balance is very important in daily activities of the elderly and greatly affects their 
 quality of life . due to age - related changes , balance ability deteriorates . osteoarthritis is 
 a degenerative disease that causes severe pain in elderly patients with low pain thresholds . research has shown that it results in a high disability score , low quality of life , and 
 limited range of motion , in addition to weak muscle strength , poor balance ability , and high 
 risk of falls1,2,3,4,5 . as osteoarthritis causes 
 severe pain and functional disorders , in general , the clinical treatment is focused on pain 
 management and amelioration of related disorders . the treatments include muscle strength 
 training , electrical stimulation , manual therapy , aquatic therapy , balance therapy , and 
 pharmacotherapy6 . as balance ability and falls are closely related in the elderly , exercise therapies need to 
 focus on the maintenance of such ability7 . horseback riding exercise is one such therapy . in research conducted by arajo et al . 8 where elderly individuals performed 
 horseback riding exercise for eight weeks , the researchers reported that the exercise 
 significantly improved the participants balance and muscle strength . unlike other 
 interventions , horseback riding exercise can arouse the interest of patients and motivate 
 them while improving their balance , bone density , muscle strength , and mental state9,10,11 . according to some studies , horseback 
 riding exercise increased the static muscular contraction of the rider against the movement 
 of the horse and improved the muscle strength in the quadriceps femoris and knee flexors of 
 young riders12 , 13 . most people do not indulge in horse riding because of where they live ( i.e. , urban rather 
 than rural areas ) or the costs and risks involved in horse riding . hence , simulator 
 horseback riding exercise equipment using virtual reality has been developed for use at home 
 and in small spaces . previous studies reported that horseback riding exercise significantly 
 increased oxygen intake , minute ventilation , met , calorie consumption , and muscle14 , 15 . although various therapeutic approaches have made with horseback 
 riding exercise in the previous studies there is a lack of research on the effects of 
 horseback riding exercise equipment on the balance and gait abilities of elderly patients 
 with osteoarthritis . experimental procedures were performed in accordance with the protocols established by the 
 institution of animal care and use committee ( iacuc ) at the daegu university . include criteria was aged 65  years or over ( table 
 1table 1.general characteristics of the subjectsvariablessubjects ( n=15)gender ( m / f)6/9age ( years)76.5  7.7height ( cm)160.6  9.7weight ( kg)54.7  9.8mean  sd ) , and with a history of none falls in previous year , lower pain for perform 
 experiment , and visual or auditory damage , nervous system or of the vestibular organ 
 problems , who ca nt understand the contents of the experiment were excluded . after providing 
 information study all subjects received a participation agreement . in this study , the subjects , while providing conventional physical therapy , 8 weeks three 
 times a week the movement of the horse riding equipment , was carried out for 30 minutes . 
 before performing horse riding simulation exercise , subjects were educated about exercise 
 program through a research assistant s demonstration . in this study , used the slimrider 
 ( shinhwa , mx-0004se , korea ) , which is a horse riding simulator . while performing a horse 
 riding equipment exercise , subjects were effort to maintain the correct posture . exercise 
 intensity was increased gradually according to the state of the subjects while performing 
 the exercise , the research assistant were always observed to prevent falling . in order to evaluate the balance of the elderly , it was using the frt ( functional reach 
 test ) and sbbsf ( short form berg balance scale ) . the spss for windows ( version 18.0 ) was used for data analysis of the study . in order to 
 compare the differences between before and after , it was analyzed using the paired t - test . in this study , sfbbs scores and range of frt increased significantly after horse riding 
 simulator exercise ( table 2table 2.comparison of measurement values at pre - test and post - testvariablesprepostsfbbs ( score)18.6  5.822.3  4.4**frt ( cm)19.7  9.526.3  7.5*mean  sd . osteoarthritis causes severe pain in elderly patients who have a low threshold for pain and 
 high disability scores , thereby resulting in a low quality of life , increased risk of falls , 
 and poor balance ability1 , 2 , 6 . in the present 
 study , the static , dynamic , and functional balance abilities of osteoarthritis patients who 
 undertook horseback riding exercises on exercise equipment were measured using a frt and 
 sfbbs . the findings are in 
 accordance with those of study that stroke patients performed horseback riding exercise for 
 35  min five times a week for eight weeks and arajo8 in which elderly patients performed horseback riding exercise for 
 eight weeks . they are also in accordance with the results of han jun - young16 in a study of stroke patients who 
 performed horseback riding exercise for 12 weeks that an eight - week - long horseback riding 
 exercise significantly improved the bbs scores of osteoarthritis patients . in general 
 elderly , the average bbs score is 20.60  4.0817 . in the present study , after eight weeks of the exercise , the average score 
 was 22.3  4.4 , higher than the average . the results suggest that horseback riding exercise 
 equipment can improve dynamic and functional balance abilities . furthermore , according to the frt results , the static balance ability of the participants 
 improved . these results are in line with the research findings of yasuhiro et al.18 and kim sung - gil11 where the frt scores improved significantly after 
 12-week - long and 8-week - long horseback riding exercise , respectively . an increase in the frt 
 score is considered an improvement in static balance ability . based on the findings of the 
 present study , horseback riding exercise equipment seems to improve the static balance 
 ability of the elderly .
[ purpose ] the aim of this study was to examine the effects of horse - riding simulator 
 exercise on balance in elderly with knee osteoarthritis . [ subjects and methods ] fifty 
 elderly patients with knee osteoarthritis were recruited , a horse - riding simulator group 
 performed exercise three times a week for eight weeks . and each exercise was performed for 
 30 minutes . 
 [ results ] the horse - riding simulator group showed significant differences 
 after the intervention in short form berg balance scale , functional reaching test . 
 [ conclusion ] the results of this study indicate that horse - riding simulator exercise is 
 effective on knee osteoarthritis . 
 therefore , horse - riding simulator exercise can be used 
 balance training for knee osteoarthritis .