OBJECTIVE: To provide an up-to-date research analysis on equine-assisted therapies and horse riding simulation exercise in older adults, and to suggest future directions in clinical practice and research. TYPE: Systematic review. LITERATURE SURVEY: A comprehensive search of studies was performed in 4 electronic databases (Cochrane, PubMed, PEDro, and Web of Science) regarding the effects of equine-assisted therapies and horse riding simulation exercise in older adults. Eight articles were selected, 5 of them focused on hippotherapy, 2 on horse riding simulation, and a single article that used the 2 types of therapy. METHODOLOGY: PRISMA guidelines were followed for the data extraction process. SYNTHESIS: The studies were all randomized controlled trials, but not double-blind, so they were classified as level of evidence B. Duration of hippotherapy programs ranged from 8-12 weeks. Sessions lasted between 15 and 60 minutes and were performed 2-5 times per week. Interventions using a horse simulator spanned 8 weeks and were conducted for 20 minutes 5 times per week. CONCLUSIONS: Results indicate that hippotherapy might improve balance, mobility, gait ability, and muscle strength, as well as could induce hormonal and cerebral activity changes in healthy older adults. Benefits of horse riding simulation could be limited to physical fitness and muscular activity. LEVEL OF EVIDENCE: I.