal movement and performing ADLs with greater ease (Murphy, Kahn-D&#39;Angelo, &amp;amp; Gleason, [&lt;reflink idref=&quot;bib16&quot; id=&quot;ref11&quot;&gt;16&lt;/reflink&gt;]). In addition, proper sitting and postural control are emphasized. In theory, a child with CP who is able to develop posture and spine alignment through hippotherapy will improve the functionality of his/her limbs and torso (Bertoti, [&lt;reflink idref=&quot;bib2&quot; id=&quot;ref12&quot;&gt;2&lt;/reflink&gt;]; Silva Borges et al., [&lt;reflink idref=&quot;bib22&quot; id=&quot;ref13&quot;&gt;22&lt;/reflink&gt;]).&lt;/p&gt; &lt;p&gt;Reduced cardiovascular stress during common physical activities may be an important, but overlooked, therapeutic benefit of hippotherapy. An increase in the magnitude of pelvic rotation may allow those who use the therapy to more easily perform ADLs with greater efficiency and ease and could potentially lead to decreased cardiovascular stress. Reduced apprehension might also decrease spasticity, increase postural control, and enhance a sense of efficacy, leading to lower energy expenditure (EE) and reduced cardiovascular responses to similar maneuvers during hippotherapy. Horseback riding may also cause a sufficient overload to the cardiovascular system to induce adaptations reflecting an improvement in cardiovascular fitness. Adaptations that indicate improvements in cardiovascular fitness, such as decreases in heart rate (HR), blood pressure, oxygen consumption (VO&lt;subs&gt;2&lt;/subs&gt;), and pulmonary ventilation (V&lt;subs&gt;E&lt;/subs&gt;), may be observed during submaximal efforts while horseback riding (Devienne &amp;amp; Guezennec, [&lt;reflink idref=&quot;bib6&quot; id=&quot;ref14&quot;&gt;6&lt;/reflink&gt;]; de Barros Souza et al., [&lt;reflink idref=&quot;bib5&quot; id=&quot;ref15&quot;&gt;5&lt;/reflink&gt;]). However, cardiovascular responses during horseback riding in most disabled populations remain poorly characterized (Bongers &amp;amp; Takken, [&lt;reflink idref=&quot;bib3&quot; id=&quot;ref16&quot;&gt;3&lt;/reflink&gt;]; Dirienzo, Dirienzo, &amp;amp; Baceski, [&lt;reflink idref=&quot;bib7&quot; id=&quot;ref17&quot;&gt;7&lt;/reflink&gt;]; McGibbon, Andrade, Widener, &amp;amp; Cintas, [&lt;reflink idref=&quot;bib14&quot; id=&quot;ref18&quot;&gt;14&lt;/reflink&gt;]; Yokoyama et al., [&lt;reflink idref=&quot;bib26&quot; id=&quot;ref19&quot;&gt;26&lt;/reflink&gt;]).&lt;/p&gt; &lt;p&gt;Measuring biomechanical and cardiovascular responses to horseback riding is a challenge. The use of a horseback riding simulator in an environmentally controlled setting may be used to overcome many of the variables that preclude reliable biomechanical and cardiovascular measurements to be made while riding a live horse during hippotherapy. The reliability of measuring cardiorespiratory and biomechanical responses while exercising on a horseback riding simulator has recently been demonstrated in healthy children (Rigby, Papadakis, Bane, Park, &amp;amp; Grandjean, [&lt;reflink idref=&quot;bib19&quot; id=&quot;ref20&quot;&gt;19&lt;/reflink&gt;]).&lt;/p&gt; &lt;p&gt;Pelvic kinematic and cardiorespiratory responses have not been investigated concurrently during simulated horseback riding at different intensities. Changes in these responses that may occur with hippotherapy in youth diagnosed with minimal to moderate CP are also underexplored. Physiological adaptations to hippotherapy are thought to be sufficient for improving functional abilities and cardiovascular responses in youth with CP and those with other chronic conditions (Bongers &amp;amp; Takken, [&lt;reflink idref=&quot;bib3&quot; id=&quot;ref21&quot;&gt;3&lt;/reflink&gt;]). The primary purpose of this investigation was to characterize pelvic kinematics and accompanying cardiorespiratory responses during simulated horseback riding in youth with and without CP before and after an 8-week hippotherapy intervention. The secondary objective was to measure the same pelvic kinematic and cardiorespiratory variables during treadmill walking in youth with and without CP before and after 8 weeks of hippotherapy. We hypothesized that pelvic kinematic responses would be less in magnitude and cardiorespiratory responses would be greater in magnitude during simulated horseback riding and treadmill walking in those with CP compared with those without CP. We also hypothesized that 8 weeks of hippotherapy would be sufficient to induce measurable biomechanical and cardiorespiratory adaptations in the youth with CP during automated horseback riding simulation and while treadmill walking.&lt;/p&gt; &lt;hd id=&quot;AN0121333112-2&quot;&gt;Methods&lt;/hd&gt; &lt;p&gt;&lt;/p&gt; &lt;hd id=&quot;AN0121333112-3&quot;&gt;Participants&lt;/hd&gt; &lt;p&gt;We recruited children and youth diagnosed with CP through several therapeutic riding centers throughout Texas. We recruited the children and youth without CP at a local school through flyers and visits to the school.&lt;/p&gt; &lt;p&gt;We screened the youth diagnosed with CP to include those who are typically classified in groups CP5 to CP8 (i.e., moderately to minimally affected; Cerebral Palsy International Sports and Recreation Association, [&lt;reflink idref=&quot;bib4&quot; id=&quot;ref22&quot;&gt;4&lt;/reflink&gt;]). Specifically, we screened the youth diagnosed with CP to include those who: (a) had the ability to sit independently without an assistive device; (b) had the ability to stand independently without an assistive device; (c) had the ability to follow verbal directions; (d) were without seizures controlled by medication; (e) were without a known allergy to horses; and (f) were free from surgical procedures performed within the previous 6 months due to their disorder. An attempt was made to match the age and sex of the youth with CP to the age and sex of those without CP.&lt;/p&gt; &lt;p&gt;We screened the youth without CP to include those: (a) without a diagnosed congenital heart condition or cardiovascular condition that would preclude them from vigorous exercise; (b) who had not had surgical procedures performed within the previous 6 months; (c) without orthopedic problems that could be exacerbated by exercise; (d) without a known allergy to horses; (e) who were not currently taking medications that would influence their HR, blood pressure, or respiration during exercise; and (f) who were free from any condition that would prevent them from participating safely in the study.&lt;/p&gt; &lt;hd id=&quot;AN0121333112-4&quot;&gt;Experimental procedure overview&lt;/hd&gt; &lt;p&gt;This research was approved by our institutional review board for research involving human subjects and the Institutional Animal Care and Use Committee for research involving animals. The experimental protocol included an entry and familiarization session and two laboratory testing sessions separated by an 8-week hippotherapy intervention. All laboratory testing was supervised and conducted by the same trained technicians. Youth without CP participated in hippotherapy activities at a single therapeutic riding center. Youth with CP completed hippotherapy at multiple therapeutic riding centers. Each participant with CP completed the hippotherapy at a single riding center under the direction of a single physical therapist. Site-specific physical therapists completed functional assessments before and after hippotherapy. The duration of this study was 10 weeks to 12 weeks for all participants.&lt;/p&gt; &lt;hd id=&quot;AN0121333112-5&quot;&gt;Design&lt;/hd&gt; &lt;p&gt;The parents of the participants enrolled their children in a hippotherapy program and scheduled their own sessions. Each child and his/her parents were informed about the study during an initial functional assessment by the physical therapist at the respective therapy center. During this assessment, the children were asked to consider volunteering for the study. As part of participation, we asked the parents and participants to allow us to have access to the clinical data collected during hippotherapy by the physical therapist as part of their participation. The assessment, which was conducted as part of the hippotherapy program, included a parent interview and weekly clinical observations.&lt;/p&gt; &lt;p&gt;All participants and their parents were informed about all aspects of the study. The parents were given a description of the therapeutic riding center. All parents and youth participants signed institutionally approved consent and assent forms, respectively. Interested participants and their parents attended an entry/familiarization session where they were introduced to all of the equipment used in the study. First, the participants sat in and rode on the Core Trainer&lt;sups&gt;&#174;&lt;/sups&gt; (Panasonic, Secaucus, NJ), the device used to simulate horseback riding, and were shown the metabolic cart (ParvoMedics, Sandy, UT) that was used to collect respiratory gas data. Next, the investigators introduced and explained the motion capture system (PhaseSpace, San Leandro, CA). Finally, the treadmill test was explained and the participants were asked to walk briefly on a motor-driven treadmill.&lt;/p&gt; &lt;p&gt;All experimental data were collected during two testing sessions in the same controlled setting. Treadmill and simulated horseback riding sessions were conducted in a randomized order. There was a 15-min rest period between the two modes of exercise.&lt;/p&gt; &lt;p&gt;Prior to each testing session, all experimental procedures were reviewed with parents and participants and the child-participant was reassented (i.e., they provided verbal affirmation of their willingness to participate). Parents were present to help with preparing the child for data collection (i.e., fitting the child with an HR monitor, helping to dress him/her in necessary clothing for data collection, and offering support and security).&lt;/p&gt; &lt;p&gt;Participants&#39; height and weight were measured first. Weight was assessed using a digital scale, and height was assessed using a stadiometer attached to the scale (Seca, Birmingham, UK). The HR monitor (Polar Electro, Lake Success, NY) chest strap was then fit on the participants.&lt;/p&gt; &lt;p&gt;An aluminum bar with two motion sensors was affixed by Velcro strap on the superior aspect of the posterior pelvis. This bar was used to accentuate the magnitude of pelvis rotation and to allow for easier tracking. Another two sensors were affixed in the same manner on the superior aspect of the anterior pelvis. The markers were placed in these locations to capture the motion of the pelvic girdle during simulated horseback riding. Pelvic displacement was tracked using multiple infrared detection cameras, and the pelvic motion data were translated into three-dimensional coordinates.&lt;/p&gt; &lt;p&gt;HR and blood pressure were measured after 5&#160;min of seated rest in a chair. HR and respiratory gasses were measured throughout the session. Blood pressure was measured manually using an aneroid sphygmomanometer and stethoscope. Just after resting measurements, the participants were asked to walk on a treadmill at 1.0&#160;mph at 0% grade for 5&#160;min to 10&#160;min, with 3&#160;min to 5&#160;min of steady-state exercise. HR and blood pressure during exercise were measured in the same manner as at rest. Respiratory gasses were measured using the metabolic cart. Blood pressure was measured once the participants reached a steady state.&lt;/p&gt; &lt;p&gt;Once the treadmill protocol had been completed, the participants were asked to step off the treadmill and sit quietly for approximately 15&#160;min. During this time, the mask was cleaned and fitted back on the participants. The youth were then asked to repeat the treadmill protocol.&lt;/p&gt; &lt;p&gt;The participants were also instructed to sit on the Core Trainer. Prior to exercise, the participants were instructed to sit quietly on the simulator for 5&#160;min. HR and blood pressure and respiratory gasses were measured continuously, and blood pressure was measured after the rest period. Just after resting measurements, the simulator was turned on. Exercise data on the Core Trainer were collected at an intensity setting of 9 on the simulator, which corresponds to a cycling rate of 0.65&#160;Hz and a medium-paced walk for a horse. HR and respiratory gasses were measured in the same manner as during the rest period, and blood pressure and pelvic kinematics were measured once the participant reached a steady state of exercise.&lt;/p&gt; &lt;p&gt;Once the simulated riding protocol had been completed, the participants were asked to sit quietly on the Core Trainer for approximately 15&#160;min. During this time, the mask was cleaned and fitted back on the participants. The youth were then asked to repeat the simulated riding protocol.&lt;/p&gt; &lt;hd id=&quot;AN0121333112-6&quot;&gt;Hippotherapy intervention&lt;/hd&gt; &lt;p&gt;The youth with CP and the youth without CP participated in an 8-week hippotherapy intervention, riding once per week for 40&#160;min to 50&#160;min. At the start of each riding session, the parents and participants were familiarized with the riding procedures. The therapeutic riding centers were accredited by the Professional Association of Therapeutic Horsemanship International. All testing was conducted under the direction and supervision of a physical therapist also certified as a Hippotherapy Clinical Specialist.&lt;/p&gt; &lt;p&gt;Participants gave verbal assent at the start of each riding session. Because each participant with CP differed in his/her functional assessment, a specific riding protocol was created for each child. A specific type of horse (based on cadence, stride length, gait rhythms) and a specific type of saddle (e.g., English saddle, bareback) was chosen based on the needs of the child. Volunteers walked along each side of the horse to ensure the child did not fall off the horse. The participants rode in different positions—backward, sideways, prone, supine—during each session. While on top of the horse, the participants performed several activities, which included but were not limited to: functional reaching exercises, such as reaching across their midline and above their head; sit-ups; standing; arm and leg ROM exercises; and throwing and hitting a target. The horse, saddle, and activities performed on top of the horse did not change from session to session during the intervention for a particular child. For the youth without CP, horses, saddles, and activities were chosen at random.&lt;/p&gt; &lt;hd id=&quot;AN0121333112-7&quot;&gt;Statistical analysis&lt;/hd&gt; &lt;p&gt;The independent variables included: group affiliation (two levels, youth with CP and youth without CP), measurement time within each testing session (two levels, rest and steady-state exercise), mode of exercise (two levels, simulated horseback riding and treadmill walking); and measurements obtained with hippotherapy (two levels, before and after 8 weeks of hippotherapy). The dependent pelvic kinematic variables included displacements along the anterior-posterior axis, vertical axis, and medial-lateral axis. The magnitude of direction (MOD), or a representative vector of all three displacement variables, was also calculated. The dependent cardiorespiratory variables included V&lt;subs&gt;E&lt;/subs&gt;, absolute and relative VO&lt;subs&gt;2&lt;/subs&gt;, EE, systolic and diastolic blood pressure, and HR. Mean arterial pressure (MAP) and rate pressure product (RPP) were also calculated.&lt;/p&gt; &lt;p&gt;The normality of the baseline dependent variable data was confirmed using univariate procedures. Individual &lt;emph&gt;t&lt;/emph&gt; tests were conducted to characterize group differences at baseline. A 2 (group)&#160;&#215;&#160;2 (measurement time) analysis of variance (ANOVA) repeated for measurement time was performed to characterize the magnitude of difference in the physical responses that occur with simulated horseback riding and treadmill walking. To characterize the effect of hippotherapy on the physical responses to simulated horseback riding and treadmill walking, 2 (group)&#160;&#215;&#160;2 (measurement time)&#160;&#215;&#160;2 (hippotherapy) ANOVAs were performed. Effect sizes (ES) were calculated for kinematic and cardiorespiratory responses using pooled standard deviations (Rhea, [&lt;reflink idref=&quot;bib18&quot; id=&quot;ref23&quot;&gt;18&lt;/reflink&gt;]) to further characterize the differences between simulated horseback riding and treadmill walking and to determine the difference in the magnitude of responses between youth with CP and youth without CP. Percent differences in ES were calculated as the difference between the CP and no-CP groups divided by the CP ES. All statistical procedures were performed using Statistical Analysis Software Version 9.3 software, and a significance level of.05 was applied throughout.&lt;/p&gt; &lt;hd id=&quot;AN0121333112-8&quot;&gt;Results&lt;/hd&gt; &lt;p&gt;&lt;/p&gt; &lt;hd id=&quot;AN0121333112-9&quot;&gt;Participants&lt;/hd&gt; &lt;p&gt;Eight youth with CP agreed to participate in the study and completed all measurements. Diagnoses of the youth with CP included four with spastic quadriplegia, two with spastic diplegia, and two with spastic hemiplegia. Other codiagnoses included impaired vision, mild autism, seizure disorders, attention-deficit disorder, asthma, and chronic lung disease.&lt;/p&gt; &lt;p&gt;Eight youth without CP completed all laboratory measurements and served as a comparison group. The physical characteristics of both groups can be found in Table 1. On average, the CP group had significantly lower weight and body mass index.&lt;/p&gt; &lt;p&gt;Table 1 Participant characteristics.&lt;/p&gt; &lt;p&gt; &lt;ephtml&gt; &amp;lt;table&amp;gt;&amp;lt;thead&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td /&amp;gt;&amp;lt;td&amp;gt;CP (&amp;lt;italic&amp;gt;n&amp;lt;/italic&amp;gt;&amp;amp;#160;=&amp;amp;#160;8; 5 girls, 3 boys)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;No CP (&amp;lt;italic&amp;gt;n&amp;lt;/italic&amp;gt;&amp;amp;#160;=&amp;amp;#160;8; 1 girl, 7 boys)&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;Variable&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;&amp;lt;italic&amp;gt;Mean &amp;amp;#177;&amp;amp;#160; SD&amp;lt;/italic&amp;gt;&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;Min&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;Max&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;&amp;lt;italic&amp;gt;Mean &amp;amp;#177;&amp;amp;#160; SD&amp;lt;/italic&amp;gt;&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;Min&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;Max&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;&amp;lt;italic&amp;gt;p&amp;lt;/italic&amp;gt; value&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;/thead&amp;gt;&amp;lt;tbody&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;Age (years)&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;10.3&amp;lt;italic&amp;gt;&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;&amp;lt;/italic&amp;gt;4.4&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;5.0&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;18.0&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;10.6&amp;lt;italic&amp;gt;&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;&amp;lt;/italic&amp;gt;2.1&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;8.0&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;14.0&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;.053&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;Height (cm)&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;136.7&amp;lt;italic&amp;gt;&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;&amp;lt;/italic&amp;gt;24.3&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;106.7&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;165.1&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;149.2&amp;lt;italic&amp;gt;&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;&amp;lt;/italic&amp;gt;14.3&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;127.0&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;168.3&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;.076&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;Weight (kg)&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;31.8&amp;lt;italic&amp;gt;&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;&amp;lt;/italic&amp;gt;15.5&amp;lt;sup&amp;gt;&amp;amp;#8224;&amp;lt;/sup&amp;gt;&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;15.4&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;54.4&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;47.4&amp;lt;italic&amp;gt;&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;&amp;lt;/italic&amp;gt;15.1&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;22.7&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;74.3&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;.007&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;BMI (kg/m&amp;lt;sup&amp;gt;2&amp;lt;/sup&amp;gt;)&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;15.9&amp;lt;italic&amp;gt;&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;&amp;lt;/italic&amp;gt;2.7&amp;lt;sup&amp;gt;&amp;amp;#8224;&amp;lt;/sup&amp;gt;&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;12.1&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;20.0&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;20.9&amp;lt;italic&amp;gt;&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;&amp;lt;/italic&amp;gt;4.5&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;14.1&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;29.0&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;.001&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;/tbody&amp;gt;&amp;lt;/table&amp;gt; &lt;/ephtml&gt; &lt;/p&gt; &lt;ulist&gt; &lt;item&gt;14 &lt;emph&gt;Note&lt;/emph&gt;. Descriptive statistics of eight youth with CP and eight youth without CP. Diagnoses of youth with CP included spastic quadriplegia (&lt;reflink idref=&quot;bib4&quot; id=&quot;ref24&quot;&gt;4&lt;/reflink&gt;), spastic diplegia (&lt;reflink idref=&quot;bib2&quot; id=&quot;ref25&quot;&gt;2&lt;/reflink&gt;), and spastic hemiplegia (&lt;reflink idref=&quot;bib2&quot; id=&quot;ref26&quot;&gt;2&lt;/reflink&gt;). CP&#160;=&#160;cerebral palsy; BMI&#160;=&#160;body mass index.&lt;/item&gt; &lt;item&gt;15 &lt;sups&gt;†&lt;/sups&gt;Statistically significant from the no-CP group.&lt;/item&gt; &lt;/ulist&gt; &lt;hd id=&quot;AN0121333112-10&quot;&gt;Responses to simulated horseback riding and treadmill walking prior to hippotherapy&lt;/hd&gt; &lt;p&gt;Pelvic displacement values recorded during simulated horseback riding and treadmill walking can be found in Table 2. During simulated riding, no significant differences were observed between groups in the three planes of motion, but the MOD was lower in the CP group versus the group without CP (&lt;emph&gt;p&lt;/emph&gt;&#160;=&#160;.032; ES&#160;=&#160;1.14). Only displacement along the vertical axis was significantly different between the groups (&lt;emph&gt;p&lt;/emph&gt;&#160;=&#160;.018; ES&#160;=&#160;1.36) during treadmill walking at 1&#160;mph.&lt;/p&gt; &lt;p&gt;Table 2 Pelvic kinematics during simulated horseback riding and treadmill walking prior to hippotherapy.&lt;/p&gt; &lt;p&gt; &lt;ephtml&gt; &amp;lt;table&amp;gt;&amp;lt;thead&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;Displacement variable&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;CP&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;No CP&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;&amp;lt;italic&amp;gt;p&amp;lt;/italic&amp;gt; value&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;/thead&amp;gt;&amp;lt;tbody&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;&amp;lt;italic&amp;gt;Pelvic kinematics during simulated horseback riding prior to hippotherapy&amp;lt;/italic&amp;gt;&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;Ant-post (cm)&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;3.7&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;0.4&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;4.3&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;0.7&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;.080&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;Vertical (cm)&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;2.9&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;0.6&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;2.8&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;1.0&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;.764&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;Med-lat (cm)&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;2.6&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;0.6&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;3.3&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;0.6&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;.055&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;MOD (cm)&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;4.7&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;0.6&amp;lt;sup&amp;gt;&amp;amp;#8224;&amp;lt;/sup&amp;gt;&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;5.5&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;0.8&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;.032&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;&amp;lt;italic&amp;gt;Pelvic kinematics during treadmill walking prior to hippotherapy&amp;lt;/italic&amp;gt;&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;Ant-post (cm)&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;4.2&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;2.2&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;5.2&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;3.3&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;.517&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;Vertical (cm)&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;5.8&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;2.6&amp;lt;sup&amp;gt;&amp;amp;#8224;&amp;lt;/sup&amp;gt;&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;3.0&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;1.5&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;.018&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;Med-lat (cm)&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;3.7&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;1.4&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;3.5&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;0.9&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;.717&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;MOD (cm)&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;6.2&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;2.0&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;6.5&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;3.0&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;.800&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;/tbody&amp;gt;&amp;lt;/table&amp;gt; &lt;/ephtml&gt; &lt;/p&gt; &lt;ulist&gt; &lt;item&gt;16 &lt;emph&gt;Note&lt;/emph&gt;. All variables are reported as means &#177;&#160; standard deviations. CP&#160;=&#160;cerebral palsy; ant-post&#160;=&#160;displacement along the anterior-posterior axis; vertical&#160;=&#160;displacement along the vertical axis; med-lat&#160;=&#160;displacement along the medial-lateral axis; MOD&#160;=&#160;magnitude of direction.&lt;/item&gt; &lt;item&gt;17 &lt;sups&gt;†&lt;/sups&gt;Statistically significant from the no-CP group.&lt;/item&gt; &lt;/ulist&gt; &lt;p&gt;Significantly greater values were measured during simulated riding versus rest for all cardiorespiratory variables. However, cardiorespiratory responses from rest to exercise were not significant between the group with CP and the group without CP. These values can be found in Table 3.&lt;/p&gt; &lt;p&gt;Table 3 Cardiorespiratory variables at rest and during simulated horseback riding prior to hippotherapy.&lt;/p&gt; &lt;p&gt; &lt;ephtml&gt; &amp;lt;table&amp;gt;&amp;lt;thead&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td /&amp;gt;&amp;lt;td /&amp;gt;&amp;lt;td /&amp;gt;&amp;lt;td&amp;gt;Time&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;CP&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;No CP&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;Group&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;Variable&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;Rest&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;Exercise&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;&amp;lt;italic&amp;gt;p&amp;lt;/italic&amp;gt; value&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;&amp;amp;#916;&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;&amp;amp;#916;&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;&amp;lt;italic&amp;gt;p&amp;lt;/italic&amp;gt; value&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;/thead&amp;gt;&amp;lt;tbody&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;V&amp;lt;sub&amp;gt;E&amp;lt;/sub&amp;gt; (L/min)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;7.20&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;1.70&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;10.40&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;2.60&amp;lt;sup&amp;gt;*&amp;lt;/sup&amp;gt;&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;&amp;amp;#160;&amp;amp;#60;&amp;amp;#160;.001&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;3.50&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;2.80&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;.069&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;VO&amp;lt;sub&amp;gt;2&amp;lt;/sub&amp;gt; (L/min)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;0.20&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;0.06&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;0.30&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;0.09&amp;lt;sup&amp;gt;*&amp;lt;/sup&amp;gt;&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;&amp;amp;#160;&amp;amp;#60;&amp;amp;#160;.001&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;0.09&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;0.09&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;.128&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;VO&amp;lt;sub&amp;gt;2&amp;lt;/sub&amp;gt; (mL/kg/min)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;5.40&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;1.20&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;8.10&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;2.30&amp;lt;sup&amp;gt;*&amp;lt;/sup&amp;gt;&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;&amp;amp;#160;&amp;amp;#60;&amp;amp;#160;.001&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;3.60&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;1.80&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;.245&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;EE (kcal/min)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;1.00&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;0.30&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;1.40&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;0.40&amp;lt;sup&amp;gt;*&amp;lt;/sup&amp;gt;&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;&amp;amp;#160;&amp;amp;#60;&amp;amp;#160;.001&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;0.50&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;0.50&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;.097&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;HR (bpm)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;97&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;13&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;105&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;13&amp;lt;sup&amp;gt;*&amp;lt;/sup&amp;gt;&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;.003&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;10&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;5&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;.067&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;MAP (mmHg)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;77.20&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;5.40&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;80.90&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;5.30&amp;lt;sup&amp;gt;*&amp;lt;/sup&amp;gt;&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;.003&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;4.00&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;3.50&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;.242&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;RPP&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;97.00&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;13.30&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;112.00&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;17.50&amp;lt;sup&amp;gt;*&amp;lt;/sup&amp;gt;&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;&amp;amp;#160;&amp;amp;#60;&amp;amp;#160;.001&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;20.30&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;9.80&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;.055&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;/tbody&amp;gt;&amp;lt;/table&amp;gt; &lt;/ephtml&gt; &lt;/p&gt; &lt;ulist&gt; &lt;item&gt;18 &lt;emph&gt;Note&lt;/emph&gt;. Rest and exercise variables are collapsed across groups and are presented as means&#160;&#177;&#160;standard deviation. Time &lt;emph&gt;p&lt;/emph&gt; value&#160;=&#160;significant change between measurement time; group &lt;emph&gt;p&lt;/emph&gt; value&#160;=&#160;significant change between groups; Δ&#160;=&#160; Exercise Mean – Rest Mean; CP&#160;=&#160;cerebral palsy; VO&lt;subs&gt;2&lt;/subs&gt; (L/min)&#160;=&#160;absolute oxygen consumption; VO&lt;subs&gt;2&lt;/subs&gt; (mL/kg/min)&#160;=&#160;relative oxygen consumption; V&lt;subs&gt;E&lt;/subs&gt;&#160;=&#160;pulmonary ventilation; EE&#160;=&#160;energy expenditure; HR&#160;=&#160;heart rate; MAP&#160;=&#160;mean arterial pressure ([SBP–DBP] / 3+DBP); SBP&#160;=&#160;systolic blood pressure; DBP&#160;=&#160;diastolic blood pressure; RPP&#160;=&#160;rate pressure product (SBP&#160;&#215;&#160;HR / 100).&lt;/item&gt; &lt;item&gt;19 &lt;sups&gt;*&lt;/sups&gt;Statistically significant from rest.&lt;/item&gt; &lt;/ulist&gt; &lt;p&gt;Ventilation, absolute and relative VO&lt;subs&gt;2&lt;/subs&gt;, EE, and RPP were all elevated during treadmill exercise versus rest in both groups. The CP group exhibited significantly greater exercise responses than did the group without CP. These values can be found in Table 4. HR (&lt;emph&gt;p&lt;/emph&gt; &amp;lt;&#160;.001; ES&#160;=&#160;0.62) and MAP (&lt;emph&gt;p&lt;/emph&gt;&#160;=&#160;.001; ES&#160;=&#160;0.69) responded the same in both groups and were greater during exercise as compared with during rest.&lt;/p&gt; &lt;p&gt;Table 4 Cardiorespiratory variables at rest and during treadmill walking prior to hippotherapy.&lt;/p&gt; &lt;p&gt; &lt;ephtml&gt; &amp;lt;table&amp;gt;&amp;lt;thead&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td /&amp;gt;&amp;lt;td&amp;gt;CP&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;No CP&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;Variable&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;Rest&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;Exercise&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;Rest&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;Exercise&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;&amp;lt;italic&amp;gt;p&amp;lt;/italic&amp;gt; value&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;/thead&amp;gt;&amp;lt;tbody&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;V&amp;lt;sub&amp;gt;E&amp;lt;/sub&amp;gt; (L/min)&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;6.00&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;1.60&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;16.70&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;6.00&amp;lt;sup&amp;gt;&amp;amp;#8224;&amp;lt;/sup&amp;gt;&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;7.90&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;1.20&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;12.90&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;2.00&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;.013&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;VO&amp;lt;sub&amp;gt;2&amp;lt;/sub&amp;gt; (L/min)&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;0.16&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;0.06&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;0.56&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;0.26&amp;lt;sup&amp;gt;&amp;amp;#8224;&amp;lt;/sup&amp;gt;&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;0.23&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;0.04&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;0.45&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;0.11&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;.044&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;VO&amp;lt;sub&amp;gt;2&amp;lt;/sub&amp;gt; (mL/kg/min)&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;5.30&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;1.10&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;16.70&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;2.50&amp;lt;sup&amp;gt;&amp;amp;#8224;&amp;lt;/sup&amp;gt;&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;5.20&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;1.50&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;9.80&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;1.70&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;&amp;amp;#160;&amp;amp;#60;&amp;amp;#160;.001&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;EE (kcal/min)&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;0.80&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;0.30&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;2.80&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;1.30&amp;lt;sup&amp;gt;&amp;amp;#8224;&amp;lt;/sup&amp;gt;&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;1.10&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;0.20&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;2.20&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;0.50&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;.038&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;RPP&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;94.30&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;17.50&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;142.30&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;37.00&amp;lt;sup&amp;gt;&amp;amp;#8224;&amp;lt;/sup&amp;gt;&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;84.50&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;15.80&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;110.10&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;15.10&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;.028&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;/tbody&amp;gt;&amp;lt;/table&amp;gt; &lt;/ephtml&gt; &lt;/p&gt; &lt;ulist&gt; &lt;item&gt;20 &lt;emph&gt;Note&lt;/emph&gt;. Rest and exercise variables are presented as means &#177;&#160; standard deviations. Time &lt;emph&gt;p&lt;/emph&gt; value&#160;=&#160;significant change between measurement time; group &lt;emph&gt;p&lt;/emph&gt; value&#160;=&#160;significant change between groups; Δ&#160;=&#160; Exercise Mean–Rest Mean; CP&#160;=&#160;cerebral palsy; VO&lt;subs&gt;2&lt;/subs&gt; (L/min)&#160;=&#160;absolute oxygen consumption; VO&lt;subs&gt;2&lt;/subs&gt; (mL/kg/min)&#160;=&#160;relative oxygen consumption; V&lt;subs&gt;E&lt;/subs&gt;&#160;=&#160;pulmonary ventilation; EE&#160;=&#160;energy expenditure; HR&#160;=&#160;heart rate; SBP&#160;=&#160;systolic blood pressure; RPP&#160;=&#160;rate pressure product (SBP&#160;&#215;&#160;HR / 100).&lt;/item&gt; &lt;item&gt;21 &lt;sups&gt;†&lt;/sups&gt;Statistically significant exercise response from no CP group.&lt;/item&gt; &lt;/ulist&gt; &lt;p&gt;The ES for responses to simulated horseback riding and treadmill walking are presented in Table 5. The ES for simulated horseback riding were similar with the exception of relative VO&lt;subs&gt;2&lt;/subs&gt; and V&lt;subs&gt;E&lt;/subs&gt;. A greater change in relative VO&lt;subs&gt;2&lt;/subs&gt; was observed in the youth with CP from rest to exercise compared with the youth without CP. However, a greater change in V&lt;subs&gt;E&lt;/subs&gt; was observed in youth without CP from rest to exercise compared with youth with CP. With the exception of MAP, the ES were 62% to 237% larger in the CP group compared with the group without CP for treadmill walking.&lt;/p&gt; &lt;p&gt;Table 5 Effect sizes calculated for simulated horseback riding and treadmill walking prior to hippotherapy.&lt;/p&gt; &lt;p&gt; &lt;ephtml&gt; &amp;lt;table&amp;gt;&amp;lt;thead&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td /&amp;gt;&amp;lt;td&amp;gt;CP&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;No CP&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;Variable&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;SHBR&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;TM&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;SHBR&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;TM&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;/thead&amp;gt;&amp;lt;tbody&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;V&amp;lt;sub&amp;gt;E&amp;lt;/sub&amp;gt; (L/min)&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;1.75&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;6.69&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;3.11&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;4.17&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;VO&amp;lt;sub&amp;gt;2&amp;lt;/sub&amp;gt; (L/min)&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;1.00&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;4.00&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;1.00&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;2.00&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;VO&amp;lt;sub&amp;gt;2&amp;lt;/sub&amp;gt; (mL/kg/min)&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;3.27&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;10.36&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;1.38&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;3.07&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;EE (kcal/min)&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;1.67&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;6.67&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;2.50&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;5.50&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;HR (bpm)&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;0.76&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;1.58&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;0.48&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;0.93&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;MAP (mmHg)&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;0.59&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;0.93&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;1.06&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;1.17&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;RPP&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;1.33&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;2.74&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;0.95&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;1.05&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;/tbody&amp;gt;&amp;lt;/table&amp;gt; &lt;/ephtml&gt; &lt;/p&gt; &lt;p&gt;22 &lt;emph&gt;Note&lt;/emph&gt;. Effect size was calculated by: (Exercise Mean – Rest Mean) / Rest Standard Deviation. CP&#160;=&#160;cerebral palsy; SHBR&#160;=&#160;simulated horseback riding; TM&#160;=&#160;treadmill walking; VO&lt;subs&gt;2&lt;/subs&gt; (L/min)&#160;=&#160;absolute oxygen consumption; VO&lt;subs&gt;2&lt;/subs&gt; (mL/kg/min)&#160;=&#160;relative oxygen consumption; V&lt;subs&gt;E&lt;/subs&gt;&#160;=&#160;pulmonary ventilation; EE&#160;=&#160;energy expenditure; HR&#160;=&#160;heart rate; MAP&#160;=&#160;mean arterial pressure ([SBP–DBP] / 3+DBP); SBP&#160;=&#160;systolic blood pressure; DBP&#160;=&#160;diastolic blood pressure; RPP&#160;=&#160;rate pressure product (SBP&#160;&#215;&#160;HR / 100).&lt;/p&gt; &lt;hd id=&quot;AN0121333112-11&quot;&gt;Effects of hippotherapy&lt;/hd&gt; &lt;p&gt;The parents reported minor or no changes in normal, daily routines and outside physical therapy throughout the 8-week hippotherapy period. Table 6 presents improvements observed and recorded by physical therapists as well as anecdotal evidence provided by parents during the course of the hippotherapy program in the youth with CP.&lt;/p&gt; &lt;p&gt;Table 6 Observable improvements in youth diagnosed with cerebral palsy determined through weekly evaluations or anecdotal evidence given by the therapist or parent.&lt;/p&gt; &lt;p&gt; &lt;ephtml&gt; &amp;lt;table&amp;gt;&amp;lt;thead&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;Recorded improvements given by therapist or parent&amp;lt;/td&amp;gt;&amp;lt;td /&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;/thead&amp;gt;&amp;lt;tbody&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;&amp;amp;#8226; Gait form, speed, and cadence (&amp;lt;italic&amp;gt;n&amp;lt;/italic&amp;gt;&amp;amp;#160;=&amp;amp;#160;6): Weeks 4 through 8&amp;lt;/td&amp;gt;&amp;lt;td /&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;&amp;amp;#8226; Balance and coordination (&amp;lt;italic&amp;gt;n&amp;lt;/italic&amp;gt;&amp;amp;#160;=&amp;amp;#160;6): Weeks 4 through 8&amp;lt;/td&amp;gt;&amp;lt;td /&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;&amp;amp;#8226; Muscle tone and strength (&amp;lt;italic&amp;gt;n&amp;lt;/italic&amp;gt;&amp;amp;#160;=&amp;amp;#160;4): Weeks 6 through 8&amp;lt;/td&amp;gt;&amp;lt;td /&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;&amp;amp;#8226; Posture (&amp;lt;italic&amp;gt;n&amp;lt;/italic&amp;gt;&amp;amp;#160;=&amp;amp;#160;2): Weeks 7 and 8&amp;lt;/td&amp;gt;&amp;lt;td /&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;&amp;amp;#8226; Joint mobility (&amp;lt;italic&amp;gt;n&amp;lt;/italic&amp;gt;&amp;amp;#160;=&amp;amp;#160;2): Weeks 3 through 8&amp;lt;/td&amp;gt;&amp;lt;td /&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;&amp;amp;#8226; ROM (&amp;lt;italic&amp;gt;n&amp;lt;/italic&amp;gt;&amp;amp;#160;=&amp;amp;#160;2): Weeks 3 through 8&amp;lt;/td&amp;gt;&amp;lt;td /&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;&amp;amp;#8226; Endurance (&amp;lt;italic&amp;gt;n&amp;lt;/italic&amp;gt;&amp;amp;#160;=&amp;amp;#160;1): Week 8&amp;lt;/td&amp;gt;&amp;lt;td /&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;/tbody&amp;gt;&amp;lt;/table&amp;gt; &lt;/ephtml&gt; &lt;/p&gt; &lt;p&gt;23 &lt;emph&gt;Note&lt;/emph&gt;. Numbers in parentheses represent number of youth for which the specific improvement was reported; range of weeks indicates when improvements were determined anecdotally by the parent and were included in the physical therapist&#39;s progress reports or were measured through unspecified tests by the participant&#39;s physical therapist. ROM =&#160; range of motion.&lt;/p&gt; &lt;p&gt;When collapsed across the hippotherapy intervention, displacement along the vertical axis was greater in magnitude in the group with CP compared with the group without CP during treadmill walking (&lt;emph&gt;p&lt;/emph&gt;&#160;=&#160;.001; ES&#160;=&#160;0.93). During resting conditions prior to treadmill exercise, V&lt;subs&gt;E&lt;/subs&gt; (&lt;emph&gt;p&lt;/emph&gt;&#160;=&#160;.007; ES&#160;=&#160;1.61), absolute VO&lt;subs&gt;2&lt;/subs&gt; (&lt;emph&gt;p&lt;/emph&gt;&#160;=&#160;.019; ES&#160;=&#160;1.56), and EE (&lt;emph&gt;p&lt;/emph&gt;&#160;=&#160;.016; ES&#160;=&#160;1.60) were significantly different between groups. During treadmill exercise, relative VO&lt;subs&gt;2&lt;/subs&gt; (&lt;emph&gt;p&lt;/emph&gt; &amp;lt;&#160;.001; ES&#160;=&#160;0.71), HR (&lt;emph&gt;p&lt;/emph&gt;&#160;=&#160;.003; ES&#160;=&#160;1.22), and RPP (&lt;emph&gt;p&lt;/emph&gt;&#160;=&#160;.002; ES&#160;=&#160;1.44) were significantly different between groups. All cardiorespiratory variables were significantly greater during treadmill exercise compared with rest, and these values can be found in Table 7.&lt;/p&gt; &lt;p&gt;Table 7 Cardiorespiratory variables at rest and during treadmill walking combined across training.&lt;/p&gt; &lt;p&gt; &lt;ephtml&gt; &amp;lt;table&amp;gt;&amp;lt;thead&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td /&amp;gt;&amp;lt;td&amp;gt;Variable&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;Rest&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;Exercise&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;Effect size&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;/thead&amp;gt;&amp;lt;tbody&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;CP&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td /&amp;gt;&amp;lt;td&amp;gt;V&amp;lt;sub&amp;gt;E&amp;lt;/sub&amp;gt; (L/min)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;6.20&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;1.50&amp;lt;sup&amp;gt;&amp;amp;#8224;&amp;lt;/sup&amp;gt;&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;16.00&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;5.20&amp;lt;sup&amp;gt;*&amp;lt;/sup&amp;gt;&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;2.93&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td /&amp;gt;&amp;lt;td&amp;gt;VO&amp;lt;sub&amp;gt;2&amp;lt;/sub&amp;gt; (L/min)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;0.17&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;0.05&amp;lt;sup&amp;gt;&amp;amp;#8224;&amp;lt;/sup&amp;gt;&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;0.56&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;0.23&amp;lt;sup&amp;gt;*&amp;lt;/sup&amp;gt;&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;2.79&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td /&amp;gt;&amp;lt;td&amp;gt;VO&amp;lt;sub&amp;gt;2&amp;lt;/sub&amp;gt; (mL/kg/min)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;5.50&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;1.30&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;16.50&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;3.00&amp;lt;sup&amp;gt;*&amp;amp;#8224;&amp;lt;/sup&amp;gt;&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;5.12&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td /&amp;gt;&amp;lt;td&amp;gt;EE (kcal/min)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;0.80&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;0.30&amp;lt;sup&amp;gt;&amp;amp;#8224;&amp;lt;/sup&amp;gt;&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;2.70&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;1.10&amp;lt;sup&amp;gt;*&amp;lt;/sup&amp;gt;&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;2.71&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td /&amp;gt;&amp;lt;td&amp;gt;HR (bpm)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;95&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;13&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;123&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;19&amp;lt;sup&amp;gt;*&amp;amp;#8224;&amp;lt;/sup&amp;gt;&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;1.75&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td /&amp;gt;&amp;lt;td&amp;gt;RPP&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;89.80&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;15.80&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;140.30&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;32.00&amp;lt;sup&amp;gt;*&amp;amp;#8224;&amp;lt;/sup&amp;gt;&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;2.11&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td&amp;gt;No CP&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td /&amp;gt;&amp;lt;td&amp;gt;V&amp;lt;sub&amp;gt;E&amp;lt;/sub&amp;gt; (L/min)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;8.30&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;1.10&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;13.30&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;2.30&amp;lt;sup&amp;gt;*&amp;lt;/sup&amp;gt;&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;2.94&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td /&amp;gt;&amp;lt;td&amp;gt;VO&amp;lt;sub&amp;gt;2&amp;lt;/sub&amp;gt; (L/min)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;0.24&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;0.04&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;0.44&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;0.10&amp;lt;sup&amp;gt;*&amp;lt;/sup&amp;gt;&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;2.86&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td /&amp;gt;&amp;lt;td&amp;gt;VO&amp;lt;sub&amp;gt;2&amp;lt;/sub&amp;gt; (mL/kg/min)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;5.30&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;1.30&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;9.50&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;1.60&amp;lt;sup&amp;gt;*&amp;lt;/sup&amp;gt;&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;2.90&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td /&amp;gt;&amp;lt;td&amp;gt;EE (kcal/min)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;1.20&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;0.20&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;2.10&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;0.50&amp;lt;sup&amp;gt;*&amp;lt;/sup&amp;gt;&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;2.57&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td /&amp;gt;&amp;lt;td&amp;gt;HR (bpm)&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;91&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;12&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;104&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;12&amp;lt;sup&amp;gt;*&amp;lt;/sup&amp;gt;&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;1.08&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;tr&amp;gt;&amp;lt;td /&amp;gt;&amp;lt;td&amp;gt;RPP&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;85.20&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;14.80&amp;lt;/td&amp;gt;&amp;lt;td&amp;gt;107.70&amp;amp;#160;&amp;amp;#177;&amp;amp;#160;13.70&amp;lt;sup&amp;gt;*&amp;lt;/sup&amp;gt;&amp;lt;/td&amp;gt;&amp;lt;td char=&quot;.&quot;&amp;gt;1.58&amp;lt;/td&amp;gt;&amp;lt;/tr&amp;gt;&amp;lt;/tbody&amp;gt;&amp;lt;/table&amp;gt; &lt;/ephtml&gt; &lt;/p&gt; &lt;ulist&gt; &lt;item&gt;24 &lt;emph&gt;Note&lt;/emph&gt;. All rest and exercise variables are presented as means&#160;&#177;&#160;standard deviations. Effect size was calculated by: (Exercise Mean – Rest Mean) / Pooled Standard Deviation. CP&#160;=&#160;cerebral palsy; VO&lt;subs&gt;2&lt;/subs&gt; (L/min)&#160;=&#160;absolute oxygen consumption; VO&lt;subs&gt;2&lt;/subs&gt; (mL/kg/min)&#160;=&#160;relative oxygen consumption; V&lt;subs&gt;E&lt;/subs&gt;&#160;=&#160;pulmonary ventilation; EE&#160;=&#160;energy expenditure; HR&#160;=&#160;heart rate; SBP&#160;=&#160;systolic blood pressure; RPP&#160;=&#160;rate pressure product (SBP&#160;&#215;&#160;HR / 100).&lt;/item&gt; &lt;item&gt;25 &lt;sups&gt;*&lt;/sups&gt;Statistically significantly greater from rest.&lt;/item&gt; &lt;item&gt;26 &lt;sups&gt;†&lt;/sups&gt;Statistically significant difference between CP and the no-CP groups.&lt;/item&gt; &lt;/ulist&gt; &lt;hd id=&quot;AN0121333112-12&quot;&gt;Discussion&lt;/hd&gt; &lt;p&gt;Several important findings resulted from this study. First, physiologic responses to simulated horseback riding at an intensity approximating what might occur during low-intensity recreational horseback riding were not different between youth with CP and those without CP. Second, treadmill walking at 1&#160;mph elicited greater cardiorespiratory and pelvic kinematic responses when compared with simulated horseback riding. In addition, treadmill walking elicited cardiorespiratory responses that were greater in magnitude in those with CP than in those without CP. Third, cardiorespiratory and kinematic responses during simulated horseback riding and treadmill walking did not change with 8 weeks of hippotherapy.&lt;/p&gt; &lt;p&gt;Before hippotherapy, cardiorespiratory responses and pelvic kinematics during simulated horseback riding were not different among youth with or without CP. These findings are not in agreement with our hypothesis that the youth with mild to moderate CP would exhibit greater cardiorespiratory responses and pelvic displacement would be of less magnitude during simulated horseback riding compared with youth without CP. With the exception of relative VO&lt;subs&gt;2&lt;/subs&gt; and V&lt;subs&gt;E&lt;/subs&gt;, all cardiorespiratory responses were of similar magnitude between both groups. The youth with CP had significantly lower body weight compared with those without CP, which accounted for the differences in magnitude of relative VO&lt;subs&gt;2&lt;/subs&gt; between groups. Absolute VO&lt;subs&gt;2&lt;/subs&gt; was identical between groups, suggesting that when body weight is not a factor such as in weight-supported activities, the difference in VO&lt;subs&gt;2&lt;/subs&gt; between the groups is negligible.&lt;/p&gt; &lt;p&gt;Explanations for similar group findings may be that the physical stimulus experienced on the simulator may be well within the physical capabilities of youth with mild spastic CP and not of sufficient intensity to distinguish between the physiologic responses observed in those without CP. Horseback riding is weight-supported and requires less engagement of the lower extremities compared with walking. The gait characteristics of an individual with CP are magnified while walking. That is not to say that more severely affected youth (i.e., those with more spasticity) may experience a greater magnitude of change in functional parameters with simulated horseback riding or lower activity levels compared with more mildly affected youth and/or youth without CP.&lt;/p&gt; &lt;p&gt;All participants exhibited greater cardiorespiratory responses on the treadmill compared with simulated horseback riding, and cardiorespiratory responses were greater in the youth with CP. Except for MAP, the magnitude of all cardiorespiratory response variables during treadmill walking was at least 70% greater than that elicited by simulated horseback riding in those with CP. These results agree with our hypothesis that cardiorespiratory responses to treadmill walking would be greater in the youth with CP versus their counterparts without CP and these responses would be greater during treadmill walking compared with simulated horseback riding.&lt;/p&gt; &lt;p&gt;Treadmill walking elicited a greater amount of physiological stress and resulted in greater EE in youth with CP. Differences between those with and without CP were evident at a very slow walking speed. The treadmill speed was fixed at 1&#160;mph, which is a slower speed than is typically exhibited during walking gait for those without CP. This low intensity experienced by the participants without CP and the fact that ES were more than double for most cardiorespiratory variables suggests that simulated horseback riding elucidates a very low physical exertion compared with treadmill walking.&lt;/p&gt; &lt;p&gt;The greater responses observed in those with CP are likely due to dysfunctional gait caused by spasticity, weakness, and abnormal muscle contractile characteristics in the lower extremities (Unnithan, Dowling, Frost, &amp;amp; Bar-Or, [&lt;reflink idref=&quot;bib25&quot; id=&quot;ref27&quot;&gt;25&lt;/reflink&gt;]). Because of previously reported improvements in gait (Encheff, Armstrong, Masterson, Fox, &amp;amp; Gribble, [&lt;reflink idref=&quot;bib8&quot; id=&quot;ref28&quot;&gt;8&lt;/reflink&gt;]; Kwon et al., [&lt;reflink idref=&quot;bib13&quot; id=&quot;ref29&quot;&gt;13&lt;/reflink&gt;]; McGibbon et al., [&lt;reflink idref=&quot;bib14&quot; id=&quot;ref30&quot;&gt;14&lt;/reflink&gt;]; Sunwoo et al., [&lt;reflink idref=&quot;bib24&quot; id=&quot;ref31&quot;&gt;24&lt;/reflink&gt;]), gross motor function (McGibbon et al., [&lt;reflink idref=&quot;bib14&quot; id=&quot;ref32&quot;&gt;14&lt;/reflink&gt;]; McGibbon, Benda, Duncan, &amp;amp; Silkwood-Sherer, [&lt;reflink idref=&quot;bib15&quot; id=&quot;ref33&quot;&gt;15&lt;/reflink&gt;]), muscle asymmetry (Benda, McGibbon, &amp;amp; Grant, [&lt;reflink idref=&quot;bib1&quot; id=&quot;ref34&quot;&gt;1&lt;/reflink&gt;]; McGibbon et al., [&lt;reflink idref=&quot;bib15&quot; id=&quot;ref35&quot;&gt;15&lt;/reflink&gt;]), posture (Bertoti, [&lt;reflink idref=&quot;bib2&quot; id=&quot;ref36&quot;&gt;2&lt;/reflink&gt;]; Shurtleff &amp;amp; Engsberg, [&lt;reflink idref=&quot;bib20&quot; id=&quot;ref37&quot;&gt;20&lt;/reflink&gt;]), and balance (Silkwood-Sherer et al., [&lt;reflink idref=&quot;bib21&quot; id=&quot;ref38&quot;&gt;21&lt;/reflink&gt;]; Sunwoo et al., [&lt;reflink idref=&quot;bib24&quot; id=&quot;ref39&quot;&gt;24&lt;/reflink&gt;]) following hippotherapy, the level of physical exertion needed to improve functional outcomes in youth with CP may be much lower than previously thought.&lt;/p&gt; &lt;p&gt;We hypothesized that the magnitude of pelvic displacement would be less in the youth with CP due to excessive stiffness leading to decreased ROM during walking gait. Although pelvic displacement along the anterior-posterior and medial-lateral axes was not different between groups, displacement along the vertical axis was significantly greater in the youth with CP. This finding is counter to what we expected based on previous reports (Encheff et al., [&lt;reflink idref=&quot;bib8&quot; id=&quot;ref40&quot;&gt;8&lt;/reflink&gt;]; Kwon et al., [&lt;reflink idref=&quot;bib13&quot; id=&quot;ref41&quot;&gt;13&lt;/reflink&gt;]). It is possible that the lack of proper muscular control and instability at the spine, pelvis, and lower extremities may lead to a greater vertical displacement and MOD of the pelvis during gait in those diagnosed with CP. Our pelvic kinematic data characterize ROM and offer little insight as to the musculoskeletal issues that influence ROM. As such, pelvic kinematics and ROM alone do not appear to be sufficient to describe the differences in gait biomechanics between those with CP and those without CP. In addition to ROM, the quantification of functional outcomes, such as changes in posture, balance, muscle asymmetry, spasticity, and gait parameters, was likely needed to describe factors that influence changes in gait kinematics and to help explain the greater EE was observed in CP youth with low-intensity walking.&lt;/p&gt; &lt;p&gt;Horseback riding can elicit increases in heart rate, VO&lt;subs&gt;2&lt;/subs&gt;, and V&lt;subs&gt;E&lt;/subs&gt; in children with CP, suggesting that if regularly practiced, improvements in cardiorespiratory fitness may be attained (Bongers &amp;amp; Takken, [&lt;reflink idref=&quot;bib3&quot; id=&quot;ref42&quot;&gt;3&lt;/reflink&gt;]). Thus, we hypothesized that short-term hippotherapy would produce physiologic adaptations that would dampen cardiorespiratory responses during simulated horseback riding and treadmill walking in youth with CP. However, posthippotherapy participant responses to simulated horseback riding and treadmill walking were not different from what was observed before hippotherapy.&lt;/p&gt; &lt;p&gt;We also hypothesized that pelvic displacement in those with CP would be greater during simulated horseback riding and treadmill walking after hippotherapy. Changes in pelvic displacement were anticipated because of decreases in muscle asymmetry and improvements in muscle tone and posture reported after hippotherapy in those with CP (Bertoti, [&lt;reflink idref=&quot;bib2&quot; id=&quot;ref43&quot;&gt;2&lt;/reflink&gt;]; McGibbon et al., [&lt;reflink idref=&quot;bib15&quot; id=&quot;ref44&quot;&gt;15&lt;/reflink&gt;]; Shurtleff &amp;amp; Engsberg, [&lt;reflink idref=&quot;bib20&quot; id=&quot;ref45&quot;&gt;20&lt;/reflink&gt;]). These musculoskeletal issues may also modify cardiorespiratory responses and enhance the ability of the participant to move comfortably within their ROM during ADLs such as walking. We may suggest from our results that regular exposure to the modest physical stress of hippotherapy was not sufficient to induce noticeable changes in the physiological variables used to characterize cardiorespiratory fitness.&lt;/p&gt; &lt;p&gt;Although hippotherapy may not be of sufficient intensity to noticeably improve cardiorespiratory fitness, the movement of the horse may facilitate improvements in functional outcomes. Indeed, the physical therapists and/or, anecdotally, the parents of the youth with CP reported several observational improvements in functional outcomes during the course of our hippotherapy intervention. Six of the youth in this study were reported to have improved gait parameters, including improved form, speed, and cadence. The youngest participant in the study exhibited the greatest improvement in gait. Before the intervention, his legs would cross over each other and his toes were pointed inward while walking. The hippotherapy greatly improved his scissoring gait, leading to improved gait form speed and cadence in just 4 weeks. Most participants improved their gait parameters and balance while walking and sitting. An increase in muscle tone and strength, specifically of the hip adductors, by some participants may have contributed to the reported improvement in balance, posture, and gait parameters. One participant could not swing either lower limb over the horse during the first few weeks of therapy. The physical therapist reported that the therapy improved the tone and strength of his hip adductors, leading to decreased stiffness in the muscles. This led to improvements in joint mobility at the hip and knee, an increased ROM in the lower extremities, and eventually an ability to properly mount the horse with little assistance. Improvements in posture, joint mobility, ROM, and overall endurance were reported for at least one participant throughout the intervention, with joint mobility and ROM being reported in as little as 3 weeks into the intervention. Due to these improvements, most participants could ambulate with less assistance after the 8 weeks of hippotherapy. These findings may translate to an ability to perform ADLs with greater ease and efficiency and with more confidence. At present, however, it is unclear how these functional parameters improved and if these changes are related to systemic changes in those diagnosed with CP.&lt;/p&gt; &lt;p&gt;A limitation of this study was that the youth with CP had varying diagnoses related to CP (e.g., diplegia, hemiplegia) and had a wide age range, as the study included young children and older adolescents (with a mean age of 13 years). As such, some youth were more mildly affected than others, and functional abilities differed among participants. Results from this study cannot be extrapolated to youth who are more severely afflicted with CP. Another related and well-recognized limitation is the interpretation of our results using a repeated-measures ANOVA with a small sample size.&lt;/p&gt; &lt;p&gt;Another limitation was that data collection on the horseback riding simulator was only performed while the participants were seated in the forward direction with no extra activity. Hippotherapy often incorporates riding in multiple positions (e.g., forward, backward, sideways) and performing multiple exercises (e.g., functional reach, sit-ups, ROM exercises) while riding at different paces. We were limited in that all participant measures were recorded while riding the simulator and not during the actual hippotherapy sessions. The characterization of cardiorespiratory responses and kinematic changes during hippotherapy might help better establish the physiologic benefits of hippotherapy.&lt;/p&gt; &lt;p&gt;Yet another limitation was that we chose to fix the hippotherapy intervention to an 8-week period, with therapy occurring once per week. There are varied protocol lengths in the literature, including multimonth interventions that occur twice per week. Riding once per week for 8 weeks may be an appropriate amount of time to notice functional changes but may not be an appropriate amount of time to notice physiologic changes in youth with CP.&lt;/p&gt; &lt;p&gt;Lastly, the majority of functional changes reported in this study were given anecdotally, by either the physical therapist and/or the parent of the youth with CP. Because not all therapy occurred at the same therapeutic riding center, multiple physical therapists who assisted in this study. Ideally, therapy needs to be conducted by one physical therapist who implements quantifiable, measurable tests of functional outcomes before, during, and after the therapy using validated tests with some measure of reliability.&lt;/p&gt; &lt;p&gt;In summary, the youth with CP had a more pronounced response to treadmill walking compared with the youth without CP before and after the hippotherapy intervention. Acute pelvic kinematic and cardiorespiratory responses during simulated horseback riding and treadmill walking were not altered with 8 weeks of hippotherapy. Several functional outcomes were reported in this study, including improved gait, balance, posture, ROM, and joint mobility in the youth with CP following hippotherapy. These results contribute to our understanding regarding the efficacy of hippotherapy as an intervention to improve functional abilities in those with CP. However, there is very little evidence that exists regarding the physiologic responses to hippotherapy, which need to be investigated concurrently with functional testing.&lt;/p&gt; &lt;hd id=&quot;AN0121333112-13&quot;&gt;What does this article add?&lt;/hd&gt; &lt;p&gt;We demonstrated that youth with CP respond similarly with respect to acute cardiorespiratory and kinematic responses from rest to exercise on a horseback riding simulator when compared with youth without CP. We also demonstrated that acute cardiorespiratory and kinematic responses were greater in magnitude while walking on a treadmill at 1&#160;mph and 0% grade in youth with CP versus youth without CP. After 8 weeks of hippotherapy, responses to simulated horseback riding and treadmill walking were not different from those responses observed prior to the hippotherapy intervention with respect to both groups. Our results support the premise that the activities performed during hippotherapy may not be of sufficient intensity to improve cardiorespiratory fitness; however, the therapy might facilitate improvements in functional outcomes such as gait, balance, posture, and ROM. These findings may be of practical significance for those utilizing hippotherapy as a therapeutic modality. Acute cardiovascular and biomechanical variables have been investigated in previous studies (e.g., Bongers &amp;amp; Takken, [&lt;reflink idref=&quot;bib3&quot; id=&quot;ref46&quot;&gt;3&lt;/reflink&gt;]; McGibbon et al., [&lt;reflink idref=&quot;bib14&quot; id=&quot;ref47&quot;&gt;14&lt;/reflink&gt;]), but a more comprehensive respiratory gas analysis and kinematic analysis using motion capture technology were employed in the current study. To our knowledge, this study is the first to measure pelvic kinematic (i.e., displacement along all three principal axes) and cardiorespiratory responses (i.e., heart rate, VO&lt;subs&gt;2&lt;/subs&gt;, ventilation, EE, and systolic and diastolic blood pressure) concurrently while exercising on a horseback riding simulator and while walking on a treadmill before and after a multiweek hippotherapy intervention in youth with and without CP.&lt;/p&gt; &lt;hd id=&quot;AN0121333112-14&quot;&gt;Acknowledgment&lt;/hd&gt; &lt;p&gt;All work was completed in the Baylor Laboratories for Exercise Science and Technology, Department of Health, Human Performance, and Recreation at Baylor University in Waco, TX.&lt;/p&gt; &lt;ref id=&quot;AN0121333112-15&quot;&gt; &lt;title&gt; References &lt;/title&gt; &lt;blist&gt; &lt;bibl id=&quot;bib1&quot; idref=&quot;ref34&quot; type=&quot;bt&quot;&gt;1&lt;/bibl&gt; &lt;bibtext&gt; Benda, W., McGibbon, N. H., &amp;amp; Grant, K. L. (2003). Improvements in muscle symmetry in children with cerebral palsy after equine-assisted therapy (hippotherapy). Journal of Alternative and Complementary Medicine, 9, 817–825. doi:10.1089/107555303771952163.&lt;/bibtext&gt; &lt;/blist&gt; &lt;blist&gt; &lt;bibl id=&quot;bib2&quot; idref=&quot;ref3&quot; type=&quot;bt&quot;&gt;2&lt;/bibl&gt; &lt;bibtext&gt; Bertoti, D. B. (1988). Effect of therapeutic horseback riding on posture in children with cerebral palsy. Physical Therapy, 68, 1505–1512. Retrieved from &lt;ulink href=&quot;http://ptjournal.apta.org/content/68/10/1505.long&quot;&gt;http://ptjournal.apta.org/content/68/10/1505.long&lt;/ulink&gt;.&lt;/bibtext&gt; &lt;/blist&gt; &lt;blist&gt; &lt;bibl id=&quot;bib3&quot; idref=&quot;ref16&quot; type=&quot;bt&quot;&gt;3&lt;/bibl&gt; &lt;bibtext&gt; Bongers, B. C., &amp;amp; Takken, T. (2012). Physiological demands of therapeutic horseback riding in children with moderate to severe motor impairments: An exploratory study. 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  Data: Changes in Cardiorespiratory Responses and Kinematics with Hippotherapy in Youth with and without Cerebral Palsy
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  Data: &lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Rigby%2C+Brandon+Rhett%22&quot;&gt;Rigby, Brandon Rhett&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Gloeckner%2C+Adam+Robert%22&quot;&gt;Gloeckner, Adam Robert&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Sessums%2C+Suzanne%22&quot;&gt;Sessums, Suzanne&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Lanning%2C+Beth+Anne%22&quot;&gt;Lanning, Beth Anne&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Grandjean%2C+Peter+Walter%22&quot;&gt;Grandjean, Peter Walter&lt;/searchLink&gt;
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  Data: 10.1080/02701367.2016.1266458
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  Data: 0270-1367
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  Data: Purpose: The purpose of this study was to characterize pelvic displacement and cardiorespiratory responses to simulated horseback riding and walking in youth with cerebral palsy and to compare responses to youth without cerebral palsy before and after 8 weeks of hippotherapy. Method: Eight youth with cerebral palsy (M[subscript age] = 10 &#177; 4 years; M[subscript height] = 137 &#177; 24 cm; M[subscript weight] = 32 &#177; 16 kg) and 8 youth without cerebral palsy (M[subscript age] = 11 &#177; 2 years; M[subscript height] = 149 &#177; 14 cm; M[subscript weight] = 48 &#177; 15 kg) underwent a hippotherapy intervention. Participants completed simulated horseback riding at an intensity approximating a fast walk (0.65 Hz) and walked on a treadmill (1 mph, 0% grade) before and after hippotherapy. Pelvic displacement along the anterior-posterior, vertical, and medial-lateral axes, heart rate, oxygen consumption, ventilation, and blood pressure were measured at rest and during steady-state exercise in both exercise modes. Results: Kinematics and cardiorespiratory responses were similar between the 2 groups during simulated horseback riding (p &gt; 0.05 for all) before the intervention. Significantly greater cardiorespiratory responses were observed in the youth with cerebral palsy compared with the group without cerebral palsy while walking before and after the intervention (p &lt; 0.05, effect sizes 26% to 237% greater). Eight weeks of hippotherapy did not alter responses, but anecdotal improvements in gait, balance, posture, and range of motion were observed in those with cerebral palsy. Conclusion: These results contribute to our understanding regarding the efficacy of hippotherapy as an intervention to improve functional abilities in those with cerebral palsy.
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      – SubjectFull: Human Body
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      – SubjectFull: Metabolism
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    Titles:
      – TitleFull: Changes in Cardiorespiratory Responses and Kinematics with Hippotherapy in Youth with and without Cerebral Palsy
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            NameFull: Sessums, Suzanne
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          Name:
            NameFull: Lanning, Beth Anne
      – PersonEntity:
          Name:
            NameFull: Grandjean, Peter Walter
    IsPartOfRelationships:
      – BibEntity:
          Dates:
            – D: 01
              M: 01
              Type: published
              Y: 2017
          Identifiers:
            – Type: issn-print
              Value: 0270-1367
          Numbering:
            – Type: volume
              Value: 88
            – Type: issue
              Value: 1
          Titles:
            – TitleFull: Research Quarterly for Exercise and Sport
              Type: main
ResultId 1