Beyond the Treatment Center: Exploring Equine Assisted Wellness

Treating cancer in patients extends beyond treating the disease itself. Throughout treatment and survivorship, patients may experience fatigue, anxiety, changes in physical functioning, loss of confidence, isolation, and difficulty adjusting. As healthcare professionals are increasingly focusing on treating patients as a whole, they may also look for alternative approaches that support emotional and social wellbeing.

One emerging option is equine assisted wellness. The Professional Association of Therapeutic Horsemanship International (PATH Intl.) defines Equine Assisted Services (EAS) as supportive interventions in which professionals incorporate horses to benefit people. Depending on the program and provider, services may include psychotherapy or other licensed therapies incorporating horses, equine assisted learning, adaptive riding, and other horsemanship-based activities. (1)

For healthcare professionals, understanding these programs can help when patients ask about supportive services outside of traditional care.

Why Horses: Supporting Emotional and Psychosocial Wellness

A cancer diagnosis can affect a person’s sense of safety, independence, identity, and connection to their body. Even after treatment ends, fear of recurrence, uncertainty, anxiety, fatigue, and the transition into survivorship can continue to affect quality of life.

Equine assisted programs offer a different type of environment. Depending on the program and a participant’s abilities, activities may include grooming, leading, observing, unmounted grounded work with horses, or mounted riding. Previous experience with horses is generally not necessary.

Participants may spend time outdoors focusing on interacting and connecting with a horse. Equine assisted activities may create opportunities to practice communication, problem solving, boundary setting, and confidence building. Although evidence is continuing to develop, research across different populations suggests that equine assisted activities and therapies may have potential benefits related to wellbeing and quality of life. (2)

This experience may be particularly meaningful for individuals with cancer whose daily lives have become centered on appointments, treatments, bloodwork, procedures, and scans. Spending time engaged in an activity focused on connection and accomplishment may offer patients an opportunity to reconnect with aspects of themselves outside of their cancer diagnosis.

Equine assisted wellness should not replace medical, psychological, or rehabilitative treatment. Instead, it may be considered one option within a broader supportive care plan.

What Does the Evidence Show for Oncology Patients?

Research specifically examining equine assisted interventions in oncology remains limited, but early findings are encouraging.

A 2014 study examined therapeutic horseback riding among 20 breast cancer survivors who had completed treatment at least 6 months earlier. Participants were randomly assigned to an intervention or control group, with the intervention group participating in a 16-week therapeutic horseback riding program. Researchers reported improvements in physical measures, including aerobic capacity and muscle strength, along with improvements in quality of life. (3)

A more recent randomized controlled clinical trial explored hippotherapy as part of rehabilitation following primary breast cancer treatment. Hippotherapy is a rehabilitation approach in which trained healthcare professionals use equine movement as part of treatment. Participants receiving the intervention demonstrated improvements across measures of quality of life, fatigue, cognitive functioning, anxiety, depression, and body image. (4)

A review of equine assisted activities and therapies has also identified potential benefits for quality of life and wellbeing across populations. (2) Additional research involving patients with different cancer diagnoses and treatment experiences are needed.

Helping Patients Explore Equine Assisted Wellness Safely

Equine assisted wellness may not be appropriate for every patient. Healthcare professionals can help patients consider whether participation is appropriate by assessing their treatment status, physical functioning, and individual risks.

Potential considerations include patients that are immunocompromised, have neuropathy or balance difficulties, fatigue, recent surgery, allergies, and comfort around large animals. Patients with medical concerns should discuss participation with their oncology team and programs should be informed of relevant limitations.

Finding a qualified program is equally important. Not everything advertised as “equine therapy” represents the same type of service. PATH Intl. distinguishes licensed therapy incorporating horses from non-therapy services such as equine assisted learning and adaptive horsemanship. (1)

Healthcare professionals can encourage interested patients to ask several questions:

• What type of service is being offered?
• What professional credentials and equine specific training do staff have?
• How are participants screened?
• What safety procedures are in place?
• Can activities be modified for medical or physical limitations?

For patients who are medically appropriate and interested, equine assisted wellness may offer something different than their treatment center; an opportunity for movement, connection, challenge, and accomplishment in an environment where cancer does not have to remain the central focus.

As supporting cancer patients continues to expand beyond the walls of the cancer center, equine assisted services offer an opportunity for further research. Although more evidence is needed to understand their role in supporting patients, these programs may provide selected patients with another meaningful way to support wellbeing during recovery and survivorship.

References

1. Professional Association of Therapeutic Horsemanship International. Optimal Terminology for Services That Incorporate Horses to Benefit People.https://pathintl.org/optimal-terminology/
2. Almasloukh KB. Equine-Assisted Activities and Therapies: State-of-the-art Review. Nurs Sci Q. 2022;35(1):92-100. doi:10.1177/08943184211051367. https://pubmed.ncbi.nlm.nih.gov/34939482/
3. Cerulli C, Minganti C, De Santis C, et al. Therapeutic horseback riding in breast cancer survivors: a pilot study. J Altern Complement Med. 2014;20(8):623-629. doi:10.1089/acm.2014.0061. https://pubmed.ncbi.nlm.nih.gov/24963599/
4. Viruega H, Galy C, Loriette C, et al. Breast cancer: How Hippotherapy Bridges the Gap between Healing and Recovery-A Randomized Controlled Clinical Trial. Cancers (Basel). 2023;15(4):1317. doi:10.3390/cancers15041317. https://pubmed.ncbi.nlm.nih.gov/36831658/