Managing Horses & Ponies with EMS

Equine Metabolic Syndrome is a collection of risk factors which leads to the development of laminitis in horses and ponies. A summary of clinical signs and diagnostics can be found here. This article will focus on the management of horses and ponies diagnosed with EMS as outlined by the 2019 ECEIM Consensus Paper.

Managing horses with EMS involves a combination of both dietary modification and exercise


Dietary modification to reduce caloric intake and decrease the post-feeding insulin response remains the cornerstone of management of obese animals with EMS.

  • Weight reduction should be aimed at 0.5%-1% body weight per week
  • This weight loss can be achieved by reducing dry matter intake to 1.4-1.7% body weight per day.
  • Horses which struggle to lose weight may have their feed intake reduced to 1.15% body weight per day.
  • Dramatic feed restriction MUST be avoided to prevent the development of life-threatening hyperlipidemia
  • Feed should ideally be less than 12-15% NSC/”sugar” (check labels of the feed bags!)
  • As a general rule: oaten hay contains approximately 35% NSC, Rhodes grass hay contains approximately 12% NSC, and meadow-hay approximately 8-15% NSC.
  • If feeding meadow hay, it is important to ensure you are sourcing your hay from a reputable supplier and the hay has been tested negative for annual rye grass toxicity. 
  • Soaking high NSC hay will help reduce the “sugar” levels. However, soaking for longer than 1hr will increase microbial growth and should be avoided.
  • The use of grazing muzzles can help reduce feed intake for horses and ponies out on pasture.
  • Slow-feeder haynets tied in the centre of stables or somewhere where its allowed to “swing” can greatly increase the time horses and ponies spend foraging and mimic more “normal” feed intake for horses and ponies confined to dry-lots or paddocks.
  • It is important to feed a ‘ration-balancer’ consisting of vitamins, minerals and salts to account for the dietary short-falls in a restricted diet. Particular attention should be paid to the Vitamin E requirement of horses and ponies without access to green grass/feed.


Exercise has been proven to improve insulin sensitivity and decrease inflammation. A controlled exercise program should only be initiated in horses and ponies without current or a recent history of laminitis. Any exercise program should also commence gradually to slowly increase fitness levels in these animals. The consensus paper outlined two exercise regimes which are described below.


  • A moderate exercise program consisting
    • Canter to fast-canter work
    • Ridden or unridden
    • Greater than 30mins per day, more than 5 days per week
    • Aim for heart-rates of 130-170 beats per minute


  • A low to moderate exercise program
    • Trot-canter work on soft ground
    • Unridden
    • Greater than 30mins per day, more than 3 days per week
    • Aim for heart-rates of 110-130 beats per minute

It is important to monitor for signs of laminitis (increased digital pulse, short-‘shuffly’ gait, reluctance to move) in any EMS horse that is enrolled in an exercise program.

It is VITAL that appropriate foot care is maintained with an experienced and knowledgeable farrier.


A variety of medications have been discussed for their use in Equine Metabolic Syndrome. Their efficacy is debatable and they should only be used an adjunct to diet and exercise NOT as an alternative.

  • Metformin : decreases glucose absorption and hence decreases the insulin response. Has low bioavailability in horses.
  • Thyroxine : promotes weight loss by increasing metabolic rate.
  • Pergolide : if your horse or pony has been diagnosed with PPID (Cushing’s), they should be treated with pergolide.
  • Velagliflozin : a new drug which has shown good results experimentally to decrease blood glucose and insulin concentrations, thereby preventing laminitis in insulin-dysregulated ponies.

Management of Equine Metabolic Syndrome is a long-term strategy involving the owner, veterinarian and farrier. It requires hard-work and discipline to follow a strict management plan of dietary modification and exercise to improve insulin sensitivity, decrease obesity and reduce the occurrence of laminitis.

CASE STUDY : Jim, 12hh pony with a history of recurrent bouts of laminitis.

Jim was enrolled in a modified diet and exercise program with close attention paid to his hooves to recognise early signs of laminitis. (courtesy of

JULY 2017 | Weight : 351 kg 









SEPTEMBER 2017 | Weight : 309 kg 




NOVEMBER 2017 | Weight : 282 kg 

DECEMBER 2017 | Weight : 260 kg 

If you would like any further information or want to test your horse or pony for Equine Metabolic Syndrome, please contact us on 0427 072 095.