Effects of Hippotherapy on Resting Heart Rate and Core Symptoms in Children With Autism Spectrum Disorder: A Randomized Controlled Trial

Dysregulation of the autonomic nervous system is frequently observed in autism spectrum disorder (ASD) and has been linked to social-communication challenges and repetitive behaviors. This randomized controlled trial tested whether a structured hippotherapy program could improve both physiological regulation and behavioral outcomes in children with ASD. Forty-eight participants, aged 9–12 years, were randomized to hippotherapy or a usual-care control. The intervention consisted of 12 sessions across six weeks. Resting heart rate (HR) was assessed under standardized baseline conditions using a wearable optical sensor, and behavioral outcomes were measured pre- and post-intervention with the Gilliam Autism Rating Scale–Second Edition (GARS-2). Compared with controls, the hippotherapy group showed a significant and clinically meaningful reduction in resting HR (mean decrease = 17.85 bpm, from 95.2 to 77.4 bpm) alongside significant improvements in communication, social interaction, and stereotyped behaviors. Reductions in HR were moderately correlated with behavioral gains, suggesting a potential autonomic mechanism underlying observed improvements. To our knowledge, this is among the first RCTs in ASD hippotherapy to integrate wearable physiological monitoring with validated behavioral assessments, highlighting the promise of movement-based, multisensory interventions for addressing both biological and behavioral domains. Larger studies incorporating additional biomarkers and longer follow-up are needed to confirm and extend these findings.