Is Therapeutic Horseback Riding Effective in Order to Stimulate Physical Activity and Fitness in Wheelchair-bound Children? A Pilot Study

This pilot study will provide information concerning the energy expenditure in
wheelchair-bound children during therapeutic horseback riding. Disabled
children, who are dependant on a wheelchair for their mobility, generally lack
a sufficient level of physical activity. This inactive lifestyle is further
stimulated since the possibilities to be physically active that fit their
age-range, including sports activities and physical education, are
inaccessible. The children will come in a vicious circle of a progressive loss
of function, hypo activity, obesity, and a reduced fitness, which leads to
secondary disabilities, including an increased tiredness, a decreasing
participation in social events, and a reducing quality of life. Programs in the
pediatric age-range that are focused on the enhancement of the children*s
fitness may contribute to prevent the aforementioned secondary disabilities.
For wheelchair-bound children, therapeutic horseback riding seems to be an
attractive and promising type of exercise to increase their daily energy
expenditure and to improve overall function. By means of this pilot study, the
researchers will investigate whether therapeutic horseback riding is able to
increase the energy expenditure in wheelchair-bound children, and if so,
whether the achieved exercise intensity is sufficient to improve the children*s
fitness.

The determination of the energy expenditure in wheelchair-bound children in
rest, during daily activities, and during therapeutic horseback riding.

In this observational pilot study, wheelchair-bound children will participate
in a single therapeutic horseback riding session. Energy expenditure will be
measured during three protocols by means of respiratory gas analysis using
lightweight, mobile measuring equipment (Cortex Metamax) and by means of
accelerometry. 1. Protocol during the resting phase: during a ten-minute rest
period (sitting on a chair), heart rate, ventilation, carbon dioxide
production, and oxygen uptake will be measured with the Cortex Metamax; 2.
Exercise protocol: one therapeutic horseback riding session (thirty minutes),
in which the physical strain (heart rate, ventilation, carbon dioxide
production, and oxygen uptake) will be measured using the Cortex Metamax; 3.
Daily activities protocol: the participants will wear two advanced
accelerometers (Actiheart and Actical) for four days (including one day in the
weekend) in order to monitor their daily activity level and their heart rate.
On the basis of this data, it is possible to determine the energy expenditure
in rest, during daily activities, and during therapeutic horseback riding. The
extent of the increase in oxygen uptake and heart rate during therapeutic
horseback riding will be determined and will be compared to the values measured
during daily activities and in rest. Furthermore, the children will be asked to
fill out a ten-point scale (with the help of pictures) concerning the level of
percieved exertion directly after the horseback riding session. A structured
interview will take place with the parents concerning the daily activity
patterns of the children, in which the physical activities (active leisure
activity) en sedentary activities (playing computer games, watching television,
surfing the net, et cetera) are of particular interest.

The participants will be asked to take part in a single therapeutic horseback
riding session for thirty minutes. These children are familiar with therapeutic
horseback riding at the riding-school of *stichting BIO kinderrevalidatie* and
the risks are not increased compared to their normal horseback riding sessions.
Moreover, the children will execute the exercise protocol riding their *own*
horse. During the protocol, the children will wear fitted helmets and use
chinstraps. One or two side walkers will use various side-helping techniques.
If the rider is more physically challenged, a back-rider will be used to sit
directly behind the child, helping to maintain upright posture. The instructor
will constantly stand nearby and directs the therapy, always monitoring the
movement and behavior of the horse. After the exercise protocol, the children
will be asked to fill out a ten-point scale concerning the rate of percieved
exertion. Before the therapeutic horseback riding session, a measurement during
rest will be conducted (ten minutes, seated on a chair). Furthermore, the
participants will be asked to wear two activity monitors for four days
(including one day in the weekend), which doesn*t induce extra risks as well.