Mindfulness and forest bath for arterial hypertension in older women: quasi-experimental pilot
Abstract
Background: Arterial hypertension (AH) is the leading modifiable cardiovascular risk factor, yet pharmacotherapy adherence remains suboptimal. ESH guidelines recommend adjunctive lifestyle interventions including stress reduction, but evidence for mindfulness- and nature-based approaches in older hypertensive populations is limited. Within the University of Rijeka project No. uniri-iskusni-biomed-23-181, we evaluated a mindfulness-based living course (MBLC) and guided forest bath (Shinrin-yoku, SY) among older women with treated AH in Rijeka, Croatia.
Methods: A quasi-experimental pre-post study enrolled 63 women aged ≥60 with diagnosed AH: MBLC (n = 21, 8 weekly workshops), SY (n = 20, 3 guided forest sessions) and a comparison group (n = 22, usual care). Outcomes at baseline (T0) and post-intervention (T1) included perceived stress (PSS-10), chronic disease self-efficacy (SEMCD-6), HRQoL (EQ-5D-5L, EQ-VAS), blood pressure, and serum cortisol. Two-way repeated-measures ANOVA with LSD correction was used; groups were balanced at baseline.
Results: Mean age was 73.3 years. A significant time×group interaction emerged for perceived stress (p = 0.002, η²=0.185): SY reduced PSS-10 (16.4→13.9, p = 0.002) while comparison did not. Both interventions improved self-assessed health (EQ-VAS: MBLC p = 0.022; SY p = 0.005; interaction p = 0.006, η²=0.157) and reduced cortisol (MBLC p = 0.016; SY p = 0.006; time effect p = 0.002, η²=0.158), with no change in the comparison group. SY also improved self-efficacy (p = 0.008) and diastolic BP (p = 0.019). No significant effects were found for systolic BP or heart rate.
Conclusions: Forest bath showed the most consistent short-term improvements across psychological, subjective health, and physiological outcomes. Both interventions reduced cortisol and improved self-assessed health, supporting non-pharmacological, person-centred approaches in AH management for older women. Larger randomised trials with longer follow-up are needed.
Key messages: • Forest bathing reduced stress, self-efficacy, and diastolic BP in older hypertensive women.
• Mind-body interventions complement pharmacotherapy and suit community-based hypertension care.
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BibTeX
@article{vasiljev2026mindfulness,
title = {{Mindfulness and forest bath for arterial hypertension in older women: quasi-experimental pilot}},
author = {V Vasiljev and D Juraga and D Roviš and M Marinović Glavić and L Bilajac and Z Trobonjača and T Rukavina},
journal = {The European Journal of Public Health},
year = {2026},
month = oct,
doi = {10.1093/eurpub/ckag169.1185},
url = {https://doi.org/10.1093/eurpub/ckag169.1185},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Mindfulness and forest bath for arterial hypertension in older women: quasi-experimental pilot
AU - V Vasiljev
AU - D Juraga
AU - D Roviš
AU - M Marinović Glavić
AU - L Bilajac
AU - Z Trobonjača
AU - T Rukavina
PY - 2026
DA - 2026/10/01
JO - The European Journal of Public Health
DO - 10.1093/eurpub/ckag169.1185
UR - https://doi.org/10.1093/eurpub/ckag169.1185
AB - Background: Arterial hypertension (AH) is the leading modifiable cardiovascular risk factor, yet pharmacotherapy adherence remains suboptimal. ESH guidelines recommend adjunctive lifestyle interventions including stress reduction, but evidence for mindfulness- and nature-based approaches in older hypertensive populations is limited. Within the University of Rijeka project No. uniri-iskusni-biomed-23-181, we evaluated a mindfulness-based living course (MBLC) and guided forest bath (Shinrin-yoku, SY) among older women with treated AH in Rijeka, Croatia. Methods: A quasi-experimental pre-post study enrolled 63 women aged ≥60 with diagnosed AH: MBLC (n = 21, 8 weekly workshops), SY (n = 20, 3 guided forest sessions) and a comparison group (n = 22, usual care). Outcomes at baseline (T0) and post-intervention (T1) included perceived stress (PSS-10), chronic disease self-efficacy (SEMCD-6), HRQoL (EQ-5D-5L, EQ-VAS), blood pressure, and serum cortisol. Two-way repeated-measures ANOVA with LSD correction was used; groups were balanced at baseline. Results: Mean age was 73.3 years. A significant time×group interaction emerged for perceived stress (p = 0.002, η²=0.185): SY reduced PSS-10 (16.4→13.9, p = 0.002) while comparison did not. Both interventions improved self-assessed health (EQ-VAS: MBLC p = 0.022; SY p = 0.005; interaction p = 0.006, η²=0.157) and reduced cortisol (MBLC p = 0.016; SY p = 0.006; time effect p = 0.002, η²=0.158), with no change in the comparison group. SY also improved self-efficacy (p = 0.008) and diastolic BP (p = 0.019). No significant effects were found for systolic BP or heart rate. Conclusions: Forest bath showed the most consistent short-term improvements across psychological, subjective health, and physiological outcomes. Both interventions reduced cortisol and improved self-assessed health, supporting non-pharmacological, person-centred approaches in AH management for older women. Larger randomised trials with longer follow-up are needed. Key messages: • Forest bathing reduced stress, self-efficacy, and diastolic BP in older hypertensive women. • Mind-body interventions complement pharmacotherapy and suit community-based hypertension care.
SN - 1101-1262
SN - 1464-360X
ER -