Mindfulness-Based and Forest Bathing Interventions for Older Women With Treated Arterial Hypertension

NCT07709962 | Completed

• 1 other identifier: uniri-iskusni-biomed-23-181
• Study Type: interventional
• Target: 60
• Locations: 1 country
• Sites: 1

Brief Summary

This pilot study, conducted by the Department of Social Medicine and Epidemiology, Faculty of Medicine, University of Rijeka, and funded by the University of Rijeka (project no. uniri-iskusni-biomed-23-181), evaluated two adjunctive non-pharmacological interventions - an eight-week Mindfulness-Based Living Course (MBLC) and a guided forest bathing (Shinrin-yoku) program - relative to a non-randomized comparison group, in older women with treated arterial hypertension. The study used a non-equivalent, pre-test/post-test quasi-experimental design; allocation was non-randomized, based on geographic catchment area and registration with community patronage nurses, with first-come, first-served enrollment until recruitment targets were met. A total of 60 women over 60 years of age were planned for enrollment: 20 in the MBLC group, 20 in the forest bathing group, and 20 in a comparison group receiving usual care. The MBLC group attended eight weekly two-hour workshops based on the Mindfulness Association (UK) curriculum, led by certified facilitators in Rijeka. The forest bathing group attended three weekly guided sessions of approximately 120-150 minutes each at a forest site near Delnice, Gorski Kotar, led by an FTHub-certified guide following the Forest Therapy Hub (FTHub) Walk Activities Sequence. The comparison group received no structured intervention. Outcomes were assessed at baseline and immediately after each group's intervention period (approximately 8 weeks for MBLC; approximately 3 weeks for forest bathing; a matched interval for the comparison group). The primary outcome was perceived stress (10-item Perceived Stress Scale). Secondary outcomes included chronic-disease self-efficacy, health-related quality of life, systolic and diastolic blood pressure, heart rate, and serum cortisol. Eligible participants were women over 60 with documented, treated arterial hypertension who gave written informed consent; exclusions included age under 60, inability to participate for the study duration, homelessness, a diagnosed psychiatric condition, cognitive impairment, and alcohol or substance dependence. The study was approved by the Ethics Committee of the University of Rijeka, Faculty of Medicine (Class: 007-08/24-01/70; 22 October 2024) and was conducted January-May 2025 in Rijeka and the Gorski Kotar region, Croatia. The study is being registered retrospectively, after data collection was complete.

Conditions

Arterial Hypertension

Keywords

hypertension; aged; women's health; mindfulness; forest bathing; stress; psychological; self-efficacy; self-management; quality of life

Outcome Measures

Primary Outcomes (1)

• Perceived stress

  The 10-item Perceived Stress Scale (PSS-10; Cohen et al., 1983) was used to assess a person's stress level based on their perception of life as unpredictable, uncontrollable, and overwhelming. The questionnaire includes 10 items rated on a Likert scale (0 = Never, 1 = Almost never, 2 = Sometimes, 3 = Quite often, 4 = Very often). The items are grouped into two factors: the first relates to perceived helplessness, and the second to perceived self-efficacy \[33\]. Higher scores indicate a higher level of perceived stress.

  Baseline and immediately after completion of the assigned intervention period: up to 8 weeks (MBLC group), up to 3 weeks (forest bathing group), matched interval (comparison group)

Secondary Outcomes (6)

• Chronic disease self-management self-efficacy

  Baseline and immediately after completion of the assigned intervention period: up to 8 weeks (MBLC group), up to 3 weeks (forest bathing group), matched interval (comparison group)

• Health-related quality of life

  Baseline and immediately after completion of the assigned intervention period: up to 8 weeks (MBLC group), up to 3 weeks (forest bathing group), matched interval (comparison group)

• Blood pressure (systolic and diastolic)

  Baseline and immediately after completion of the assigned intervention period: up to 8 weeks (MBLC group), up to 3 weeks (forest bathing group), matched interval (comparison group)

• Cortisol

  Baseline and immediately after completion of the assigned intervention period: up to 8 weeks (MBLC group), up to 3 weeks (forest bathing group), matched interval (comparison group)

• Heart rate

  Baseline and immediately after completion of the assigned intervention period: up to 8 weeks (MBLC group), up to 3 weeks (forest bathing group), matched interval (comparison group)

Study Arms (3)

Mindfulness group

EXPERIMENTAL

The mindfulness group attended the Mindfulness-Based Living Course (MBLC), a structured program developed by the Mindfulness Association of the United Kingdom for acquiring the knowledge and skills to practice mindfulness. Workshops were held once weekly for two hours over eight weeks. The eight sessions progressed from an introductory workshop and training the mind and body for one's own well-being, through healthy habits, healthy thinking, healthy nutrition, healthy physical activity (including SMART goal-setting), and healthy relationships, to a final session on living healthily despite a chronic condition, encouraging participants to take an active role in managing their own health and to focus on their own resources rather than on disease symptoms. The workshops were led by a certified MBLC educator at the Department of Social Medicine and Epidemiology, Faculty of Medicine, University of Rijeka.

Behavioral: Mindfulness-Based Living Course (MBLC)

Forest therapy group

EXPERIMENTAL

The forest therapy group took part in a guided forest bathing (Shinrin-yoku) program comprising three organized visits to a forest environment, each lasting for up to three hours, led by a certified forest therapy guide. Sessions took the form of guided immersion walks in forests in the vicinity of Rijeka, delivered as three organized, guided, single-day forest visits. Sessions were led by a certified Forest Bathing guide accredited by the Forest Therapy Hub (FTHub) and followed the FTHub Walk Activities Sequence (introduction/arrival; Mechanical Senses; Chemical Senses; Engage/Direct Exposure activities; Txoko sit-spot; closing Circle of Incorporation). The program involved active participation in guided immersion in the forest environment, intended to allow participants to experience first-hand the benefits of the method, which has been associated internationally with reductions in blood pressure and in stress-hormone levels in blood, saliva, and urine.

Behavioral: Forest therapy

Control group

NO INTERVENTION

The control group did not took part in the intervention pathways and was part of their usual care during the study.

Interventions

Forest therapy BEHAVIORAL

The forest therapy group took part in a guided forest bathing (Shinrin-yoku) program comprising three organized visits to a forest environment, each lasting for up to three hours, led by a certified forest therapy guide. Sessions took the form of guided immersion walks in forests in the vicinity of Rijeka, delivered as three organized, guided, single-day forest visits. Sessions were led by a certified Forest Bathing guide accredited by the Forest Therapy Hub (FTHub) and followed the FTHub Walk Activities Sequence (introduction/arrival; Mechanical Senses; Chemical Senses; Engage/Direct Exposure activities; Txoko sit-spot; closing Circle of Incorporation). The program involved active participation in guided immersion in the forest environment, intended to allow participants to experience first-hand the benefits of the method, which has been associated internationally with reductions in blood pressure and in stress-hormone levels in blood, saliva, and urine.

Forest therapy group

Mindfulness-Based Living Course (MBLC) BEHAVIORAL

The mindfulness group attended the Mindfulness-Based Living Course (MBLC), a structured program developed by the Mindfulness Association of the United Kingdom for acquiring the knowledge and skills to practice mindfulness. Workshops were held once weekly for two hours over eight weeks. The eight sessions progressed from an introductory workshop and training the mind and body for one's own well-being, through healthy habits, healthy thinking, healthy nutrition, healthy physical activity (including SMART goal-setting), and healthy relationships, to a final session on living healthily despite a chronic condition, encouraging participants to take an active role in managing their own health and to focus on their own resources rather than on disease symptoms. The workshops were led by a certified MBLC educator at the Department of Social Medicine and Epidemiology, Faculty of Medicine, University of Rijeka.

Mindfulness group

Eligibility Criteria

• Age: 60 Years+
• Sex: female
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Woman older than 60 years
• Diagnosed arterial hypertension (pharmacologically treated)
• Signed informed consent form for participation

You may not qualify if:

• Age under 60 years
• Inability to participate in the study over a six-month period (e.g., persons planning extended travel or terminally ill patients)
• Without stable housing (homeless individuals)
• Diagnosed psychiatric disorder(s)
• Cognitive impairment
• Alcohol or other substance dependence
• Unsigned consent form for participation

Sponsors & Collaborators

• University of Rijeka: lead

Study Sites (1)

University of Rijeka, Faculty of Medicine

Rijeka, Croatia

Location

MeSH Terms

Conditions

Hypertension

Interventions

Forest Therapy

Condition Hierarchy (Ancestors)

Vascular Diseases; Cardiovascular Diseases

Intervention Hierarchy (Ancestors)

Relaxation Therapy; Mind-Body Therapies; Complementary Therapies; Therapeutics

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NON RANDOMIZED
• Masking: NONE
• Purpose: SUPPORTIVE CARE
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Deputy principal Investigator

Study Record Dates

• First Submitted: July 1, 2026
• First Posted: July 17, 2026
• Study Start: February 3, 2025
• Primary Completion: May 3, 2025
• Study Completion: May 30, 2025
• Last Updated: July 17, 2026

Record last verified: 2026-07

Data Sharing

• IPD Sharing: Will not share

Locations

CR (1)